This article was also published on Mass Device
Japan is a rapidly aging society with one of the highest life expectancies in the world. Today, more than 23% of Japanese — 30 million people — are over the age of 65. By 2025, this will jump to 33%. Japan has a purchasing power parity GDP per capita of almost $40,000– and seniors account for more than half of Japanese consumer spending. Japan’s aging, wealthy society offers Western elder care device companies many opportunities.
Many diseases that are commonly related with aging, such as orthopedic issues, cardiovascular disease and cancer, are an increasing problem in Japan. Devices that treat these diseases, will continue to see increasing growth. Few Japanese companies offer advanced products in this senior market segment — such as pacemakers and cardiac valve prostheses — so Western device companies have captured the majority of the market.
As Japanese grow older, they often require joint replacements and reconstruction. Furthermore, Japanese usually prefer higher quality, expensive orthopedic devices, such as those with advanced flex capabilities. The market for these devices is expected to maintain strong growth for the next decade — and Japan already accounts for approximately half of the Asia-Pacific orthopedic device market, by revenue.
Japan’s large joint reconstruction and replacement market — which includes products such as knee and hip implants as well as large joint arthroplasty — is valued at almost $1.5 billion. Japan’s small joint market, which includes reconstruction and replacement devices for shoulders and hands, is worth $75 million. The leading companies in these Japanese market segments are DePuy Synthes, Stryker, Zimmer and Acumed.
Small and mid-sized Western orthopedic companies have also been expanding in Japan as demand for their products has grown. For instance, in June 2014, Kinamed (Camarillo, CA) received Japanese approval for its SuperCable Iso-elastic Polymer Cerclage System, which is used in orthopedic reconstructive surgery.
Japan is also one of the largest markets for minimally invasive spinal surgery in the world, and the open surgery spinal implant market is also very robust. Medtronic, which has been in the Japanese market for over 40 years, is one of the key players in this market segment.
However, smaller western companies have also been entering the market. For example, in 2012, NuVasive’s (San Diego, CA) CoRoent Large Impacted and Large Tapered titanium alloy implants were approved in Japan. In 2013, Alphatec (Carlsbad, CA) received Japanese approval for three models of its Novel PEEK Spinal Spacers. NuVasive’s and Alphatec’s devices are used in posterior spine fusion procedures. Also in 2013, Boston Scientific (Marlborough, MA) signed a marketing agreement with a local distributor for its Precision Plus spinal cord stimulation device, which treats chronic pain.
CARDIOVASCULAR DEVICES AND SURGICAL IMPLANTS
Compared with the West, Japanese have lower rates of cardiovascular disease. However, this trend has recently been changing, in part due to lifestyle and diet changes in Japan. Among adults over the age of 20, it is estimated that half have hypertension. Cardiac issues later in life are increasingly common.
A growing number of U.S. and European companies are getting their cardiovascular devices approved in Japan. For example, in 2012, Sorin (Italy) received Japanese approval for its Mitroflow aortic pericardial heart valve. The product was designed to function well in patients with small aortic roots, common in Japan. In June 2013, Edwards Lifesciences’ (Irvine, CA) Sapien XT became the first transcatheter aortic valve — which treats aortic stenosis — available in Japan. In 2012 and 2013, both Thoratec (Pleasanton, CA) and Jarvik (New York, NY) received government approval to sell their left ventricular assist devices in Japan.
A variety of Western companies have also marketed advanced stents in Japan over the past several years. For instance, in May 2014, Boston Scientific released its next-generation Promus Premier Everolimus-Eluting Platinum Chromium Coronary Stent System, a cost effective stent that comes in 94 sizes. Also in 2014, Lombard Medical (Oxfordshire, U.K.) received approval for its endovascular stent graft system for abdominal aortic aneurisms.
