Dive Brief:

• Abbott Laboratories' recently approved Amplatzer Amulet left atrial appendage occluder device will win around one-fifth of a market currently monopolized by Boston Scientific's Watchman device by 2023, a survey of electrophysiologists found.
• SVB Leerink only polled 56 electrophysiologists but the similarity of the results to an earlier survey of interventional cardiologists increases confidence in the findings. Both polls suggest growth of Watchman, a key device for Boston Scientific, will slow as Abbott gains share. 
• The poll of electrophysiologists, who the SVB Leerink analysts estimate do 65% of Watchman procedures, is somewhat more encouraging for Boston Scientific than the earlier survey but still highlights the threat to the Watchman franchise.

Dive Insight:

Boston Scientific has enjoyed a monopoly on the left atrial appendage closure device market since it won FDA approval in 2015, enabling it to establish Watchman as a key growth driver before COVID-19 temporarily slowed progress. Now, Boston Scientific faces a more permanent headwind with Abbott gaining approval for a rival product. 

Analysts at SVB Leerink have tried to forecast the impact of the Abbott approval, first by polling interventional cardiologists and now by surveying electrophysiologists. The headline findings of both polls are the same. Abbott is expected to quickly claim a sizable slice of the market. 

The electrophysiologists collectively predicted Abbott will control 18% of the market by 2023, versus the 24% share shift forecast in the survey of interventional cardiologists. Compared to the previous survey, the latest poll forecasts faster growth of the overall market. Centers that offer both Abbott and Boston Scientific devices are expected to increase volumes faster than single-product sites.    

"The incremental volume growth from a second device shown in this survey does more closely follow what we view to be the best historical precedents for cardiology device monopolies moving to duopolies, and we view this datapoint as encouraging for the market broadly," the SVB Leerink analysts wrote.

While the survey is more encouraging for Boston Scientific than the earlier poll, as it suggests Abbott will take less share and faster market growth, it still raises the prospect of Watchman sales falling short of expectations in the coming years. Both surveys suggest Watchman growth will fall into the high single digits in 2023.

SVB Leerink puts the consensus analyst growth forecast for 2023 at 13%, suggesting "there appears to be downside risk to Watchman numbers over the next few years." The risk is important because Watchman will approach 10% of total sales in 2023 and beyond, according to the analysts, making it a cornerstone of Boston Scientific's business.  

The SVB Leerink analysts acknowledged the risk but "think the nuances around the data and the market growth assumptions are likely to ultimately prove much less bad than feared" for Boston Scientific, leading them to maintain their forecast that Watchman will record double-digit sales growth for the foreseeable future.

Abbott said in the Aug. 16 approval announcement that the company plans to release results of a head-to-head trial with Watchman on Aug. 30 during the European Society of Cardiology 2021 Congress.