Total Wrist Reconstruction - MarketResearch · The total wrist replacement (TWR) sales market in...

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Total Wrist Reconstruction US Analysis and Market Forecasts

GDME1018CFR / Published March 2013

Executive Summary

© GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form. GDME1018CFR / Published MAR 2013

Total Wrist Reconstruction, Key Metrics in the US Market (2012) Prevalence of Symptomatic Wrist Arthritis 1.5million

2012 US Market Sales for Wrist Reconstruction ($m) $24.3m

2012 US Market Sales for Wrist Replacement ($m) $19.3m

2012 US Market Sales for Total Wrist Fusion ($m) $5.1m

Key Events (2011–2018) Impact

(2012) US Food and Drug Administration approval of Medartis' Arthrodesis System 2.0/2.3, 2.5 APTUS Wrist in January

↑↑

(2013) Expected commercial launch and approval of two products by Small Bone Innovations late 2013 in the US for total wrist fusion and partial wrist fusion currently in development

↑↑↑

(2014) Expected approval of Tornier Resurfacing Capitate Pyrocarbon Implant via 501(k) in the US in April 2014 and commercial launch in July 2014

↑↑↑

Competitive Assessment

Number of Devices in Marketing Phase 10

2018 US Market Sales for Wrist Reconstruction ($m) $33.8m

2018 US Market Sales for Wrist Replacement ($m) $28.2m

2018 US Market Sales for Total Wrist Fusion ($m) $5.6m

Source: GlobalData, primary research interviews with leading hand orthopedic surgeons in 10 markets (US, France, Germany, Italy, Spain, UK, Japan, Brazil, China, and India). Note: 5EU = France, Germany, Italy, Spain, and the UK; Asia-Pacific = Japan, India, and China.

Sales for Total Wrist Reconstruction

The total wrist replacement (TWR) sales market in 2012

is estimated to be $19.3m across the US market covered

in this report. The total wrist fusion (TWF) market is

estimated to be $5.1m in the US. Combined, the market

is $24.3m.

By the end of the forecast, the TWR sales will grow to

over $28.2m with a Compound Annual Growth Rate

(CAGR) of 6.23%. The TWF sales will grow to over

$5.6m with a CAGR of 1.69%.

The key drivers for the market in the forecast are:

The growing prevalence of symptomatic osteoarthritis

and post-traumatic arthritis due to the growing aging

segment of the population across the globe

The major unmet need for late stage arthritis in the

wrist and desire to be able to maintain full range of

motion amongst patients and regain productivity

The high prevalence of revision surgery for those

with TWR driving surgical volumes up

TWR and TWF Revenue in the US (2009–2018)

0

510152025

303540

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Milli

ons

Year

TWR TWF

Source: GlobalData, primary research interviews and surveys with leading orthopaedic hand surgeons in 10 markets (US, France, Germany, Italy, Spain, UK, Japan, Brazil, China, and India).

Executive Summary


As of 2012, the US comprised a majority of the global

market share for TWR. GlobalData estimates that the

market share will remain relatively stable for the forecast

period in the US. There is expected to be an increase in

procedural volumes of 47% in the US for TWR and 11%

for TWF over the forecast period. The questionable long-

term efficacy of TWRs will keep adoption rates low. But

ample opportunities exist as these products continue to

technologically advance and a focus is kept on improving

technique during implantation.

Unmet Needs Remain a Challenge

While TWR technology has developed greatly over the

last 40 years, there is still much room for technological

advancement. Physicians still overwhelmingly see wrist

fusion as a safer alternative to wrist replacement. One

reason for this is the extensive bone resection still

needed for total wrist replacements. Orthopedic surgeons

have called for devices with better materials and coatings

on implants for better biological fixation. As for wrist

fusion plates, the materials required are different since

bone fixation and ingrowth is not expected to be at the

same level as with the replacement devices.

Additionally, the majority of TWR clinical trials to date

have been only short-term studies. The clinical efficacy of

TWR has yet to be proven as failure rates have been

high beyond five years of implantation. With complication

rates also high, it remains a challenge for physicians to

justify implantation of wrist implants in young patients.

Finally, better surgical training is needed, as wrist surgery

is one of the most complex to perform. Physicians have

given feedback that refined instrumentation is a must

from manufacturers to obtain more successful

implantation.

