Disease Management in MIS

Can disease management help the struggling MIS market recover its momentum?

Can disease management help the struggling minimally-invasive surgery (MIS) market recover its momentum? While laparoscopic cholecystectomies are now done with MIS 90% of the time, other candidates like hernia repair, and appendectomy are done with MIS in fewer than 33% of the cases.

Disease management may be one solution. At a conference sponsored by the International Society for Optical Engineering, Ethicon EndoSurgery’s VP of marketing, Nick Valeriani, revealed that the MIS market leader is currently launching disease management initiatives in two areas relatively new to MIS: urinary stress incontinence and gastroesophogeal reflux disease (GERD).

Currently GERD is treated largely by drug therapies, most notedly H2 antagonists such as Glaxo’s Zantac. Drug therapy costs about $820 and successfully treats about 70% of GERD patients. But treating the remaining patients costs more than $6,800 when subsequent drug therapies are found wanting. One-time open surgery costs nearly $15,000. Ethicon’s point: MIS would achieve the same end at much lower costs.

But pursuing disease management requires major adjustments for device companies. First, the target customer for such programs is not surgeons but payers and employers. Ethicon has already put together a marketing team to call on these new customers, promoting MIS by having incentives written into health benefit packages. Such marketing programs not only identify new customers, who require new messages (more economic and less clinical), but risk putting device companies at odds with traditional surgeon customers, who have resisted widespread MIS adoption. Partly to blunt any potential backlash from surgeons, Ethicon isn’t trying to shift popular open procedures to MIS; instead it is focusing on new disease states. But at some point, Ethicon will likely have to face the issue squarely.

Another important adjustment: explaining MIS to primary care physicians, who, as gatekeepers in MCOs, will make the decision to try surgery rather than drugs as a therapy. In promoting disease management, Ethicon will not only find itself competing against US Surgical, but also Lilly, Merck, and Glaxo. Drug companies have an edge since primary care physicians by training are more likely to use drug therapies than surgical interventions.

Finally, how far is Ethicon willing to take disease management? As some drug companies are finding, MCOs who buy disease management programs not only want companies to go at-risk for the cost of the treatment, they also want a variety of treatment options. If surgery doesn’t work, will Ethicon enter the drug business?