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ICS Questionnaire

TRACK CODE DATABASE NO. ON LINE RECORD NO.

MONTH / WEEK

HRG/CENTRE/YEAR/JB NO./MONTH QUESTIONNAIRE
For office use only: Q’re SL. NUMBER [WITHIN CENTRE] STARTING POINT NUMBER CONTACT NUMBER [WITHIN STARTING POINT] HOUSEHOLD NUMBER [WITHIN STARTING POINT] Center Mumbai Code 01
RANDOM

0

1

[1-8] [11-13] [14-15] [16-17]

Center Delhi

Code 02
1

Center Kolkata

Code 03
BOOSTER

Center Ahmedabad
2

Code 04
[18-19] [20]

Name of the Respondent: Address of the selected Household
Flat. No. Bldg/Block No.

Street Name : Area Name : Landmark : 0 0 PIN CODE :
[2131] [3242] [43-49] [50-56]

Landline Phone No. with STD Code Mobile No. with STD Code Email ID Name of Interviewer Name of Supervisor Date of interview
D D M M

Int. No. Sup No. Start time
Y Y H H M M

End time
H H M M Rate Qualit y (out of 10)

[57-70]

By

QC Srutinized

Yes 1 1 1 1 1 1

No 2 2 2 2 2 2

Name

ID No.

Sign

Date

[71-80] [81-90] [91100] [101110] [111120] [121130] BH ZH NH CL [131140] [141150] [151160] [161] Name Sign Date [162] Scrutinizer No.
[163165]
[166167]

Supervisor

Accompany Backcheck Srutinized

Executive

Accompany Backcheck

Srutinized
BH / ZH / NH/CL

1 1 1 1
Yes

2 2 2 2
No 2

1 1 1 3 NA

2 2 2

3 3 3

4 4 4

Accompany Backcheck

Open ended questions translated

FOR TABULATION Scrutinized [Tab. Supervisor] Name of Tab Scrutinizer Initials of the Coders - [Open ended] CWE Detail Name of CWE Age Designation Name of organization Mobile No. E mail ID QUOTA DETAILS 0 Sex M F Education Industry SEC [173174] [175185]
[168172]

1

Rate Qnr Quality (Out of 10)

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etc. -10 for a 10% decrease. 10 for a 10% increase.ICS Questionnaire Stent Usage Trends Q1 Are you a board-certified interventional cardiologist currently performing angioplasty (PCI/PTCA) procedures that include the placement of stents? SC Yes No 1 2 TERMINATE Q2 How many stent procedures do you or your practice perform in a typical year? ______ stent procedures INST: [Terminate if less than 50] Q3 Where do you currently practice? SC India South Korea Australia / New Zealand Japan Brazil Russia China Other: 1 2 3 4 5 6 7 8 [Terminate] Q4 For how many years have you been an interventional cardiologist? ______ years Q5 Approximately how many angioplasty (PCI/PTCA) procedures did you or your practice perform in 2010? ______ procedures Q6 How do you expect the number of angioplasty (PCI/PCTA) procedures you performs to change in 2011? Please answer as a percent change (e.g. ______ % Q7 What do you expect the percent change to be in 3 years (e.. ______ % Page 2 of 7 . -10 for a 10% decrease. etc. 0 for no change.)? ______ % Q8 When would you anticipate this trend stabilizing (i. 0 for no change. what % included the placement of stents? ______ % Q10 How do you expect the number of stents you or your practice places during PCI/PCTA procedures to change in 2011? Please answer as a percent change (e. 10 for a 10% increase.g.. flattening at 0% change)? Never In the next 6 months In 7-12 months In 1-2 years In 3-5 years In 6-10 years More than 10 years from now 1 2 3 4 5 6 7 Q9 Of the {Fill from Q5 Answer} PCI/PCTA procedures you or your practice performed in 2010. 10 for a 10% increase.g. -10 for a 10% decrease.. 0 for no change.). etc..e.).