Japan has one of the largest intravascular imaging markets in the world. In early 2013, St. Jude (Saint Paul, MN) released its Ilumien Optis in Japan. This imaging technology can be used during coronary angioplasty procedures, which often involve implanting stents. Approximately 250,000 of these procedures are performed annually in Japan. Similarly, in September 2014, Infraredx received Japanese approval for its TVC Imaging System, which helps diagnose and treat coronary artery disease. Several companies, including Medtronic and St. Jude, have recently released pacemakers that are safe to use with MRIs. More than 410,000 Japanese use pacemakers, and approximately 70% of these patients will at some point need an MRI.
Other surgical implantable devices that meet the needs of the elderly, such as cochlear implants and vision correction implants, are also seeing increasing demand in Japan. In 2013, Abbott’s implantable Tecnis lenses for cataract patients were approved by in Japan.
Chronic diseases like cancer also affect the elderly much more than younger demographics. Cancer is the top cause of mortality in Japan, and more than 350,000 Japanese died of cancer in 2013. The most prevalent cancers are lung and stomach. Japanese cancer treatment centers and hospitals often offer advanced diagnostic and treatment systems like gamma and particle knife technologies. Western companies’ cancer devices are in high demand.
In early 2013, Elekta’s (Sweden) Extend System for multi-session Gamma Knife radiosurgery was approved by the Japanese government. The company’s Versa HD radiation therapy system was approved in September 2014. Elekta is also involved in educating and training Japanese healthcare workers in how to use its products. Since 1991, Elekta’s cancer devices have treated almost 200,000 Japanese patients.
In March 2014, Accuray (Sunnyvale, CA) received approval in Japan for its CyberKnife M6 System, a radiotherapy device for the treatment of cancer. Varian (Palo Alto, CA), which has been active in the Japanese market for over two decades, recently installed its 500th medical linear accelerator in Japan, the Novalis Tx.
GE Healthcare in Japan is one of the top companies in the country’s imaging and diagnostic sector. In 2010, GE initiated a “Silver to Gold” strategy, identifying innovative medical device growth opportunities in Japan’s aging population. For instance, GE is currently working on MRI imaging software that can improve the accuracy of radiofrequency ablation treatments. In developing this product, GE solicited the opinions of Japanese doctors, incorporating their feedback into its designs — such as by reducing the height of the device’s table so that it was easier for elderly Japanese patients to use.
HOMECARE DEVICES AND NURSING HOMES
Home healthcare services are also growing in popularity. From 2000 through 2012, the number of home healthcare providers increased almost 300%. Home Instead Senior Care (Omaha, NE) already has more than 130 franchises in Japan. Right at Home (also based in Omaha) has partnered with a leading Japanese company to start offering homecare services this year.
At the same time, the traditional Japanese custom of elderly parents living with their children is decreasing. The number of nursing home facilities in Japan has increased almost 500% over the past decade. Private nursing homes are increasingly common, in addition to semi-public and public options. An estimated 400,000 Japanese are waiting for a nursing home bed.
More portable elder care devices — such as respiratory equipment and home dialysis systems — are in high demand as home healthcare services and nursing home facilities expand.
The Japanese government is promoting the advancement of technology to address the needs of its growing elderly population. Japanese and American companies have developed robots to assist with elder care. This includes robots that help nurses lift non-ambulatory elderly patients as well as robots that assist with walking.
For example, Japan’s Cyberdine is developing medical robot bionic suits and home-health aides to be used in rehabilitation and elder care. Cyberdine’s exoskeleton is used in more than 160 hospitals and nursing homes in Japan. Other Japanese companies, like Toyota and Honda, are also developing mobility assistive robots. Argo Medical Technologies (Israel) has recently partnered with a Japanese company to market Argo’s Rewalk bionic suits in Japan, starting in 2015. Ekso Bionics (Richmond, CA) is also working on exoskeleton products and plans to enter the Asian market in the next 1-2 years.
Advanced and innovative medical devices and services that meet the needs of Japan’s rapidly aging population will continue to see increasing demand over the next several decades. Western device companies selling these types of products should consider taking advantages of the many opportunities in the Japanese medical device elder care market.