Fisher & Paykel Healthcare Corporation Limited · NZX:FPH
Fisher & Paykel Healthcare — Investor Day (October 2017)
72 slides from Fisher & Paykel Healthcare's investor day presentation, Oct 16, 2017
Slide 1: Nasal High Flow: The Brisbane (Paediatric) Experience
Nasal High Flow The Brisbane (Paediatric) Experience For personal use only Associate Professor Andreas Schibler Paediatric Intensive Care Staff Specialist FCICM - PICU Medical Lead of Paediatric Critical Care Research Group (PCCRG) Lady Cilento Children's Hospital and The University of Queensland Th
Slide 2: 2016: Current intubation rate <3%
For personal use only 2016: Current intubation rate <3%
Slide 3: Survey of NHF therapy use in Australia
Survey of NHF therapy use in Australia • 83 general paediatric departments (peripheral/secondary/tertiary) For personal use only • 7/8 tertiary, 5/6 secondary and 38/69 peripheral response 50 • 45/49 use HFNC: 91% 45 Number of departments using 45 40 38 HFNC (of 49 total) 35 30 30 25 25 20 14 15 10
Slide 4: Survey of NHF therapy use in Australia: Diagnostic groups
Survey of NHF therapy use in Australia For personal use only Diagnostic groups • 100% of departments use it for bronchiolitis • 82% in pneumonia • 55% in reactive airways (asthma) • 40% in other respiratory disease
Slide 5: Other benefits of NHF therapy
Other benefits of NHF therapy For personal use only • Can be applied very early in the disease process • Greater patient tolerance • Ease of application • Clinical effectiveness
Slide 6: What are the trials we need to do?
What are the trials we need to do? For personal use only • RCT in infants with bronchiolitis • RCT in infants and children with Acute Hypoxic Respiratory Failure: - Pneumonia - Pneumonitis - Reactive Airway Disease (Asthma) When, Where and How? •Start in ED ? Early ? •Start only if admitted ? •Start
Slide 7: PARIS: Paediatric Acute Respiratory Intervention Studies
PaRIs Paediatric Acute Respiratory Intervention Studies High Flow Trial Children’s Health Queensland
Slide 8: PARIS Background
PARIS 1 Background For personal use only Burden of Bronchiolitis •Highest number of non-elective PICU admissions in 2015 (19%). •Low mortality (~0%) •Median PICU LOS 3.08 days •Currently ANZPIC data registry showing higher figures for bronchiolitis admitted to ICU. Compatible with USA data which is
Slide 9: Respiratory support modes by year
Mechanical Non-Invasive For personal use only Year Ventilation Intubation Ventilation NHF therapy 2002 57.2% 36.6% 30.5% 2003 53.9% 30.9% 35.0% 2004 57.4% 29.2% 42.6% 2005 56.8% 29.5% 42.4% 2006 60.5% 26.9% 47.5% 2007 62.8% 26.5% 49.7% 2008 53.2% 23.5% 40.9% 2009 63.4% 25.9% 46.8% 2010 58.6% 24.5% 4
Slide 10: Modes of Respiratory Support in PICU for Bronchiolitis
Modes of Respiratory Support in PICU for Bronchiolitis For personal use only
Slide 11: Health care costs associated with Bronchiolitis infants admitted to ICU
Health care costs associated with Bronchiolitis infants admitted to ICU For personal use only
Slide 12: NHF introduction
For personal use only NHF introduction
Slide 13: NHF = Everybody Loves it
NHF = Everybody For personal use only Loves it
Slide 14: NHF Everybody is over it
NHF Everybody is over it For personal use only
Slide 15: NHF Introduced in Paeds Ward
NHF Introduced in Paeds Ward For personal use only
Slide 16: NHF Reducing ICU admission
For personal use only NHF Reducing ICU admission
Slide 17: PARIS I: NHF therapy in infants with bronchiolitis RCT
PARIS I – Nasal High Flow therapy in infants with bronchiolitis – a Randomised Controlled Trial For personal use only AIM To compare in a Randomised Controlled Trial, Nasal High Flow therapy to standard oxygen delivery in infants with bronchiolitis, presenting to regional, metropolitan and tertiary
Slide 18: Secondary Outcomes
Secondary Outcomes For personal use only To measure: • reduction in the need for retrievals/ICU admission • reduction in intubation rate • reduction in LOS • length of oxygen therapy • adverse effects • health care costs • study effect of room air only?
