ome to over half the world’s population, Asia offers the best market potential for the medical technology (medtech) industry. With its ageing population, the growing affluence of the middle class and rise of chronic non-communicable diseases, it is driving growth for a broad range of medical devices, from contact lenses to catheters. McKinsey expects the Asian market for medtech to hit US$133 billion by 2020 from US$88 billion in 2015 to overtake the European Union as the second largest market globally.
This development augurs well for Singapore, host to one of the region’s biggest medtech clusters. Over 60 multinational medtech companies are here, including the industry’s top ten, leveraging on its well-honed capabilities to undertake a range of activities, including regional headquarters functions, manufacturing and research and development (R&D).
Becton Dickinson, a Fortune 500 company, has opened a strategic innovation centre in Singapore to develop new technologies; Medtronic has its first first-in-Asia Rhythm Heart Failure manufacturing facility and regional headquarters in Singapore; while Royal Phillips is partnering EDBI, the investment arm of the Economic Development Board (EDB), to invest in digital health companies from around the world which plan on using Singapore as their gateway to the Asian market.
They are joined by an increasing number of home-grown companies developing cutting-edge innovations that continue to push the envelope on patient care. Today, there are over 220 medtech start-ups developing healthcare solutions.
Several have made their mark, including EndoMaster Medical, which has developed a novel robotic-assisted surgical arm for gastrointestinal surgery combining invasive endoscopic surgery with intuitive robotic-assisted surgery; AYOXXA Biosystems, a chip-based platform that can detect multiple biomarkers and biomarker signatures from a small biological sample; and HistoIndex, a medical diagnostics company breaking new ground in developing diagnostics for fibrosis and cancer.
Robust Growth in Manufacturing
Manufacturing output has made strong gains. From a mere S$1.5 billion in 2000 when the industry was first promoted by the EDB and the Agency for Science, Technology and Research (A*STAR) as part of Singapore’s Biomedical Sciences (BMS) initiative, the industry now generates over S$11 billion annually.
Growth has been particularly impressive since 2008 following Singapore’s decision to refocus its BMS development to home in on medtech, which requires lower investment and shorter timelines to bring to market compared with pharmaceuticals. While it may take five to six years to develop new medical devices, test them and gain the necessary regulatory approvals, it can easily take double the duration for new drugs. There is also a stark difference in investment required, S$20-S$40 million for a new device, as against US$2-3 billion for a new drug.
From S$2.9 billion in 2008, manufacturing output rose to S$11.7 billion in 2017, accounting for 47% of BMS’ output.
The range of products now includes pacemakers, heart valves, hearing aids and contact lenses. Some 60% of the world’s microarrays and one-third of the world’s thermal cyclers and mass spectrometers are made in Singapore.
Developing R&D Capability Targeted at Asian Market
As the industry’s potential is huge, companies are ramping up their R&D capabilities to develop new innovations and applications in medtech as well as finding new ways to innovate. As Singapore has the necessary attributes for research, many have opted to use the city state to conduct research targeted at the Asian market.
As a country, Singapore is heavily invested in R&D in its drive to foster economic growth through value creation. It also has the innovative capacity: scientists at public research institutes and local universities have proven track records in developing innovative cutting-edge technologies, many of which have moved beyond the laboratories and into the market.
With an intellectual property (IP) regime rated amongst the best in the world, Singapore offers companies the assurance of protection for their innovations. Its comprehensive IP law is complemented by a robust enforcement regime and an efficient IP registration and filing procedure.
Setting up research facilities is also a cinch as there are ready-made infrastructures such as the Biopolis, a dedicated biomedical sciences R&D hub and the heart of Singapore’s biomedical ambition, and the Singapore Science Park, a research, development and technologies hub in close proximity to key research and tertiary institutions and the technology start-up community.
Over 25 R&D centres are already here, including those set up by Abbott, GlaxoSmithKline, Novartis, Heraeus Medical, Hill-Rom and Greatbatch, and more are being established. Among the recent entrants is Munich-based Dornier Medtech, known for its pioneering technologies and revolutionary therapies in urology.
