A STUDY OF PRODUCT CANNIBALISATION

CAPSTONE PROJECT

POST GRADUATE DIPLOMA IN MANAGEMENT

(PHARMACEUTICAL MANAGEMENT)

MARKETING ABDHINI BISWAS

2016-2018 . ROLL NO-01

SIES COLLEGE OF MANAGEMENT STUDIES , NERUL

NAVI MUMBAI-400706.

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A STUDY OF PRODUCT CANNIBALISATION
CAPSTONE PROJECT

SUBMITTED

AS A PARTIAL FULFILMENT OF THE CURRICULUM

FOR POST GRADUATE DIPLOMA IN MANAGEMENT
(PHARMACEUTICAL MANAGEMENT)

BY
ROLL NO-01
ABDHINI BISWAS
MARKETING
2016-2018.

SIES COLLEGE OF MANAGEMENT STUDIES , NERUL

NAVI MUMBAI-400706.
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 Declaration

I, Ms. Abdhini Biswas, studying in the second year of POST GRADUATE DIPLOMA IN PHARMACEUTICAL MANAGEMENT
(PGDM) at SIES College of Management Studies, Nerul, Navi Mumbai, hereby declare that I have completed the Capstone Project titled “A
STUDY OF PRODUCT CANNIBALIZATION “as part of the course requirements for POST GRADUATE DIPLOMA IN
PHARMACEURICAL MANAGEMENT (PGDM) pharmaceutical management.
I also declare that the work undertaken by me is original and has not been copied from any sources. I further declare that the information presented
in this project is true and original knowledge and has not been submitted to SIESCOMS or any other Institute for any other examination.

Date: 16th April , 2018

Name of the Student: Abdhini Biswas
Roll No.: 01

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 Certificate by Faculty Project Guide

This is to certify that Ms. Abdhini Biswas studying in the second year of POST GRADUATE DIPLOMA IN PHARMACEUTICAL
MANAGEMENT at SIES College of Management Studies, Nerul, Navi Mumbai, has completed the Capstone Project titled “A STUDY OF
PRODUCT CANNIBALIZATION “ as a part of the course requirements for POST GRADUATE DIPLOMA IN PHARMACEUTICAL
MANAGEMENT Program.

Prof. Rajesh Nair

Faculty Guide
Date: 18th April, 2018

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 Acknowledgement
I take immense pleasure in thanking the SIES College of Management Studies, Mumbai, Administrators and Faculty members for providing me
an opportunity to do my Capstone Project as a Project Researcher.

I wish to express my deep sense of gratitude to my Mentor, Prof. Rajesh Nair for guiding me throughout my project and for his wise suggestions
and crisp advice which helped me to complete the project in time.

I would like to thank Dr. Chitra Ramanan (HOD Pharma-Biotech) ,for her encouragement in carrying out this project work.
This project work has been a very good experience for me in the way that it has been given me a chance to understand the real aspects of
industries with concepts.

Abdhini Biswas

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 TABLE OF CONTENTS

Sr No Particulars Page No.

1 Project Rationale & Objectives 7

2 Scope & Purpose of the project 7

3 Review Of Literature 8

4 Cannibalisation w.r.t product categories 12

5 Approaching business model through cannibalisation 15

6 Cannibalisation in spinal implant market 20

7 Reverse innovation in capital instrument 28

8 Cannibalisation in VNA & Imaging market 30

9 Primary Research on Expanding a Product Portfolio 34

Without Cannibalizing

10 Key takeaway 42

11 Limitation 43

12 Conclusions 44

13 References & Appendices 45

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Objective
To study Product Life Cycle Management with the aid of Cannibalization Technique

SCOPE & PURPOSE OF THE PROJECT

 The project aims to understand product cannibalisation in medical device/biotech /pharmaceutical industry
 To understand the factors responsible for cannibalization with different product categories.
 The project aims to device strategies w.r.t to different business model and to tackle it.
 Approach of cannibalisation Insights on spinal implant market/VNA market& imaging market

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Literature Review

In industry, product lifecycle management (PLM) is the process of managing the entire lifecycle of a product from its conception, through
design and manufacture, to service and disposal. PLM integrates people, data, processes and business systems and provides a product information
backbone for companies and their extended enterprise.

Product lifecycle management (PLM) should be distinguished from 'Product life cycle management (marketing)' (PLCM). PLM describes the
engineering aspect of a product, from managing descriptions and properties of a product through its development and useful life; whereas, PLCM
refers to the commercial management of life of a product in the business market with respect to costs and sales measures.

Table 1: Stages of Product Life Cycle

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All products and services have certain life cycles. The life cycle refers to the period from the product’s first launch into the market until its final
withdrawal and it is split up in phases. During this period, significant changes are made in the way that the product is behaving into the market
i.e. its reflection in respect of sales to the company that introduced it into the market. Since an increase in profits is the major goal of a company
that introduces a product into a market, the product’s life cycle management is very important. Some companies use strategic planning and others
follow the basic rules of the different life cycle phase that are analyzed later.

The understanding of a product’s life cycle, can help a company to understand and realize when it is time to introduce and withdraw a product
from a market, its position in the market compared to competitors, and the product’s success or failure. For a company to fully understand the
above and successfully manage a product’s life cycle, needs to develop strategies and methodologies, some of which are discussed later on.

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Product cannibalization market is when a firm has multiple products that compete with each other in the same.
Negatives
The term product cannibalization has negative connotations. It implies that a firm has invested capital to develop new products only to take market share
from its own products. In some cases, large firms lack coordination between business units in areas such as product management and marketing. In other
cases, business units may actively compete with each other.
Positives
Some firms encourage business units to compete or intentionally develop similar products intended `to compete for the same customer segment. The
thinking is that it is better to compete with yourself than an actual competitor. A firm with multiple brands can give the impression of great variety in the
marketplace, even if they have a high market share with little competition.
Examples
An automotive firm that offers two models of large pickup truck.
A fast moving consumer goods company offers both a regular apple juice and an organic apple juice to customers under different brands.
A hotel spa sees bookings drop when the hotel opens a rooftop pool and bar with a view.
A restaurant sees a drop in wine sales when they begin to offer craft beers.
A software company loses customers for its business rule engine to its event processing product.
A solar panel company sees sales drop when it preannounces a future product that is far more advanced.

Cannibalization is a phenomenon that results when a firm develops a new product or service that steals business or market share from one or more of
its existing products and services. Thus one product may take sales from another offering in a product line. Although the idea of cannibalization may
seem primarily negative, it also has some positive implications. In the evolving world of E-commerce, some companies are intentionally choosing
to cannibalize their retail sales through bargain-priced online offerings.

