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  1. 1. Qualitative Research Quantitative Research Profiles MedPanel, Inc., 44 Brattle St., Cambridge, MA 02138 617-661-8080 www.medpanel.com KNOWLEDGE CAPTURED. INTELLIGENCE DELIVERED. Evaluation of Dermal Fillers and BOTOX Markets Prepared by MedPanel, Inc. March 2007
  2. 2. Contents  Project Objectives 2  Methodology & Sample 3  Respondent Practice Background 4-7  Executive Summary 8-12  Detailed Findings 13-37 • Fillers Market Dynamics 14-16 • Market Growth 17-21 • Medicis vs. Allergan 22-30 • BOTOX 31-35 • Follow-Up 36-37
  3. 3. Study Objectives Specific Objectives:  Examine current dermal filler market dynamics  Determine the anticipated growth in use of dermal filler products  Compare and contrast Allergan’s (Juvederm) and Medicis’ (Restylane) dermal filler products  Identify current and anticipated future use of BOTOX Primary Objective: Evaluate the current dermal fillers and BOTOX markets and determine the potential for growth within these markets
  4. 4. Survey Specifics: A 20-minute self-administered survey was fielded online via MedPanel’s Web site from February 26 - March 1, 2007. Sample: The total sample comprises 50 physicians selected from MedPanel’s U.S. database:  Dermatologists: 25  Plastic surgeons: 25  To qualify, all respondents were required to meet the following criteria:  Board certified as a plastic surgeon or dermatologist  In practice at least 5 years since board certification  Use at least 10 vials of BOTOX in their practice in a typical month  Have at least 25 filler treatments in their practice in a typical month Methodology & Sample
  5. 5. Respondent Practice Background S1. What is your primary medical specialty? S3. How many years have you been in practice since receiving board certification in dermatology/plastic surgery? 42% of the respondents have been in practice between 5 and 10 years, and 36% have been in practice for 16 or more years. 25 25 Dermatology Plastic Surgery Primary Medical Specialty (n=50) 42% 22% 36% 5-10 years 11-15 years 16 years or more Years in Practice (n=50)
  6. 6. Respondent Practice Background S4. Please indicate the number of dermatologists/plastic surgeons, including you, in your practice. S5. Which of the following best describes your primary practice setting? The majority (62%) of dermatologists and plastic surgeons work in a solo practice. There is a nearly even mix of physicians who practice in top 10 metropolitan areas (38%) and who practice in suburban areas (44%). 62% 16% 4% 18% Solo practice 3-5 5 or more (Aesthetic) 5 or more (Mixed) Number of Dermatologists/Plastic Surgeons in practice (n=50) 38% 18% 44% Top 10 Metropolitan Smaller city Suburban Rural Practice Setting (n=50)
  7. 7. Respondent Practice Background S6. Please indicate the number of vials of BOTOX used in your practice in a typical month (all dermatologists). S7. Please indicate the number of filler treatments in your practice (all dermatologists) in a typical month. 68% of respondents report 11 to 25 vials of BOTOX are used and 26-50 filler treatments take place in their practice in a typical month. 68% 22% 10% 11-25 26-40 41 or more Vials of BOTOX (n=50) 68% 22% 10% 26-50 51-100 101 or more Filler Treatments (n=50)
  8. 8. Respondent Practice Background S8. Please indicate the percentage of your practice dedicated to fillers and toxins. A little more than half of the respondents work in a practice in which 26%-50% is dedicated to fillers and toxins. 38% 56% 2% 4% 1%-25% 26%-50% 51%-75% 76%-100% Percentage of Practice Dedicated to Fillers and Toxins (n=50)
  9. 9. Executive Summary
  10. 10. Executive Summary Fillers Market Dynamics  Dermatologists and plastic surgeons indicate using fillers most frequently for deep lines (44% of procedures involving fillers)  Most frequently used products for each procedure – Fine lines: Restylane (59%) and Collagen (19%) – Deep lines: Restylane (61%) and Radiesse (19%) – Lip treatment: Restylane (70%) and Juvederm (14%) – Facial contouring/volumizing: Restylane (33%), Sculptra (29%), and Radiesse (23%) Market Growth  The majority of respondents anticipate moderate growth (1%-30%) in use of fillers in each of the listed applications over the next two years  They anticipate slightly more growth in deep lines than the other filler applications  When asked for specific product growth over the next two years, the majority of respondents anticipate no growth to 20% growth – For Collagen, Sculptra, and Artefill, the majority of respondents expect either no growth or a reduction in product use