Key Players in the TWR and TWF Market

The four primary players in the TWR market are Small

Bone Innovations, Biomet, Integra LifeSciences and

Zimmer. While there are a few other smaller players as

well, these four comprise of 77.8% of the market share.

Small Bone Innovations has become a niche player by

making key acquisitions in arthroplasty. In the total fusion

market, Depuy Synthes, a Johnson & Johnson company,

has dominated the plate market. The other most

commonly used plate in the market is by Acumed.

Medartis, with the launch of TWF plates in 2012, is one

company that is expected to gain market share based on

feedback from interviews by GlobalData of key opinion

leaders. This would lead to the other firms to potentially

lose some market share in the US and EU. The

opportunity though is great in the emerging markets as

there is a large untapped population with the surgical

need. GlobalData believes that innovation and

penetration of the developing nations can drive their

growth and increase market share. Most importantly,

emergence of long-term clinical data can fuel significant

growth.

TWR and TWF Market Future Outlook

The TWR market is expected to only have moderate

growth, while TWF will be steady. The market is based

on and will be driven by the rising prevalence of

osteoarthritis and the rising aging population. As positive

clinical trial data with long-term results come out,

GlobalData expects sharper growth for TWRs. Until then

the growth and adoption is expected to be slow. Currently

the CAGR for the forecast period in the US until 2018 is

6.23% for TWR and 1.69% for TWF.

Executive Summary


What Do Physicians Think?

Physicians are optimistic about the future adoption of

TWR devices.

“I think it will increase a lot because patients are getting

older and older. Health conditions of patients are better

and they want to use their wrists. And they don’t want to

have the wrist fused. So the indication will increase.”

Key Opinion Leader, December 2012

“I think that total wrist arthroplasty was a challenging

procedure years ago. But now it is getting to be more and

more popular and products are safer and there are less

complications. There is a large panel of implants, total

wrist, hemi, interposition arthroplasty. So we can give a

good answer to wrist problems for any kind of post-

traumatic or any kind of arthritis.”


“Well, I think wrist arthroplasty has gone up because … I

think it is all due to promotional activities by companies.

Holding courses, showing you how to use it, tell you how

great it is.”


Physicians expect better long-term efficacy studies in

order to substantiate additional implantations.

“Well, I think you just have to use an implant that has a

reasonable track record which there aren’t any and that’s

the problem. I mean, there are no wrist implants that

have been around for many years with good long-term

follow up. So that is the issue: to get an implant where

you are fairly convinced about the design rationale.”


“Well, the major issue is that we don’t have long-term

follow-up available. We don’t really know how long they

last. There has been no studies. There are studies

coming through that show a failure rate of 60% in five

years perhaps. It’s very, very high. Much higher than

knee replacements or hip replacements. I think the worry

is how long do they last? Do they wear out?”


Physicians are interested in more innovation.

“If people start thinking outside the box, start using other

materials. You mentioned pyrocarbon: that would be a

very good material to think about in the wrist.”


Physicians are concerned about training programs

and implantation for wrong indications

“Yeah, there are ongoing studies to see how the

replacements fare. That’s important. In regards to cost

structure, it requires manufacturers to look at the process

and regards to training for the surgeons not too many

people doing it. In Britain [there is] a system of

commissioning where only certain surgeons will be

allowed to do the procedures. That’s important.”


“The surgeon has to know what he is doing and [have]

experience. So wrist replacement should not be done by

every single hand surgeon or orthopedic surgeon. It

should be done by just a few people. The experience

concentrates.”


Table of Contents


1 Table of Contents

1 Table of Contents ............................................................................................................... 5

1.1 List of Tables ............................................................................................................. 11

1.2 List of Figures ........................................................................................................... 13

2 Introduction ....................................................................................................................... 14

2.1 Catalyst ..................................................................................................................... 14

2.2 Related Reports ........................................................................................................ 15

2.3 Upcoming Related Reports ........................................................................................ 15

3 Disease Overview ............................................................................................................. 16

3.1 Anatomy and Physiology ........................................................................................... 16

3.2 Pathophysiology ........................................................................................................ 17

3.2.1 Overview............................................................................................................. 17

3.2.2 Osteoarthritis ...................................................................................................... 17

3.2.3 Rheumatoid Arthritis ............................................................................................ 17

3.2.4 Carpal Tunnel Syndrome .................................................................................... 18

3.2.5 Others ................................................................................................................. 18