POSITIVE AND NEGATIVE ASPECTS OF CANNIBALIZATION

Having a new product take sales away from an existing product is not usually an attractive situation for a firm. Clorox, for example, saw sales of
their bleach products suffer when they introduced laundry detergents with bleach as an added ingredient.
A new Subway sandwich franchise can cannibalize sales from another franchise just two miles down the street. Other examples of the power of new
products to harm companies or even entire industries are everywhere. In this case of cannibalization, a firm will need to reduce the benefit calculated for a
new product by the amount of the existing product benefit lost. However, firms need to recognize that cannibalization is not always avoidable. After all,
competing companies might have entered the market with a similar product and taken these sales anyway, even if the new product had not been

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introduced. Cannibalization can even occur before a new product is introduced. In fact, some experts claim that a pre-announcement for a new product
can cannibalize the sales of an old product in a prior period. hristensen calls the concept While cannibalization may seem to be very negative, several
researchers have found that truly innovative firms are sometimes willing to sacrifice or cannibalize their prior investments. In fact, this may be a type of
growth strategy. Professors Chandy and Tellis state that as digital-imaging technology replaces film cameras, Kodak could lose billions of investment
dollars in their film-based technologies—including plants and photo development processes. If firms like Kodak try to preserve the value of their
investments, they can risk making themselves obsolete. The best strategy is to embrace the new technology and make new products like digital cameras.
Some experts argue that organizations should encourage cannibalization. By encouraging competition among their stand-alone business units, companies
could create a climate in which risk taking and new ideas were both rewarded and valued. Having a future market focus and abandoning an old product as
soon as a new one comes along can benefit overall profits.
Some firms currently encourage the act of cannibalization and forced obsolescence. According to business writer Jerry Useem in an article for Fortune ,
Jack Welch refers to General Electric's Internet business units as "destroy-your-business.com," while Andy Grove talks about a "valley of death," and
Harvard Business School's Dr. C "survival by suicide."

CANNIBALIZATION AND THE E-ECONOMY

Changes in Internet upstarts are threatening to overturn successful technologies and business models of the past. Remaining competitive in this rapidly
evolving business environment may mean destroying the value of past investments—factories, relationships within a supply chain, or commitments to a
certain way of doing things. It may mean actively working to depress share price and profitability, even if these actions may go against a manager's training
or beliefs.
The Internet is making cannibalization a common phenomenon. As an example, Pet Smart, like Barnes and Noble and Toys 'R' Us before, launched an
online venture as a separate company. With this launch, they cannibalized sales at their brick and mortar stores, in some cases pricing online goods lower
than those in their stores. Other retailers are following similar strategies with Web-based versions of their retail stores. Bank One launched a completely
virtual bank, Wingspan Bank.com, with more attractive rates than Bank One. Changes in financial measures are necessary to embrace cannibalization. In
fact, return on investment measures may not be appropriate in the new economy.
In the trend toward intentional cannibalization, entrepreneurial companies often prevail through excellent innovation. Small firms are seen as quick and
nimble and better able to take the risks necessary to develop radically new product and service innovations. In the future, they may surpass the larger
firms with greater research and development capacities and financial resources.

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Capturing the new ‘value’ segment in medical devices

The growing demand for products that are “good enough” and competitively priced has pushed medical-product manufacturers to develop strategies to attract and
retain this new segment of customers.
The medical-device industry is facing challenging headwinds. As governments and health insurers worldwide implement measures to control costs, public hospitals
are operating on tighter budgets, while private facilities are receiving lower reimbursements. These measures are triggering a transformation of the purchasing
process that will change the way that medical products are bought and valued.

In the developed world, decisions that used to be the sole preserve of doctors are now also made by regulators, hospital administrators, and other non clinicians.
This broader set of influencers comes with different objectives (for example, the prioritization of cost effectiveness or even just costs). The result of this
phenomenon is a shift from individual outcomes to a focus on population-level effectiveness, such as the overall improvement seen within a population for a given
level of spending. Meanwhile, emerging markets, once seen as a safe haven for premium products thanks to their growing middle classes and rising investments in
healthcare, are leapfrogging developed economies and introducing cutting-edge purchasing processes and pricing mechanisms.

At the same time, the medical-products industry has become more competitive. Established blockbuster categories such as wound care, coronary stents, and
orthopedic devices are becoming more crowded as they mature. As high-impact scientific innovation in these categories has become harder to identify, smaller
companies, such as Draco in Germany, are gaining market share by offering very low prices and innovative business models. The greater price transparency enabled
by the growing use of tenders in Europe and the United States is giving an advantage to low-cost players like these.

All these trends are combining to create demand for products that are “good enough” and competitively priced. Our estimates indicate that this new segment is
growing twice as fast as the industry as a whole in some categories. Aware of the emerging opportunity, global medical-product manufacturers have been looking
to capture it and protect themselves from disrupters that could eventually move upstream—for instance, Mindray in China. However, few have yet managed to
build a sustainable business around the new segment while protecting their premium offering. Indeed, in some markets, manufacturers have offered heavy
discounts without sufficiently differentiating their premium offerings, leading to double-digit-percentage annual declines in pricing in some categories such as
stents.
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Before companies can develop a comprehensive strategy to serve value-oriented customers, they need to address tough questions about tiered portfolios,
differentiated offerings, go-to-market models, ways of working with customers, business development, M&A, cost of goods sold, and implications for the supply
chain.

Products and priorities for the new segment

The past few years have seen a rise in “value” customers—those who gravitate to products that are good enough and competitively priced. Unlike customers who
seek premium products, value customers are willing to sacrifice a degree of innovation, quality, and service in return for a lower price. This trade-off can be seen in
many different industries: Dunkin’ Donuts customers know the coffee will not have milk foam, and Ryanair passengers do not expect first-class service during
flights, for instance.

While value customers are concerned about price, they also have standards for product quality, efficacy, safety, and service. However, they are generally reluctant
to pay for additional features or services once their basic expectations of a product have been satisfied. Many recent medical-product tenders in Europe illustrate
the rise of the value customer. For example, in some regions of Spain, the technical specifications are rudimentary and account for only a small proportion—often
less than 20 percent—of the award criteria.

