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Defining the landscape for neuromodulation

This presentation offers an in-depth look into the evolving landscape of neuromodulation therapies, highlighting advancements from 2012 through 2020. It covers the significance of expanding treatment indications for neurodegenerative diseases, improved efficacy of less invasive implant procedures, and the transition towards a healthier ecosystem. Key topics include the effective integration of digital health technologies, economic considerations, and the future potential of closed-loop systems. The comprehensive analysis aims to illuminate how neuromodulation is becoming a standard of care.

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Defining the landscape for neuromodulation

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  1. Defining the landscape for neuromodulation 2020 or 20/20 Dana Mead 12/6/2012

  2. Company and Market Building Since 1972 Over 350,000 jobs More than US $650 billion market cap KPCB Confidential

  3. Innovation Markets • Health Care & Life Sciences • Targeted therapeutics • “Digital” Health • Medical Devices • New Energy Technology • Science of small àenormous markets • Speed and scale • Information Technology • Smartphones + tablets à PCs + laptops • Third Wave of Innovation KPCB Confidential

  4. Life Sciences Portfolio DIAGNOSTICS THERAPEUTICS DEVICES TOOLS/SERVICES KPCB Confidential

  5. Presentation Pathway: 2012 2020 Therapies/Indications Technology Care Continuum Healthcare Economics Markets A Healthy Ecosystem ? KPCB Confidential

  6. Neuromodulation Therapies 2012 2020 Expanding therapies to more complex neurodegenerative diseases 2020 • Expanded indications • Enhanced efficacy • Less invasive implant procedures • Improved efficacy, eliminate trial (SCS) 2012 • Foundation of therapies across pain, spasticity, movement disorders, incontinence, epilepsy, sensory deficits • Therapy efficacy is mixed despite trial step (SCS) KPCB Confidential

  7. Traditional SCS: Trial Success Rates* Chest (31%) Back (50%) Arms(49%) Hand (44%) Leg (75%) Pelvic/Groin(37%) Foot (59%) *Success defined as >50% VAS score improvement Source: Leerink Swann, Physician survey (n=50) and SMI prospective/retrospective data KPCB Confidential

  8. Neuromodulation Therapies: Current & Future Depression Parkinson’s Disease • Epilepsy • Essential Tremor • Migraine/Headache Dry Eye • Dystonia • Neurodegenerative Diseases • Alzheimer’s • Parkinson’s • Huntington’s • ALS • Vision Disorders • Obsessive Compulsive Disorder • Hearing Disorders Sleep Apnea • HeartFailure • Chronic Pain COPD/Asthma • Gastroparesis • Malignant Pain • Bowel Disorders • Spasticity • Pelvic Floor Disorders • Urinary & Fecal • Incontinence KPCB Confidential

  9. Neuromodulation Technology2012 2020 Approaching next phase of technology innovation 2020 • Closed loop (sensing & therapy) • Therapy less intrusive for patient (stim perception, passive recharging, no MRI restrictions) • Device data flow provides for remote Dx, EHR, etc. • MEMS/NANO/Next Gen Power Supplies/Wireless 2012 • Complex programming • Intense patient involvement, subpar UI’s • Poor connectivity (EHR & provider) • High patient burden (size, stimulation, no MRI) KPCB Confidential

  10. Neuromodulation Care Continuum 2012 2020 Moving from modest adoption to standard of care 2020 • Standard protocols for managing pain & other neuro conditions emerge • Treatment paths well-defined and adopted • Quality outcomes defined, enforced & measured • Neuromodulational moving up the care continuum 2012 • Disjointed care • Best practices undefined or concentrated with leaders • Role/sequence of therapy; devices, medication, & other pain therapies remains unclear • Neuromodulation often a last-resort therapy KPCB Confidential

  11. Neuromodulation Healthcare Economics (US)2012 2020 Industry must quantifiably demonstrate therapy value 2020 • Expanded patient coverage WW • Value= quality outcomes/costs • Comparative effectiveness filter for • de novo therapies • ASP pressure for legacy therapies • Accountable, at risk care 2012 • Primarily fee for service • Rewards treatment vs. outcome • Incentives don’t support ACO model • $20-25K ASP with mixed outcomes KPCB Confidential

  12. Worldwide Neuromodulation Market2012 2020 New therapies, new indications and market penetration drive WW growth 2020 • $6.2B WW • $3B SCS • 70-80% US; Asia? • 10% CAGR 2012 • $2.87B WW • $1.41B SCS • 80% U.S./14% EU • 10% CAGR Source: Analyst reports. Includes SCS, OBS, SNM, VNS, TDD KPCB Confidential

  13. Optogenetics: Potential for Therapeutic and Cellular Specificity • Target specific phenotypes • Induce suppression or activation • Affect specific neuroanatomies • Combined genetic and device therapy Optogenetics: What does it do?

  14. Brain-Machine Interfacing • Progress in tissue-machine interfacing and coupling can provide advanced methodologies to develop neural-based therapies • Nanoscafolding and other microfabrication techniques may contribute to providing the ability to control specific neural networks

  15. A Healthy Neuromodulation Ecosystem - 2020 • Invest in the clinical trials to support efficacy/safety, indication expansion and cost-effectiveness • Design “product” for emerging markets • Develop closed-loop devices (sensing & therapy) • Reduce programming requirements and need for follow-up visits • Enhance connectivity (e.g., remote Dx, EHR interface) • Make the therapy non-invasive (e.g., reduce size, volume, weight, subcutaneous, etc.) • Demonstrate clear value to the system KPCB Confidential

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