The general manager of ResMed’s Swiss affiliate explains the company’s efforts to raise the awareness of sleep apnea in the country, and elaborates on how Switzerland can act as a “role model” for the other affiliates of the Group.
As much as 80 percent of all sleep apnea cases worldwide go underdiagnosed. How would assess the level of awareness among Swiss patients and physicians?
“As the leader in our field, it is our mission to increase awareness; on the one hand, we recognize this as our responsibility and on the other it is also what is expected of us.”
Unfortunately, the level of awareness in Switzerland is even worse. The 80 percent figure is derived from a five percent prevalence assumption. A recent study, however, concluded that in Switzerland sleep apnea has a prevalence of approximately 8 percent hence why 80 percent is an underestimate for the country. There are different reasons to explain this underestimate. Firstly, the symptoms of sleep apnea in men and women differ, and women are completely underrepresented in terms of diagnosis as many physicians are not aware of the symptoms affecting women. Moreover, across the globe, we witness a trend towards increasing obesity, which is closely related to sleep apnea. Not only does that imply that prevalence of sleep apnea will rise but moreover it shows that although we know these diseases are linked, the diagnosis of sleep apnea has not risen hence why the 80 percent figure likely lacks accuracy.
What can be done to raise this level of awareness in Switzerland?
Raising awareness of sleep apnea is of utmost significance to us! We have engaged in a multitude of awareness campaigns including the set-up of an information website available in 2 languages: German and French, www.Sommeiletrespiration.ch. I would like to highlight that this homepage is not in any way linked to ResMed on a commercial level, this is not the intention and goal, and we do not engage in these awareness campaigns to increase our sales figures.
Moreover, we have regular mailing campaigns tailored to general practitioners. Additionally, we use these mailings to highlight the link of sleep apnea to a variety of diseases including hypertension and diabetes for instance. We also spend a significant amount of resources on studies to be published in leading medical magazines as well as on our communication department which raises awareness by publishing in magazines – most recently increasingly in women magazines for example—and giving interviews on relevant radio and TV channels. Finally, we have moved on into the digital arena and have developed an application which increases the awareness and compliance at patient level.
And to what extend is ResMed a facilitator of these processes?
As the leader in our field, it is our mission to increase awareness; on the one hand, we recognize this as our responsibility and on the other it is also what is expected of us. Therefore, on a global scale, we act as a facilitator of raising awareness. We utilize the significant amount of data we gathered through clinical trials and showcase the flexibility to support physicians in scientific endeavours surrounding sleep apnea.
If we take a closer commercial look at ResMed, one can see that since its inception in 1989 it has continuously grown and reached USD 1.8 billion net revenue in fiscal year 2016, moreover employing approximately 5000 people. In that context, how significant are the Swiss operations?
The goal of ResMed is to treat 20 million patients by 2020; the potential of the Swiss affiliate to contribute in those terms is limited simply due to the small population of Switzerland. Nonetheless, Switzerland is the country in which ResMed enjoys one of the highest market penetration on a global scale, hence why we are a solid contributor to the group despite the limited population size.
ResMed’s products range from highly innovative masks, appliances, humidifiers, orthotic products, accessories – which of these are highest in demand, also in terms of resource allocation?
In Switzerland, half of our revenue is generated through our ventilation system segment and the other half through our sleep apnea segment. We also place a significant amount of our resources on introducing new products to the markets, as in Switzerland, patients can have a reimbursed treatment even if their Apnea–Hypopnea Index (AHI) – which indicates the severeness of sleep apnea – is at low to medium level. This is not the case in such markets as France for example.
Next to resource allocation to our mandibular repositioning devices (MRD) for instance, we also engage in partnerships with other companies providing solutions in areas such as positional apnea products for patients that only have apnea in certain positions. The rationale for us to do so is simple: sleep apnea is typically a lifelong disease and patients need to have the right product which provides the right solution to their specific situation. As the patient journey is very long, convenience, comfort and compliance are important aspects to consider—especially patient compliance, which is a major aspect. For some patients, it can be a challenge, however, if they do not use their device properly, results will not come; hence why, making it as personalized and comfortable as possible for the patients is very important.
ResMed distinguishes itself not only through its patient and physician education efforts, but also through being the technological leader in its area. High innovation, however, has a price and it seems that the Swiss health insurances do not realize the genuine value behind this innovation. Given this context, to what extend is ‘insurer education’ a topic for you in Switzerland?
