1. www.yhahsn.org.uk @AHSN_YandH The Development Direction of Advanced Wound Management Products in Major Global Markets Kevin Kiely Founder & International Executive Medilink UK

2. www.yhahsn.org.uk @AHSN_YandH Medilink Professional association and specialist consultancy which brings together clinicians, academics and industry on a provincial basis to stimulate innovation in the health technologies sector and drive wealth.

3. www.yhahsn.org.uk @AHSN_YandH Medilink UK The largest representative body for the UK Medical Technology industry Medilink Y&H Medilink NW Medilink WM MediWales Medilink EM BioBusiness NI SEHTA Medilink SW Scotland

4. www.yhahsn.org.uk @AHSN_YandH National Institute for Health Research Health Technology Cooperatives

5. www.yhahsn.org.uk @AHSN_YandH Healthcare Technology Cooperatives Clinical Area or ThemeHosting NHS Organisation Wound Prevention and TreatmentBradford Teaching Hospitals NHS Foundation Trust Chronic gastrointestinal (GI) diseaseBarts Health NHS Trust Devices for DignitySheffield Teaching hospitals NHS Foundation Trust Trauma Management University Hospitals of Birmingham NHS Foundation Trust Colorectal TherapiesLeeds Teaching Hospitals NHS Trust Brain Injury Cambridge University Hospitals NHS Foundation Trust Cardiovascular diseaseGuy ’ s and St Thomas ’ NHS Foundation Trust Mental Health and Neurodevelopmental Nottinghamshire Healthcare NHS Trust, Institute of Mental Health

6. www.yhahsn.org.uk @AHSN_YandH Aims: Focus on clinical areas and/or themes of high morbidity which will improve the quality of life of NHS patients and improving the effectiveness of healthcare services that support them Act as a catalyst for NHS “pull” for the development of new medical devices, healthcare technologies and technology - dependent interventions Work collaboratively with patients and patient groups, charities, industry and academics Healthcare Technology Cooperatives

7. www.yhahsn.org.uk @AHSN_YandH Wound Prevention & Treatment – Health Technology Cooperative (WoundTec) Hosted by Bradford Teaching Hospitals NHS Foundation Trust, this HTC is a Strategic partnership between:

8. www.yhahsn.org.uk @AHSN_YandH Role of HTC Strategic Partners: Kings:Clinical data capture, identification of unmet needs, co-design novel medical devices with users and manufacturers, proof of concept testing. Southampton: Sensor development, device and support system assessment, end-user evaluation. Leeds: Evidence review and clinical trial design and evaluation. Birmingham: Acute and chronic wound management, clinical trial and care evaluation, horizon scanning. Bradford: Laboratory and cellular research understanding biological action of device. Industry Link: patient focus and clinical trial delivery, clinical care and education.

9. www.yhahsn.org.uk @AHSN_YandH The WoundTec HTC Aim Target device development to address unmet need to: Work with patients, carers and HCP to identify areas of need Improve wound prevention and reduce wound recurrence, decreasing the treatment burden while generating improved outcomes Reduce hospital-based treatments while delivering clinical and cost effective care in the community Reduce cost burden of treating long term wounds by improving healing rates and empowering patients to self-manage their wound effectively Generate wealth by supporting UK industry and releasing NHS resources

10. www.yhahsn.org.uk @AHSN_YandH Key Themes Wound prevention – Support Services Diagnostics Infection Detection & Treatment Co-Design Strategies

11. www.yhahsn.org.uk @AHSN_YandH Why Do We Care?

12. www.yhahsn.org.uk @AHSN_YandH

13. www.yhahsn.org.uk @AHSN_YandH Global Advanced Wound Management Market $7.0 bn in 2013 growing at +4% 1 Definitions of products that fall within this market vary between reports and countries hence some companies may not be represented on this chart $7.0bn Advanced Wound Management Includes Advanced Wound Care, Advanced Wound Devices and Advanced Bioactives 1 1 Smith & Nephew Annual Report 2013 1

14. www.yhahsn.org.uk @AHSN_YandH Sector Overview Advanced Wound Management $7bn £13bn Traditional Wound Management $6bn Surgical closure $6.0-8.0bn 1 1 MedMarket Diligence Oct 2013

15. www.yhahsn.org.uk @AHSN_YandH Segmentation of Wounds and Products Wound Healing Devices e.g. VAC, e-stimulation, Ultrasound, Oxygen therapy