  11. 11. Executive Summary Market Growth (continued)  Most frequently indicated ideal durations of effect for filler applications:  Fine lines: 9-12 months (42%)  Deep lines: 13-24 months (38%)  Lip treatment: 9-12 months (50%)  Facial contouring / volumizing (38%)  The most frequently selected feature respondents indicate using for choosing one product over another is safety (34% of respondents) Medicis vs. Allergan  Fewer than half (40%) of the physicians believe there is a clinical difference between Restylane and Juvederm  Of the respondents who find a difference, many favor Juvederm for its smoothness, better filtration, and ease of injection  14% of the plastic surgeons and dermatologists indicate significant differences and 36% indicate moderate differences between formulations of Juvederm  Very few of the respondents state specific differences among the formulations of the products
  12. 12. Executive Summary Medicis vs. Allergan (continued)  52% of the respondents anticipate preferring Prelane over existing products when it becomes available  Most frequently stated advantages of Prelane: – Better than existing products for deep lines or folds (16) – Longer duration (5)  40% of the dermatologists and plastic surgeons expect that 1%-20% of their HA filler use will involve Juvederm products in the next 12 months  If results show better longevity for Juvederm than Restylane, respondents show an increase in the percentage of HA fillers they expect to be Juvederm (36% anticipate 21%-40% of HA fillers will be Juvederm over the next 12 months)  Company ratings for all attributes (for every attribute, the order of ratings among the companies remained the same):  1. Medicis 2. Allergan 3. Bioform 4. Dermik 5. Arte  Nearly half of the respondents (46%) would give a patient the specific brand of HA filler they request if it was medically appropriate  Half of the respondent are excited about products in development (mostly Perlane)
  13. 13. Executive Summary BOTOX  Growth in BOTOX use:  Over the past two years: – 1% - 25%: (42% of respondents) – 26% - 50%: (28% of respondents)  Anticipated over the next two years: – 1% - 25%: (42% of respondents) – 26% - 50%: (20% of respondents)  Respondents indicate 83% of their BOTOX is for aesthetic use (glabellar lines) and 6% is for hyperhidrosis  Most frequently mentioned other uses of BOTOX: – Forehead lines (8) – Headaches and migraines (7) – Crow’s feet (5)  Respondents are very divided about the anticipated use of Reloxin in the first two years following approval if it is priced at a 20% discount to BOTOX: – 1% - 20% of toxin use: (26% of respondents) – 21% - 40% of toxin use: (18% of respondents) – 41% - 60% of toxin use: (20% of respondents) – Greater than 80% of toxin use: (16% of respondents)
  14. 14. Detailed Findings
  15. 15. Fillers Market Dynamics
  16. 16. Q1. Please estimate the percentage of your fillers that are used for each of the following. Your answers must sum to 100%. Dermatologists and plastic surgeons estimate that their fillers are most frequently used (44%) for deep lines. Survey Details Fillers Market Dynamics Categories of Filler Use (n=50) 20% 44% 26% 10% Fine Lines Deep Lines Lips Facial Contouring / Volumizing %ofFillerProcedures
  17. 17. Q2. Please estimate the percentage of procedures in which the following products are used for the treatment of fine lines. Your answers must sum to 100%. Q3. Please estimate the percentage of procedures in which the following products are used for the treatment of deep lines. Your answers must sum to 100%. Q4. Please estimate the percentage of procedures in which the following products are used for the treatment of lip treatment. Your answers must sum to 100%. Q5. Please estimate the percentage of procedures in which the following products are used for the treatment of facial contouring / volumizing. Your answers must sum to 100%. Restylane is the product most frequently used by the respondents for each of the listed procedures. Collagen is often used for fine lines (19% of procedures), Radiesse is often used for deep lines (19% of procedures) and facial contouring / volumizing (23% of procedures), and Sculptra also is frequently used for facial contouring / volumizing (29% of procedures). Survey Details Fillers Market Dynamics Category Product Use for Filler Procedures Fine Lines (n=44) Deep Lines (n=50) Lip Treatment (n=49) Facial Contouring / Volumizing (n=34) Collagen 19% 4% 10% 3% Restylane 59% 61% 70% 33% Juvederm 10% 10% 14% 9% Radiesse 9% 19% 2% 23% Sculptra 1% 2% 0% 29% Artefill 0% 1% 0% 0% Other 2% 3% 5% 3%
