Medical technology company Chordate Medical has developed a new treatment method for chronic nasal congestion and migraines called Kinetic Oscillation Stimulation (KOS). The treatment technique stimulates the nervous system via mechanical vibrations in the nose, which can reduce the number of headache days per month for the patient. KOS received a CE mark in migraine in May 2021 and Chordate Medical is now preparing for market introduction in, among others, Italy, Israel and the Nordic countries and possibly additional markets.
Interview with CEO Anders Weilandt
Chordate Medical's technology is expected to provide competition to migraine drugs and other medical devices for migraine treatment on the market. Some examples of medical devices for migraine treatment are CEPHALY, Religion, gammaCore Sapphire, TVNS L, Nerivio, sTMS mini, HeadaTerm, cerena and PainXtDCS all of which are CE marked and thus approved for sale within the EU.
Chordate Medical has recently received a report from DelveInsight which provides an overview of the seven largest markets for migraine treatment – the US, Germany, France, Italy, Spain, the UK and Japan. BioStock contacted Chordate Medical’s CEO Anders Weilandt to learn more about the insights from the report.
Migraine is a widespread disease that affects many people. How big is the total market?
– Commercial market analyses of migraine treatments usually report that the pharmaceutical industry has a turnover of approximately USD 8-9 billion annually in the seven largest markets, with a growth rate of ten percent. An alternative to pure pharmaceuticals is Botox treatment, which is admittedly a pharmaceutical but is performed as a clinical procedure, where the turnover is reported to be approximately USD 700 million.
»It is interesting that of the nine competitors to Chordate reported in the report, it is our technology that is attributed to the strongest growth trend by far at the end of the forecast period«
– A recent special report on neuromodulation for migraine, focusing on treatments performed privately in the home, shows a forecast for 2026 sales of $46 million for the seven largest markets. The report only touches on the potential for clinic treatments, which is the market that Chordate is working on. However, it is interesting that of the nine competitors to Chordate reported in the report, it is our technology that is attributed to the strongest growth trend by far at the end of the forecast period, with a market share of approximately 13 percent.
– Our assessment is that the clinic market will grow to be many times larger than the market for private use, and it seems that the analysts behind the report partly agree as they show growth on the clinic side from 2023 – which roughly corresponds to the description of Chordate's sales growth. The clinic market is also the most lucrative segment.
Where do medical technology treatments come into the picture?
– Common to the treatment options with drugs for migraine is that barely half of the patients receive sufficient relief, some patients do not respond to the treatment at all. In addition, the effect of a drug often decreases over time – or it is felt that side effects are no longer tolerable. Therefore, the doctor often looks for the next possible treatment that may work for that particular patient. Patients often actively look for alternatives to feel better.
– Today, pharmaceuticals are by far the most common choice, followed by botox treatment. We see a growing demand for other methods that are not pharmaceuticals. This is where these new medical technology alternatives come into the picture. According to the analysis report above, Chordate's technology is presented as the strongest candidate by far, with impressive growth potential. We are of course both happy and a little flattered by that description – but we have a partly different view of the importance of the clinic market over time.
How will the market develop for your segment?
– It is in the clinic market that the great potential exists, but it always takes a long time to develop. We do not offer our technology for private use, even though it is technically prepared for it. Migraine is an extremely expensive disease for society and therefore the reimbursement levels are very high, for example, a chronic migraine patient in Sweden costs approximately SEK 120 per year in care and loss of production. Neither private nor public insurance systems reimburse private home care to any great extent, regardless of segment. However, providing clinical care to migraine patients is good business for healthcare providers that they will not want to miss out on. That is why we have focused on that from the beginning. At the same time, this strategy means that it will take a little longer before our intensive sales work can bear fruit. Private individuals with their own health problem react much faster, but pay much less, which results in lower margins. The clinic market is traditionally quite sluggish, but over time is significantly more profitable.
»Migraine is an incredibly expensive disease for society and therefore the reimbursement levels are very high«
What other medical devices for migraine are on the market and how does Chordate Medicals differentiate itself from these competitors?
– Of the nine other companies with registered products reported in the new analysis report, all but two offer only acute treatment during ongoing migraines. Our treatment is approved for preventive treatment and has a long-term effect, so you may need 4-6 treatments per year. Many of the competing treatment options are used acutely every time you get a migraine, and in some cases several times per day.
– The other big difference is that the competitors are different types of electrical or magnetic stimulation on the head or upper arm. Our treatment is a mechanical vibration that stimulates the nasal mucosa and thus the autonomic nervous system directly. We have also shown in a study that our treatment clearly regulates the variability in the heart rate – which means that the treatment likely has a pronounced central effect on the nervous system.
»Our treatment is a mechanical vibration that stimulates the nasal mucosa and thus the autonomic nervous system directly.«
You have already received CE marking in the EU for KOS as a migraine treatment. Are there any regulatory aspects that could facilitate or complicate the registration process in other markets?
– There are clear differences between the regulatory processes for market approval in different countries. There are different requirements for what must be met, including the level of clinical verification. A CE mark is an excellent basis to start from, but it will be a lot of work to get additional approvals in place - but nothing that we cannot handle.
You are currently working on introducing the migraine treatment in selected markets. Can you tell us about how this work is progressing?
– Since we received the CE mark in May this year, over a year earlier than expected, work has recently started in earnest. We have communicated that our Italian distributor quickly placed two systems on the market, and that we have three installations in Sweden. The Israeli distributor has started the application for market authorization based on the CE mark. We will come back with more results from these three countries, but given the continued pandemic obstacles and holiday periods, you have to realize that it is only at the beginning of the product launch. We have also communicated that we are looking at additional markets, something that we will come back to.
What role does cost reimbursement play in Chordate's market establishment?
– Public or private insurance reimbursements obviously make all sales much easier. But in several markets there is also a private-pay market where the patient pays themselves. In some markets it is even the dominant reimbursement model. Initially, we are looking for markets where there is a significant amount of privately paid migraine care, in order to build market share. In the long term, we are of course working on preparing and establishing insurance reimbursement for the treatment method. In some markets and regions, this work has already been successful for rhinitis treatment, which is the second indication for this technology.
Finally, what are your hopes for gaining market share with KOS?
– We are working long-term to establish evidence that we can sell this new technology in different markets. Since we are focusing on the clinical side, it will take some time to get there, but we are completely convinced that we will succeed. The most important components of that conviction are the scientific results that led to the CE mark, and the patients' own drive to constantly seek something that gives better results than the treatment they have. Both the profession and those affected by migraine are actively looking for new or better alternatives to current drug treatments. Here, Chordate's treatment method is a very attractive alternative, and according to the analysis report, Chordate's technology is presented as by far the strongest candidate on the market, with impressive growth potential.
»Both the profession and those affected by migraine are actively searching for new or better alternatives to current drug treatments. Here, Chordate's treatment method is a very attractive alternative «
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