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ChangeWave Research: Taxus Stent & Avastin
April 5, 2004
ChangeWave Research Report:
New Medical Products: Cardiac Care & Cancer
Taxus Stent and Avastin – Success Based on Insurance Reimbursement
Overview
Past ChangeWave Alliance surveys show market acceptance for new medical products
can often be hampered by insurance reimbursement rates and the lack of real world
track records.
In a March 4-15, 2004 Alliance healthcare survey, we explored market acceptance and
insurance reimbursement issues for two new medical products – Boston Scientific’s
Taxus stent and Genentech’s cancer drug Avastin. A total of 96 healthcare members,
knowledgeable about stents and/or cancer treatments, participated in the survey.
Here’s what we found:
A. Cardiac Care: Taxus Stent vs. Cypher Stent

Drug-Eluting Stents: Still Encountering Resistance. Although drug-eluting stents
have now been on the market for some time, they have yet to gain full market
acceptance. When asked why there is still some market resistance, 44% of
respondents said that payor reluctance to reimburse is the major reason bare-metal
stents are still being used. Another 32% said physicians are waiting for more real
world data on the efficacy of drug-eluting stents.

Taxus vs. Cypher – Taxus Favored. The recent approval of the Taxus stent is
likely to threaten the primacy of Johnson & Johnson’s Cypher stent in the drugeluding marketplace. A total of 1-in-5 respondents (20%) believe the two stents are
equal in reducing restenosis rates. The Taxus Stent, however, is favored by 23% of
respondents who view it as superior to the Cypher Stent in reducing restenosis
rates, while only 2% believe it is inferior.

Restenosis Rates Determine Stent Selection. Two-in-three respondents (67%)
believe that “Data on Restenosis Rates” is the primary driver when choosing
between the Cypher and Taxus Stent. Another 25% believe it’s “Guidelines from
Payors,” while 21% say it’s the “Relationship with Vendor/Vendor Sales Force.”

Marketing War Will Define Battle Between Taxus and Cypher Stents. Nearly a
third (32%) of respondents believe the success of the Taxus Stent depends on the
outcome of a head-to-head marketing war between Johnson & Johnson and Boston
Scientific. Another 26% believe the Taxus stent will be gradually accepted over time
as more real world data becomes available.
Copyright ©2004 ChangeWave Research
All rights reserved.
ChangeWave Research: Taxus Stent & Avastin
B. Cancer Treatments: Avastin and Off-Label Use

Avastin: Is it Likely to be Prescribed Off-Label? Currently Avastin, combined
with chemotherapy, has been approved with a narrow label for the treatment of
Metastatic Colorectal Cancer. Respondents are fairly evenly split on whether it is
likely to be prescribed off-label. Twenty-nine percent (29%) believe the drug will be
prescribed off-label, while 23% think off-label use will only happen if it’s
reimbursable. Another 11% believe it will be prescribed off-label, but patients or
medical institutions will have to pay for the treatment.

Reimbursement for Labeled Treatment Only. Respondents were bearish on the
possibility of Avastin being reimbursed for off-label treatment. While 46% believe
Avastin will be reimbursed by insurance companies for labeled use, only 5% believe
insurance companies will reimburse for off-label use. Another 24% of respondents
think insurance companies will wait at least 1 year before reimbursing for the new
drug. Doctors (61%) were most likely to believe Avastin will be reimbursed for
labeled use, but no doctors believed Avastin will be reimbursed for off-label
treatment.
Bottom Line: In our March 2003 Stents survey, we reported that drug-eluting stents
would “gain market share slower than many analyst forecasts.” The current survey
results point to the issue of insurance company reluctance to reimburse for drug-eluding
stents as a main roadblock to acceptance.
In addition, the newly approved Taxus Stent appears to have an edge over Johnson &
Johnson’s Cypher Stent – but the overall success of the Taxus Stent will likely depend
on the outcome of a head-to-head marketing war between Johnson & Johnson and
Boston Scientific.
The survey results also suggest the cancer treatment drug Avastin is likely to be
prescribed for off-label use. However, insurance company reimbursement will likely be
limited to labeled treatment only.
The ChangeWave Alliance is a group of 4,500 highly qualified business, technology, and medical professionals in
leading companies of select industries—credentialed professionals who spend their everyday lives working on the
frontline of technological change. ChangeWave surveys its Alliance members on a range of business and investment
research and intelligence topics, collects feedback from them electronically, and converts the information into
proprietary quantitative and qualitative reports.
Helping You Profit From A Rapidly Changing World ™
www.ChangeWaveResearch.com
Copyright ©2004 ChangeWave Research
All rights reserved.
2
ChangeWave Research: Taxus Stent & Avastin
Table of Contents
Summary of Key Findings ............................................................................................ 4
The Findings .................................................................................................................. 5
A. Cardiac Care: Taxus Stent vs. Cypher Stent.................................................... 5
B. Cancer Treatments: Avastin and Off-Label Use ............................................. 12
ChangeWave Research Methodology ....................................................................... 18
About ChangeWave Research ................................................................................... 19
Copyright ©2004 ChangeWave Research
All rights reserved.
3
ChangeWave Research: Taxus Stent & Avastin
I. Summary of Key Findings
Drug-Eluting Stents:
Still Encountering
Resistance
Avastin: Is it Likely
to be Prescribed
Off-Label?