  18. 18. Market Growth
  19. 19. Q6. Over the next two years, how fast do you anticipate your use of fillers will grow in each of the following applications? A majority of respondents expect slower or more moderate growth (between 1% and 30% growth) for each of the filler procedure types. Between 10% and 14% of the respondents anticipate growth of more than double the current number of procedures to take place for each of the filler procedure types over the next two years. Survey Details Market Growth % Growth Growth in Use of Filler Applications (n=50) Fine Lines Deep Lines Lip Treatment Facial Contouring / Volumizing Same or less 18% 6% 12% 14% 1-10% 26% 8% 20% 18% 11-20% 20% 32% 20% 14% 21-30% 18% 20% 20% 16% 31-40% 0% 4% 2% 8% 41-60% 6% 16% 16% 12% 61-80% 2% 2% 0% 4% 81-100% 0% 0% 0% 0% More than Double 10% 12% 10% 14%
  20. 20. Q7. Over the next two years, how fast do you anticipate your use of each of the following fillers to grow? When asked for anticipated growth in use of specific products, respondents indicate slower growth than for anticipated growth for filler applications. The vast majority of respondents expect either no growth or moderate growth (up to 30%) for each of the products within the next two years. Survey Details Market Growth % Growth Growth in Use of Filler Products (n=50) Collagen Restylane Juvederm Radiesse Sculptra Artefill Other** Same or less 86% 30% 18% 22% 56% 68% 81% 1-10% 8% 20% 18% 22% 12% 20% 10% 11-20% 6% 18% 16% 24% 16% 8% 0% 21-30% 0% 14% 16% 14% 8% 4% 0% 31-40% 0% 4% 14% 8% 2% 0% 0% 41-60% 0% 2% 6% 0% 0% 0% 0% 61-80% 0% 0% 2% 0% 0% 0% 0% 81-100% 0% 2% 0% 0% 0% 0% 0% More than Double 0% 10% 10% 10% 6% 0% 10% **Only 21 respondents mentioned another product. Other products mentioned were Perlane, Hylaform, and silicone
  21. 21. Q8. In your opinion, what would be the ideal duration of effect for fillers in each of the following applications? Respondents indicate the ideal duration of effect for fine lines is shorter (majority between 5 and 12 months) and the ideal duration for facial contouring / volumizing is longer (between 13 and 60 months). For deep lines and lip treatment, the majority believe the ideal duration is between 9 and 24 months. Survey Details Market Growth Duration of Effect Ideal Duration of Effect for Filler Applications (n=50) Fine Lines Deep Lines Lip Treatment Facial Contouring / Volumizing 0-4 months 6% 0% 0% 2% 5-8 months 26% 6% 18% 4% 9-12 months 42% 34% 50% 24% 13-24 months 18% 38% 28% 22% 24-60 months 4% 12% 4% 38% Permanent 4% 10% 0% 10%
  22. 22. Q9. In choosing fillers, what are the features that make you choose one product over the other? Please allocate 100% across the following categories. 34% of the respondents indicate choosing one filler product over another based on safety. 26% base this decision on the longevity of the product. Survey Details Market Growth Features Used to Choose Between Products (n=50) 6% 7% 12% 15% 26% 34% Versatility Customer service Price Smoothness Longevity Safety % of respondents
  23. 23. Medicis vs. Allergan
  24. 24. 40% of the plastic surgeons and dermatologists believe there is a clinical difference between Restylane and Juvederm that leads them to choose one over the other. Many of the respondents claim to favor the smooth flow and easy injection of Juvederm. 60% 40% Yes No Difference between Restylane and Juvederm (n=50) Survey Details Medicis vs. Allergan Q10. In your opinion, is there a clinical difference between Restylane and Juvederm which will lead you to choose one over the other in certain patients? Q11. Please describe these clinical differences. Clinical Differences (n=20) Juvederm: - Too firm and non-pliable in the lips and under the eyes - Swells and bruises less - More versatile - Syringe volume supplied is less - Easier to inject, greater filtration, and flows more smoothly - Longer lasting - Better company assistance - Less lumpy Restylane: -Longer duration -More robust -More reactive to tissues