In industries such as apparel, automotive, and food, the value customer has been rising for more than a decade, and this has led to a clear “tiering” of brands and
offerings. As cost pressures continue to increase in the medical-product sector, we expect the value customer to have a similar effect—but only in certain
categories. Highly innovative products that have just entered the market will fall into the premium-differentiated category and still command high prices. But once
competitors emerge and offer similar products at much lower prices, customers will begin viewing the products as commodities. In categories with numerous
products and few differentiating features, customers may choose on the basis of price alone (Exhibit 1).

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 Exhibit 1

The value segment is more relevant in mature product categories.

At the moment, medical-device companies offer customers four levels of products and services:

 Premium differentiated. These products and services are differentiated by efficacy, outcomes, or care delivery and are usually supported by high-touch selling
and servicing models. Because they are innovative and provide proven benefits, they command high prices.

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 Premium undifferentiated.- Although incrementally innovative, these products and services are not clinically differentiated from competitors’ offerings.
Research suggests that this category will suffer intense erosion in price and share. The many premium companies that profit from these products because of
strong customer relationships or a brand image attractive to consumers will be at greatest risk .

 Value.- The features and services this group provides are tailored to meet customer expectations for good-enough products and usually sell at much lower
prices than premium products. The sales model for these offerings may involve online support or light-touch representatives who call on clients.

 Basic- These products do their job but offer minimal service. They compete purely on price and are often used in settings where providers seek to supply a
basic service rather than optimize outcomes. In McKinsey’s estimation, this segment is growing faster than the premium segment in many product categories.
However, is believed to offer fewer opportunities because it is more competitive and has lower profit margins.

Playing to win: Developing a strategy for the value segment -To win in the value segment, companies need to evaluate the likely risks and
economic impact of different business models to find the one that works best for their organization.

Deciding Cannibalisation on a business model

Armed with insights into market dynamics and promising product categories, premium players may feel they are sufficiently prepared to capture the value
segment. All too often, though, they lack a strong strategy for doing so. One common mistake is to offer significant discounts on premium products to respond
to market pressures, without doing enough to reduce costs structurally. Although this strategy may secure volumes in the short term, it has a devastating effect
on the longer-term viability of the product category—stents being a case in point.

As an alternative, it is suggested that companies entering the value segment adopt one of three business models focused on preserving profits:

 Lean-selling model. This approach involves designing the least expensive sales model possible and limiting service support. Low costs enable lower prices, for
instance, as seen in insurance, where the introduction of direct online sales with no broker involvement has enabled some companies to dramatically reduce
their costs and their prices. This model is suitable for medical products such as wound dressings and disposables with simple sales cycles, recurring purchases,
and limited service-support needs. It can also be used to manage products nearing the end of their life cycle after more innovative products have been
introduced. For example, Medtronic launched its spinoff NayaMed to sell end-of-life-cycle pacemakers and defibrillators through a web-based channel.

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 No-frills service. This model hinges on selling good products at lower prices by reducing service levels in areas such as distribution and clinical support. It differs
from the previous model in that it requires a strong sales organization focused on capturing new accounts. It is appropriate for product categories with a
complex sales cycle, high switching costs, and high service levels, such as orthopedic devices and negative-pressure wound therapy.

 Plain product-. In this model, companies offer low-cost products either by “de-engineering” existing premium products—removing high-end features to make
them cheaper to produce—or by developing new offerings. Their sales and servicing models are left intact. Renault’s low-cost Dacia car brand is one example of
this approach. In medical devices, it can be applied to two product categories: those that offer considerable scope for reducing the cost of goods sold because they
have a large number of components and processes, and those that have complex sales cycles or require critical servicing support, such as imaging equipment.
Carestream Health, which acquired OREX, a manufacturer of X-ray value products, to complement its portfolio of computed-radiography systems, is one
medicdevice maker that has moved into plain products.

Although these new business models seem straightforward, they require companies to make important decisions about underlying strategy, especially in
relation to five building blocks: product type, operational support model, sales model, clinical support and services, and brand name .

Exhibit 2
Companies need to weigh decisions on the building blocks for business models.

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Companies face a wide range of options but need to be realistic about whether they have the capabilities to develop a new value offering themselves or whether
suitable acquisition targets are available. Examining strategies that other players have adopted to enter the value sector can be a useful source of insights during
the decision-making process.

Getting the economics right

When companies are evaluating business models, economic concerns are paramount. Prices for value products can be 20 to 40 percent lower than for premium
products, so each model needs to be analyzed to establish how it reduces costs.

Exhibit 3 shows an analysis of a value wound-care product that was priced 30 percent lower than its premium counterpart. By adopting a lean-selling model, the
company expected to reduce its sales and servicing costs considerably, as well as to realize smaller savings in cost of goods sold, R&D, and distribution. Together,
these cost reductions would more than compensate for the product’s lower price.

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 One company expected cost savings from its lean-selling model. Assessing risks what ever business model companies select to enter the value segment, they
will need to address three main concerns:

 Minimizing cannibalization. New value products could win share from a company’s premium offerings and cut into its profits. Depending on the business
model the company has adopted, there are various measures it can take to counteract this risk. For instance, a company taking a plain-products approach must
ensure it has a deep understanding of premium customers and the features they prefer and ensure that these needs are not met by its value offerings. A
company with a no-frills service model must identify customers who are keen to reduce costs and might be open to lower service levels. Regardless of the
business model, companies usually benefit from using a dedicated lower-cost sales force to segment and target value accounts.

 Defending against the competition.-To gain a competitive advantage in value products, premium companies must reach scale quickly. Again, the best
path depends partly on the business model. Companies with a no-frills service model can use their brand-name credibility and existing account relationships to

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 differentiate themselves from other low-cost entrants. Companies following a lean-selling approach should ensure their pipeline is well stocked with new
products to avoid a situation where they offer only end-of-life-cycle products and competition is based solely on price.

 Remaining flexible- As market dynamics and customer needs evolve, companies must be prepared to re evaluate their business model. Those with a no-
frills service model should continue to look for opportunities to reduce service costs and simplify new and existing products to make service and maintenance
easier. Those following a lean-selling model may need to offer additional clinical support or more flexible inventory support for some key accounts. War gaming
or business-case assessment can help companies evaluate risks and opportunities. For instance, they could estimate the revenue flows from new-product sales
and the effect of cannibalization or increased competition on profits. War gaming can also help companies assess whether value products are likely to erode
their brand and damage their premium categories. To mitigate risks, companies can pilot new products and business models in one market to gain competitive
advantage and customer insights that can help them refine their strategies. In some circumstances, though, they may prefer to undertake a large-scale global
rollout to outpace competitors and capture first-mover advantage.
As decision makers become more cost conscious and competition intensifies, opportunities to serve value-oriented customers in medical devices are growing fast.
To adapt to this new world, manufacturers need a deep understanding of the value segment’s needs and profit pools. The key to success does not always lie in
changing the product itself but could involve altering sales models or service offerings. Companies should act now to determine what options are best for them and
create a business model to enable them to thrive in the value segment.