44% of respondents
said that payor
reluctance to
reimburse is the major
reason bare-metal
stents are still being
used
Another 32% said
physicians are waiting
for more real world
data on the efficacy of
drug-eluting stents


29% of respondents
believe Avastin will be
prescribed off-label
23% think off-label use
will only happen if it’s
reimbursable
Another 11% believe it
will be prescribed offlabel, but patients or
hospitals will have to
pay for the treatment
Taxus vs. Cypher
Reimbursement for
Labeled Use Only




20% view the 2 stents
as equal in reducing
restenosis rates
23% see Taxus as
superior to Cypher
2% see it as inferior
46% believe Avastin will
be reimbursed by ins.
companies for labeled
use, while only 5%
believe ins. companies
will reimburse for offlabel use
Bottom Line:




Insurance company
reluctance to reimburse
for drug-eluding stents
is a main roadblock to
acceptance
The Taxus Stent
appears to have an
edge over Johnson &
Johnson’s Cypher Stent
The overall success of
the Taxus Stent will
likely depend on the
outcome of a head-tohead marketing war
between Johnson &
Johnson and Boston
Scientific
Avastin is likely to be
prescribed for off-label
use, but reimbursement
will likely be limited to
labeled treatment only
Introduction
Past ChangeWave Alliance surveys show market acceptance for new medical products
can often be hampered by insurance reimbursement rates and the lack of real world
track records.
In a March 4-15, 2004 Alliance healthcare survey, we explored market acceptance and
insurance reimbursement issues for two new medical products – Boston Scientific’s
Taxus stent and Genentech’s cancer drug Avastin. A total of 96 healthcare members,
knowledgeable about stents and/or cancer treatments, participated in the survey.
Here’s what we found:
A. Cardiac Care: Taxus Stent vs. Cypher Stent
B. Cancer Treatments: Avastin and Off-Label Use
Copyright ©2004 ChangeWave Research
All rights reserved.
4
ChangeWave Research: Taxus Stent & Avastin
II. The Findings
A. Cardiac Care: Taxus Stent vs. Cypher Stent
(1) Question Asked: Johnson & Johnson's Cypher drug-eluting stents have been
on the market for a while, yet some patients are still receiving bare-metal stents.
Why do you think this is still occurring?
Physicians are waiting for more
real world data on the efficacy
of drug-eluting stents
Cost/payor reluctance or
refusal to reimburse for drugeluting stents
Don't Know/No Answer
Other
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
32%
32%
37%
31%
44%
59%
37%
31%
24%
10%
26%
39%
13%
7%
5%
22%
Drug-Eluting Stents: Still Encountering Resistance. Although drug-eluting stents
have now been on the market for some time, they have yet to gain full market
acceptance. When asked why there is still some market resistance, 44% of
respondents said that payor reluctance to reimburse is the major reason bare-metal
stents are still being used. Another 32% said physicians are waiting for more real world
data on the efficacy of drug-eluting stents.
Copyright ©2004 ChangeWave Research
All rights reserved.
5
ChangeWave Research: Taxus Stent & Avastin
(2) Question Asked: Assuming Boston Scientific gets FDA approval, it will soon
introduce the Taxus drug-eluting stent into the marketplace. Do you believe the
new Taxus stent is superior to, inferior to, or the same as Johnson & Johnson's
Cypher stent in reducing rates of Restenosis?
Total
Respondents
Taxus Stent is Superior
to Cypher Stent in
Reducing Restenosis
Taxus Stent is Inferior to
Cypher Stent in
Reducing Restenosis
Taxus Stent is Same as
Cypher Stent in
Reducing Restenosis
Don't Know/No Answer
Other
Doctors
Healthcare
Other
Workers Respondents
23%
29%
21%
17%
2%
0%
0%
6%
20%
22%
16%
19%
55%
49%
63%
58%
7%
7%
11%
6%
Taxus vs. Cypher – Taxus Favored. The recent approval of the Taxus stent is likely
