The European Medical Technology Industry - in figures 2020

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The European Medical Technology Industry - in figures 2020
The European Medical
Technology Industry
in figures 2020
The European Medical Technology Industry - in figures 2020
Table of contents

What is Medical Technology?			    3

Regulations							7

Innovation						                 11

Employment					                  15

Companies						                  19
The European Medical Technology Industry - in figures 2020
Expenditure on Medical Technology 21

MedTech Market in Europe		       25

Trade in Europe					             33

About MedTech Europe			          39
The European Medical Technology Industry - in figures 2020
What is Medical
Technology?
The European Medical Technology Industry - in figures 2020
Medical technologies are products, services or solutions used to save and improve people’s lives.
In their many forms, they are with you all the time, from prevention, to diagnosis to cure.

There are three main categories of medical technologies:

  • Medical devices (MDs) are products, services or solutions that prevent, diagnose, monitor, treat and
    care for human beings by physical means.

  • In vitro diagnostics (IVDs) are non-invasive tests used on biological samples (for example blood, urine
    or tissues) to determine the status of one’s health.

  • Digital health and care refers to tools and services that use information and communication technologies
    (ICTs) to improve prevention, diagnosis, treatment, monitoring and management of health and lifestyle.

For the sake of this document, medical technology refers to medical devices and in vitro diagnostics.

                                                                                                               4
The European Medical Technology Industry - in figures 2020
There are more than 500,000 medical technologies available in hospitals, community-care settings and at home.
    Medical technology can be everyday objects such as sticking plasters, syringes, screening tests, or latex gloves.
    It could also be spectacles, wheelchairs, pregnancy tests or hearing aids.
    Medical technologies also include total body scanners, gene mutation tests, implantable devices such as
    heart valves and pacemakers, and replacement joints for knees and hips.
    You may not always notice medical technologies, but they are always there for you.

5
The European Medical Technology Industry - in figures 2020
Medical technologies provide value in different ways. They allow people to live longer and better lives, thus
empowering them to contribute to society for longer. At the same time, medical technologies improve the
quality of care, and the efficiency and sustainability of healthcare systems.

                                                                                                                6
The European Medical Technology Industry - in figures 2020
Regulations
The European Medical Technology Industry - in figures 2020
In the European Union, medical technologies are tightly regulated
by laws that govern the safety and performance of devices across their lifetime, pre- and post-market. Over
the next few years, the European medical technology sector will transition from being regulated under the
current medical devices directives to two new regulations.

                                                                                                              8
The European Medical Technology Industry - in figures 2020
Classification of In Vitro Diagnostic Medical Devices
    Today, the in vitro diagnostic (IVD) sector is regulated by Directive 98/79/EC. From 26 May 2022, the new
    Regulation 2017/746/EU will fully apply. Until this date, manufacturers can choose to comply with either the
    Directive or the Regulation.

    Classification of IVDs is important as it determines the level of involvement by a third party (the “notified
    body”) in assessing IVDs both pre- and post-market. This level of control is generally relative to the risk of an
    erroneous result from the assay.

    Under the IVD Directive, IVDs are classified into four classes following a positive list approach:

                    Annex II                  Annex II               Devices for              Self-declared
                     List A                    List B                self-testing                devices

                 (e.g. ABO blood-        (e.g. blood glucose        (e.g. pregnancy           (e.g. clinical
                       typing)               monitoring)                  tests)           chemistry analyser)

    Under the IVD Regulation, all IVDs will be classified under a new risk-based classification system according to
    the risk the device poses to the health of the public and or an individual as a result of an incorrect test result.
    All IVDs will be classified under class A, B, C or D, with class D being the highest risk class.

9
Classification of Medical Devices
The medical device (MD) sector is regulated by Directives 93/42/EC and 90/385/EEC. From 26 May 2021, the
new Regulation 2017/745/EU will fully apply. Until this date, manufacturers can choose to comply with either
the Directives or the Regulation.

Classification of medical devices (estimated to be more than 500,000) drives many pre- and post-market
requirements. Due to the large variety of products, the level of control made by a third-party (the “notified
body”) before placing them on the market depends on the level of impact on the human body that their
use might imply. The same notified body, together with the Competent National Authorities, is involved
post-market to ensure the continued safety and performance of medical devices.

