Products & Services

Just gauze no more, bandage and dressing products coming of age

by Curt Werner

Thousands of years ago, during times of the most primeval treatment of patients suffering from a variety of wounds and other ailments, those patients were cared for using bandages and dressings. The ancient Egyptians are credited with creating and using the first bandages. And judging from paintings and other works of art that offered recorded evidence of eras long past, and especially documenting wars, simple cloth was the bandage of choice.

Talk about a mature market. While there are far more modern choices available today, cloth has remained in use, a fact that makes bandages and dressings among the oldest markets in medical supply.

But in a steady technologic evolution, those ancient products have been slowly replaced by newer, higher-tech successors, and today, the product parade marches further and further away from its ancestral roots. Cost-effective products that promote faster healing are now readily available.

“We are reinventing the market,” says Chad Campbell, an associate product manager with Kendall Healthcare, the Mansfield, MA-based unit of Tyco International. “We have looked at the high infection rates in acute care and worked hard to develop ways to reduce those infections in a way that benefits the customer and the patient.”

Specifically, he mentions one way in which Kendall has responded to the infection rate and that is the company’s Kerlix A.M.D. (Antimicrobial Dressing), which was released in 2002. The new product differs from the older predecessors in that it is impregnated with an antimicrobial compound that the company says resists bacterial colonization and penetration through the dressing. Kendall says the A.M.D. dressing resists such nasty foes of good health as MRSA or Methicillin-Resistant Staphylococcus Aureus and VRE, Vancomycin-Resistant Enterococci.

Keenly aware of rising infection rates in wound care, hospitals have demanded from wound care product producers like Kendall and others a stronger emphasis on technology. “Just using different packaging isn’t going to do it,” says Campbell. “We want to have a direct impact on infection control. Our customers want dressings that can do more.”

More succinctly than new and old, the market can probably better be segmented into traditional wound care, which encompasses gauze and other mature products, and advanced wound care with its passel of modern technologies such as hydrocolloids and foams. Not surprisingly, growth in the market for the former is considered flat or in decline, while the latter is the place for opportunity. “Today’s market is driven by a value-oriented approach to wound care,” says Gary Ackert, market development manager in the skin care group for St. Paul, MN-based 3M, a major player in the wound care market. “The idea is to consume fewer supplies and make more efficient use of clinicians’ time and resources.”

Ackert outlines the 3M approach to wound care by using the “three VPs”: Value to the patient (improving quality of life and alleviating pain); Value to the provider (enabling clinicians to be more efficient and effective at a lower overall cost); and Value to the payer (lowering overall cost by consuming fewer supplies while maintaining a wound healing environment).

He points to recently released products such as 3M’s Tegasorb hydrocolloid dressing, a sterile wound dressing consisting of a hydrocolloid adhesive with an outer clear adhesive cover film, as a good example of a product that meets the three VP criteria.

The next wave of technology for wound care could float the boat of the venerable bandage and dressing products. That wave involves so-called “interactive” wound care products, third generation products in the wound management market.

Market researchers Frost and Sullivan define “interactive wound care products” in an August 2002 report as biocompatible products that are intended to actively promote wound healing by interacting either directly or indirectly with the wound tissues. They are either composed entirely of biological material or denatured through cross-linkage with synthetic or other biological products. The segment includes skin substitutes and biomaterial dressings. Skin substitutes are bio-engineered devices that can mimic the structure and function of skin. Biomaterial dressings are wound dressings that use biopolymers like collagen and/or hyaluronic acid as their major components. 

Frost and Sullivan says that the North American market for interactive wound care products generated an estimated $63 million in revenue in 2001, and adds that the market surged by 34.3 percent over 2000 and is expected to grow at a compound annual rate of 12.2 percent over the next five years. The researchers said that revenue from growth factor wound dressings was expected to increase 13 percent for the period 1997-2004, with a compound annual growth rate greater than 40 percent. There is general agreement that approximately $500 million is spent on wound management products annually in the U.S today.

The trick for manufacturers of the next generation of dressings products has been to inspire interest from end-users who have been generally content to apply the older products and reluctant to change their ways. The premium prices that the new products command is yet another factor, as manufacturers stress total cost while providers keep their eyes on transaction price. Naturally, as acceptance increases, this tug-of-war may ease and producers should be able to lower prices by raising manufacturing capacity and streamlining manufacturing processes. That, however, will take time.

3M’s Ackert says that hospitals are catching on. “There has been a great willingness to accept new technology and its benefits from the nursing community,” he says. “The demands of the market in the 21st century are to manage patients who are sicker in many ways and to focus on early intervention in skin damage. Instead of waiting for a nosocomial infection to occur, today’s nurses use today’s products to intervene.”

J&J soon to exit market
The reach of the bandages and dressings market is deep and broad. Thanks to Medtech Insight, here are some of the products that could be included in the market: alginate and foam dressings; allograft, autologous and tissue-engineered skin graft products; antimicrobial and odor-control dressings; compression bandage and stocking products; film and hydrocolloid dressings; hydrogel and non-adherent dressings; mechanically assisted wound closure devices; non-occlusive and semi-occlusive dressings; specialty beds, mattress replacements and overlays; surgical sealants and tissue glues/adhesives; topical wound analgesics and antibiotic formulations; wound cleansers and chemical/enzymatic wound debriders; and wound closure strips and surgical staplers. 

The market leaders, the companies with the most to gain from shifting share, include Kendall, 3M, St. Paul, MN; Johnson & Johnson’s Wound Management, a unit of Ethicon Inc.; Smith & Nephew, Largo, FL; and ConvaTec, a Bristol Myers Squibb company based in Princeton, NJ. 

But that lineup will change significantly before long. That’s because earlier this year Johnson & Johnson announced its decision to phase out production and marketing of selected general wound care product lines, a lineup of traditional wound care products that includes eye pads, sponges, gauze pads, tapes and cleaners, according to a letter to its distributors. Johnson & Johnson, which said that those products would no longer be available after the end of this year, said that it is “focusing on building its global leadership in advanced wound care by pioneering products and technologies that facilitate the healing process. These selected general wound care products no longer match our long-term strategy.” Those older products were produced at the company’s Sherman, TX, facility, a plant that will close. J&J will, however, maintain its advanced wound care line. In many ways, the move signifies the lack of sales in the traditional wound care segment and the unwillingness of a major manufacturer to pour more resources into a flat or declining commodity market.

Already, companies like Medline Industries Inc., Mundelein, IL, are seeking to fill what could be a market void by releasing new products into the segment like its cotton and polyester blended gauze sponge called Accu Sorb.

Like it is with most products, particularly for commodities or semi-commodities such as bandages and dressings, there has been pressure to keep prices down. Pricing has been driven down by powerful group purchasing organizations and integrated delivery networks, particularly in the older categories. Another large factor is offshore competition from places like China and its vast reserves of cheap labor. Other regions as disparate as India and Mexico produce similar products and there are scores of dealers selling bandages and dressings in the U.S. and many other far-flung outposts across the globe, all of which places even more downward pressure on pricing. To combat that price pressure, manufacturers have sought to shift the market toward the more robust advanced and interactive wound care products areas. 

HPN

October
2003