. ______ Drug eluting stents (DES) ______ Bare metal stents (BMS) Q15 Do you currently use bioabsorbable stents? SC Yes No 1 2 Answer If Do you currently use bioabsorbable stents? Yes Is Selected Q16 In 2011.. ______ Drug eluting stents (DES) ______ Bare metal stents (BMS) Q13 In 2011. what percent of you or your practice’s stent placements do you expect to be drug eluting stents (DES) and what percent do you expect to be bare metal stents (BMS)? May sum to over 100% due to placement of both DES and BMS in a single procedure. etc. what perce.) ______ % Page 3 of 7 . Drug eluting stents (DES) Is Greater Than 0 Q18 In stent procedures with DES. -10 for a 10% decrease.. 10 for a 10% increase. what percentage were drug eluting stents (DES) and what percentage were bare metal stents (BMS)? May sum to over 100% due to placement of both DES and BMS in a single procedure. -10 for a 10% decrease..)? ______ % Q12 Of the stent placements you or your practice performed in 2010. what do you expect the % breakdown of your stent usage to be for bioabsorbable stents vs. DES? ______ Bioabsorbable stents ______ DES Q17 Five years from now. 0 for no change.g.g. what do you expect the % breakdown of your stent usage to be for bioabsorbable stents vs. 0 for no change. what perce. DES? ______ Bioabsorbable stents ______ DES Answer If Of the stent placements you performed in 2010. etc. Drug eluting stents (DES) Is Greater Than 0 Q19 In stent procedures with DES. how many stents do you typically place per patient? ______ stents per procedure (per patient) Answer If Of the stent placements you performed in 2010... how do you expect the number of stents you typically place per patient to change over the next 3 years? Please answer as a percent change (e.ICS Questionnaire Q11 What do you expect the percent change of stent placements to be in 3 years (e. 10 for a 10% increase. what percentage of your stent placements do you expect to be drug eluting stents (DES) and what percentage might be bare metal stents (BMS)? May sum to over 100% due to placement of both DES and BMS in a single procedure. ______ Drug eluting stents (DES) ______ Bare metal stents (BMS) Q14 Three years from now.

etc. 10 for a 10% increase. -10 for a 10% decrease. Bare metal stents (BMS) Is Greater Than 0 Q21 In stent procedures with BMS.001 . Resolute) Abbott Vascular (Xience) Boston Scientific (Taxus Liberte. 150. 75.000 (10) 10 10 10 Don't know (11) 11 11 11 Q29 Which of the following companies' product offerings are you familiar with?Please select all that apply.000 (8) 8 8 8 Rs.000 – Rs 75. 150. 100.000 (6) 6 6 6 Rs. 200.000 (4) 4 4 4 Rs.g. how many stents do you typically place per patient? ______ stents per procedure (per patient) Answer If Of the stent placements you performed in 2010. Promus Element) Biosensors International (BioMatrix Flex. 50. Bare metal stents (BMS) Is Greater Than 0 Q20 In stent procedures with BMS.001Rs.001 – Rs. 225.Rs. 125. Resolute) Abbott Vascular (Xience) Boston Scientific (Taxus Liberte.000 (1) DES BMS Bioabsorbable stents 1 1 1 Rs.001 – Rs. where 1 = HIGH quality and 4 = LOW quality. 200. 50.000 (2) 2 2 2 Rs.. 250. 0 for no change.001 . what perce. 250. 175.Rs.. what perce.001 .000 (7) 7 7 7 Rs.000 (3) 3 3 3 Rs. Axxess) Lepu Medical Technology (Patner) Microport Medical (Firebird 2) Local Competitor (please specify) ________________________ Local Competitor (please specify) ________________________ Local Competitor (please specify) ________________________ 1 2 3 4 5 6 7 8 9 10 ASK Q30 TO ALL THOSE CODED IN Q29 Q30 Please rate the quality of each company's product offerings on a scale of 1 to 4.ICS Questionnaire Answer If Of the stent placements you performed in 2010. HIGH quality 1 1 1 1 1 1 1 1 1 1 LOW quality 4 4 4 4 4 4 4 4 4 4 J&J Cordis (Cypher) Medtronic (Endeavor. Promus Element) Biosensors International (BioMatrix Flex.. 175. 225. J&J Cordis (Cypher) Medtronic (Endeavor. Axxess) Lepu Medical Technology (Patner) Microport Medical (Firebird 2) Local Competitor (please specify) ________________________ Local Competitor (please specify) ________________________ Local Competitor (please specify) ________________________ 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 Page 4 of 7 .000 (5) 5 5 5 Rs. 100. how do you expect the number of stents you typically place per patient to change over the next 3 years? Please answer as a percent change (e.000 (9) 9 9 9 More than Rs.. ______ % Q23 What is the average price paid per stent for the following? Less than Rs.. 125.Rs.001 – Rs.).

