ABMD - pretty amazing survival data

MC
I guess you are suggesting that you have information about the PHP through your professional associations that are not generally known? I guess I am trying to bridge the gap between the February 2017 trial halt and your statement about not “sleeping on PHP.” Are there any publications you can point us to that might give us updated information about the product fixes, etc?

And, can you make an educated guess as to how long it would take a product like this to gain enough acceptance to be a true Impella threat?

Thanks
David

ABT is a big company where the PHP will not make as much of an impact on its finances. So you have to invest in all the other stuff to invest in the PHP.

That’s why I like ABMD, much more focused on a fast growing product. Penumbra (PEN) is similar in my opinion and worth a look if you’re interested. They started with a device to retrieve clots in the brain to treat stroke and are now expanding to the rest of the body, particularly extremities and lungs.

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@ MD (HeartMD)

…I love the Impella but do not sleep on the PHP. You seem to dismiss it as irrelevant and it won’t be.

Thanks for your expert comment (that’s why I alerted you). Sorry I gave the wrong impression. I only meant that for now and the indeterminate future, the HeartMate PHP is no imminent threat to the Impella 2.5. I have continued to follow the PHP until about a year and a half ago. Since then I have been unable to get any info on it from SJM-Abbott. I’ve searched its US site for the PHP but it brings up HeartMate II, and both the French and German websites, both in countries were the PHP was available, state “Sorry, 0 results.” So no new insights into my nearly two year old information. The NIH is no help either. Abbott’s study should be completed by September 2019 but there is no reliable information as to how many patients were actually enrolled, https://clinicaltrials.gov/ct2/show/record/NCT02468778. I ‘d definitely be curious as to the numbers.

As to the flow data, I know that the ABMD’s Impella 2.5 brochure only claims a 2.5 L/Min. Unfortunately I jotted down those high numbers from some article comparing percutaneous left ventricular support devices without a link.

@Treepak,

ABT is not a Saul type stock as stated before and I don’t think anybody, except a St. Jude Medical - Abbott insider could likely know how successful the PHP could possibly be and at what point it’d be a threat to ABMD, see my above attempts to get info from Abbot.us.fr.de.

We should focus on ABMD’s development of three new products, the Impella 5.5, Impella BTR, and the Impella ECP. I will post on ABMD in the future when I have had time to go through my voluminous files, update the info and checked with ABMD on the status of their research.

Let’s not get carried away with on-line posts and technical details as it clutters up the board and may force Saul to intervene.
The End.
im

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HeartMD:

I’m curious who you are putting these devices in. In part for investing, in part medical curiosity.

The NCSI inclusion criteria says the patient has to be able to sign consent… Yet post arrest does not seem to be an exclusion if less than 30m down time.

What I’m getting at is that ROSC patient who needs pressors due to cardiogenic shock +/- pacing … Even without STEMI pattern, if they’re young enough and a witnessed arrest without asystole as presenting rhythm, going to the cath lab improves survival…

Are these one type of patient getting impellas? … Because it seems like they’re the ones that need it most/could benefit most, and yet NCIS seemingly requires an ability to give consent. Ie, an ability to give consent preselects a less sick patient population.

What scenarios are you using it for?

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im,

I’m not giving you information you can find on the net. It comes from a higher up at Abbott (think way up) who is also a friend and a leading investigator for many of the trials who knows things waaaaaaay before you or I. I did speak with my friend again today and he reaffirmed what I said but told me it was more like 3 years away instead of 2. So there is that. He did tell me the issues that caused all of their problems with the prior device iteration have been resolved. Trials will end in 2019 or 2020 he believes. Data is gathered and presented. Then the FDA gets to say yeah or nay. Looks like 2021 to me if things go very well.

That is a long time for ABMD to lock the space down and/or to continue to innovate along the way and make the PHP irrelevant by the time it hits the market.

Funny, the more I type, the more I think I should buy ABMD.

MC

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Fuma,

So, by far and away the number 1 indication is high risk PCI patients. For example, unprotected left main in a non-surgical candidate or a post CABG patient with only 1 graft left and that graft needs intervention. They almost always have a depressed EF but there are a few scenarios where they don’t. If I know I will be occluding or nearly occluding the left main for more than a few seconds during the procedure (usually for distal left main bifurcation lesions), they will get an Impella regardless of EF. I have seen patients talk to me with an Impella in place while they were in asystole for 2 minutes. The thing is amazing in that regard.