Under the MD Directive, MDs are classified into 4 classes following a risk-based classification system:

                Class I                  Class IIa                Class IIb                Class III
            (e.g. simple             (e.g. syringes for       (e.g. anaesthesia          (e.g. stents)
         bandages or wound            pump infusion)              machines)
           care products)

Under the new MD Regulation, the risk-based classification system contained in the current Directives has been
maintained, although some changes/additions have been introduced. The principle is the same: to link the class
of the device to the potential risk posed to the health of the public and an individual as a result of fault in the
functioning. All MDs are classified under class I, IIa, IIb or III, with class III being the highest risk class.

                                                                                                                      10
Innovation
Medical technology is characterised by a constant flow of innovations,
which are the results of a high level of research and development within the industry, and of close co-
operation with the users. The average global R&D investment rate (R&D spending as a percentage of sales)
is estimated to be around 8% in the medical technology sector1. Products typically have a lifecycle of only
18-24 months before an improved product becomes available.

In 2019, nearly 14,000 patent applications were filed with the European Patent Office (EPO) in the field of
medical technology representing a 0.9% growth in patent applications compared to the previous year.2 The
medical technology field accounts for 7.7% of the total number of applications, second highest among all
the sectors in Europe. In comparison, around 7,700 applications were filed in the pharmaceutical field and
around 6,800 in the field of biotechnology. (Figure 2)

39% of all patent applications were filed from EPO countries (including EU27, UK, Norway and Switzerland)
and 61% from other countries, out of which with the majority of applications filed from the US (40%).

Figure 1. Medical technology patent applications filed
with EPO in 2019
                                                                        39%
                                                                        EPO countries
                                                                        (including EU27,
                                                                        NO, CH, UK)

                  61%
            Other countries

                                                                                                              12
Figure 2 – Top 10 technical fields in patent applications
Number of patent applications filed with EPO, 2019 (ref. 2)

                                                                                            Digital communication    14,175

                                                                                            Medical technology      13,833

                                                                                Computer technology        12,774

                                                   Electrical machinery, apparatus, energy       11,255

                                                                       Transport    9,635

                                                             Measurement       9,045

                                                 Pharmaceuticals       7,697

                                             Biotechnology     6,801

                                  Other special machines     6,436

                                  Organic fine chemistry   6,167

  THOUSAND SEPARATORS 0   2,000         4,000        6,000           8,000         10,000         12,000         14,000       16,000
While over the last decade the number of EPO filings in the field of medical technology has doubled, pharma
and biotech patent applications were relatively stagnant. Furthermore, the ratio of granted patents to patent
applications in the medtech sector has been continuously growing in the past years reaching 76% in 2019.
In comparison, this ratio is around 50% in the pharmaceutical and biotechnology field. (Figure 3)

          Figure 3 – Evolution of European patents by technical field
          (ref 2.)

               16,000                                                                                                     80%

               14,000                                                                                                     70%

               12,000                                                                                                     60%

               10,000                                                                                                     50%

                                                                                                                                Granted Patents
Applications

                8,000                                                                                                     40%

                6,000                                                                                                     30%

                4,000                                                                                                     20%

                2,000                                                                                                     10%

                   0                                                                                                      0%

                        2010   2011        2012      2013    2014      2015        2016         2017        2018   2019

                                      MedTech Applications   Pharma Applications          BioTech Applications

                                      MedTech Granted        Pharma Granted               BioTech Granted
Employment
730,000

The European medical technology industry employs directly more
than 730,000 people3. Germany had the highest absolute number of people employed in the
medical technology sector, while the number of medical technology employees per capita is highest in Ireland
and Switzerland. In comparison, the European pharmaceutical industry employs around 765,000 people4.

The jobs created by the medical technology industry account for around 0.3% of total employment in
Europe.5 These jobs are also highly productive, as the value added per employee is estimated to reach
€160,000 per employee. These indicators show that the medical technology industry has an important
economic and societal impact in Europe.

