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Defining the landscape for neuromodulation

Defining the landscape for neuromodulation. 2020 or 20/20. Dana Mead 12/6/2012. Company and Market Building Since 1972. Over 350,000 jobs More than US $650 billion market cap. Innovation Markets. Health Care & Life Sciences Targeted therapeutics “Digital” Health Medical Devices.

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Defining the landscape for neuromodulation

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  1. Defining the landscape for neuromodulation 2020 or 20/20 Dana Mead 12/6/2012

  2. Company and Market Building Since 1972 Over 350,000 jobs More than US $650 billion market cap KPCB Confidential

  3. Innovation Markets • Health Care & Life Sciences • Targeted therapeutics • “Digital” Health • Medical Devices • New Energy Technology • Science of small àenormous markets • Speed and scale • Information Technology • Smartphones + tablets à PCs + laptops • Third Wave of Innovation KPCB Confidential

  4. Life Sciences Portfolio DIAGNOSTICS THERAPEUTICS DEVICES TOOLS/SERVICES KPCB Confidential

  5. Presentation Pathway: 2012 2020 Therapies/Indications Technology Care Continuum Healthcare Economics Markets A Healthy Ecosystem ? KPCB Confidential

  6. Neuromodulation Therapies 2012 2020 Expanding therapies to more complex neurodegenerative diseases 2020 • Expanded indications • Enhanced efficacy • Less invasive implant procedures • Improved efficacy, eliminate trial (SCS) 2012 • Foundation of therapies across pain, spasticity, movement disorders, incontinence, epilepsy, sensory deficits • Therapy efficacy is mixed despite trial step (SCS) KPCB Confidential

  7. Traditional SCS: Trial Success Rates* Chest (31%) Back (50%) Arms(49%) Hand (44%) Leg (75%) Pelvic/Groin(37%) Foot (59%) *Success defined as >50% VAS score improvement Source: Leerink Swann, Physician survey (n=50) and SMI prospective/retrospective data KPCB Confidential

  8. Neuromodulation Therapies: Current & Future Depression Parkinson’s Disease • Epilepsy • Essential Tremor • Migraine/Headache Dry Eye • Dystonia • Neurodegenerative Diseases • Alzheimer’s • Parkinson’s • Huntington’s • ALS • Vision Disorders • Obsessive Compulsive Disorder • Hearing Disorders Sleep Apnea • HeartFailure • Chronic Pain COPD/Asthma • Gastroparesis • Malignant Pain • Bowel Disorders • Spasticity • Pelvic Floor Disorders • Urinary & Fecal • Incontinence KPCB Confidential

  9. Neuromodulation Technology2012 2020 Approaching next phase of technology innovation 2020 • Closed loop (sensing & therapy) • Therapy less intrusive for patient (stim perception, passive recharging, no MRI restrictions) • Device data flow provides for remote Dx, EHR, etc. • MEMS/NANO/Next Gen Power Supplies/Wireless 2012 • Complex programming • Intense patient involvement, subpar UI’s • Poor connectivity (EHR & provider) • High patient burden (size, stimulation, no MRI) KPCB Confidential

  10. Neuromodulation Care Continuum 2012 2020 Moving from modest adoption to standard of care 2020 • Standard protocols for managing pain & other neuro conditions emerge • Treatment paths well-defined and adopted • Quality outcomes defined, enforced & measured • Neuromodulational moving up the care continuum 2012 • Disjointed care • Best practices undefined or concentrated with leaders • Role/sequence of therapy; devices, medication, & other pain therapies remains unclear • Neuromodulation often a last-resort therapy KPCB Confidential

  11. Neuromodulation Healthcare Economics (US)2012 2020 Industry must quantifiably demonstrate therapy value 2020 • Expanded patient coverage WW • Value= quality outcomes/costs • Comparative effectiveness filter for • de novo therapies • ASP pressure for legacy therapies • Accountable, at risk care 2012 • Primarily fee for service • Rewards treatment vs. outcome • Incentives don’t support ACO model • $20-25K ASP with mixed outcomes KPCB Confidential

  12. Worldwide Neuromodulation Market2012 2020 New therapies, new indications and market penetration drive WW growth 2020 • $6.2B WW • $3B SCS • 70-80% US; Asia? • 10% CAGR 2012 • $2.87B WW • $1.41B SCS • 80% U.S./14% EU • 10% CAGR Source: Analyst reports. Includes SCS, OBS, SNM, VNS, TDD KPCB Confidential

  13. Optogenetics: Potential for Therapeutic and Cellular Specificity • Target specific phenotypes • Induce suppression or activation • Affect specific neuroanatomies • Combined genetic and device therapy Optogenetics: What does it do?

  14. Brain-Machine Interfacing • Progress in tissue-machine interfacing and coupling can provide advanced methodologies to develop neural-based therapies • Nanoscafolding and other microfabrication techniques may contribute to providing the ability to control specific neural networks

  15. A Healthy Neuromodulation Ecosystem - 2020 • Invest in the clinical trials to support efficacy/safety, indication expansion and cost-effectiveness • Design “product” for emerging markets • Develop closed-loop devices (sensing & therapy) • Reduce programming requirements and need for follow-up visits • Enhance connectivity (e.g., remote Dx, EHR interface) • Make the therapy non-invasive (e.g., reduce size, volume, weight, subcutaneous, etc.) • Demonstrate clear value to the system KPCB Confidential

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