to threaten the primacy of Johnson & Johnson’s Cypher stent in the drug-eluding
marketplace. A total of 1-in-5 respondents (20%) believe the two stents are equal in
reducing restenosis rates. The Taxus Stent, however, is favored by 23% of
respondents who view it as superior to the Cypher Stent in reducing restenosis rates,
while only 2% believe it is inferior.
Copyright ©2004 ChangeWave Research
All rights reserved.
6
ChangeWave Research: Taxus Stent & Avastin
(3) Question Asked: Which of the following do you think will be the primary
drivers in choosing between the Cypher Stent and the Taxus Stent? (Choose No
More Than Two)
Data on Restenosis Rates
References from Other
Professionals
Relationship with
Vendor/Vendor Sales Force
Guidelines from Payors
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
67%
80%
58%
56%
17%
10%
21%
22%
21%
22%
37%
11%
25%
37%
21%
14%
Patient Input
3%
0%
11%
3%
Other
7%
7%
0%
11%
Restenosis Rates Determine Stent Selection. Two-in-three respondents (67%)
believe that “Data on Restenosis Rates” is the primary driver when choosing between
the Cypher and Taxus Stent. Another 25% believe it’s “Guidelines from Payors,” while
21% say it’s the “Relationship with Vendor/Vendor Sales Force.”
Copyright ©2004 ChangeWave Research
All rights reserved.
7
ChangeWave Research: Taxus Stent & Avastin
(4) Question Asked: Which of the following statements best describes how you
believe the new Taxus Stent will fare once it is introduced into the marketplace?
The Taxus stent will
dominate the market within
six months, due to claims
by Boston Scientific that its
trials show superior rates in
eliminating restenosis
There will be a head to
head marketing war
between Johnson &
Johnson and Boston
Scientific - with success
driven by each vendor's
ability to market their
product
Acceptance of the Taxus
stent will occur slowly.
Practitioners and payors
will wait until there is real
world (and not just trial)
data before accepting the
Taxus stent
Don't Know/No Answer
Other
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
12%
12%
16%
11%
32%
44%
26%
22%
26%
27%
37%
19%
29%
17%
21%
47%
3%
2%
5%
3%
Marketing War Will Define Battle Between Taxus and Cypher Stents. Nearly a third
(32%) of respondents believe the success of the Taxus Stent depends on the outcome
of a head-to-head marketing war between Johnson & Johnson and Boston Scientific.
Another 26% believe the Taxus stent will be gradually accepted over time as more real
world data becomes available.
Copyright ©2004 ChangeWave Research
All rights reserved.
8
ChangeWave Research: Taxus Stent & Avastin
(5) Question Asked: Finally, are there any other important factors that will
influence stent product acceptance (e.g., ease of insertion)?
Important Factors. A significant number of respondents named ease of insertion as an
important factor that will influence stent acceptance. Other factors mentioned were cost
and restenosis rates.
Sample of Alliance Member Responses:
a. Doctor Respondents

BOB8982 writes, “There is currently a perception that the Taxus stents are easier to
place, based on past difficulties placing other J&J stents. Hence there will be a
marketing war between Cordis (JNJ) and Boston Sci.”

ZSA8198 writes, “Taxus stent already widely used and the dominant stent in
Europe.”

LEO7024 writes, “Reduction of bodily trauma and increase in patient survivability.”

MTA6607 writes, “J & J has annoyed lots of Cardiologists; Bos. SC. Stent is much
easier to use!”

MIK3319 writes, “Incidence of thrombus formation, I had a patient die last night
because her Cypher stent thrombosed 5 days after it was inserted, this may be a
more significant problem than was thought previously and was a problem with some
stents when they first came out years ago.”

JGE3402 writes, “In Europe only reimbursement problems will count.”