16. www.yhahsn.org.uk @AHSN_YandH The Direction & Drivers of Future Wound Care

17. www.yhahsn.org.uk @AHSN_YandH Leading Drivers in Wound Care

18. www.yhahsn.org.uk @AHSN_YandH The Shift in Wound Therapies? Majority of products still passive and physical dressings Active dressings finding it difficult to get traction due to development costs and delivery of strong clinical evidence Next generation active products require strong scientific and clinical evidence

19. www.yhahsn.org.uk @AHSN_YandH Worldwide Wound Management Market, Size and Growth to 2021 by Segment $Millions Bubbles represent size of market in 2013 Traditional dressings will remain as largest part of the market by 2021 but with the least growth Active/physical dressings will grow the most but from a smaller base

20. www.yhahsn.org.uk @AHSN_YandH Demand from new markets BRIC countries grew at a CAGR of 4.5% from $840 million in 2004 to $1.1 bn in 2011 Expected to grow at a CAGR of 4.7% to reach $1.6 bn by 2018 Additional Drivers in Global Wound Care

21. www.yhahsn.org.uk @AHSN_YandH Other key factors influencing future AWC market –Reimbursement challenges (nationally and globally) –Future research investment –Technology (meeting the needs of the customers)

22. www.yhahsn.org.uk @AHSN_YandH Diabetic Wounds in US cost upwards of $1bn per year in healthcare related costs Chronic Wounds in US cost each patient upwards of $20k

23. www.yhahsn.org.uk @AHSN_YandH US Advanced Wound Care Products Segmented Most growth around biologics and synthetic dressings Growth around wound healing devices forecast to be slow but from a higher base

24. www.yhahsn.org.uk @AHSN_YandH Advanced Wound Care UK

25. www.yhahsn.org.uk @AHSN_YandH £4700 for each wound on average Prevalence chronic wounds in UK & Europe 3-4 per 1000 population 1/3 wounds unhealed after 6 months and 1/5 after 1 year Up to 500K people annually suffer from chronic wounds and numbers growing Complicated care pathway with co-morbidities 3 rd highest cost to NHS behind cancer and heart disease

26. www.yhahsn.org.uk @AHSN_YandH What can the UK offer? Strong industrial presence Skill and scientific base – large medical device sector Key opinion leaders Centres of excellence [Bradford, Cardiff, Kings College London, University of Hertfordshire, University of Leeds] Capacity and motivation in academia, national research facilities and clinical centres Access to UK and European funding for innovation and access to the NHS Barrier –Lack of international collaboration to drive development

27. www.yhahsn.org.uk @AHSN_YandH UK Technologies

28. www.yhahsn.org.uk @AHSN_YandH Wound diagnostics –A changing paradigm in wound care Identification of factors [proteases] that contribute to slow healing Better to direct to the right treatment early [protease inhibitors] Reduce costs as more expensive treatments are used only when needed Technology spun out from Systagenix Wound Management [now KCI] A Wound Protease POC Diagnostic - WOUNDCHEK™

29. www.yhahsn.org.uk @AHSN_YandH Resorbable scaffolds for tissue regeneration –Electrospun three-dimensional matrix comprising nano/micro-scale synthetic bioresorbable polymer fibres –Supports the migration and proliferation of fibroblast cells from surrounding healthy skin tissue in order to facilitate healing –Resorbs within 7-10 days and is completely degraded after 3 weeks A Tissue Scaffold for Surgical Repair - Neotherix

30. www.yhahsn.org.uk @AHSN_YandH Fuel 3D Eykona™ - scanner wound measurement technology –3D images of wounds –Objective measurement for accurate wound assessment –Remote assessment –Accurately understand the healing process and adapt treatment with optimum efficiency saving time and money in an increasingly resource-strapped healthcare system –WoundTec HTC are clinical partners Remote Assessment of Chronic Wounds – Eykona™

31. www.yhahsn.org.uk @AHSN_YandH Opportunities for International Collaboration Targeted funding at the fundamentals –Address some of the basic understanding of wound healing –Create opportunities for technology exchange and joint IP Targeted support –Allow pre-competition support –Use outcomes to further target funding –Stimulate activity UK/China

32. www.yhahsn.org.uk @AHSN_YandH A Major Global Challenge Need for: –A paradigm shift in the way that global healthcare delivery systems view and manage skin breakdown –A co-ordinated international programme To support interdisciplinary research, technology exchange/licensing and joint IP (leading to new spin out companies) Build on UK research and facilities

33. www.yhahsn.org.uk @AHSN_YandH Medilink Wound Technology Specialists

34. www.yhahsn.org.uk @AHSN_YandH Thank You