Slide 19: Recruitment over years – 1400 patients
Recruitment over 3 years – 1400 patients • Nine Regional Hospitals For personal use only • Ipswich Hospital • Logan Hospital • TPCH • Nambour Hospital • Redcliffe Hospital • Toowoomba Hospital • Redland Hospital • The Tweed Hospital • Caboolture Hospital Additional PREDICT sites with NHMRC funding •
Slide 20: Study Protocol
Primary Study Protocol Outcome n=1400 $1.3 M NHMRC funding For personal use only Responder NHF Non-Responder Transfer 2L/kg/min Inclusion Criteria * Bronchiolitis * SpO2 <92/94%% Responder * < 12mths Control Responder NHF Non-Responder 2L/kg/min Non-Responder Criteria for non-responder: RR, HR and E
Slide 21: Baseline Characteristics
Baseline Characteristics For personal use only Standard Nasal High Oxygen Flow Sex N=731 N=745 Male 469 (64%) 455 (61%) female 261 (36%) 287 (39%) Median age months (IQR) months (IQR) 6.1 (3.4) 5.8 (3.5) Age ≤3 month 185 (25%) 207 (28%) 3-12 months 546 (75%) 538 (72%) Prematurity 107 (15%) 127 (17%)
Slide 22: Primary Outcomes
Standard Nasal High P value Odds ratio Primary Outcomes Oxygen Flow N=731 N=745 For personal use only Failure Rate 167 89 #0.0001 2.20 (1.65-2.89) % of patients 23% 12% Non- 55/130 28/179 #0.0001 2.71 (1.63-4.50) responders/Responders <3month of age Non- 112/434 61/477 #0.0001 2.02 (1.44-2.83) respo
Slide 23: PARIS II: Acute Hypoxemic Respiratory Failure
P RIS Il Paediatric Acute Respiratory Intervention Studies Acute Hypoxemic Respiratory Failure AHRF Trial Children’s Health Queensland
Slide 24: AHRF Background
AHRF BACKGROUND For personal use only • 6.3 million children < 5yrs died worldwide in 2013 (WHO) 1 million of these deaths - caused by resp infections • AHRF - most frequent reason for paeds admission Most common initial treatment is to offer 02 • Approx 20% of children with AHRF rapidly deterio
Slide 25: PARIS II: NHF therapy in children with Acute Respiratory Failure
PARIS II Nasal High Flow therapy in children with Acute Respiratory Failure – a Randomised Controlled Trial For personal use only AIM To compare in a Randomised Controlled Trial, Nasal High Flow therapy to standard oxygen delivery in infants and children with Acute Hypoxemic Respiratory Failure (AHR
Slide 26: Secondary Outcomes
Secondary Outcomes For personal use only To determine if use of NHF therapy reduces the need for hospital transfer to a tertiary centre To determine if there is an age dependent efficacy of NHF therapy To perform Subgroup Analysis for children with: eg. RAD (asthma), Bronchiolitis 12-24mths, A
Slide 27: Challenges PARIS II – Study specific
CHALLENGES PARIS 1 & 2 – Study specific For personal use only • Bias (creep in effect) • If NHF therapy has been used prior in a centre (stronger bias present) • Adherence to protocol by medical staff – change in diagnosis to place child on NHF (bias) Consent Research culture present or not • Study
Slide 28: Thank you
For personal use only THANK YOU
Slide 29: myAirvo Research Update
myAirvo Research For personal use only Update Chris Crone Research & Development Manager – Airvo/Optiflow
Slide 30: Nasal High Flow - Acute vs. Chronic use
Nasal High Flow - Acute vs. Chronic use • Same therapy, different uses, different benefits For personal use only Acute Chronic
Slide 31: Home-based clinical research
Home-based clinical research • More research being carried out in the home For personal use only • Challenges − Patient group – age, care needs − Logistics − Compliance monitoring − Longer treatment times (1 year : 5 years) − Higher costs
Slide 32: Mechanisms research
Mechanisms research For personal use only Author Journal Yr n Population Comparison F/up Effects Hasani 10 Bronchiectasis NHF vs no NHF 7d ↑ Increased Mucociliary clearance Chron Resp Dis 2008 Fraser 10 COPD NHF vs O2 <1d ↓ Reduced CO2 (measured through skin) 273 sleep studies in the Thorax 2016 ↓ R
Slide 33: Outcomes research
Outcomes research For personal use only Author Journal Yr n Population Comparison F/up Message Rea 108 COPD & NHF (w and w/o 1y Improved exacerbation days, time to 1st Resp Med 2010 Bronchiectasis O2) vs SC exacerbation, reduced antibiotic use Cirio 12 COPD in NHFO2 vs Venturi <1d Improved exercise
Slide 34: COPD research underway
COPD research underway For personal use only PI, Country n Population Comparison F/up Primary Outcome Weinreich, Denmark 200 COPD NHFO2 vs O2 1y Exacerbations & hospital admissions Mansfield, Australia 150 COPD NHF vs no NHF 30d Length of Stay, 30 d readmission Bräunlich, Germany 100 COPD NHF vs Bil
Slide 35: A bright outlook
A bright outlook • There are challenges to home-based For personal use only research • Studies are underway with myAirvo and early results are promising
Slide 36: Questions?