SR10005 writes, “I believe acceptance will be based on clinical factors such as
restenosis rates and ease of use however, we can never forget the importance of
insurance reimbursement in this equation.”

GHM8270 writes, “Flexibility of the stent, expandability and such influence its
acceptance. But if one is CLEARLY superior to the other, it will get the largest
market share – and the inferior stent will probably have some refinements made to
it.”

SHA3342 writes, “Easy to use is an important factor.”

KER5863 writes, “Delivery system adaptability, third party payor reimbursement for
cost of device.”

JAM8235 writes, “Cost, ease of use, reimbursement.”

SOM4483 writes, “BSX's stent delivery tools have incumbent position and this
perhaps is BSX's biggest advantage.”
Copyright ©2004 ChangeWave Research
All rights reserved.
9
ChangeWave Research: Taxus Stent & Avastin

STE3218 writes, “Actual data and cost.”
b. Healthcare Worker Respondents

1CL7343 writes, “Taxus is easier to insert.”

RJR3451 writes, “Real world data and that which we may not know yet will
determine the outcome and product acceptance. Some MD's are old school as
many are always futuristic in thought and technology. TIME WILL TELL.”

DDU7628 writes, “Physicians' knowledge about The Taxus stent and its side effect.”

BPB4890 writes, “Marketing and advertising.”

DEL7220 writes, “How well the hospital keeps each stent in stock and which doctors
are allowed to use them.”

MAJ8741 writes, “How much longer will the device makers be able to cram these
costs on the hospitals? The hospitals cannot pass these costs along. Shades of
being a GM supplier!”

ERI7758 writes, “Factors effecting stents are always the same. Long term success,
cost, and real restenosis rates. Currently we have a very limited picture of real
restenosis rates. Cost/benefit ratio is yet to be established. Payors are very hesitant
to commit to a very expensive item given the current data.”

CRA1451 writes, “Ease of insertion is always major, as is cost vs. reimbursement
(medical has only two drivers, money and technology).”
c. Other Respondents

MAD2680 writes, “Yes, the lead system product may lend to acceptance more
readily by Cardiologists even if closure data is the same.”

GRE5724 writes, “Yes, ease of insertion/ease of delivery is key.”

BIO9114 writes, “Variety of sizes available, cost, thrombosis rate is accepted as
same rate for non-coated stents.”

WIL1338 writes, “Reimbursement, visibility in the market for both patients and
doctors.”

PWG2815 writes, “...while the excuse for not using the new coated stents will be
there is not enough data the real reason is cost containment. That will continue until
the data is too strong to ignore.”

JEN2085 writes, “Ease of insertion.”
Copyright ©2004 ChangeWave Research
All rights reserved.
10
ChangeWave Research: Taxus Stent & Avastin

CEN9132 writes, “Ease of Insertion and catheter withdrawal; stent's esthetic
appearance.”

JFD0468 writes, “Cost will drive acceptance as will the perception of the ease of
insertion (i.e., Taxus stent is perceived to be better); however, data from REALITY
trial shows comparable insertion.”

WAT6220 writes, “As more patients learn that there are non-invasive approaches to
dealing with the underlying problem nutritionally, more and more patients will (like I)
refuse stents except in emergency situations. Fortunately, I did not have any
significant blockage, but the nutritional approaches have corrected what little there
was. Those approaches, in my experience, have also dealt effectively with rhythm
problems (arterial flutter and ventricular tachycardia) which have disappeared within
a short period of time.”

ALV6211 writes, “80% of MDs are conservative and will wait until: they see a lot of
real world data, are pushed by use in their own institution, or fear law suits for not
using.”
Copyright ©2004 ChangeWave Research
All rights reserved.
11
ChangeWave Research: Taxus Stent & Avastin
B. Cancer Treatments: Avastin and Off-Label Use
(1) Question Asked: Avastin has been approved with a narrow label for the
treatment of Metastatic Colorectal Cancer combined with chemotherapy. Do you
believe the drug will be prescribed "off-label?"
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
29%
26%
43%
27%
Yes, it will be prescribed
"off-label"
Yes, it will be prescribed
"off-label," but only if it's
reimbursable
23%
32%
21%
16%
Yes, it will be prescribed "offlabel," but patients or medical
institutions will have to pay for
the treatment
No, it will not be prescribed
"off-label"
11%
13%
14%
9%
8%
8%
0%
11%
Don't Know/No Answer
28%
21%
21%
36%
1%
3%
0%
0%
Other
Avastin: Is it Likely to be Prescribed Off-Label? Currently Avastin, combined with
chemotherapy, has been approved with a narrow label for the treatment of Metastatic
Colorectal Cancer. Respondents are fairly evenly split on whether it is likely to be
prescribed off-label. Twenty-nine percent (29%) believe the drug will be prescribed offlabel, while 23% think off-label use will only happen if it’s reimbursable. Another 11%
believe it will be prescribed off-label, but patients or medical institutions will have to pay
for the treatment.
Copyright ©2004 ChangeWave Research
All rights reserved.
12
ChangeWave Research: Taxus Stent & Avastin
(1A) Question Asked: Please elaborate.
a. Doctor Respondents