                                                                                                               16
Figure 4 – Top 10 European countries with highest
medtech employment
Direct employment in the medical technology industry in 2018, or latest year available (ref. 3)

                                         Denmark
                                          16,500
                                                    Sweden
                               Belgium              27,000
                                17,800                                  Germany
 United Kingdom

   97,600                                                               227,700
       Ireland
                                                                                     Switzerland
       40,000
                                                                                     58,500

France
89,130
       Spain
     25,500

                                                                                       Italy
                                                                                       76,400
Figure 5 – Number of people directly employed in the
  medical technology industry per 10,000 inhabitants
  2018 or latest year available (ref. 3)
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83     69        29      28        27        16      15   13       13    12        10         9          7          5       5         4      3    3
Companies
32,000
                medical technology
               companies in Europe
                                                           95%
                                                           SMEs

There are more than 32,000 medical technology companies in Europe.
The highest number of them are based in Germany, followed by Italy, the UK, France and Switzerland. Small
and medium-sized companies (SMEs) make up around 95% of the medical technology industry, the majority
of which employ less than 50 people (small and micro-sized companies)3.

                                                                                                            20
Expenditure
on Medical
Technology
225
                     Expenditure on
                    medical technology
                       per capita
                        in Europe

In Europe, an average of approximately
10% of gross domestic product (GDP) is spent
on healthcare. Of this figure, around 7.4% is attributed to medical     10%
technologies, i.e. less than 1% of GDP. The spending on medical       of GDP spent
technology is estimated to vary significantly across European
                                                                      on healthcare
countries, ranging from around 5% to 12% of the total
healthcare expenditure. Expenditure on medical technology
per capita in Europe is at around €225 (weighted average).*

* Medtech Europe calculation based on sources 4-8.

                                                                                      22
Figure 6 – Breakdown of total healthcare expenditure in Europe
2018 (ref. 4–8)

                                    16% Pharmaceuticals &
                                    other medical non-durables

                                                            7.4%
                                                            Medical Technology

                         0.7% In vitro diagnostics

                         6.7% Medical devices
                         (incl. imaging)

                                  76.6% Inpatient &
                                  outpatient care, other
24
MedTech
Market in
Europe
120
                     billion market

The European medical technology market is
estimated at roughly €120 billion in 2018. 7,8
The biggest medical device markets in Europe are Germany, France,
the United Kingdom, Italy and Spain. The same group of countries
                                                                              27%
form the top 5 IVD markets in Europe. (Figures 7 and 8)                      of the world
                                                                                market
Based upon manufacturer prices the European medical device

                                                              2
market is estimated to make up 27% of the world market.             nd
It is the second largest medical device market after the US
(around 43%).8                                              largest market
                                                                after US

                                                                                            26
Figure 7 – European medical device market by country
2018 (ref. 8)

     27.1% Germany

     14.6% France

     11% UK

     10.1% Italy

     6.3% Spain

     4.2% Netherlands

     3.7% Switzerland

     2.7% Belgium

     2.6% Poland

     2.5% Austria

     15% Others
Figure 8 – European IVD market by country
2018 (ref. 7)

       19.4% Germany

       14.5% Italy

       14.5% France

       9.0% Spain

       8.8% UK

       4.2% Switzerland

       3.6% Poland

       3.5% Belgium

       2.6% Netherlands

       2.4% Austria

       17.5% Other
Figure 9 – Europe in the global medical device market
2018 (ref. 8)

6% China        7% Japan   17% Rest of the world   27% Europe   43% US
Figure 10 – World medical technology market by
                            area and sales growth
                            2017-2024 (ref. 1)

                            18%

                            16%
                                                                         In–Vitro
                                                                      Diagnostics
                                                                             (IVD)
                            14%
WW Market Share % in 2024

                            12%
                                        Diagnostic
                                         Imaging
                            10%

                                                                                                                                         Source: Evaluate, September 2018
                                                                                                         Cardiology
                             8%
                                                                         Ophtalmics                    General &
                                                                                                       Plastic Surgery
                                                     Drug Delivery
                             6%
                                       Orthopedics
                             4%
                                                                             Endoscopy