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MARKET INSIGHTS OF CANNIBALISATION BASED ON TYPES OF MEDICAL DEVICES

Spine Implant Market

The spine is perhaps the single most important part of the human body. It provides us with the support and flexibility we need to stand and
move about freely, or bend and twist with relative ease. It also houses the spinal cord, a column of nerves that connects the brain with the
rest of the body and gives us control of our movements. Without the spine, our bodies would be motionless cadavers with no real purpose.

Its various functions, however, make the spine extremely vulnerable to injury, possibly more so than any other body part. It is not surprising
then that technologies focusing on preserving the natural motion of the spine are becoming more popular with researchers and surgeons and
are driving growth in the spinal implant market.
“Motion preservation technologies are believed to revolutionize spinal surgery,” said Kamran Zamarian, president and CEO of iData Research,
an international market research and consulting group. “The market is expected to continue experiencing tremendous growth globally,
slowly cannibalizing spinal fusion procedures.”That cannibalization is expected to propel the U.S. market for spinal motion preservation
devices to a net worth of $2.54 billion by 2015, according to iData Research figures.

The spinal fusion market is not about to become extinct any time soon, though. Improvements in minimally invasive surgery (MIS) and an
increase in demand for the procedure will help drive growth over the next six years, an iData Research report concluded. The number of MIS
procedures, according to the report, is estimated to increase at a compound annual growth rate of 18 percent through 2015, with companies
such as Medtronic Inc., NuVasive Inc. and DePuy Inc. leading the charge.

Smaller firms such as Globus Medical Inc. are expected to capture some market share too, as an aging Baby Boom population increases the
need for minimally invasive treatments that work quickly to relieve back pain caused by arthritis or fractures. Globus attributed its record
third quarter (2009) revenues of $66.2 million on sales of products such as the Coalition System, Independence System and Signature MIS TLIF
Spacer system. The latter device includes an articulating implant that enables surgeons to utilize a single instrument—from insertion through
final placement—to deliver the spacer into the biomechanically ideal position through a portal or small incision while performing a

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transforaminal lumbar interbody fusion (TLIF) procedure.To gain a better understanding of the new kinds of technology that will be driving
growth in the spinal implant market over the next few years, Orthopedic Design & Technology with several industry experts who provided
their expertise on current market conditions, sector trends and the challenges currently facing orthopedic firms:

Overall market trends that have characterized the spinal implant market over the last few years-

a: The market is expanding. We’re able to gain access to the spine that is much different than in the past through novel minimally invasive
techniques. Ability to diagnose and recognize problems is improving, and the development of technologies to address these issues is also
expanding at a very rapid rate. People are getting older and are more active. It’s no longer acceptable to say to people, ‘do nothing’ or ‘don’t
try to exercise and be active’ or be ‘[don’t] be productive in society.’ Everything is changing. Understanding of technology is better and our
ability to do things is enhanced. With those basic principles, the market is showing expansion. More novel technologies are coming about and
being developed to address the underlying problems and functional challenges that people have. Simple things like MRI scans are getting
better. Our ability to understand what a finding may mean pathologically and functionally to a patient is enhanced. If we look at MRI scans 20
years ago, they were great—for the time—but their clarity has become better and we’re doing things like functional MRI scans [now].
Through years of research, it has become viable to look at certain patterns of problems, follow them and understand what they mean to the
patient.
b: There are three trends that have characterized the spinal implant market over the last few years: the continued dominance of fusion
related procedures; a handful of device introductions that spurred growth in fledgling product categories; and M&A [merger and
acquisition] transactions that transformed the industry. Approximately five years ago, it was widely believed that motion preservation
devices for the spine would soon transform the way physicians alleviate patients’ spine-induced pain. Major players such as Johnson &
Johnson’s DePuy, Medtronic and Stryker were paying hundreds of millions of dollars for artificial discs, a motion preservation device, that
were still several years away from receiving approval in the United States. These acquisitions encouraged the venture community to invest in
scores of start-up companies solely focused on motion preservation technologies, seeking to hit the next home run. Unfortunately for many
companies in the market, the majority of motion preservation technologies still have not received approval from the U.S. Food and Drug
Administration (FDA) or have encountered considerable hurdles in receiving reimbursement post-regulatory approval. Therefore, while
several years ago industry pundits were forecasting motion preservation technologies to expand the patient population and cannibalize the
fusion product category, that has largely Snot come to fruition yet and the market size for motion preservation technologies is just a fraction
of what it was projected to be.

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Within the motion preservation technology category there have been a few products in particular that spurred competitors to devise devices
with similar design and objectives. One example is the Dynesys from Zimmer, a pedicle screw-based dynamic stabilization device that
received 510(k) approval. While the Dynesys was approved as an adjunct to fusion, many surgeons used the device “off-label” as a motion
preservation device, and the product has become a commercial success with a reported run rate of more than $60 million in U.S. sales.
Witnessing this success, several companies patented similar devices, received 510(k) approval as an adjunct to fusion and began to market
them to surgeons; examples include Applied Spine’s Stabilimaxx BAR, Synthes’ Spine Ngarde and Vertiflex’s Dynabolt. In October 2009, the
FDA ordered 12 spinal implant manufactures to initiate collecting post-market data to determine the efficacy of these pedicle screw-based
dynamic stabilization devices for what they were cleared for, as adjunct to spinal fusion. Depending on the results of these studies, it may
deter other spinal implant companies from pursuing this regulatory path for this product category.

