JP摩根美股医疗供应与设备行业糖尿病设备调查胰岛素泵和CGM市场展望20196339页

NorthAmericaEquityResearch03June2019DiabetesDevicesJPMSurvey:OutlookfortheInsulinPump&CGMMarketsAheadofThisYear'sADAMeetingMedicalSupplies&DevicesRobbieMarcus,CFAAC(1-212)[e-mail](1-212)[e-mail](1-212)[e-mail]ge36foranalystcertificationandimportantdisclosures.J.P.Morgandoesandseekstodobusinesswithcompaniescoveredinitsresearchreports.Asaresult,investorsshouldbeawarethatthefirmmayhaveaconflictofinterestthatcouldaffecttheobjectivityofthisreport.Investorsshouldconsiderthisreportasonlyasinglefactorinmakingtheirinvestmentdecision.(June7-11)inSanFrancisco,thebiggestmeetingoftheyearfortheindustry,we’veconductedourannualdiabetessurvey.We'vepublishedextensivelyontheDiabetesmarketinthepastfewmonths(Top5ThingsinDiabetes;G6/G7vs.Libre2.0;Type2DiabetesDeepDive),butthisyear’ssurveycomesatatimeofrapidinnovation,multiplenewproductlaunchesoverthenext12-18months,andafurtherconvergenceofCGMandinsulinpumps.Keytakeawaysfromthesurveyare:(1)pumpandCGMpenetrationarestillrelativelylowandshouldcontinuetoexpand;(2)innovationandaffordabilitycontinuetobethetwomostimportantfactorsdrivingbothadoptionandshare;(3)withinpumps,weexpectTandemandInsulettocontinuetotakeshare,butwewouldn’twriteoffMedtronic’s780Glaunchnextyeargiventhepositivequalitativefeeback;and(4)inCGM,thereisstillamajorneedforbothAbbott’sLibre(lowercost,easytouse)andDexcom’sG6(predictivealertsandalarms,betteraccuracy).Comingoutofthesurvey,weseeDXCM,ABT,TNDM,andPODDaswellpositionedforcontinuedoutsizedgrowth,andwearemoreencouragedonMDT’sdiabetesfranchisefollowingenthusiasmaroundtheupcoming780Glaunch.KeyCGMtakeaways:ThereisbothplentyofroomforgrowthandastrongneedforAbbott’sLibreandDexcom’sG6.OnthecontroversialLibre2.0vs.G6debate,superiorfeaturesets(predictivealerts&alarmsrankedmostimportant)andaffordability(“initialout-of-pocketcost”ranked2nd)wereindicatedasthehighestprioritiesthatdoctorsseeforpatientsinmakingadecisionbetweenthetwodevices.We’vesaidthisbefore,butwebelievebothproductscansucceedatthesametime.Importantly,whileCGMpenetrationhasacceleratedoverthelastyearonthebackofeffortsbyDexcomandAbbott,thereisstillsignificantroomtorun,withrespondentspointingtocontinuedstrongadoptionineveryagegroupacrossbothType1andType2patients.Keyinsulinpumptakeaways:InsuletandTandembestpositioned,butdocsexcitedaboutMedtronic’s780G.Thisyear’ssurvey,thefirstwithJ&J’sAnimascompletelyremovedfromthepicture,skewedtowardsTandemandInsuletusersversusMedtronic(58%shareforMedtronicvs.~75%inreality,withTandemat20%vs.12-14%).WhileweanticipateTandemandInsulettocontinuetocaptureadisproportionateamountofnewuserscomingtoinsulinpumpsforthefirsttimefromMDI(multipledailyinjections),docsinthesurveyareforecastingsteadynewpatientshares.Thatsaid,Medtronic’s780G(1Q20)washighlightedasthemostanticipatednewtechnology,followedbyTandem’sControl-IQ(2H19),followedbyInsulet’sHorizon,whichisfurtherout(2H20).Thetopicofinnovationcontinuestobeamajordrivingforceoftechnologyadoption,bothonthepumpandontheCGMside.Atahighlevel,nothingthatwecameacrossinoursurveyofendocrinologistsfor2019intermsoftechnologiesorproductchangespointstoamajorchangeintrendfromwhatwe’vebeenseeingandhearinginthemarketsofar.Theunderlyingmessageissimple:innovationiskeywithmuchenthusiasmexpressedaroundthetopic,butafterthiscostremainsaconsiderationformostdoctors,mostnoticeablyinCGMwhenrespondentswereaskedaboutAbbott’sLibre.2NorthAmericaEquityResearch03June2019RobbieMarcus,CFA(1-212)[e-mail]ForInsulet,thesurveyhighlightedtheimportanceofbothHorizon'ssmartphonecontrolfeatureandthecompany'scollaborationwithTidepool.OutsideofbeingInsulet'sfirstinternallydevelopedproducttopushintothehybridclosed-loopspace,Horizonwillalsopotentiallybethefirst-everinsulinpumpthatiscontrolleddirectlybyapatient’ssmartphone(actuallydosinginsulin,notjustmonitoring).Two-thirdsofoursurveyedendocrinologistsconsiderthisfeaturetobe“veryimportant,whiletherestofthegroupsawitofmediumimportance,withzeroviewingitasunimportant.Thequestionherewillbethecadenceofrollouttodifferentpatientpopulations,asthecompanyhasguidedtoinitiallyonlyoffercompatibilitywithSamsungsmartphoneswhenHorizonfirstcomestomarketinlate-2020,withiPhoneandotherandroidintegrationtocomelater.Tidepoolisanonprofitdiabetessoftwarecompanythathasdevelopedanopen-sourcehybridclosed-loopalgorithmforintensiveinsulinmanagement.Today,InsuletistheonlycompanythatisformallypartneredwithTidepool,andthetwocompaniesareworkingonaTidepoolLoop-enabledOmnipodfortheUSmarket.WeaskedourrespondentstodescribetheimpactofsuchaproductcomingtomarketforOmnipodpumpvolumesandreceivedpositiveresults,with40%seeingthiscollaborationas“muchmorelikely”toboostsales,another40%seeingitas“somewhatmorelikely,”andonly20%seeingitas“notmorelikely.”WenotethataTidepool-integratedOmnipodcouldreceiveapprovalinthe2H20timeframe,potentiallymakingitInsulet'sfirsthybrid-closedloopoff