RJR3451 writes, “Again, originally it may start NOT off-label but in time, if Avastin
shows great value, it WILL be allowed off-label. TIME again will be a factor.”

STE3218 writes, “Almost all cancer drugs are used in some off label application
since the FDA is slow to approve new indications. Thus a lot of clinical practice is
adopted prior to an application to the FDA (if it ever happens).”

2464180 writes, “But only for private pay or exceptional insurance; that is in less
than 10% of use or less.”

WDO7675 writes, “Different arrangements are made between physician practices
and payors. Many payors include chemo RX under physician payments while others
count them as pharmaceuticals. If the costs are attributed to the physician, under
many managed care arrangements, overall physician reimbursements will be
reduced. Direct linkage may be absent but pressure is there.”

ABG4789 writes, “Drug companies will not pay for this therapy until forced to do so.
Thus, they will not pay for off-label use. However, the drug should work in any
highly vascular, rapidly growing tumor. It will be tried in cancers other than bowel
carcinoma.”

ZSA8198 writes, “Expense of the drug is always a key factor, particularly oncologic
agents.”

SR10005 writes, “I believe in situations where there is a terminal condition with little
hope, there will be a desire on both the patients and physicians part to use this drug
as a last resort if there is even the slightest chance of improvement - no matter the
cancer type.”

LEO7024 writes, “I don't know where and under what circumstances this would
occur.”

SOM4483 writes, “More time will be needed before off-label use picks up steam.”

MAM7387 writes, “Most physicians will not use off label drug treatments for cancer
without some good reason. Frequently there is a protocol involved in using new
medications combined with chemotherapy and the hospital will not be happy if those
guidelines are not followed. Also the medical legal risks would be increased.”

GDA7384 writes, “Need to know the precise labeling, but oncologists are notorious
for off-label usage since so many advanced tumors respond so relatively poorly to
conventional care later in the illness.”
Copyright ©2004 ChangeWave Research
All rights reserved.
13
ChangeWave Research: Taxus Stent & Avastin

MTA6607 writes, “People wouldn’t mind to pay $600 to change the oil in their
Mercedes, but would bark if they have to pay $60 from their pocket!”

CAL8396 writes, “Pharmaceutical companies are not allowed to advertise off label
uses.”

MAN6043 writes, “Physicians loathe providing treatments that the payors do not
reimburse.”

KEN1900 writes, “Some patients will be willing to pay for the cost on a waiver of
Medicare or insurance payment. This will be an infrequent event. Most oncologists
will not risk non-payment for this drug. A good analogy is Remicade for rheumatiod
arthritis and Crohn's disease. Its cost is about the same monthly, it can be used off
label in some cases of ulcerative colitis, but is rarely covered by insurance and
almost never by Medicare for this purpose.”

GHM8270 writes, “To early to tell. The medico-legal situation and some discussion
about regulations to reduce or prevent off label prescribing may prevent that from
occurring. Remember too that the side effects of hemorrhage, bowel perforation and
death should tell one that this is not a drug to be lightly experimented with.”

LSA5734 writes, “Unless it is in a clinical trial.”
b. Healthcare Worker Respondents

CRA1451 writes, “About 60% of all prescribing is off label now.”

CJB5810 writes, “It will be prescribed off label for vascular cancers, but not for nerve
types (brain cancer), leukemia, etc. It will only be reimbursed for non-FDA approved
uses until more data is collected. Cost is too high. Expect to see it used only on
paying patients or by charitable/experimental hospitals of colo-rectal treatments until
then.”