The example you posted is almost exactly the patient I placed one in this past Sunday. Out of hospital arrest in a 59 year old. Successful ROSC with ACLS, large anterolateral STEMI on EKG. EF 10-15% on arrival to the Cath lab (he also smelled like a brewery). PCI of the LAD/Diagonal and placed the Impella during the procedure for cardiogenic shock. He walked out of the hospital 3 days later. He never signed a consent, it was all emergent.

Hope that helps.

MC

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MC, really appreciate you sharing real-world data. It adds more than color to the investment pieces, not to mention making it “real” as opposed to just numbers in a tracking spreadsheet somewhere. Thanks for taking the time, and DO keep us updated on ABMD and competitors. It may not be a Saul-approved stock but there are enough of us here that own it that I think it’s worth discussing.

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IRDoc
Funny you should mention PEN. That one was going to be my homework this weekend. I just ran across it this week. Maybe it was mentioned in an article w ABMD or AxGN…I think AXGN. Probably some investing junk piece about possible take out candidates. Anyway, sounded interesting.
Thanks

IRDoc,

I can’t really comment on the overall quality, of importance, of each co’s product. Both seem to offer very strong value propositions. But, simply looking at mkt cap to tam- I have axgn at $1.4bn with potential tam at $2.5bn+ compared to PEN w a mkt cap north of $5bn w a potential tam of $2.5bn or so +. Also, looks like PEN might have more potential competition-JNJ, Stryker, Medtronic. By the way, in each case TAM seems to just address the US opportunities. I can’t find much yet that talks other US other than very generally.

I would love to be able to assess the growth opportunities for each company in terms of peripheral or new markets. Haven’t gotten there yet. Maybe you can help w this when it comes to PEN?

Thanks

Treepak,

To be honest with you I find it hard to know what to do with TAM numbers. Bigger is better but then what percentage can a company take, what’s the likelihood of that, how fast, etc is hard to assess.

I first learned about Penumbra when it was first getting started in stroke treatment but didn’t get interested in investing until they expanded into the peripheral market. Their product is easy to use and the company has been aggressively supporting further research into various fields beyond stroke and limb ischemia. I think it will prove to be useful in dialysis access circuits, pulmonary arteries, deep vein thrombosis, among others. The current mainstay for a lot of these applications is the Angiojet (Boston Scientific) which has a variety of complications and more difficult to set up and more recently the Angiovac which is huge and requires a perfusionist which really limits its use.

So I read somewhere before the TAM for stroke is somewhere in the $1.5b range. I’m not sure if it’s used in cardiac applications much (I’ve heard of it being used for vein graft thrombosis). The other applications I’ve described probably aren’t as high value as stroke per procedure but expands the number of hospitals that might use the Penumbra system (Indigo) by quite a bit. A relatively small number of hospitals have the means to accept and treat stroke patients whereas many more smaller hospitals and ambulatory surgery centers treat clots in the legs, lungs, dialysis grafts, etc.

So at the end of the day I have to say that my investment is based in good part on personal experience and word of mouth. I also like that it’s a relatively small company (compared with JNJ, Boston Sci et al) so it’s really one of the only companies I know of that is relatively focused on the interventional market.

As for AXGN I simply have not heard of anyone using it or how well it works. It looks like interesting tech but it’s outside my field of expertise. I prefer to invest in companies that I know have good products beyond the financials. This keeps me out of some of the popular names on the board but has served me well.

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To be honest with you I find it hard to know what to do with TAM numbers. Bigger is better but then what percentage can a company take, what’s the likelihood of that, how fast, etc is hard to assess.

TAM is like the pot of gold at the end of the rainbow, you never get here. There are two ways I find TAM useful.

1.- If you are talking about an increasing returns kind of business, the leader, the Gorilla, will take over half of the market. It could be 60%, it could be 80% but not likely. On the other hand, in a commodity type of business the likelihood of large market share is quite low.

2.- Market penetration by the whole industry – not any specific company – is a good indicator of growth rate which tends to follow the “S” curve. Below 15% adoption is slow because only geeks and innovators are buying. At some point the “pragmatists” get on board and adoption accelerates until the market starts to get saturated. Somehere around 85% market penetration the top of the “S” is reached. The Gorilla becomes a Cash Cow but fast growth is gone.

Denny Schlesinger

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