The composition of the companies participating in the spinal implant market has changed dramatically over the last several years. While the
top 5 companies still collect nearly 75 percent of the revenues generated in the United States, there are now more than 100 companies
developing and marketing products to orthopedic and neurosurgeons, a tremendous growth from just five years ago. A large percentage of
these companies were founded after the M&A frenzy in the artificial disc product category from 2002-2004 and after Kyphon’s 2006
acquisition of St. Francis Medical Technology and its lone commercial product, the X-Stop, for $750 million. These landmark transactions
encouraged the venture capital community to invest unprecedented amounts of capital in the spinal implant market in order to achieve
superior financial returns. However, given the current economic environment and new challenges facing spinal implant market, many
industry experts believe there is going to be a decrease in the number of new companies entering the spine industry. In addition, many spinal
implant companies have been forced to shut their doors in 2009, including Innovative Spine Technologies, Archus Orthopedics and Vertebron.

c:It seems like the spine market is interested in three major areas. The first area would be biologics to help in healing and help the hardware
that’s installed work better. Biologics would be one of the major trends which is evolving. The second would be minimally invasive spine
surgery—there’s a lot of interest in this area both for spinal fusion and certainly for treatment of vertebral compression fractures. And the
third would be searching for a non-fusion solution to the spine. Those are the three major areas that I’ve seen emerging over the last several
years in the spine market.

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Non-fusion solution-

Looking for a solution that would allow physicians to retain mobility in the spine, approximate what a healthy disc used to do before it
degenerated or became damaged and without having to fuse the vertebrae together. Finding the right solution that is useful across a broad
spectrum of patients and across a broad spectrum of surgeons that’s reimburseable has been elusive this far. But there’s certainly a lot of
interest in that area.

Key challenges currently faced by the market& how organizations overcoming these challenges:-

a: One of the key challenges is that the financial pot is not endless. Innovation, novelty, development and research are all extremely important, but those
things need to be cost-effective and incorporate evidence-based medicine. There’s a lot of “me-too” products, where a company develops a portfolio of
products to compete with the next company. That’s being done in parallel with true innovation. The “me-too” development doesn’t really advance the
market at all; it just advances somebody’s investment. The novel development is very important, but it needs to be done with an eye toward really
making a difference in a patient’s health and well-being. At some point a question has to be asked: You can develop a new widget to do something 5
percent better, but how does that really translate into a benefit for the patient? That’s part of the research process, so you need to make that
development and think about that development, but then you need to study it in a way that looks at patient safety, efficacy and the true functional gains
for patients. What you have now are competing interests for the R&D [research and development] dollar and for the spine market. Are we going to
support “me-too” products or change for the sake of getting around somebody else’s patent or are we going to support things that are truly innovative
and make a difference in patients’ lives? For a while the money has been great but with what’s been happening with the global economy, the money isn’t
great [anymore]. The talking heads in New York keeps on telling that spine market is ripe for development and expansion and there’s going to be glorious
profits. People were buying into that hook line and sinker. I think what’s going to probably happen is, like anything, there’s going to be some consolidation
or a contraction on the business side. But there will also be an expansion in real research that’s being done for true patient benefit.

b: The two largest challenges currently facing the spinal implant market are the lengthening and narrowing of regulatory and reimbursement pathways
and the limitation of financial capital for start-up companies, or those seeking to expand their operations. Spinal implant companies have been forced to

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re-evaluate their timelines and budgets to bring new products to market. From a regulatory perspective, as the new post-market studies required of
pedicle screw-based dynamic stabilization systems illustrates, even devices approved through a 510(k) are being scrutinized to a higher degree and
requiring more biomechanical and clinical data. Devices requiring premarket approval (PMA) have experienced significantly longer timelines as the number
of patients per trial has increased and the pace of enrollment has not met original targets, resulting in trials considerably over budget. From a
reimbursement perspective, the public and private insurance payers in the United States have been increasingly strict on approving compensation for new
devices under current codes and on creating new codes for truly novel devices. As an example, TranS1 is currently in a battle to receive a new
reimbursement code for its AxiaLIF because current codes are limiting surgeon adoption because it is not easily reimbursable. Lastly, given the current
economic environment, companies have been forced to advance devices further in development on less capital than just a couple of years ago. The
venture capital community has largely pulled back from investing in startup spinal implant companies and many firms have re-evaluated all current
portfolio companies to determine if each is viable in the new economic and competitive environments. All spinal implant companies are confronted with
these challenges to some degree and strategies are emerging to address them. Due to the new regulatory and reimbursement environment, companies
are spending more time and resources to determine what device categories have a suitable risk/reward ratio. Further, if a new device is approved for
development, companies are focusing as much on obtaining favourable reimbursement rates as they are on regulatory approval, which was certainly not
the case five years ago. Companies are now designing “health care economics” into trials by more diligently tracking improvements such as return-to-work
which can significantly reduce the total financial expense to treat a condition. Market participants need to prove that while the cost of their spinal
implants may be a substantial portion of a surgical procedure, in the long run, this course of treatment is the least expensive and provides the patient with
the best clinical results.
Concerning the capital environment, private companies have had to reduce cash burn considerably by rationalizing all expenses in order to lengthen their
runways as long as possible. By doing so, it may be possible to survive until the capital markets improve, or even reach profitability without raising
additional capital. As Archus Orthopedics bankruptcy has illustrated, even after raising more than $72 million, there is a considerable amount of risk in
pursuing a one-product strategy that relies on receiving a PMA to market in the United States. By cultivating a product portfolio of traditional spinal
hardware, augmented by innovative devices requiring investigational device exemption (IDE) clinical trials, appears to be a more reliable strategy for
success in today’s market conditions.
c: looking at the three areas of interest, each one of those areas can be representative of the overall schematic challenges that spine companies face. If
you look at the biologics area, one [challenge] would be the long regulatory timelines requiring complex clinical trials in some cases where good guidance
documents and clinical protocols don’t exist yet. If you take a look at the minimally invasive [area], the challenges there are less than biologics for

24
regulatory and more around training, developing good surgical techniques that can be done reproducibly, and securing reimbursement for some of those
techniques. [With] discs, [the challenge] has been one of searching for the right technology and the development of reimbursement. If you look across all
three major areas, the major challenges would be the regulatory and complexity in clinical trials that are going to be required now and in the future, and
securing reimbursement for new technologies, which is going to be based on a true value proposition that includes an economic value proposition and is
supported and driven by clinical data. Those are the major areas of complexity facing spine companies today. And all of that is required to develop
differentiation. To develop truly novel proprietary technology that offers benefits to patients and surgeons and is truly differentiated, you’ve got to focus
on not only the R&D side but on the clinical trial, regulatory development and reimbursement environments as well.