                             2%
                                                                                              Dental
                                                                                                                      Diabetic Care
                             0%
                               +3.0%           +4.0%             +5.0%                +6.0%             +7.0%               +8.0%     +9.0%

                                                                     % Sales Growth: CAGR 2017-24

Medical technology offers solutions for many disease areas. On a worldwide perspective, in vitro diagnostics (IVD)
are the largest sector, followed by cardiology and diagnostic imaging.1

                                                                                                                                                                            30
Figure 11 – European medical device market growth rates
      2009-2018 (ref. 8)

15%

10%

                USA                 Europe                     Japan                China
5%              43%                  27%                        7%                    6%

0%
         2009     2010     2011      2012     2013      2014      2015      2016     2017      2018
            Canada                   Brazil                    Russia              Others
                2%                     1%                       1%                   13%
-5%

 The European medical device market has been growing on average by 4.2% per annum over the past 10
 years. Demand fell in 2009 due to the economic crisis, resulting in a growth rate of only 1%. The market
 recovered in 2010, since then the annual growth rate has varied between 2.6 and 9.3% in the European
 medical device market.7
Figure 12 – European IVD market growth rates
      2009-2018 (ref. 7)

5%

4%

3%

2%

1%

0%
                                                2013       2014       2015        2016       2017        2018
-1%

-2%

-3%

-4%

The European IVD market growth has been slowing down until 2013, while annual growth rates in the pre-crisis
period were at around 2-4%. In 2013 the European market started to recover and the annual growth rate in 2018
was around 1%.
Trade in
Europe
billion
               Estimation of Europes   ’
                 trade surplus in 2018

Europe has a positive medical devices trade balance of €11.7 billion (2018).
Compared to the previous years, the main European medical device trade partners remain the same: the US,
China, Japan and Mexico.9

Medical devices trade balance of individual countries varies a lot across Europe as shown in
Figures 15 and 16. Based on export and import values including European intra-community
trade, the international trade balance indicator is highest in Ireland and Germany followed
by Switzerland and the Netherlands.

                                                                                                           34
Figure 13 – Top export destinations of the European
  medical devices market
  2018 (ref. 9)

                                                    Russia
   Canada                                           3.8%
   1.9%

                                                                Japan
  USA                                                           6.5%
                                                                     South Korea
41.5%                                   Turkey
                                          1.9%
                                                             China
                                                                     2.3%
                         Saudi Arabia
                                1.9%                         10.2%
                                            India
                                            2.1%

                                                    Australia
                                                    3.1%
Figure 14 – Top import suppliers to the European
   medical devices market
   2018 (ref. 9)

   USA                                                       Japan
                                                             6.0%
50.4%                                                         South Korea

  Mexico
                             Israel                   China 1.5%
     6.6%
                             1.5%
                                                      12.7%
         Costa Rica                   Malaysia
              2.1%
                                          3.7%
                                       Singapore
                                             3.7%

                                                 Australia
                                                     1.6%
Figure 15 – Export and import of medical devices by country
Including intra-community trade, million euros, 2018 (ref. 9)

          GERMANY                                                                                                    26,604
                                                                                          17,217

                                                                                                   20,677
      NETHERLANDS                                                                15,384

           IRELAND                                                      11,599
                             2,083

          BELGIUM                                               10,401
                                                            9,146

       SWITZERLAND                                              9,915
                                        4,154

            FRANCE                                      7,352
                                                                9,607

                                                5,861
                UK
                                                        7,600

              ITALY                  3,816
                                             5,737

           POLAND               2,596
                               2,186

           AUSTRIA           2,031
                             2,055

          DENMARK            1,880
                            1,303

           FINLAND          1,822
                           931

              SPAIN        1,560
                                        4,242

           SWEDEN          1,414
                            1,673

     CZECH REPUBLIC        1,161
                          1,100

                      0              5,000                10,000             15,000          20,000         25,000        30,000
                                                                  Export         Import
Figure 16 – Medical devices trade balance by country
Including intra-community trade, million euros, 2018 (ref. 9)

                                     IRELAND                                                                9,516
                                    GERMANY                                                                9,386

                               SWITZERLAND                                                 5,761
                               NETHERLANDS                                              5,293
                                     BELGIUM                          1,255