SBE5857 writes, “Off-label use will dominate the proposed use until payors match
diagnosis with drug use for reimbursement. A similar picture will exist as seen with
rituximab, where 80% of use is off-label. DNA has mastered the art of off-label use
and has a top notch team to deliver the goods. But just wait until the pass-thru
period or 2005 reimbursement rates pop. It will be a different time for cancer
regimens.”

ELW4764 writes, “Once it is approved, the doctor can prescribe it as he thinks
appropriate. Whether the insurance company will reimburse is another matter.”

IND7726 writes, “Pretty obvious - reimbursement is important.”

MAJ8741 writes, “These drugs are usually prescribed off label. It is a moral thing.”
Copyright ©2004 ChangeWave Research
All rights reserved.
14
ChangeWave Research: Taxus Stent & Avastin
c. Other Respondents

JFD0468 writes, “Almost all drugs and medical devices are used off-label.”

WIL1338 writes, “As soon as doctors get factually based data for other potential use
they will try this for patients who have no or limited alternatives, the first positive
article in a recognized professional/scientific paper will trigger this.”

DVI6923 writes, “Avastin mediates cancers with VEGF angiogenesis pathway, which
is why it failed in breast cancer trials earlier. This will limit its use to the prescribed
indication.”

LON6196 writes, “Has to be on the market for awhile before it can be off label.”

MAD2680 writes, “Indication expansion is very likely over time in a staggered
fashion. Results will cause more coverage from insurance due to pressure but also
should get some patient cost coverage during insurance deliberation.”

TIS3735 writes, “It is approved for refractory, end-stage patients, and many will be
keen to try it earlier. Earlier is off label.”

PWG2815 writes, “It will be demanded by patients in hopeless situations and the
docs will comply with the patient request. Because of cost, the practice may be
limited.”

DDU7628 writes, “Off-label use refers to the use of an approved treatment for any
purpose, or in any manner, other than what is described in the treatment's labeling.
Off-label use of an approved treatment is not the same as expanded access or
special exemption, which are mechanisms allowing patient access to investigational
treatments not yet approved by the FDA. Off-label uses may include giving an
approved treatment: for a disease other than the disease it is approved for, at a
different dose or frequency than specified in the product's labeling, or to treat a child
when the product is approved to treat adults Obviously, Avastin does not fit this
requirement. Avastin, a monoclonal antibody, is the first product to be approved that
works by preventing the formation of new blood vessels, a process known as
angiogenesis.”

BVE2993 writes, “Patients don't want to pay for expensive drugs not covered by
insurance.”

ACL9698 writes, “Physicians need to worry about liability, but terminal cancer
patients have no other hope, so non-approved indications for treatments will
sometimes be tried, since the patient has little hope otherwise.”
Copyright ©2004 ChangeWave Research
All rights reserved.
15
ChangeWave Research: Taxus Stent & Avastin

ROB0038 writes, “Since most cancer patients are Medicare eligible, it is instructive
to look at that patient population first. With the changes Medicare enacted recently
regarding chemotherapy reimbursement, it is proving difficult for medical oncologists
to get on-par reimbursement for the newer, more costly drugs. Many are losing
money on the newer agents because Federal reimbursement often no longer meets
the purchase price of these drugs. Medical oncologists are still making money on
the administration of all chemo regimens but not so for the drugs themselves. This
will lead to a marked decrease in the off label utilization of higher priced drugs such
as Taxotere, Gemzar and ultimately Avastin and Erbitux, particularly in the Medicare
eligible population if this change in policy is not reversed by lobbying efforts. Private
insurers will follow the lead of Medicare in time, as they always do. If this key issue
is resolved, the new drugs will continue to be embraced by medical oncologists and
reimbursed for both labeled and off-labeled indications by all insurance carriers for
the foreseeable future.”

CRL0022 writes, “The data is not that strong, so more data along with a push by
Genentech to get reimbursement will be key to getting it used.”

ALA8640 writes, “The phase III for other Ca are not far off.”

