market research on hernia mesh-final edit

SYNOPISIS

M/s. Alfa Corpuscle Ltd, Delhi , wanting to expand their product line in India approached

Our Institution Garden City College, Bangalore. They conducted an interview for MBA-

Marketing Students offering an internship programme on market research on Hernia Mesh.

Having got shortlisted for the internship programme, we had a training at their Delhi Office

briefing us about the Hernia Surgeries and their product range, The objective of the internship

Programme was to understand the current market of hernia mesh in Karnataka, and to get the

opinions of the General surgeons on the current available meshes in Karnataka Region, and to

know the market potential for the new product in the Karnataka Region.

To achieve this purpose, Karnataka region was divided into two geographic zone- Bangalore

Zone and Rest of Karnataka Zone. The target was to meet 150 Surgeons in a span of 15 days

in both the Zones. The Bangalore Zone was assigned to Jobin Babu Varghese and the other

being the rest of Karnataka assigned to Athar Amin.

We had planned to meet the General surgeon of both the Zone, based on reputed hospitals

and reputed surgeons. Some of the well know hospitals in Bangalore Zone like Columbia

Asia, MS Ramaiah, CMH Hospital, Baptist Hospital and Reputed Surgeons like Dr.

Anjanappa of General Surgeon Association. In Rest of Karnataka Zone, Famous Hospitals

Bapuji Hospital Davangere, SS Hospital Davangere, VIMS Bellary, Sidhartha Medical

College Tumkur, and reputed surgeons like Dr. Arun S K of Bellary were visisted and data

was collected based on the sample questionnaire(attached in Annexure). We were able to

cover about 100 hospitals and 121 surgeons. The said data is as summarised in the report in

detail below.

1

TABLE OF CONTENTS

2

SL.NO INDEX PAGE

NO

1 OBJECTIVE 3

2 MARKET RESEARCH

FACTS & FIGURES

MESH USAGE

IPOM MESH

SURGEONS ON MESH

PRIORTIES ON DECIDING

THE MESH

BUYING PATTERN

REASONS FOR NOT USING

THE MESH

COSTING

4

5

10

11

12

15

18

19

20

3 DISTRIBUTOR’S

INFORMATION

23

4 FACTS & FINDINGS 25

5 SUGGESTIONS &

RECOMMENDATIONS

26

6 ANNEXURE 27

OBJECTIVES OF THE MARKET SURVEY ON HERNIA MESH

To understand the current market situation of Hernia Mesh in Karnataka .

To know the surgeons opinion of the Mesh that is currently available in the market.

To analyse the present useage of the Mesh.

To understand the market potential for a new product (mesh) in the Market.

To Understand the patients decision criteria for hernia surgery .

To know the distribution channel design of Hernia mesh in the Market

3

MARKET RESEARCH ON HERNIA MESH

We conducted a market research on hernia mesh in Bangalore and other parts of Karnataka to

understand the views and opinions of the surgeons on the hernia mesh.

We surveyed 121 doctors in Karnataka (68 in Bangalore and 53 in cities of Karnataka).

During the 15 days of our survey we found many doctors who were really willing to share

with us their experiences and their valuable suggestions, but at the same time some were

reluctant to give us their suggestions. Based on their responses we summarise our findings as

below .

During the survey we found that at an average a surgeon performs 10 hernia surgeries in a

month.

The surgeons have started performing the laproscopic surgeries recently as it reduces the pain

for the patients and they feel more comfortable but the common man cannot afford the

laproscopic surgery as the cost of the surgery and the cost of the mesh is really high. Because

of this most of the surgeons prefer open surgery over laproscopic one as it costs much lesser.

Since the last five years the surgeons have started using the mesh more frequently in the

hernia surgeries.

The surgeons have the opinion that they require the best quality mesh at a very reasonable

price which meets the general specifications and standards.

Based on the cost of the surgeries we have categorized the surgeons into three groups such as

1. tier I Surgeons- high cost, 2. tier II Surgeons- medium cost 3. tier III Surgeons-low cost.