3.3 Clinical Presentation .................................................................................................. 19

3.4 Clinical Outcomes ..................................................................................................... 20

3.4.1 Overview............................................................................................................. 20

3.4.2 Conservative Therapy ......................................................................................... 21

3.4.3 Arthroscopic Debridement ................................................................................... 21

3.4.4 Proximal Row Carpectomy .................................................................................. 21

3.4.5 Total Wrist Fusion ............................................................................................... 22

3.4.6 Total Wrist Replacement ..................................................................................... 24

3.4.7 Wrist Fusion Versus Total Wrist Replacement ..................................................... 26

3.5 Epidemiology ............................................................................................................ 28

3.6 Economic Impact ....................................................................................................... 30

3.6.1 Economic Impact of Treating Arthritis .................................................................. 30

Table of Contents


3.6.2 Cost Effectiveness of Orthopedic Implants .......................................................... 31

4 Competitive Assessment ................................................................................................... 32

4.1 Total Wrist Implant .................................................................................................... 32

4.1.1 Overview of Historical Designs ............................................................................ 32

4.1.2 Current Designs .................................................................................................. 32

4.2 Total Wrist Fusion ..................................................................................................... 45

4.2.1 Overview of Historical Designs ............................................................................ 45

4.2.2 Current Designs .................................................................................................. 45

5 Unmet Needs.................................................................................................................... 54

5.1 Long-Term Clinical Data ............................................................................................ 54

5.2 Limited Product Offerings .......................................................................................... 55

5.3 Failure and Revision Rate ......................................................................................... 56

5.4 Minimal Bone Resection and Other Complications ..................................................... 56

5.5 Lack of Pipeline Products .......................................................................................... 58

5.6 Need for Better Physician Training ............................................................................ 58

6 Pipeline Products .............................................................................................................. 60

6.1 Overview ................................................................................................................... 60

7 Industry Overview ............................................................................................................. 61

7.1 US Procedure Volumes ............................................................................................. 61

7.2 Market Access........................................................................................................... 64

7.2.1 Regulation .......................................................................................................... 65

7.2.2 Adoption ............................................................................................................. 65

7.3 US Reimbursement Trends ....................................................................................... 66

7.4 Regulatory Issues/Recalls ......................................................................................... 68

7.5 Mergers & Acquisitions / Key Partnerships ................................................................ 69

8 Company Profiles ............................................................................................................. 71

8.1 Small Bone Innovation Inc. ........................................................................................ 71

8.1.1 Overview............................................................................................................. 71

Table of Contents


8.1.2 Portfolio Assessment .......................................................................................... 71

8.1.3 SWOT Analysis ................................................................................................... 72

8.2 Depuy Synthes International ...................................................................................... 72

8.2.1 Overview............................................................................................................. 72


8.2.3 SWOT Analysis ................................................................................................... 73

8.3 Integra LifeSciences Inc. ........................................................................................... 74

8.3.1 Overview............................................................................................................. 74


8.3.3 SWOT Analysis ................................................................................................... 74

8.4 Biomet Orthopedics ................................................................................................... 75

8.4.1 Overview............................................................................................................. 75


8.4.3 SWOT Analysis ................................................................................................... 76

8.5 Medartis AG .............................................................................................................. 76

8.5.1 Overview............................................................................................................. 76


8.5.3 SWOT Analysis ................................................................................................... 77

8.6 Acumed..................................................................................................................... 77

8.6.1 Overview............................................................................................................. 77


8.6.3 SWOT Analysis ................................................................................................... 78

8.7 Tornier N.V................................................................................................................ 79

8.7.1 Overview............................................................................................................. 79


8.7.3 SWOT Analysis ................................................................................................... 80

8.8 Swemac Orthopaedics AB ......................................................................................... 80

8.8.1 Overview............................................................................................................. 80

Table of Contents



8.8.3 SWOT Analysis ................................................................................................... 81

8.9 Zimmer Holdings Inc. ................................................................................................ 82

8.9.1 Overview............................................................................................................. 82


8.9.3 SWOT Analysis ................................................................................................... 83

8.10 Skeletal Dynamics ..................................................................................................... 84

8.10.1 Overview............................................................................................................. 84


8.10.3 SWOT Analysis ................................................................................................... 84