Driving innovation in the spinal implant market:

a: What drives innovation in anything? There is an unmet need or a problem that needs to be solved. Those are some of the best ideas that come about.
The other thing is the potential for profit, and that’s not unique to the spine world. Some of the drug innovations would be great but there’s no profit in it
so they don’t go anywhere. Other drugs are developed because there’s huge market [potential]. The aging population is really going to present a challenge
to us because people are going to live longer. They are going to want to be more active, and they’re better at taking care of their overall health.
Osteoporosis, arthritis and maintaining functional capabilities are going to be more of an issue because there’s simply going to be more people that are
living longer and are healthier. The operation you may do in a 30-year-old laborer to help a certain spine condition may not be the right operation for a 75-
year-old that isn’t a laborer but wants to be physically active and involved in exercise or day-to-day activity. People want to be active and have the ability
to do so. But there are challenges with the 75-year-old compared with the 30-year-old—there’s arthritis that is not present in the 30-year-old, there’s a
degree of osteoporosis, there’s mobility issues and compensatory mobility issues. The older person doesn’t have the reserve that a younger person does
to recover. An operation or a procedure is a tool. Using that tool for the 30-year-old may look okay on an X-ray and it may be okay for the patient as a
whole. But applying that tool to the 75-year-old because of those other challenges related to osteoporosis, impaired mobility, and impaired reserve may
not be the right thing to do. You have to be able to adjust what you do to match the patient and the [patient’s] specific needs. That’s where true
innovation comes in.

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New technologies have been or are currently in development for spine surgery with advantages and disadvantages of
these newer procedures compared to existing ones:

a: Device categories receiving a substantial amount of attention from the spine and venture communities include diagnostic devices and minimally invasive
approaches. As mentioned in the discussion regarding what is driving innovation in the spinal implant market, the accurate, reliable diagnosis of what
specifically is causing spine induced pain is still largely a mystery. While X-rays and even MRI scans may be helpful in deducing some spine conditions,
more sophisticated devices and methodologies are necessary to confidently conclude the cause and severity of most spine conditions. Due to this need,
several companies are in the process of developing and commercializing new devices and methods to provide better diagnostic tools to the physician
community. If technologies can be proven to be accurate and reliable, physicians are able to address the source of pain earlier in the continuum of care
and thousands of dollars can be saved in unnecessary or inappropriate surgical treatments. Further, due to the non-invasive nature of diagnostic
procedures, the risk to the patient is minimal. The development of minimally invasive procedures to treat spine conditions has advanced considerably over
the past several years. In contrast to motion preservation devices which require extensive IDE clinical trials, minimally invasive devices and
instrumentation can typically be approved through the less rigorous 510(k) pathway with the FDA, significantly reducing the time to market and cost of
development. The alleged benefits of MIS include shorter hospital stays, more rapid return to work for patients, and superior cosmetic results. The
disadvantages include steeper learning curves for surgeons and the amount of radiation exposure a patient receives if the surgical procedure is
significantly extended. As more data is collected on procedures performed through minimally invasive means, spinal implant manufactures will continue to
refine and improve these systems for the surgeon community.

b: Orthovita has a great new technology for patients who are a little bit older than 65. We just got FDA approval for a bioactive bone augmentation
material called Cortoss. It’s the first new injectable, settable polymer designed to fix fractures [that has been] invented and FDA cleared in 50 years. It’s the
only alternative biomaterial available other than Poly(methyl methacrylate) bone cement which has been around since the ’50s. It was approved in June
2009 for treatment of vertebral compression fractures. We ran the largest, most rigorous vertebral compression facture clinical trial that resulted in some
great clinical data. We’re currently in the process of launching and rolling that product out. It’s a new technology that’s targeted at patients that tend to be
older, perhaps have osteoporosis and are in need of fracture fixation in their spine.

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Is this product strictly for older patients or can it be used on younger patients as well?

It certainly would work on patients that are younger. But one of the major factors in fixing compression fractures of the spine causative effects is due to
osteoporosis and that tends to be a patient population that’s older. However, Cortoss certainly would be able to treat younger patients that have fractures
of their spine as well. In fact, the profile of Cortoss is quite a bit different than the older technology PMMA bone cement in that it doesn’t release any
MMA [methyl methacrylate] monomer, it’s got a bioactive ceramic component to it and bone tends to grow to it. So it would definitely be a good implant
choice for younger patients.

Is Cortoss used only for spine fractures?

Right now, it’s been (FDA) approved for use in the spine. But it can be used in other parts of the body. In fact, we are currently studying opportunities to
expand the label outside of the spine into other areas of the skeleton. Hopefully we’ll have some more to say about that publically at some point in 2010
once we develop our label expansion strategy. We’re not going to promote off-label use.

What possible impact will healthcare reform have on the spinal implant market?

a: There’s going to be limited dollars to take care of healthcare. Where do you spend those dollars? Things that are high-priced that have a relatively
narrow impact are probably not going to be the ones that survive. The things that are going to be embraced are the ones that are both cost-effective and
beneficial together. Some of the research and development may not happen because there’s no money to do so. Who’s going to pay for the application of
this stuff? There’s going to have to be studies done in patients. Who’s going to pay for that? It just may not happen. People like to do a little comparison to
some of our colleagues that have limited access to [healthcare] funds in different countries. Some of those countries don’t have the research and
development or the evolution of procedures and techniques because there are no resources to do so. The places where a lot of this is occurring is in
countries that don’t grace that type of expenditure right now. You see that coming out of the United States, you see that coming out of Japan. You see it
coming out of Germany or South Korea. There are certain people there that can innovate, do things outside the box and study things in patients, and do so
in a system that supports it. There is a limited supply of money; it’s not endless. There are going to have to be some decisions made as to what we value
and what we’re willing to spend on it.

b: What type of healthcare reform that passes will obviously determine what the impact is on the spine market. Reform that modifies or expands the
current healthcare system to be more inclusive to those who are uninsured or underinsured may bring tens of thousands of additional patients into the

27
physician’s office for treatment. [That is] a tremendous opportunity for the spinal implant market, even if the reform requires costs to be held flat or be
reduced over a reasonably period of time. However, if legislation passes that considerably reduces the economic incentive to spinal implant manufacturers
or physicians, there may be negative consequences. First, if spinal implant manufacturers are not rewarded for spending millions of dollars and years of
development on new devices and methods to treat the spine, then the number of innovative devices will decrease dramatically and the implant market
will be commoditized by a handful of market players. Second, if payments to physicians for performing spine surgery is severely reduced, then students
currently in medical school may be lured away to other areas of medicine that compensate them for the hundreds of thousands of dollars [spent] and
years of medical training. Ultimately, this may result in a dramatic shortfall in qualified spine surgeons in the next 10-20 years. The issue of healthcare
reform is being closely monitored and opined on by physician groups such as the Spine Arthroplasty Society and commercial interest groups such as
AdvaMed.

