By Jackie Liu and Lexie Code, DRG, Part of Clarivate
While it’s true that peripherally inserted central catheters (PICC) have been overused historically, their refined and more careful use — mainly as infusion devices — remains entrenched and beneficial.
Advantages of PICCs as vascular access devices include:
- Nonsurgical placement
- Placement by trained nurses, which improves cost efficiency
- Lower infection rate compared to acute central venous catheters
- Suitability to longer-term use relative to short peripheral intravenous and midline catheters
- Compatibility with tip-location devices to facilitate appropriate placements (more on this below)
Despite some continued contraction of use, due to these advantages, the PICC market continues to generate more than $200M annually in the U.S. alone and PICC competitors continue to innovate and strategize in this space. This article offers a detailed look at some of the major competitive strategies employed in the U.S. PICC market.
Table 1 — PICC Competitive Factors and Strategies
Physician Training and Marketing
A growing awareness of the costs of catheter-related complications in healthcare facilities has led to an increased demand for solutions that can reduce complication rates.
Numerous clinical studies have demonstrated that a substantial portion of complications result from inappropriate use and maintenance of vascular access devices. By offering either online or on-site training programs, manufacturers and distributors in this space are differentiating their products from competitors, as well as building brand loyalty by assisting with proper use of their devices.
Successful examples include Teleflex Medical's Teleflex Academy program and BD's Clinical Training program. Furthermore, training programs targeting a wide spectrum of end users, including nurse practitioners and vascular access specialists, have offered manufacturers a competitive advantage — particularly in facilities where nurses are the primary users of vascular access devices.
Product Portfolio Management
Because nurses, rather than interventional radiologists, place the majority of PICCs in the U.S., manufacturers and distributors have designed their offerings to better help these nurses. One way this is accomplished is through compilations, such as bedside PICC placement kits, which help save preparation time for nurses, allowing them to focus on patients.
Such kits contain all the necessary items required during bedside PICC placements, including dressings, gowns, alcohol wipes, and syringes. Examples include BD's Maximal Barrier Kit for its PICCs, Teleflex Medical's Arrow PICC Bedside Kit, and AngioDynamics' Morpheus SMART PICC bedside insertion kit.
Further, major competitors BD, Teleflex Medical, and Medcomp all provide tip location systems to complement their PICC products in the U.S. market. Open systems can be used with any company's PICCs and stylets. However, companies that offer closed platform systems, which can only be used with associated PICCs and stylets, usually from the same company, may hold an advantage over companies that offer open tip location systems. Examples include BD’s Sherlock 3CG Tip Confirmation System and Teleflex Medical’s Arrow VPS system.
Therefore, if a company is able to demonstrate the benefits of its closed system over other tip location systems, this will support sales of the company's own PICCs and stylets.
Product Improvements and Innovations
Innovation in the PICC market has focused on improved device functionality and demonstrable patient outcomes, both of which have led to increased demand and the ability to garner premium prices.
For example, Teleflex Medical has seen increasing sales of its PICC devices following the introduction of Chlorag+ard technology, which offers both antimicrobial and antithrombogenic protection. Similarly, AngioDynamics has added its antithrombogenic Endexo technology to its existing vascular access products, which could help the company increase its market share across several device segments.
Sites of Service
As more procedures move out of hospitals, pricing, messaging, and support needs can change.
Given the shift toward value-based care in the U.S., patients and payers are favoring less expensive and more accessible outpatient procedures when possible and a significant portion of procedures involving PICC insertion are performed in these settings. Nevertheless, non-hospital facilities often have more restricted budgets and less inventory space than hospitals.
As a result, vascular access device manufacturers and distributors are targeting their marketing and purchasing options to better meet the needs of non-hospital facilities. Specifically, competitors are offering premium and value-priced device options, just-in-time delivery, and flexible payment options to expand their sales.
Mergers, Acquisitions, and Partnerships
Acquisitions and strategic partnerships remain an important way to expand complementary device offerings.
For example, Teleflex Medical's 2016 acquisition of Nostix added an ECG-only tip location device to its portfolio of central access devices. BD's 2017 acquisition of C. R. Bard significantly expanded BD's portfolio of complementary products, including infection control and needle-stick safety devices.
Despite slower acquisition activity during the coronavirus pandemic, M&A will remain an important strategy across vascular access, as well as the wider medtech market.
Companies are using clinical studies more often to differentiate their products by highlighting device safety, efficacy, and cost-efficiency. However, COVID-19 is delaying trials and changing the way studies are designed.
Value-based healthcare continues to drive the need for strong clinical data to support device selection and purchasing decisions, especially when new, premium-priced product innovations are being considered. For example, clinical trials have been used to measure the complication rate associated with antimicrobial and antithrombogenic PICCs. Because many vascular access devices have only a limited degree of differentiation, clinical data demonstrating the safety, efficacy, and cost-efficiency of specific models can strongly influence device purchasing decisions.
Nevertheless, the current pandemic is negatively impacting clinical trial norms. Specifically, enrollment and in-person treatments in many ongoing trials have been limited, postponed, or cancelled. This has delayed companies' efforts to generate clinical data intended to support the regulatory approval of devices, reimbursement decisions, and new product launches.
Still, sponsors are developing new ways to enroll patients remotely through online platforms, phone, and video. Moreover, real world data — data originating from EHRs or claims, for example — is being used more often as part of clinical study designs, which can also reduce the need for additional in-person patient contact.
Overall, much of the long-term demand for PICCs will remain established. Some competitive strategies in this space, such as efforts to accumulate clinical data and acquisition activity, have been negatively affected by COVID-19 priorities. However, other key strategies, such as ongoing product improvements, targeted training, and an increased focus on outpatient procedures, will continue to be important in this space through and beyond the pandemic.
About the Authors
Jackie Liu is an Analyst with DRG part of Clarivate’s vascular group and is the author of the team’s most recent US vascular access market report. Jackie holds a Master of Public Health & Epidemiology as well as a Ph.D. in Molecular Genetics from the University of Toronto.
Lexie Code is the Director of Learning & Thought Leadership for DRG part of Clarivate’s Medtech division. Lexie holds a Master of Education from Memorial University and is currently focused on expertise development related to DRG’s new medical supply data program, which includes vascular access products.