9 Market Drivers & Opportunities ......................................................................................... 85

9.1 Market Drivers ........................................................................................................... 85

9.1.1 Rise in Osteoarthritis ........................................................................................... 85

9.1.2 Aging .................................................................................................................. 85

9.1.3 Trauma ............................................................................................................... 85

9.1.4 Patient Demand and Awareness ......................................................................... 86

9.1.5 Availability of Long-Term Clinical Data ................................................................ 86

9.1.6 Further Technological Advancement ................................................................... 87

9.1.7 Corporate Promotions and Teaching Seminars ................................................... 87

9.2 Opportunities ............................................................................................................. 88

9.2.1 Expanding Aging and Arthritis Indication ............................................................. 88

9.2.2 Revision Surgery ................................................................................................. 88

9.2.3 Emerging Markets ............................................................................................... 89

9.2.4 Capitalizing on Market Fragmentation ................................................................. 89

10 Market Threats & Substitutes ............................................................................................ 90

10.1 Market Threats .......................................................................................................... 90

10.1.1 Slow Technological Advancement ....................................................................... 90

10.1.2 Physician Perception and Learning Curve ........................................................... 90

Table of Contents


10.1.3 Complications ..................................................................................................... 91

10.1.4 Cost .................................................................................................................... 91

10.1.5 Lack of Long-Term Studies ................................................................................. 92

10.2 Substitutes ................................................................................................................ 92

10.2.1 Therapeutic Options and Fusion .......................................................................... 92

11 US Outlook & Forecast ..................................................................................................... 93

11.1 Market Overview ....................................................................................................... 93

11.2 US Market Analysis ................................................................................................... 93

12 Appendix .......................................................................................................................... 95

12.1 Abbreviations ............................................................................................................ 95

12.2 Bibliography .............................................................................................................. 96

12.3 Report Methodology ................................................................................................ 102

12.3.1 Overview........................................................................................................... 102

12.3.2 Coverage .......................................................................................................... 102

12.3.3 Secondary Research ......................................................................................... 102

12.3.4 Forecasting Methodology .................................................................................. 103

12.3.5 Primary Research – Key Opinion Leader Interviews .......................................... 104

12.3.6 Primary Research – Physician Survey ............................................................... 104

12.3.7 Expert Panel Validation ..................................................................................... 104

12.4 Physicians and Specialists Included in this Study .................................................... 105

12.4.1 Dr. Philippe Bellemère....................................................................................... 105

12.4.2 Dr. Vikas Gupta, MBBS, MS .............................................................................. 105

12.4.3 William H. Seitz, Jr., MD .................................................................................... 105

12.4.4 Robert M. Szabo, MD, MPH .............................................................................. 105

12.4.5 David Warwick, MD, BM, DIMC, FRCS (Orth) ................................................... 105

12.5 About the Authors ................................................................................................... 106

12.5.1 Analysts ............................................................................................................ 106

12.5.2 Global Head of Healthcare ................................................................................ 107

Table of Contents


12.6 About MediPoint ...................................................................................................... 108

12.7 About GlobalData .................................................................................................... 108

12.8 Contact Us .............................................................................................................. 108

12.9 Disclaimer ............................................................................................................... 109

Table of Contents


1.1 List of Tables

Table 1: Clinical Symptoms and Descriptions ..................................................................... 19

Table 2: Advantages and Disadvantages of Wrist Fusion and Total Wrist Replacement ...... 27

Table 3: Direct and Indirect Costs of Arthritis ...................................................................... 30

Table 4: Universal 2 Total Wrist Implant System (Integra LifeSciences Inc.)........................ 34

Table 5: SWOT Universal 2 Total Wrist Implant System ..................................................... 34

Table 6: ReMotion Total Wrist (Small Bone Innovations, Inc.) ............................................. 36

Table 7: SWOT ReMotion Total Wrist ................................................................................. 36

Table 8: Maestro Total Wrist System (Biomet Orthopedics) ................................................ 38

Table 9: SWOT Maestro Total Wrist System ....................................................................... 38

Table 10: Tornier Resurfacing Capitate Pyrocarbon Implant ................................................. 40

Table 11: SWOT:Tornier Resurfacing Capitate Pyrocarbon Wrist Implant ............................. 40

Table 12: Motec Wrist Joint Prosthesis (Swemac Orthopaedics AB) .................................... 42