Reverse innovation way to tackle cannibalisation –

Is any innovation that is adopted first in the developing world. Such an innovation has the potential to defy gravity and flow uphill to rich countries. The
fear of cannibalization is often used as a weapon against reverse innovation projects. That is because they aspire to deliver performance roughly
comparable to that of a company’s higher-priced offerings, but at a dramatically lower price—obviously a red flag for such fears.We are likely to see the
reverse innovation phenomenon in a wide range of industries such as ultra-low-cost transportation, renewable energy, clean water, micro finance,
affordable health, low-cost housing, and many others. There is certainly a cost of cannibalization, but there is also a cost of inaction. In the case of reverse
innovation, the cost of inaction is much higher than the cost of cannibalization. Unless the chief executives of Western multinationals can overcome their
fears of cannibalization, they are likely to be disrupted by emerging market giants.

EXAMPLE -Taking the case of General Electric. In the 1980s, GE's CEO Jack Welch ramped up the company’s investment in ultrasound, a lower-
cost medical diagnostic technology whose image output was primitive compared with GE’s more technically sophisticated lines of CT-scan and
MRI machines. In part, Welch wanted a hedge against the possibility that ultrasound might one day threaten GE’s lucrative business in those
big-ticket items. If and when that day arrived, GE would have a stake in the successor. This, in essence, is the practice of foresightful self-
cannibalization—a useful element of strategy despite the word’s unfriendly meaning.

Leaders of reverse innovation efforts should be prepared to address cannibalization concerns. There are four basic ways of responding:

 “The goal of reverse innovation is to create products or services that address the unmet needs of emerging-market populations
that are not already our customers. We are making more-affordable products for a new set of customers who will never buy our
existing offerings.” For that reason, there is really no immediate threat of cannibalization. GE Healthcare has been a leading

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 supplier of big, powerful, premium-priced ultrasound scanners since the 1980s. Looking to stimulate growth, the company created
a sales-and-distribution center in China with the goal of distributing global products locally. This was a classic "glocalization" move.
After ten years in the market, GE Healthcare was unable to unlock China’s potential. Sales were a mere $5 million—negligible in GE
terms—and growth was slow. It remained a marginal player. When glocalization fails to serve emerging markets’ unique unmet
needs, reverse innovation is the only option. In 2002, GE innovated a portable, easy-to-use, ultra-low-cost ultrasound scanner that
was able to address the unique market needs in China. Today the portable ultrasound machine is the growth engine for GE’s
ultrasound business in China.

 “Yes, it’s true that there’s a plausible risk of cannibalization. But technologies mature rapidly, and new technologies replace
them. We will be outflanked if we don’t pursue these opportunities. And isn’t it better to cannibalize ourselves than to let a
competitor do it?” Between 2002 and 2011, GE improved the image quality of compact ultrasound devices to the point where
mainstream consumers in the developed world became increasingly intrigued. High-price PC-based premium portable models
can now perform cardiology, radiology, and obstetrics functions that once required much more expensive machines. Between
2002 and 2011, worldwide sales from portable ultrasound products skyrocketed from $5 million to about $280 million, an
average annual compounded growth rate of about 50%.

 “We see opportunities to take elements of what we have created for emerging markets and offer them to our customers in the
developed world. But we will do this in a way that doesn’t undermine successful existing products.” When Procter & Gamble
developed Naturella, a new feminine-hygiene product for women in emerging markets, it positioned the product as an
unthreatening complement to its successful rich-world Always brand. Within the company, Naturella was known as the “anti-
Always”—so thoroughly differentiated that cannibalization seemed a remote possibility. Now, however, P&G is looking at ways
of incorporating Naturella into its rich-world product mix, perhaps as part of a “variety pack” geared to meet women’s
changing needs during menstruation.

 “For some customers in certain rich-world locales, our business model could benefit from an alternative approach. Therefore,
we would like to bring home an idea that has been very successful in emerging markets.” In Mexico and other Latin American
markets, where big-box stores don’t suit the way local consumers shop, Wal-Mart began opening so-called small marts, scaled
to the familiar dimensions of local bodegas (grocery stores). These proved popular and inspired the company to adopt the
same model in New York and other large U.S. cities where the big-box approach was less popular and the necessary real estate
prohibitively expensive. In such environments, it’s better to have a dozen small stores that fit into their neighborhoods than
one or two big boxes that might clash or stick out. This alternative business model might look like cannibalization. But instead
of replacing the big box, it provides flexibility where big boxes don’t make sense.

Cannibalization is a complicated question, and it’s reasonable not to risk it without first weighing the pros and cons. But it would be unwise to
let the fear of cannibalization close the window on rich opportuniess
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Cannibalisation In VNA &Imaging Market
Following an initial period of uncertainty, Vendor Neutral Archives (VNA) are now better understood by health providers, and more available.
Moreover, their introduction and adoption signalled a market transition, expanding the focus of providers and vendors to the management
and use of clinical content thus far excluded by electronic medical records.
However, after an initial uptake flurry, market momentum and provider focus has slowed. Based on the findings from our recent coverage of
the global market for imaging IT and archiving management, we dig into the outlook for VNA and the biggest factors driving this market.

The Rise of Enterprise Imaging

Enterprise imaging products, which bundle together traditional PACS functions with enhanced clinical content management capability, are
rapidly gaining momentum. Many of the major incumbent PACS vendors now offer enterprise imaging capability, usually through the addition
of a VNA, universal viewer and specific enterprise features, such as federated case load management, operational analytics and business
intelligence. This approach has appealed to the core customer base of traditional single-vendor PACS users, especially in mid and large-size
hospitals and large provider networks, as a single platform can in theory handle their imaging IT needs while bringing in wider clinical content
(e.g. non-DICOM data such as visible light images and .wav electrophysiology recordings) that until now was handled in separate, siloed
applications.

30
As the figure above shows, enterprise imaging is forecast to cannibalise global market revenue from standalone imaging IT and standalone
VNA. While the nuances of adoption in each provider segment and geography are complex, three themes underlie this trend:
A large proportion of demand from mature markets for enterprise imaging is driven by upgrades of existing PACS and RIS systems, especially
for the largest PACS incumbents.
Many providers favour a single vendor approach for the core imaging IT platform, especially due to concerns around interoperability and
length of implementation of multi-vendor solutions.

