Hier aber auch mal Argumente gegen NARI. Wie sieht ihr das:
INARI's products "treat" deep venous thrombosis (DVTs) by removing the clot. But the difference between "treating" the clot, and "preventing the next one" is the nuance here. Most times, blood clots in the venous system disintegrate over time on their own. When we find them (usually a patient comes in with a swollen and painful leg) we put them on anticoagulants not for THAT clot but for the PREVENTION OF THE NEXT ONE (the next one might be the killer). And while Inari's devices remove the current one, in only the rarest of cases is the clinical history and patient-specific characteristics sufficiently known for all of us to promise the patient that they aren't at risk of another clot. And so we put them on anticoagulation for at least 3-6 months while a hematologist decides if they have any specific condition to suggest they might have another one. Some folks stop anticoagulation after this 3-6 month period, others continue it indefinitely. This includes even those treated with Inari devices, and I'm not even sure the Inari reps understand this!
TAM is vastly over-estimated because only a small subset of DVTs are in the right place, with the right burden, in the right patient, to warrant the use of this device -- most patients aren't gonna get whisked off to the cath lab for this type of intervention because it's cheaper to treat the patient in other ways (mainly observation and anticoagulants) and only a small subset of patients are the ones that benefit from aggressive clot REMOVAL. That's what Inari isn't very forthcoming about when they talk about TAM because their estimate of DVT prevalence isn't granular enough to tease out the specific subset that might actually need a clot REMOVED IMMEDIATELY. Also, among those patients who fit the REMOVE NOW criteria, there are other devices -- and even altogether different strategies -- that might be used to remove the clot. Even if there are TAILWINDS here that expand the pool of patients considered candidates for clot removal (mostly related, I suspect, to interventional doctors who want to make a lot of money doing this procedure when it really doesn't make a difference in most patients, most of the time) I don't see the percentage of eligible patients growing to the extent the company suggests.
Even if you discount the above two paragraphs, hospital CEOs aren't in the business of necessarily purchasing large numbers of expensive medical devices that will "save ICU days and reduce hospital length of stay". These are, cynically, money makers after all. Unless there is COMPELLING data such that hospital systems really can't justify in the face of, say, a lawsuit, the interests of all stake holders are not necessarily aligned (Ah, American Healthcare!). The data isn't that robust.
For me, it is too specific a device, for too specific of a condition, with too narrow of a subset of afflicted condition holders for me to sleep soundly with this position.