For personal use only Questions?
Slide 37: Hospitalized COPD Exacerbations: Nasal High Flow Humidified Air via Hospital in the Home
For personal use only HOSPITALIZED COPD EXACERBATIONS: NASAL HIGH FLOW HUMIDIFIED AIR VIA HOSPITAL IN THE HOME A/PROF DARREN MANSFIELD MONASH HEALTH
Slide 38: Disclosure
DISCLOSURE For personal use only • A/Prof Mansfield has received research funding from Fisher & Paykel Healthcare. • Fisher &Paykel Healthcare will make a donation to the Monash Lung and Sleep Institute and Assoc Prof Mansfield will be reimbursed for any expenses incurred in connection with his part
Slide 39: The burden of disease on the acute facility
THE BURDEN OF DISEASE ON THE ACUTE FACILITY For personal use only • COPD exacerbations Dandenong Hospital • 90% are admitted to hospital • No/yr • LOS 5.9 days • 60 day readmission rate 22% Large numbers due to comorbidities and social circumstances rather than severe acute exacerbations
Slide 40: Characteristics
CHARACTERISTICS For personal use only FLOW RATES -60L/MIN TEMPERATURES 37 DEGREES LOOSE FITTING CANNULA
Slide 41: Postulated benefits
POSTULATED BENEFITS For personal use only • Facilitative effects • Staff • Patients • Clinical/Physiological Effects
Slide 42: Respiratory: reduction of dead space
For personal use only Respiratory Reduction of dead space =iovon Reduces rebreathing of gas with high CO, and depleted O2 TIDAL VOLUME Unassisted breathing Mandel T. Moller W. Dead space volume et al. J Appl Physiol. 2013. et al. Am J Respir Care Mec. 2012. Optiflow NHF ; TIDAL VOLUME Washout Dead s
Slide 43: Preliminary numbers
PRELIMINARY NUMBERS For personal use only • Admissions under Hospital In The Home (HITH) = 20 • Readmissions post discharge from HITH = 1 • Patients who purchased AIRVO system privately = 2 • Good outcomes in patient satisfaction with care & symptom improvement while on NHF
Slide 44: Summary
SUMMARY For personal use only • Can realistically be incorporated into an acute clinical management setting • Reduces hospital length of stay, inpatient complications and recurrent admissions • Beneficial not only to patients • Can assist in unloading the healthcare system
Slide 45: Thank you
For personal use only Thank you
Slide 46: Driving Patient Success with OSA Therapy
Driving Patient For personal use only Success with OSA Therapy Fiona Cresswell General Manager Marketing
Slide 47: Unique and Personal
For personal use only Unique and Personal
Slide 48: The Threat
The Threat For personal use only • Up to 100M OSA sufferers 1,2 • CPAP therapy is the gold standard of treatment • Up to 50% will abandon therapy, many within first 2 weeks • Untreated sleep apnea has many life threatening consequences 1. Chronic disease epidemics. World Health Organization website.