The largest enterprise imaging vendors have influence in the wider clinical setting (e.g. modality hardware and clinical care products) and
position themselves as a long-term clinical IT partner. This is also opening the opportunity for more innovative contracting (operationalised
budgets or risk-sharing contracting).
With almost all leading enterprise imaging products on the market today, VNA plays a significant role as the underlying enabler for storage
and management of imaging and broader clinical content.

While it is very difficult to accurately capture the proportion of revenues from enterprise imaging deals attributed to the VNA (most deals are
sold as a single platform)

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Consolidation…

A further notable market impact is the dwindling availability of “independent” VNA products on the market. Following a flurry of M&A activity
in the last five years, the competitive structure of the VNA market has consolidated significantly.

Leading vendors such as Acuo (now part of the Hyland portfolio), TeraMedica (now Fujifilm), Karos Health (now Vital Images) and Viztek (now
Konica Minolta) have all been integrated into much larger organisations, leading to greater opportunity to package their VNA capability into
enterprise imaging platforms. This has had two major consequences in the last few years, notably a slowing of product innovation (due to
having to integrate into a wider portfolio), and a shift in focus towards servicing and protecting the existing customer base of the acquirer,
rather than winning new business.

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The remaining independents, NTT Data (formerly Dell Services), Mach7 Technologies and Bridgehead Software, have also had to evolve to
compete, expanding their focus from pure VNA. Some now boast portfolios including universal viewers, workflow tools and image exchange
products, in a bid to cater for both the enterprise imaging demand and “deconstructed PACS” customer base.Such market fluidity and
blurring of vendor focus and product portfolios has certainly had an impact on the market. Providers have more choice, leading to longer
assessment of vendor capability. Combined with expansion of clinical content handling and the required inter-departmental co-ordination,
provider decision making is slowing, compared to single solution sign-off. VNA specialist focus has been expanded from just archiving and
management, a challenge for small to mid-size specialists with limited R&D resources.

…at a cost?
Looking forward, consolidation is expected to continue, leading to a smaller pool of clinical content IT platforms for providers to choose from,
mostly based on the enterprise imaging model. However, from a VNA perspective, this has a downside. Few of the integrated VNA solutions
offered as part of these platforms lead the way from a technological standpoint.

Rigorous standards adoption (e.g. XDS) or more advanced technological capability (e.g. dynamic tag morphing, intelligent information lifecycle
management, performance analytics, load balancing, etc.) is scarce in most solutions offered today, and some remain bugged by
interoperability issues, a by-product of their being pieced together from disparate, legacy modules. Therefore, while enterprise imaging
adoption looks set to dominate the VNA market over the next five years, much of the promise of VNA in improving cross-enterprise clinical
content capture, access, management and storage will fail to be realised.

33
Secondary research

Best Practices in Expanding a Product Portfolio Without Cannibalizing an

Established Pharmaceutical Brand

Research Overview: Objective & Key Topic Areas

Best Practices, LLC conducted this research to identify successful strategies and practices used by biopharmaceutical and medical device company
managers and executives to avoid uncontrolled brand cannibalization and maximize

Objective: the potential of multi-drug portfolios or franchises.StuObjective & Methodology

This benchmarking study was designed to identify effective strategies and tactics for marketing multiple
brands for the same indication or area of use.
Special attention was given to strategies for managing resources and for avoiding or controlling product
cannibalization.

34
Methodology:
Best Practices, LLC used an online survey instrument to collect quantitative data. Research analysts also
conducted in-depth interviews to collect executive insights and to harvest best practices and lessons
learned.Covered


Effective methods of differentiating multiple brands

Positioning strategies that minimize product cannibalization

Operational changes that drive success when introducing a new brand into a product family

Positive & negative impacts of introducing a new brand

New product’s share of the combined marketing spend during first three years both are marketed

Marketing mix for new & legacy products

Marketing activities that drive continuing success for legacy brand

Best indicators of marketing effectiveness

Pitfalls, failure points and best practices

35
36
37
38
39
40
41
Key takeaway -:

1. Benefits of New Brand: Most benchmark participants realized benefits from introducing a new brand
where they already had a legacy product. Top among those benefits were market leadership,
expanded market share and improved reputation with physicians and specialists.

2. Negative Impacts: There can be negative impacts in introducing a new brand for the same indication or
area of use as a legacy brand. The most common of those include creating product confusion among
internal and external stakeholders.

3. Minimizing Cannibalization: Benchmark partners successfully use more than a dozen different strategies
to control or minimize product cannibalization. Targeting different patient subtypes and aligning with
thought leaders are viewed as the most effective of these.
.

42
Limitations –

 Cannibalization is not always avoidable.

 Competing companies might have entered the market with a similar product and taken these sales
anyway.
 Cannibalization can even occur before a new product is introduced.
 Experts claim that a pre-announcement for a new product can cannibalize the sales of an old product
in a prior period.
 Cannibalisation may have negative impact in the long run though initiated for positive outcome.

43
Conclusion-
.

 It is considered as a type of growth strategy

 Organizations should encourage cannibalization.
 By encouraging competition among their stand-alone business units, companies could create a
climate in which risk taking and new ideas were both rewarded and valued.
 Having a future market focus and abandoning an old product as soon as a new one comes along can
benefit overall profits.
 Some firms currently encourage the act of cannibalization and forced obsolescence
 In the trend toward intentional cannibalization, entrepreneurial companies often prevail through
excellent innovation.
 Small firms are seen as quick and nimble and better able to take the risks necessary to develop
radically new product and service innovations
 Understanding the value segment and deciding cannibalisation on business model is

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References & Appendices :-
This article is by Vijay Govindarajan, the Earl C. Daum 1924 Professor of International Business at Dartmouth’s Tuck School of Business. He
was the first professor-in-residence and chief innovation consultant at General Electric. His new book, written with with Chris Trimble,
isReverse Innovation: Create Far from Home, Win Everywhere
Read more: http://www.referenceforbusiness.com/small/Bo-Co/Cannibalization.html#ixzz59YSVWGHV
http://incentius.com/blog-posts/sales-cannibalization-what-you-may-have-overlooked/
https://en.wikipedia.org/wiki/Cannibalization_(marketing)
http://www.investinganswers.com/financial-dictionary/businesses-corporations/market-cannibalization-1817
http://drvidyahattangadi.com/is-cannibalization-good-or-bad/
https://www.signifyresearch.net/healthcare-it/vna-market-growth-will-fuelled-enterprise-imaging/
https://www.prnewswire.com/news-releases/spinal-implants-and-spinal-devices-market-by-product-technol

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