In September 2017, the company opened its Asia Pacific Headquarters and Global Clinical Innovation Centre for its new urology unit Dornier Aries. The centre represents one of the first medtech innovation centres in Singapore to lead a global clinical research, regulatory and commercialisation strategy. Over the next five years, Dornier Medtech will invest US$30 million to build its capabilities at the centre.
Dornier Aries is a non-surgical, drug-free treatment option that uses low-intensity Extracorporeal Shockwave Therapy (Li-ESWT) for erectile dysfunction, a condition that affects about 30% of all men above 40 years old and has been shown to be extremely common among men with diabetes, a major disease burden globally.
Speaking at the centre’s opening, EDB chairman Beh Swan Gin noted that Singapore is “well placed to help global medtech companies navigate the diversity and complexities of Asia’s regulatory landscape and clinical needs, accelerating their ability to develop and bring new products to regional and global markets”.
Leg Up for AM
Singapore is backing the industry’s R&D effort. Under the Research, Innovation and Enterprise 2020 plan, the government has allocated S$3.2 billion for advanced manufacturing and engineering to develop cross-cutting technologies in areas such as robotics, automation and additive manufacturing (AM).
At the National University of Singapore (NUS), a new centre has been set up to advance the application of 3D printing in medtech. Launched in July 2017 with an initial funding of S$18 million, the NUS Centre for Additive Manufacturing (AM.NUS) brings together industry, clinicians, hospitals, engineers and designers to develop and apply ground-breaking 3D technology in the biomedical and healthcare fields.
“We have targeted the biomedical sector, as the end goal is to introduce new innovative products to the market which can improve patient outcomes and healthcare delivery,” said Associate Professor Wilson Wang Ee Jen, co-director, AM.NUS.
Projects it is currently pursuing include the following:
• Surgical instruments, simulators and prosthetics – Researchers from the Division of Industrial Design at the NUS School of Design and Environment aim to create customisable surgical tools and simulators for educating the next generation of doctors or simplifying difficult clinical tasks. The team will also design functional prosthetics using AM technology.
• Restorative repairs and implants – Researchers from the NUS Faculty of Engineering are exploring functional printing and developing ceramic and metal AM materials and processes, in order to bring novel and more biocompatible implants to market.
• Oral health and craniofacial applications – The NUS Faculty of Dentistry is leading educational efforts in advanced computer-aided oral surgery and surgical planning. The faculty is also conducting research on AM use in dental implant design and tissue engineering.
Medtech Firms and Hospitals – A Match Well-Made
As the best healthcare innovation often marries the expertise of medical workers and the know-how of businesses, Singapore is stepping up effort to promote such tie-ups.
Playing matchmakers are Enterprise Singapore, formed following the merger between International Enterprise Singapore and SPRING Singapore, and the National Healthcare Group (NHG), one of three integrated clusters in the country’s public healthcare system.
Through the Partnerships for Capability Transformation (PACT) programme, Enterprise Singapore has facilitated more than 30 hospital–industry collaborations. Jointly administered with the EDB, PACT offers grant support for large organisations to work with local small and medium-sized enterprises (SMEs) in the areas of knowledge transfer, supplier upgrading, development and test-bedding of innovative solutions.
“Having a clinical partner to provide clinical advice and resources for test-bedding and validation helps to fast-track the development of innovations,” Enterprise Singapore’s director of its healthcare and biomedical division, Johnny Teo, told The Straits Times.
In 2015, Tan Tock Seng Hospital and consultancy and engineering firm CoNEX worked together to develop a thermal-detection system that could more accurately detect patient movement on the bed as compared with conventional bed sensor pads. After a year of testing prototypes, the system is now being used at the hospital.
In September 2017, NHG set up the Centre for Medical Technologies and Innovations to facilitate the development of medtech solutions between its healthcare professionals and technology SMEs.
Leveraging the experience and technological expertise of industry players makes developing solutions faster, as well as more practical and focused, said centre committee member Loh Yong Joo. “Most importantly, the industry provides an avenue to scale up the solutions through commercialisation, which brings the solutions to the wider market and population.”