Slide 49: Main Drivers of Non-Adherence
Main Drivers of Non-Adherence For personal use only • Leaks 1 • Facial Abrasions 1 • Mask Discomfort 1,2 • Claustrophobia 1,2 1. Bollig, S.M. Respir Care, 2010. 55(9): pp. 1230-9 2. Aljasmi, M., et al. J Sleep Med Disord, 2016. 3(2): 1044
Slide 50: Intimacy of the Mask
Intimacy of the Mask For personal use only • Comfort • Seal • Ease of Use = CONFIDENCE
Slide 51: User Experience Mask Design Philosophy
User Experience Mask Design Philosophy For personal use only Perception Fitting Seal Disassembly Cleaning Reassembly Confident ongoing use Patient Equipment Provider Perception Fitting Education Eliminates need Part identification for support & Resupply
Slide 52: Complex and Diverse Facial Anatomy
Complex and Diverse Facial Anatomy For personal use only
Slide 53: Our Leading-Edge Masks
Our Leading-Edge Masks For personal use only
Slide 54: AirPillow Seal
For personal use only AirPillow Seal
Slide 55: We Measure What Nature Created
We Measure What Nature Created • Facial Scanning For personal use only − Many hundreds of real OSA participants − 200,000+ points captured • Anthropometric Database − 42 key facial dimensions − Statistically analysed − Numerically driven seal design
Slide 56: We Use Technology to Optimise Design
We Use Technology to Optimise Design • 3D CAD Modelling For personal use only ‒ Gradient transitions ‒ Integrated mask stabilizers • Massive Variable Thickness Moldings ‒ 1200% range in single molded part ‒ Satin surface finish
Slide 57: The Benefit
The Benefit For personal use only 1 • Soft Nasal Prongs 2 ‒ 1/33 inch (0.75mm) thickness (1) ‒ Gently contours to nostril shape ‒ Significantly less pressure on the septum • Super Thin Silicone Seal Membrane ‒ Prongs surrounded by thin silicone ‒ 1/100 inch (0.25mm) thickness (2) ‒ Allows prong rota
Slide 58: Adjustable Headgear
Adjustable Headgear For personal use only Adjustable to offer Tactile Feedback and Provides stability personalised secure fit locks in place against dislodgement
Slide 59: We Consider Real World Use
We Consider Real World Use For personal use only • Lifecycle Testing ‒ Soaked in sweat solution ‒ Cleaned over 50 times ‒ Stretched 2800 times • Destruction Testing ‒ Pulled until broken ‒ Target = 30N Force
Slide 60: Washable Exhaust Diffuser
Washable Exhaust Diffuser For personal use only
Slide 61: We Quantify the Invisible
We Quantify the Invisible • Sound Testing For personal use only ‒ Target less than 25dBA • Draft Testing Anechoic Chamber
Slide 62: We Amplify Accuracy Using Technology
We Amplify Accuracy Using Technology For personal use only • Computational Fluid Dynamics ‒ Map airflow ‒ Highlight turbulence ‒ Optimise design • Optical Gauge Smartscope ‒ Accuracy of 1.4µm
Slide 63: The Benefit
The Benefit Reduced air flow disruption For personal use only • • Sound reduction - 17.5dB ‒ similar to a ticking watch
Slide 64: Visiblue
Visiblue For personal use only • Blue Highlights incorporated into key components • Supports mask education, orientation and reassembly
Slide 65: F&P SleepStyle CPAP/Auto Therapy
F&P SleepStyle For personal use only CPAP/Auto Therapy
Slide 66: Freedom in Simplicity
Freedom in Simplicity For personal use only Easy-access User-friendly Chamber menu & buttons Built-in Quiet, integrated connectivity design options
Slide 67: Powered by Technology
Powered by Technology For personal use only Auto Expiratory relief algorithm ThermoSmart™ SensAwake™
Slide 68: Engaging Patients
Engaging Patients For personal use only Apple, the Apple logo and iPhone are trademarks of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google Inc.
Slide 69: Empowering Clinicians
Empowering Clinicians For personal use only
Slide 70: The Mask Matters Most
The Mask Matters Most For personal use only
Slide 71: Questions?
For personal use only Questions?
Slide 72: Thank you
Thank you For personal use only Fisher & Paykel Healthcare Investor Day Sydney, October 2017
Fisher & Paykel Healthcare — Investor Day (October 2017) on 6ix