I do not think it is. From my perspective, it is the patient and the physician who decide which product will make a differentce in terms of quality of the treatment and also in terms of patient compliance. Having a very high market share in Switzerland, a country in which quality is a key decision making factor, shows that we provide the best quality in this segment. There are many cheaper products available on the market, in majority from Asian countries; nonetheless these really do not challenge us because through our clinical proven algorithm, our devices, our high seal masks, it brings a significant change in the quality of life of the patient thus achieving a high compliance rate ; and patient compliance is the real cost factor in this equation!
If the patients do not use their device as instructed, results will not come which means they will miss days at work, may have car accidents, or develop mental (not sure it is the most appropriate word) diseases such as depression. Therefore, the cost of the device is to be differentiated from the costs of treatment. There have been clinical and economic studies evaluating the exact costs beyond the initial investment costs, and they concluded that when the device quality for the patient is bad, it will result in rising costs for the system at large. In Switzerland, we enjoy one of the highest patient compliance rates in Europe, which is also due to the fact that the Swiss homecare providers and physicians do a tremendous job of explaining the devices and the necessity to use them properly and regularly. Moreover, they are very well educated and capable of adjusting the treatment to the right interface fitting the individual patient needs.
When we met Lucile Blaise, VP ResMed Western Europe, she told us that ResMed is aiming to become a full solution provider, rather than a diagnostics and equipment provider. More specifically, she highlighted that the companies’ goal is to drive further towards 5P medicine (personalized, preventive, predictive, participative and proven). What can the contribution of Switzerland to this development be?
I believe that Switzerland, in this context, represents two sides of the coin. On the one hand, everything takes a bit longer to implement in Switzerland. Changing the habits of its people, both patients and physicians, is a slow process. Telemedicine for instance, which we are leading in many countries, has not yet fully arrived in Switzerland despite all of the benefits it has to offer; there is no reimbursement and physicians, home care providers and nurses are not familiar with this technology and want to be sure of its utility (pilot studies are currently running with major hospitals and customers). Moreover, due to the strict and the tightly regulated nature of Swiss hospitals, implementing this technology is difficult due to data protection concerns.
Nonetheless, I am convinced that this technology has a lot to offer, including giving the physicians and care providers the ability to fine-tune treatment parameters and perhaps in the future the capability to prevent acute exacerbations (the sudden worsening of COPD symptoms).
Although implementing this type of innovation does take longer than in other countries, once it is implemented it will be done correctly with utmost accuracy and patient compliance to the extent that Switzerland can and will be a role-model to other countries. Not for the rationale of economic reasons, but rather for the rationale of providing high quality medical solutions for its patients; and even more importantly, this will not replace the human contact for patients!
I am convinced that in Switzerland things are done properly, in a fair and sane approach. Thus, Switzerland can be a role model; not only in terms of showcasing how to reduce costs, but also to introduce the successful utilization of medical and clinical benefits of tele observance and telemedicine.
Looking forward, what will allow you to further grow in Switzerland?
Placing all the services surrounding our products, thus successfully being a patient solution provider rather than a product developer or equipment provider; this is where we will further grow. And, as aforementioned, we are completely open to collaborate with other companies in an effort to find the right solution for the right patient. We genuinely want to be by the side of the patient throughout his journey as partner; and this will be achieved on a global scale by providing the right solution and educating physicians and patients alike.
You have been heading the Swiss affiliate for 18 months now. What are your priorities for the coming five years?
I wish to further develop the ventilation business as, for the moment, the business model is not advanced as much as the business model for sleep apnea and I am convinced that we still have significant opportunities to seize in the ventilation business. Moreover, telemedicine is a current weak point of our business here which we want to be turning into a strength; the aforementioned application we have developed is already proven to increase patient compliance by 24 percent.
We have a genuine interest to further push such developments because this is the origin of patient and system benefits. We also plan to increase our offering for patients with low to medium AHI so as to further cater the individual needs of these patients. Another important aspect for us is to create a solid networks in between general practitioners and pneumologists in an effort to increase the level of awareness and patients being diagnosed.
Furthermore, ResMed has recently acquired a US based oxygen concentrator company which we are currently integrating into our Ventilation operations. This recent acquisition provides us with enhanced methods and solutions to accompany the patients along the entirety of their journey from the early stage of pathology step-by-step.