and local stents? Please select all that apply.Brand 1 Local companies . what percent. established Chinese companies. BRAND NAME Multinational Corporations .Brand 2 1 2 3 4 5 6 Page 5 of 7 ... what percent. and local companies.. Drug eluting stents (DES) Is Greater Than 0 Q31 Please list up to 3 DES brands you have tried: 1 2 3 1 2 3 Answer If Of the stent placements you performed in 2010. Quality of product Brand Quality of service Price Reimbursement Government or Hospital Regulations Product Features Clinical Efficacy/Safety Clinical/Economic Evidence Other (please specify) ________________________ 1 2 3 4 5 6 7 8 9 10 Q37 What are the major 1 or 2 brands you prefer from each category? Please leave any field blank for which you have no applicable answer.Brand 1 Established Chinese companies such as Lepu Medical. or feel are additional reasons for the change in the percent use of MNC. Microport and Biosensors . Microport and Biosensors . Bare metal stents (BMS) Is Greater Than 0 Q32 Please list up to 3 BMS brands you have tried: 1 2 3 1 2 3 Q33 What percentage of the stents you or your practice uses are from each of the following? % 1 2 3 Multinational Corporations Established Chinese companies such as Lepu Medical. Microport and Biosensors Local companies Q35 Please explain the reasons why you anticipate the above changes between the percent use of stents manufactured by MNCs. Microport and Biosensors Local companies Q34 What do you expect to be the breakdown 3 years from now? % 1 2 3 Multinational Corporations Established Chinese companies such as Lepu Medical.ICS Questionnaire Answer If Of the stent placements you performed in 2010.Brand 1 Multinational Corporations .Brand 2 Established Chinese companies such as Lepu Medical. Q36 Which of the following factors did you indicate in your response to the previous question.Brand 2 Local companies . Chinese.

ICS Questionnaire Q38 How do you see your brand preference changing going over the next few years? SC No change in preference Prefer MNC brands over Chinese and Local Brands Prefer Chinese brands over MNC and Local brands Prefer Local brands over MNC and Chinese brands 1 2 3 4 ASK Q39 IF 2/3/4 IS CODED IN Q38 ELSE SKIP TO Q40 Q39 Please explain why you see your brand preference changing as indicated in your response to the previous question. or both covered by reimbursement? SC PCI/PCTA product is covered by reimbursement PCI/PCTA procedure is covered by reimbursement Both the PCI/PCTA product and procedure are covered by reimbursement 1 2 3 Page 6 of 7 . Please rank so that 1 = the STRONGEST influence and 9 = the WEAKEST influence. Please rank so that 1 = the STRONGEST influence and 9 = the WEAKEST influence. Please rank so that 1 = the STRONGEST influence and 9 = the WEAKEST influence. Microport and Biosensors. RANK Quality of product Brand Quality of service Price Reimbursement Government or Hospital Regulations Product Features Clinical Efficacy/Safety Clinical/Economic Evidence Q43 In India. procedure. is the Angioplasty (PCI/PCTA) product. RANK Quality of product Brand Quality of service Price Reimbursement Government or Hospital Regulations Product Features Clinical Efficacy/Safety Clinical/Economic Evidence Q41 Please rank the following factors in order of how they influence your purchasing decision for established Chinese companies such as Lepu Medical. Q40 Please rank the following factors in order of how they influence your purchasing decision for MNCs. RANK Quality of product Brand Quality of service Price Reimbursement Government or Hospital Regulations Product Features Clinical Efficacy/Safety Clinical/Economic Evidence Q42 Please rank the following factors in order of how they influence your purchasing decision for established local companies.

ICS Questionnaire Q44 What is the approximate percentage of reimbursement for the PCI/PCTA procedure? SC Less than 10% 10-20% 21-30% 31-40% 41-50% 51-60% 61-70% 71-80% 81-90% 91-100% NA/ Don't know/ Cannot discuss 1 2 3 4 5 6 7 8 9 10 11 Q45 What is the approximate percentage of reimbursement for the stent product? SC Less than 10% 10-20% 21-30% 31-40% 41-50% 51-60% 61-70% 71-80% 81-90% 91-100% NA/ Don't know/ Cannot discuss 1 2 3 4 5 6 7 8 9 10 11 Q46 Approximately what percentage of the population in India is covered by insurance for PCI/PCTA procedures? Less than 10% 10-20% 21-30% 31-40% 41-50% 51-60% 61-70% 71-80% 81-90% 91-100% NA/ Don't know/ Cannot discuss 1 2 3 4 5 6 7 8 9 10 11 THANK YOU Page 7 of 7 .