Overall we visited 121 surgeons in Karnataka out of which 19 % falls into tier I Surgeons

Category, 55 % falls into tier II Surgeons Category and 26% falls into tier III Surgeons

Category

4

FACT AND FIGURES ON HERNIA SURGERIES

Surgeries PercentagesTier Type

Inguinal 80% I, II, IIIVentral 20% I, II, III

Hernia Surgeries

InguinalVentral

5

I- Inguinal Hernia

Surgeries PercentagesTier Type

Open 70% I, II, IIILaproscopi

c 30% I, II, III

Open70%

Laproscopic30%

Ingunial Hernia surgeries

Open Laproscopic

6

A) OPEN SURGERIES DETAILS IN INGUINAL

70% are done through Open surgeries

Tier Type Tier I Tier II Tier III

Percentages 10% 20% 70%

Tier I13%

Tier II39%

Tier III18%

Laproscopic30%

Open surgeries with Tier dataTier ITier IITier IIILaproscopic

B) LAP SURGERIES DETAILS IN INGUINAL

30% are done through Laparoscopic surgeries

Tier Type Tier I Tier II Tier IIIPercentage

s 10% 75% 15%

Tier I6%

Tier II17%

Tier III8%open

70%

Laproscopic SurgeriesTier ITier IITier IIIopen

8

II Ventral Hernia

Surgeries Percentages Tier TypeOpen 70% I, II, III

Laproscopic 30% I, II, III

Open

70%

Laproscopic

30%

Ventral Hernia surgeries

Open Laproscopic

9

A) OPEN SURGERIES DETAILS IN VENTRAL

70% are done through Open surgeries



Tier I13%

Tier II39%

Tier III18%

Laproscopic30%

Open surgeries with Tier dataTier ITier IITier IIILaproscopic

B) LAP SURGERIES DETAILS IN VENTRAL

30% are done through Laparoscopic surgeries



Tier I6%

Tier II17%

Tier III8%open

70%

Laproscopic SurgeriesTier ITier IITier IIIopen

10

MESH USAGE IN HERINA SURGERIES

A) In Inguinal Hernia

At an average 85% of the surgeons use the Mesh

Tier Type Tier I Tier II Tier IIIPercentages 100% 95% 95%

With Mesh85%

Without Mesh15%

Usage of MESH

With MeshWithout Mesh

B) In Ventral Hernia

At an average 98% of the surgeons use the Mesh


With Mesh

98%

without Mesh2%

Useage of mesh in Ventral Herina

With Meshwithout Mesh

11

IPOM MESH

Only 10% of the surgeons use the Composite Meshes in Laparoscopic surgeries


Tier 1 Tier 2 Tier 30%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10 5 2

Column2Not using the Mesh

Reason for not using the composite mesh is that the price of the mesh is very high therefore

the common man is not able to afford so much for the composite mesh for a Laparoscopic

surgery. The surgeons have suggested that the price of composite mesh has to be brought

down so that the common man can afford it but without compromising with the quality of the

mesh

12

SURGEONS OPINIONS ON THE PRESENT MESH

A) Tier I Surgeons opinion on the Present Mesh

MESH WEIGHT (9)

PORE SIZE (9)

ELASTICITY (9)

MEMORY (9)

COST (8)

Of the current mesh that they are using .The Surgeons don’t have an issue with

the cost of the Mesh as most of the patients are coming from a high class

family background or they are coming through an insurance company. For

these patients the quality of the product and the service of the hospital is more

important than the cost. The surgeons are bothered about the properties and the

features of the mesh rather than the price of the mesh.

13

B) Tier II Surgeons Take on the Present Mesh

MESH WEIGHT (7)

PORE SIZE (7)

ELASTICITY (9)

MEMORY (9)

COST (6)

Of the current mesh that they are using, the Surgeons concentrate more on the

features, the cost and the technical specifications of the Mesh. They want the

Best Mesh at the Best Price.

The Patients are concerned about the cost of the mesh and the surgery as well as

the Quality of the Service. The Cost is the main factor for the patients while

deciding on the Mesh and the hospital for a surgery.