  25. 25. Half of the respondents indicate there is no difference between the formulations of HA products that would lead to a choice between them. 50% 36% 14% Significant differences Moderate differences No Difference between Formulations of HA Products (n=50) Survey Details Medicis vs. Allergan Q12. Is there a difference between the formulations of HA products (for Juvederm – Ultra, Ultra plus and Juvederm; for Restylane – fine lines, Restylane and Perlane) which will lead you to choose one formulation over the other? Q13. Please describe these clinical differences. Significant Differences (n=7) Unspecified: Restylane: - Ease of use / ease of injection -Perlane is better for fine line - Dependent on depth of line Moderate Differences* (n=18) Unspecified: Juvederm: - Bonding - Juvederm Ultra Plus good - Particle size deep lines - Patient preferences - Use for fine lines versus deep lines *Some of the respondents were not familiar enough with the product formulations to state differences between them. No respondents who find moderate differences made comments specific to Restylane and no respondents who find significant differences made comments specific to Juvederm
  26. 26. Slightly more than half (52%) of respondents anticipate they will prefer Perlane over existing products when it becomes available. The most frequently mentioned advantages of Perlane over existing products are its use for deep lines and folds and its longer duration. 48% 52% Yes No Preference for Perlane Over Existing Products (n=50) Survey Details Medicis vs. Allergan Q14. When Perlane becomes available, will you prefer it over existing products for certain patients? Q15. Please describe the patients for which you would use Perlane and reasons you would prefer it? Reasons for Preference for Perlane (n=26) - Better for patients with deep lines or folds (16) - Longer duration (5) - Better efficacy (2) - Better for fine lines (2) - Use for facial contouring (2) - Use for volumizing (2) - Use for cheek sculpting
  27. 27. Q16. Thinking about all of the hyaluronic acid (HA) fillers you anticipate using over the next 12 months, what percentage do you anticipate will be Juvederm (all formulations)? 40% of the dermatologists and plastic surgeons anticipate 1%-20% of their HA fillers over the next 12 months will be Juvederm formulations. Percentage of HA Fillers Expected to Be Juvederm over Next 12 Months (n=50) 12% 40% 24% 16% 8% 0% 1-20% 21-40% 41-60% 61-80% Greater than 80% %ofHAFillerUse Survey Details Medicis vs. Allergan
  28. 28. Q17. Allergan is conducting a head to head study of Juvederm vs. Restylane. Assuming the results show slightly better longevity for Juvederm (1 month more than Restylane), what percentage of your HA use will be Juvederm (all formulations)? A majority (60%) of the respondents anticipate 1%-40% of their HA filler use will be Juvederm formulations following study results showing better longevity for Juvederm. The other 40% anticipate 41%-80% of HA filler use will be Juvederm formulations. Juvederm Use Assuming Juvederm has Superior Longevity to Restylane (n=50) 24% 36% 20% 20% 0% 1-20% 21-40% 41-60% 61-80% Greater than 80% %ofHAFillerUse Survey Details Medicis vs. Allergan
  29. 29. Q18. Please rate your impressions of the following companies on each of the following attributes using a scale from 1 to 5 where 1=Poor, 2=Fair, 3=Average, 4=Good and 5=Excellent. If you cannot rate a particular company on a given attribute please select the “Not Applicable option from the drop-down list. Medicis/Restylane receives the highest ratings of all of the companies on all attributes, closely followed by Allergan/Juvederm. Arte/Artefill is rated lowest on all attributes. Attribute Company Impressions (1=Poor, 5=Excellent) -Mean Ratings- (n=50) Medicis / Restylane Allergan / Juvederm Bioform / Radiesse Dermik / Sculptra Arte / Artefill Longevity 4.3 4.0 3.7 3.0 2.4 Safety 4.8 4.0 3.4 3.0 2.2 Smoothness 4.5 3.9 3.1 2.6 2.0 Versatility 4.4 4.0 3.1 2.6 2.2 Price 3.6 3.2 2.8 2.2 1.8 Customer service 3.7 3.3 3.0 2.3 1.9 Consumer brand 4.1 3.8 2.9 2.8 2.1 Science / clinical data quality 4.5 4.1 3.6 3.2 2.4 Overall relationship - “I prefer to do business with this company” 3.9 3.5 2.9 2.5 2.0 Survey Details Medicis vs. Allergan
