Propel Mini Device Cropped

Intersect ENT's Sinus Implant Proves Effective, But Is It Too Expensive?

Posted on November 06, 2017 by Medtech[y] Staff


Start-up reps fortunate enough to sell a great product hear the cost objection from surgeons all the time.

"The product is great, but it is too expensive"

Well, here we go again.

This past week, an article was published in JAMA Otolaryngology - Head & Neck Surgery stating that Intersect ENT's Propel Mini Sinus Implant was effective.

End of story, right?

Hardly. 

In the same JAMA issue, a commentary was published acknowledging the success of the 80 patient, prospective, randomized, controlled multi-center trial (what else do they want?), yet went on to state, that while implants have the potential to be important tools in treating CRS, there is also an increased need to control skyrocketing healthcare expenses. 

Yes and yes. 

Most rational people agree with that statement. 

Medtronic CEO, Omar Ishrak, just commented about escalating costs in healthcare at OCTANe’s Medical Technology Innovation Forum

From MassDevice:

“Right now, medical technology is paid on the promise of the change of an outcome, but if something goes wrong, and the procedure must be done again, we get paid again - so there is a lack of accountability,” Ishrak said.

Ishrak said this lack of accountability for outcomes is up and down the healthcare chain, which leads to waste. “When everybody gets paid for service but no one is accountable for value, you get escalating costs.”

Instead, Ishrak hopes to see revenues based on delivering improved outcomes as a result of technology innovation. Without such a shift, he said: “Healthcare will be completely unaffordable.”

The commentators fail to understand the product development process for a medical device company.

These days, products typically do not make it off the white board unless they address healthcare savings. If a company has an idea for a product, one of the first things a VC/Board/CEO will ask is if there be a clinical benefit and an economic value to the healthcare system.

Surgeons need to understand that VC's and medical device companies will not invest in a product if they believe the company will not be able to sell the product. 

Plain and simple.

Once a product hits the market, a company's sales reps need to take the product to surgeons and then convince a hospital or surgery center (at times, the surgeon) to purchase the device. The first thing a hospital asks is how much a product costs. If there is no argument/data that shows a cost savings to the healthcare system, the product will have a hard time getting traction.

If they can't get traction, the company dies and the VC's are out money.

With the success Intersect ENT has had with their Propel line of products, it's safe to say they have done their due diligence and have addressed a long-term savings to the patient and overall healthcare system.

How did I come to this conclusion?

I didn't have to. The authors of the commentary argued against themselves.

The Commentary

As noted in the commentary, the primary outcome involved an independent reviewer determining the need for post operative intervention. The study showed the implanted side was significantly lower (11.5% on the treatment side compared to 32.8% on the control side).

Post operative intervention was defined as either the need for debridement of obstructive scar tissue/adhesion formation or the need for oral steroid therapy to resolve inflamation or polypoid edema of the frontal recess. 

The commentators also acknowledged that revision surgery is required in 6% to 19% of ESS patients, including recurrent polyposis being especially problematic in the frontal recess.

Ok, so they admitted that up to 20% of patients end up coming back for revision sinus surgery and Propel Mini was substantially more effective in reducing post operative intervention. 

Does Propel need to be used on every patient? Of course not.

With this said, the reduction in interventions is a good thing and can help save patients and the healthcare system money. Intersect ENT, while funding this study, had no problem putting themselves out there by allowing the study authors to do a prospective, randomized study. 

Maybe it's time surgeons write a commentary giving intersect ENT credit for using clinical evidence to drive product development and improve the healthcare system.

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