14

C) Tier III Surgeons Take on the Present Mesh

MESH WEIGHT (7)

PORE SIZE (7)

ELASTICITY (9)

MEMORY (9)

COST (5)

Of the current mesh that they are using. These Surgeons concentrate more on

the cost and the technical specifications of the Mesh. They want the Mesh at the

most reasonable Price. Their Patients are bothered about the cost of the mesh

and the surgery. The Cost is the main factor for the patients while deciding on

the Mesh for a surgery. Their patients will not be bothered about anything else

other than the cost. These surgeons sometimes does surgeries at a very low cost

as the patient is not able to afford it and sometime at free of cost too in

government hospitals. Special consideration should be given to these hospitals

when the Mesh is sold to them

15

PRIORITES OF DECIDING THE MESH

A) Tier I Surgeons Priorities while deciding on the Mesh

PRIORTIES PERCENTAGESTechnical 50%

Cost 15%Brand Name 30%Availability 5%

Technical Specifica-

tion50%

Cost15%

Brand Name30%

Availability5%

Priorities of Tier I surgeons

Technical SpecificationCostBrand NameAvailability

These surgeons concentrate on the technical specification and the Brand

name of the Mesh rather than the cost and the availability of the Mesh. As

mentioned in the previous page , the patients are not worried about the

cost because it is covered through insurance companies

16

B) Tier II Surgeons Priorities while deciding on the Mesh



Technical Spe-cifications

40%

Cost50%

Brand Name5%

Availability5%

Priorities of Tier II surgeons

Technical SpecificationsCostBrand NameAvailability

These surgeons concentrate on the cost of the mesh and then the technical specifications as

their patients are from middle class families.

For these patients the surgery has to be done with a good quality mesh & without any

defects. The brand name and the availability of the Mesh are not given much importance.

They want good quality product and service.

17

C) Tier III Surgeons Priorities while deciding on the Mesh



Technical Spe-cification

30%

Cost60%

Brand Name5%

Availability5%

Priorities of Tier III surgeons

Technical SpecificationCostBrand NameAvailability

These surgeons concentrate on the cost of the mesh and then the technical

specifications as their patients are from middle class or Lower class families.

For these patients the surgery has to be done with a good quality mesh without any

defects. The brand name and the availability of the Mesh is not given much

importance. They want good quality product and service. They t want the surgery to be

done. In some cases the surgeon waives off the cost of the surgery of cost as the

patient is not able to afford it by themselves.

These surgeons should be given special considerations on the cost of the mesh.

18

PURCHASE PATTERN OF MESH

PURCHASE PATTERN IN BANGALORE

In 80% of the hospitals, Pharmacy deals with the purchase of the Mesh,

the Medical officer decides on the purchase of the Mesh(examples: Multi

specialist Hospitals)

20% of the hospitals ,the Surgeons take the final decision on the Mesh

(examples: Nursing homes, Clinics, etc)

PURCHASE PATTERN IN OTHER PLACES IN KARNATAKA

In 70% of the hospitals, Pharmacy deals with the purchase of the Mesh,

but the surgeons decide on the brand and type of the mesh

30% of the hospitals, the Surgeons take the final decision on the Mesh

and deals with the purchase of the Mesh..

19

REASONS FOR NON-USAGE OF MESH

WHEN MEDICALLY PRESCRIBED(Only in other parts of Karnataka other than Bangalore)

Financial Condition of the Patients: the surgeons prefer not to use the

mesh in an Hernia Repair Surgery as the patients are not able to afford

the cost of the surgery.

Strong Muscle tone: Sometimes in some Patients the muscle tone would

be very strong. In these cases the surgeons do not use the Mesh as it is not

required in the Patients

Old aged patients with Diabetes, BP: Because of the presence of

Diabetes and BP in the Old aged patients the surgeons do not use the

meshes as the body might not accept the foreign body and might cause

infections leading to complications.

In case of small Hernial Defects: in cases of small hernia defects the

surgeons do not prefer to use the mesh in the surgeries as it is not

required and can be repaired without a mesh.