                                     FINLAND                      891
                                    HUNGARY                     577
                                    DENMARK                     576
                                      POLAND                410
                             CZECH REPUBLIC                61
                                    LITHUANIA          45
                                       MALTA           22
                                     ESTONIA           8
                                             -19       SLOVENIA

                                             -23       AUSTRIA

                                            -34        BULGARIA

                                            -51        LATVIA

                                            -60        CYPRUS

                                            -93        LUXEMBOURG

                                           -168        SLOVAKIA

                                      -235             CROATIA

                                      -259             SWEDEN

                                      -359             ROMANIA

                                    -586               GREECE

                                    -674               PORTUGAL

                                 -684                  NORWAY

                      -1,740                           UK

                    -1,921                             ITALY

                  -2,255                               FRANCE

             -2,681                                    SPAIN

         -4,000            -2,000                  0                    2,000   4,000   6,000      8,000   10,000
About
MedTech
Europe
MedTech Europe is the European trade association representing the
medical technology industries, from diagnosis to cure.
We represent diagnostics and medical devices manufacturers operating in Europe.

MedTech Europe’s mission is to make innovative medical technology available to more people while helping
healthcare systems move towards a sustainable path. MedTech Europe encourages policies that help the medical
technology industry meet Europe’s growing healthcare needs and expectations. It also promotes medical
technology’s value for Europe focusing on innovation and stakeholder relations, using economic research and
data, communications, industry events and training sessions.

MedTech Europe’s Facts & Figures publication is an annually updated report with robust industry data compiled
from multiple sources. The publication is used as the quintessential source of data by international stakeholders
seeking an up-to-date view of industry innovation and employment, SME activity, expenditure on medical
technology, trade and market size in Europe.

                                                                                                                    40
Scope of this report
     • In this report Europe refers to EU27, Norway, Switzerland and the United Kingdom, unless specified otherwise.

     • The Innovation chapter defines medical technology following the methodology of the World Intellectual Property Orga-
       nization (based on the WIPO IPC-Technology concordance as revised in August 2014).
       Patents are attributed by the country of residence of the applicant. EPO countries refer to the 38 member states of the
       European Patent Organisation.

     • The Employment and Companies chapters are based on data from the 2019 survey carried out among MedTech Europe’s
       National Associations. Figures refer to 2018 or the latest year available.
       An enterprise is considered to be a SME if it employs fewer than 250 persons and has an annual turnover not exceeding €50
       million (small and micro-sized companies employ fewer than 50 persons and have a turnover of less than €10 million).

     • The Expenditures on Medical Technology chapter is based on MedTech Europe calculations using healthcare statistics
       from the following sources: EFPIA, Eurostat, Fitch Solutions, WHO.

     • The MedTech Market in Europe chapter is based on manufacturers’ sales (revenue) not including margins, such as value
       added in the wholesaling and retailing, transportation costs, some taxes included in the final price, etc.

     • The Trade in Europe chapter data refers to the medical technology products in the following categories, excluding in
       vitro diagnostics: orthopaedics & prosthetics, patient aids, dental products, diagnostics imaging, consumables, other
       medical devices (incl. wheelchairs, ophthalmic instruments, hospital furniture, medical & surgical sterilisers, ultra-violet
       or infra-red ray apparatus, blood pressure monitors, endoscopy apparatus, dialysis apparatus, transfusion apparatus,
       anaesthetic apparatus & instruments).

     References
     1 Evaluate MedTech, 2018, World Preview 2018, Outlook to 2024.
     2 European Patent Office (EPO), 2020, Patent Index 2019.
     3 MedTech Europe, 2019, National Associations Survey.
     4 EFPIA, 2019, The Pharmaceutical Industry in figures.
     5 Eurostat, 2020, Employment and Population Statistics.
     6 WHO, 2019, Global Health Expenditure Database.
     7 MedTech Europe, 2019, European IVD Market Statistics Report 2019.
     8 Fitch Solutions, 2019, Worldwide Medical Devices Market Factbook.
     9 International Trade Centre, 2020, International Trade Statistics – MedTech Europe calculations.

41
www.medtecheurope.org
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