1. Cardiac Diagnostics - Changing Practices Review of key markets in Europe Sohail Sheikh Frost & Sullivan, 2003

2. The Future of Cardiac Testing Agenda Troponins in Europe - end user feedback Decentralised testing in cardiac diagnostics New and emerging markers Questions Motivation Troponin usage - how much, how often and how widespread ? Demand for POCt - what factors effect uptake ? Emerging markers - How widespread will their use be ?

3. State of Cardiac Markers

4. Troponins Usage - 2002 Sw Fi Fr % penetration of cTn in acute hosp. Monthly usage per site Dk It Be Ne UK Ge No Sp High Low 0 100

5. The Cost of Troponin

6. Factors to Consider COST IMPACT - POCt must have a real impact on cost savings through workflow patterns, ie. impacting on waiting times, hospitalisation and bed stay TIME SENSITIVE - POCt which target conditions where a rapid result and response outweighs the high sensitivity/performance of lab tests. PATIENT MANAGEMENT BENEFIT - A POCt allowing real benefits through therapeutic programmes, ie, the availability of routine medication following rapid diagnosis or by allowing constant monitoring of a patient drug regime, and or increase of QALY.

7. What Markers Make Good POC Tests? COST IMPACT PATIENT MANAGEMENT TIME SENSITIVE STREPA GLUCOSE HP TROP

8. Cardiac POCt - Challenges & Hurdles Benefits of troponins still being fully realised High up-front costs of POCt NOT offset by potential of cost savings Lack of will amongst non-lab staff Lack of end user choice

9. The Future of POC Testing TAM End user acceptance of cardiac POCt Be Ge Fr Scan UK Sp Ne It

10. End Users and New Markers Lack of implementation practices - hindering usage Low usage of BNPs not surprising hs-CRP - widely researched, but less clinical applications so far Only one visible company (Mercodia) offering mLDL

11. Natriuretic Peptides - The New ‘Troponins’ ! End users unable to differentiate between BNP and proBNP Growth of proBNP will outpace BNP 40% of NP market $ will be proBNP by 2005 Adoption of NPs dictated by platform in use at lab Over 50% of end users unable to quickly adopt BNP test

12. And Finally…….. Have companies forecasted the impact NP use will have on troponin sales? If a troponin - NP double test panel is recommended, will there be end users jumping from one supplier to another? What will happen to your supply chain if group purchasing continues?

13. Thank You - Any Questions? For further information: call: +44 (0)20 7343 8383 email: enquiries@frost.com www.biotech.frost.com