Table 13: SWOT Motec Wrist Joint Prosthesis ..................................................................... 42

Table 14: MWP III Total Wrist Prosthesis (Zimmer Inc.) ........................................................ 44

Table 15: SWOT MWP III Total Wrist Prosthesis .................................................................. 44

Table 16: LCP Wrist Fusion Set (DePuy Synthes, Johnson & Johnson Co.) ........................... 47

Table 17: SWOT LCP Wrist Fusion Set ................................................................................ 47

Table 18: Integra Total Wrist Fusion System (Integra LifeSciences Inc.) ............................... 49

Table 19: SWOT Integra Total Wrist Fusion System ............................................................. 49

Table 20: Arthrodesis System 2.0/2.3, 2.5 APTUS Wrist (Medartis AG) .................................. 51

Table 21: SWOT Arthrodesis System 2.0/2.3, 2.5 APTUS Wrist ........................................... 51

Table 22: Arthrodesis System 2.0/2.3, 2.5 APTUS Wrist (Medartis AG) ................................ 53

Table 23: SWOT Implate Wrist Arthrodesis Nail.................................................................... 53

Table 24: Complications and Risks for TWR and TWF ......................................................... 57

Table 25: Product Components and Costs ........................................................................... 64

Table 26: Reimbursements Associated with TWR ................................................................ 67

Table 27: Medicare Payment Trend for Wrist Procedures,1992–2004 ................................... 67

Table of Contents


Table 28: Company Profile – Small Bone Innovation Inc. ...................................................... 71

Table 29: SWOT Analysis – Small Bone Innovations Inc. ..................................................... 72

Table 30: Company Profile – Depuy Synthes International ................................................... 73

Table 31: SWOT Analysis – Depuy Synthes International ..................................................... 73

Table 32: Company Profile – Integra LifeSciences Inc. ......................................................... 74

Table 33: SWOT Analysis – Integra LifeSciences Inc. .......................................................... 74

Table 34: Company Profile – Biomet Orthopedics ................................................................. 75

Table 35: SWOT Analysis – Biomet Orthopedics .................................................................. 76

Table 36: Company Profile – Medartis AG ............................................................................ 76

Table 37: SWOT Analysis – Medartis AG ............................................................................. 77

Table 38: Company Profile – Acumed LLC ........................................................................... 78

Table 39: SWOT Analysis – Acumed LLC ............................................................................ 78

Table 40: Company Profile – Tornier N.V. ............................................................................ 79

Table 41: SWOT Analysis – Tornier N.V. .............................................................................. 80

Table 42: Company Profile – Swemac Orthopaedics AB....................................................... 81

Table 43: SWOT Analysis – Swemac Orthopaedics AB ........................................................ 81

Table 44: Company Profile – Zimmer Holdings Inc. .............................................................. 82

Table 45: SWOT Analysis – Zimmer Holdings, Inc. ............................................................... 83

Table 46: Company Profile – Skeletal Dynamics LLC ........................................................... 84

Table 47: SWOT Analysis – Skeletal Dynamics LLC............................................................. 84

Table 48: US Sales ($m) Forecast for TWF and TWR, 2009–2018 ....................................... 94

Table of Contents


1.2 List of Figures

Figure 1: Anatomy of the Wrist ........................................................................................... 16

Figure 2: Treatment Paradigm for Wrist Arthritis ................................................................. 20

Figure 3: Wrist Arthrodesis with a Fusion Plate .................................................................. 23

Figure 4: Total Wrist Arthroplasty ....................................................................................... 25

Figure 5: Population with Wrist Arthritis in the US, 2008–2020 ........................................... 28

Figure 6: Disease Segments of Wrist Arthritis .................................................................... 29

Figure 7: Universal 2 Total Wrist Implant System (Integra LifeSciences Inc.) ...................... 33

Figure 8: ReMotion Total Wrist (Small Bone Innovations, Inc.) ........................................... 35

Figure 9: Maestro Total Wrist System (Biomet Orthopedics) ............................................... 37

Figure 10: Tornier Resurfacing Capitate Pyrocarbon Implant ................................................ 39

Figure 11: Motec Wrist Joint Prosthesis (Swemac Orthopaedics AB) ................................... 41

Figure 12: MWP III Total Wrist Prosthesis (Zimmer Inc.) ...................................................... 43