20

SURGEON OPINION ON IDEAL COST OF MESH

FOR TIER I SURGEONS IDEAL COST OF MESHES

SIZE RANGE PERCENTAGE GRAPH

3”X6” 500 to 750 (10%) (A)

750 to 1000 (30%) (B)

>1000 (60%) (C)

4”X6” 650 to 850 (10%) (A)

850 to 1150 (30%) (B)

>1150 (60%) (C)

6”X6” 900 to 1400 (10%) (A)

1400 to 1800 (30%) (B)

>1800 (60%) (C)

3" X 6" 4" X 6" 6"X 6"0%

10%20%30%40%50%60%70%80%90%

100%

CBA

21

FOR TIER II SURGEONS IDEAL COST OF MESHES


3”X6” 500 to 750 (50%) (A)

750 to 1000 (40%) (B)

>1000 (10%) (C)

4”X6” 650 to 850 (50%) (A)

850 to 1150 (40%) (B)

>1150 (10%) (C)

6”X6” 900 to 1400 (50%) (A)

1400 to 1800 (40%) (B)

>1800 (10%) (C)

3" X6" 4"X6" 6"X6"

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CBA

22

FOR TIER III SURGEONS IDEAL COST OF MESHES


3”X6” 500 to 750 (80%) (A)

750 to 1000 (20%) (B)

>1000 (0%) (C)

4”X6” 650 to 850 (80%) (A)

850 to 1150 (20%) (B)

>1150 (0%) (C)

6”X6” 900 to 1400 (80%) (A)

1400 to 1800 (20%) (B)

>1800 (0%) (C)

3"X6" 4"X6" 6"X6"

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

80 80 80

CBA

23

DISTRIBUTOR’S INFORMATION

During the project we also surveyed the distributiors who supply different brands of hernia

meshes to the hospitals. The objective of the distributor’s survey is to find out the distributing

channel that the distributors follow to supply the meshes to hospitals. And, also to find out

the cost of mesh at which they supply it to the hospitals and to the customers( i.e the MRP).

The details of the survey are given below.

COST DETAILS:

Brand: Ethicon (J & J)

Sl. No Mesh Type Size MRPCost to

HospitalsCost to

Distributors

1 Prolene Mesh 3"X6" Rs. 1759 Rs. 1408 12%4"X6" Rs. 2565 Rs. 2308 12%6"X6" Rs. 3934 Rs. 3147 12%

2 Ultra Pro Mesh 3"X6" Rs. 7191 Rs. 5531 12%4"X6" Rs. 7582 Rs. 5832 12%6"X6" Rs. 8105 Rs. 6234 12%

3 Vipro Mesh30cmsX30cm

sRs.

15362 Rs. 11817 12%

4 Vipro II Mesh 3"X6" Rs. 2605 Rs. 2005 12%4"X6" Rs. 3566 Rs. 2744 12%6"X6" RS. 5353 Rs. 4117 12%

5 Proceed Mesh 3"X6"Rs.

19689 Rs. 15145 12%

6"X6"Rs.

31658 Rs. 24352 12%

24

Brand: Sutures India

Sl. No Mesh Type Size MRP Cost to HospitalsCost to

Distributors

1 Trulene Mesh 3"X6"Rs.

1350 25% 33%

4"X6"Rs.

1966 25% 33%

6"X6"Rs.

2258 25% 33%

Brand: Dolphin

Sl. No Mesh Type Size MRP Cost to HospitalsCost to

Distributors

1 Dolphin Mesh 4"X6"Rs.

1600 20% 40%

From the survey we came to know that Ethicon is the major player in the Karnataka market.

The reasons for this being its quality and its availability. Ethicon (J & J) has got good

network of distributors who supply the meshes to hospitals effectively and efficiently.

DISTRIBUTION CHANNELS:

The distribution channels that the distributors (Ethicon, Sutures India etc.,) follow are

- The medical representitives get the orders from the hospitals and the distributors gives

the delivery of the meshes ordered.

- Sometimes hospitals buy the meshes on yearly or monthly basis from distributors.

- Sometimes hospitals give the order for meshes when there is need.