BIO9114 writes, “Those with cancers of kidney or lung may opt to try Avastin, due to
clinical research showing efficacy. I don't have an idea about who will pay for it.”
Copyright ©2004 ChangeWave Research
All rights reserved.
16
ChangeWave Research: Taxus Stent & Avastin
(2) Question Asked: Avastin does not cure colorectal cancer - it extends life (an
average of 5 months in trials) and costs roughly $5,000 per month. How do you
think insurance companies will reimburse for the new drug?
Insurance companies will
reimburse for Avastin, for
both labeled and off-label
use
Insurance companies will
reimburse for Avastin, but
only for a labeled treatment
Insurance companies will not
reimburse for Avastin for at
least 1 year
Insurance companies will not
reimburse for Avastin period
Don't Know/No Answer
Other
Total
Healthcare
Other
Doctors
Respondents
Workers Respondents
5%
0%
0%
11%
41%
61%
50%
20%
24%
21%
29%
25%
5%
0%
7%
9%
25%
18%
14%
34%
4%
8%
7%
0%
Reimbursement for Labeled Treatment Only. Respondents were bearish on the
possibility of Avastin being reimbursed for off-label treatment. While 46% believe
Avastin will be reimbursed by insurance companies for labeled use, only 5% believe
insurance companies will reimburse for off-label use. Another 24% of respondents think
insurance companies will wait at least 1 year before reimbursing for the new drug.
Doctors (61%) were most likely to believe Avastin will be reimbursed for labeled use,
but no doctors believed Avastin will be reimbursed for off-label treatment.
Copyright ©2004 ChangeWave Research
All rights reserved.
17
ChangeWave Research: Taxus Stent & Avastin
III. ChangeWave Research Methodology
This report presents the findings of the latest ChangeWave Alliance survey conducted
on use of stents in cardiac care and the introduction of new cancer treatments with
special attention on the drug Avastin. The survey was conducted March 4-15, 2004 for
all healthcare members who are knowledgeable about Cardiac Care and/or Cancer
Treatments. A total of 96 Alliance members participated.
The Alliance’s proprietary research and business intelligence gathering system is based
upon the systematic gathering of valuable business and investment information directly
over the Internet from accredited members.
ChangeWave surveys its Alliance members on a range of business and investment
research and intelligence topics, collects feedback from them electronically, interprets
and reconciles the information in a cohesive manner and converts the information into
valuable quantitative and qualitative reports.
The Alliance has assembled its membership team from senior technology and business
executives in leading companies of select industries. Nearly 3 out of every 5 members
(58%) have advanced degrees (e.g., Master’s or Ph.D.) and 94% have at least a fouryear bachelor’s degree.
The business and investment intelligence provided by the Alliance provides a real-time
view of companies, technologies and business trends in key market sectors, along with
an in-depth perspective of the macro economy – well in advance of other available
sources.
Copyright ©2004 ChangeWave Research
All rights reserved.
18
ChangeWave Research: Taxus Stent & Avastin
IV. About ChangeWave Research
ChangeWave Research, of Phillips Investment Resources, Inc. is a market research
intelligence network powered by thousands of accredited and organized front-line
professionals – the ChangeWave Alliance.
ChangeWave is the alternative to traditional “sell-side” investment research. The
company publishes ChangeWave Investing, the investment advisory service for
individual investors dedicated to researching and discovering growth stocks that profit
from radical change, and Weekly WaveWire, a free e-mail newsletter distributed to
nearly 200,000 investors.
ChangeWave has a very unique asset in its 4,500-member Alliance. We have
assembled our membership team from a broad cross section of more than 20 vertical
markets such as Internet e-commerce, semiconductors, data storage, and
biotechnology, along with a wide range of professional disciplines including CIOs, IT
managers, executive management, scientists, engineers and sales personnel.
The ChangeWave Alliance is composed of senior technology and business executives
in leading companies – credentialed professionals who spend their everyday lives
working on the frontline of technological change.
ChangeWave Research Reports provide a real-time view of companies, technologies
and business trends in key market sectors along with an in-depth perspective of the
macro economy – well in advance of other available sources. ChangeWave surveys its
4,500 Alliance members on a wide range of investment research topics and converts
the findings into valuable investment and business intelligence reports. ChangeWave
delivers its products and services on the Web at www.ChangeWaveResearch.com
ChangeWave Research does not make any warranties, express or implied, as to
results to be obtained from using the information in this report. Investors should
obtain individual financial advice based on their own particular circumstances
before making any investment decisions based upon information in this report.
For More Information:
ChangeWave Research
9420 Key West Avenue, 4th Floor
Rockville, MD 20850
USA
Telephone: 301-279-4200
Fax: 301-610-5206
www.ChangeWaveResearch.com
[email protected]
Helping You Profit From A Rapidly Changing World ™
www.ChangeWaveResearch.com
Copyright ©2004 ChangeWave Research
All rights reserved.
19