Figure 13: LCP Wrist Fusion Set (DePuy Synthes, Johnson & Johnson Co.) ........................ 46

Figure 14: Integra Total Wrist Fusion System (Integra LifeSciences Inc.) ............................. 48

Figure 15: Arthrodesis System 2.0/2.3, 2.5 APTUS Wrist (Medartis AG) ............................... 50

Figure 16: Implate Wrist Arthrodesis Nail (Skeletal Dynamics LLC) ...................................... 52

Figure 17: Importance of Safety of Arthrodesis and Arthroplasty Implants ............................ 57

Figure 18: US Arthrodesis and Arthroplasty Procedure Volumes (2009–2018) ..................... 63

Figure 19: Medicare Payment Trend for Wrist Procedures, 1992–2004 ................................ 68

Figure 20: US TWR and TWF Market, 2009–2018 ............................................................... 94

Introduction


2 Introduction

For patients suffering from severe wrist pain from degenerative osteoarthritis, traumatic arthritis or

rheumatoid arthritis, and gout, total wrist replacement and total wrist fusion provide a surgical

alternative to living with excessive pain that is no longer placated by non-surgical treatment. The

most significant clinical benefit in these surgical options is the relief from pain. In deciding between

the two options, fusion has been a more conservative one, with much less risk of complications

than replacement. Though wrist fusion has been more traditionally used in the past, replacement

has been gaining momentum as a choice for patients who want to retain more motion and have

more functional use of their hand. Though new technology development has been slow in the past,

the increasing popularity amongst patients and doctors to provide an option for better range of

motion will drive technology to improve amongst the current players and new companies looking to

enter the market. GlobalData’s analysis shows that with the unmet needs being great, companies

will need to step up the development of wrist implants to gain the confidence of physicians and

patients and create new opportunities for long-term studies. As these issued are addressed, the

industry is likely to grow moderately in the years to come.

2.1 Catalyst

Total wrist replacement and total wrist fusion offer patients with a surgical approach to regain some

function in their degenerative wrist. For those patients who no longer have proper usage of their

hand, experience extreme pain and at times take narcotics for the pain, wrist fusion and wrist

replacement offer good options. According to GlobalData’s interviews, an estimated 16% of

individuals in the US have arthritis and 6.9% of those are in the arthritis-attributable activity

limitations category of which 7% have wrist arthritis. Of the global prevalence, we can estimate that

30% have arthritis severe enough to be considered for surgery. The patient candidates need to be

selected carefully by indication and other clinical factors.

Joint replacement for the wrist is a complicated surgery with a high learning curve for the surgeon,

yet still it is being adopted in the US more and more by orthopedic hand surgeons. Total wrist

replacement is being adopted in countries such as India, China and Brazil, and depends heavily on

the availability of implants, reimbursement schemes and surgical training. As the population ages

and patients demand better treatment options and better outcomes, there develops a need for

long-term studies. This report addresses the various unmet needs, presents the current technology

and the drivers for the future and market growth in the US. Adoption rates are examined as well as

the decision makers in penetrating the market.

Appendix

© GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form. Page 108 GDME1018CFR / Published MAR 2013

12.6 About MediPoint

MediPoint is the flagship product for GlobalData’s Medical team. Each MediPoint report is built

from the ground-up by our team of healthcare analysts in the US and UK. Each report includes

input from experienced physicians and leading Key Opinion Leaders (KOL). Running throughout

each report in the series, “What Physicians Think” quotes provide a unique insight into how

healthcare professionals are reacting to events within the industry, and what their responses could

mean for industry strategists.

12.7 About GlobalData

GlobalData is a leading global provider of business intelligence in the Healthcare industry.

GlobalData provides its clients with up-to-date information and analysis on the latest developments

in drug research, disease analysis, and clinical research and development. Our integrated business

intelligence solutions include a range of interactive online databases, analytical tools, reports and

forecasts. Our analysis is supported by a 24/7 client support and analyst team. GlobalData has

offices in New York, Boston, London, India and Singapore.

Appendix

© GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form. Page 109 GDME1018CFR / Published MAR 2013

12.9 Disclaimer

All Rights Reserved.

No part of this publication may be reproduced, stored in a retrieval system or transmitted in any

form by any means, electronic, mechanical, photocopying, recording or otherwise without the prior

permission of the publisher, GlobalData.

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