25

FACTS & FINDINGS

1. Average surgeries performed by a surgeon in a month is 10 Cases

2. 80% of these surgeries are inguinal

3. 20% of these surgeries are Ventral

4. 70% of these are Open surgeries

5. 30% of these are Laparoscopic surgeries

6. 90% of the surgeons use Mesh in the Surgeries

7. 99% of the surgeons are of the opinion that the ideal weight of the mesh, pore size is

as it is available in the market

8. 10% of the surgeons use Composite Meshes

9. 80% of the Surgeons use the Brand ETHICON

10. 10% of the Surgeons use the Brand Lotus

11. 10% of the Surgeons use the other Brands Like Sutures India, Dolphin, Bard, etc..

12. Tier I surgeons prefer the quality and technical specification of the mesh over the Cost

13. Tier II surgeons prefer both cost and technical specification along with the quality of

the mesh

14. Tier III surgeons area concerned with the Cost of the mesh

26

SUGGESTIONS & RECOMMENDATIONS

1. Price should be competitive

2. No Compromise on Quality

3. Quality should be according to the Standards

4. Should be easily available

5. Bio acceptability of the MESH should be good

6. Pre-medicated MESH are good but should be available at cheaper price

7. Texture of the mesh should be strong

8. Mesh should be available in Flexible Sizes and Price..

27

ANNEXURE

MARKET SURVEY ON HERNIA MESH

Doctor: Hospital:

Years of practice in hernia surgery:

Phone:

Email:

Other Hospitals Visited:

Q1. How many hernia surgeries do your perform in a month?

Total: ____________________________

a) Inguinal Open _________ Percentage of usage of mesh__________

Brand _________ Size:- __________

Laparoscopic________

Brand ________________ Size:- _______

Do you prefer :Pre- shaped Mesh over Flat Mesh? Yes/No

b) Ventral: Open _________ Percentage of usage of mesh__________

Brand __________

Laparoscopic________

Brand _______________

28

When you do a Laparoscopic Ventral hernia surgery and put an IPOM do you use a composite mesh? Yes(Brand:-_____________________) / No

Q2: Are you satisfied with the Mesh that you are using currently? Yes/ No

Reasons_________________________________________________________________________________________________________________________________________

Q3: On a scale of 1 to 10 how will you rate these parameters in the Mesh that you are currently using? (10 being the best 1 being least)

a) Cost Rating out of 10 :_______________b) Availability Rating out of 10:_______________c) Mesh weight Rating out of 10 _______________

d) Pore size Rating out of 10________________

e) Elasticity Rating out of 10 _______________

f) Memory Rating out of 10 ________________

Q4: What according to you should be the ideal measures for:

a) Mesh Weight _________________b) Pore Size _________________c) Elasticity/ Memory what is more important?.

Q5:When you decide to buy a mesh how would the following four play a role: (Rank them in order of priority) (Most important being 1and 4 being least important)

a) Cost________________

b) Brand Name__________

29

c) Availability___________

d)Technical specification________

Q6: Who is the dealer for the Mesh in the Hospital?

Name_______________________________________________________________

Phone no____________________________________________________________

Q7: What is the buying process in your hospital?

________________________________________________________________________.

Q8: Who is the decision maker to buy the mesh in your hospital?

Q9:What is the reason in cases where you don’t use a mesh

(Question not applicable where use of mesh is medically not indicated)

_______________________________________________________________________

________________________________________________________________________________________________________________________________________________

Q10. How bothersome is mesh infection in your hospital setting and do you feel adding antibiotics to mesh will help in reducing infection?

________________________________________________________________________________________________________________________________________________________________________________________________________________________

30

Q 11.What should be the price to the Hospital for an Ultra Light Weight Mesh

( Monofilament Polypropylene, Macro porous Mesh) with good Elasticity and Memory in size of

3X6”: 500 to 750

750 to 1000

>1000

4X6” 650 to 850

850 to 1150

>1150

6X6” ” 900 to 1400

1400 to 1800

>1800

Q12.What is the total cost of surgery for a one sided inguinal hernia repair with mesh in your hospital:

Laparoscopy:_______________

Open:_____________________

31

Please give some suggestions to help us make a product more suited to your needs:

____________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature :

Date:

Remarks:

32

market research on hernia mesh-final edit

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