  30. 30. Q19. If a patient comes to you and requests a specific HA brand (e.g. Restylane, Juvederm, etc.) and HA is the medically appropriate product to use, how would you most likely react? Nearly half of the physicians would give a patient a specific HA brand if the patient requested it. 38% say they would gently suggest the patient consider their preferred product. Reaction to Patient Request for a Specific HA Brand (n=50) 4% 12% 38% 46% Other I would convince the patient to use my preferred product I would gently suggest they consider my preferred product I would give the patient the HA brand they asked for % of respondents Survey Details Medicis vs. Allergan
  31. 31. Half of the respondents are excited about a new filler product(s) currently in development. Of those respondents, the majority are excited about Perlane for its use in deep lines, volume enhancement, and smoothness on fine lines. 50% 50% Yes No Excitement Over New Filler Products (n=50) Survey Details Medicis vs. Allergan Q20. Are you excited about any of the filler products currently in development? Q21. Please indicate which product(s) you are excited about and why. Exciting Products Reasons for Excitement Perlane - More volume enhancement, thicker, good for deep lines, more cross links, smoother on fine lines Evolence - Good for lip procedures, long duration, low immunogenicity Medical grade silicone - Permanence Unspecified - Fine line fillers, greater choice, price competition, longer duration
  32. 32. BOTOX
  33. 33. Respondents most frequently (42%) indicate their practice use of BOTOX has grown by 1%- 25% over the past two years. Growth in BOTOX Use Over the Past Two Years (n=50) 8% 42% 28% 10% 4% 8% Same or less 1-25% 26-50% 51-75% 76-100% More than Double Survey Details BOTOX Q22. Over the past two years, your practice use of BOTOX grew by:
  34. 34. Many of the dermatologists and plastic surgeons indicate they anticipate the same trend that appeared over the past two years in BOTOX use will continue over the next two years. Anticipated Growth in BOTOX Use Over the Next Two Years (n=50) 10% 42% 20% 16% 4% 8% Same or less 1-25% 26-50% 51-75% 76-100% More than Double Survey Details BOTOX Q23. Over the next two years, do you anticipate your practice use of BOTOX will grow by:
  35. 35. The physicians estimate a mean of 83% of their BOTOX is for aesthetic (glabellar lines) and only 6% is used for hyperhidrosis. Most frequently mentioned other uses of BOTOX are for forehead lines and headaches or migraines. 83% 6% Aesthetic (Glabellar lines) Hyperhidrosis %ofBOTOXUse BOTOX Uses (n=50) Survey Details BOTOX Frequently Stated Other Uses of BOTOX: - Forehead lines (8) - Headaches/migraines (7) - Crow’s feet (5) - Brow elevation (3) - Perioral lines (3) - Periorbital lines (3) - Lip lines (3) - Neck lines (2) - Blepharospasm (2) Q24. Please estimate the percentage of your BOTOX use that is for aesthetic (glabellar lines). Q25. Please estimate the percentage of your BOTOX use that is for hyperhidrosis. Q26. Please list any other conditions for which you currently use BOTOX.
  36. 36. Q27. When Reloxin is approved in the United States for aesthetic use and assuming it is priced at a 20% discount to BOTOX, what percentage of your overall toxin use will be Reloxin in the first two years after its approval? Respondents are divided on the amount of Reloxin use in the first two years after its approval if it is priced at a 20% discount to BOTOX. A very slight majority indicate Reloxin would account for 40% or less of overall toxin use. Reloxin Use at 20% Discount to BOTOX in First Two Years Following Approval (n=50) 14% 26% 18% 20% 6% 16% 0% 1-20% 21-40% 41-60% 61-80% Greater than 80% Survey Details BOTOX
  37. 37. Follow-Up
  38. 38. 72% of respondents would participate in the ongoing survey. Two-thirds of these respondents believe pricing and promotions data will be the most useful data from these surveys. 28% 72% Yes No Participate in Ongoing Survey (n=50) Survey Details Follow-Up Q28. Would you like to participate in the ongoing survey? Q30. What data from these surveys would you find most useful? 22% 67% 11% Share of volume used by each product Pricing and promotions No need for data Other Most Useful Data from These Surveys (n=36)
  39. 39. For additional information specific to this project, please contact: Ben Crane Analyst, Quantitative Services Phone: 617.661.8080 x228 benjamin.crane@medpanel.com For sales and future projects, please contact: Howard Brick Managing Director, Financial Group Phone: 617.661.8080 x323 howard.brick@medpanel.com Qualitative Research Quantitative Research Profiles MedPanel, Inc., 44 Brattle St., Cambridge, MA 02138 617-661-8080 www.medpanel.com

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