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In 2023, the Russian market of technical rehabilitation products may face an influx of customers. According to experts, we should expect an increase in demand for prosthetic arms and legs. The reason for this may be the injuries received as a result of a special military operation and the need among residents of the annexed territories and Russian military personnel.

Until 2022, the largest suppliers of prostheses to Russia were the USA and Iceland, namely Open Bionics, Ossur, Endolite and others. In 2020 0.66 million pieces of products were imported from the USA (24.8% of all–Russian imports), from Ireland - 0.43 million pieces (16.2%). Germany was in third place – its share in the total supply of prostheses was 10.1% in 2020 (0.27 million pieces). Despite the fact that the Ministry of Industry and Trade of Russia supported new projects and the process of import substitution, the volume of domestic production of prostheses until recently lagged far behind the volume of imports: in 2016-2020, deliveries from abroad were 5.2-6.2 times higher than domestic output.

The sanctions have led to the fact that the market situation has changed a lot.  It became clear that at any moment such major suppliers of components for prosthetics as Turkey and Germany may cease cooperation with Russia, as happened, for example, with the Icelandic Ossur. But even with the preservation of supplies, sanctions have a negative impact on the supply on the market. In the case of the German Ottobock, Ivan Khudyakov from Salyut Orto gives an example, which sends goods to the Russian Federation only under the order and not by direct deliveries, it takes three to five months to wait for the material.

According to Sergey Kazimov, the head of the physiotherapy department of the Medscan rehabilitation center, the sanctions affected the prostheses of high mobility classes the most: as a rule, foreign semi-finished products are purchased for them. "Almost all the electronics of the prostheses were built on a foreign component base, most of the electric drives and motors were made abroad. Foreign composites, sheet elastomers, resins are often used for the manufacture of cultured sleeves," he noted.

After the departure of Western companies from Russia, Maria Bogomolova, acting General Director of the Moscow Innovation Agency, told Vedomosti, "the niche has been vacated, and literally over the past year we have seen a spasmodic development of domestic developments." In general, the Russian market for the production of prostheses and other assistive (assistive) technologies is now on the rise. According to the Moscow Innovation Agency, about a third of the Russian population are potential users of assistive technologies.

"The available volume of the prosthetics market in Russia is estimated at 193.7 billion rubles, which is slightly more than 20% of the potential volume. Imported goods occupied almost three quarters of the available market. Thus, a significant potential for import substitution and development of Russian products is obvious."   

Experts estimate the target audience of AssistiveTech at 49.3 million people, of which 34% are people with visual impairments, 26% – mobility, 22% – hearing and 17% – cognitive impairments (research data from the Moscow Innovation Agency for June 2023). At the same time, only a fifth of the Russian AssistiveTech market experts called mastered.

On average, about 45,000– 48,000 products are issued to citizens per year," the representative of the social fund noted, including 5,500 people receive prosthetic arms and 22,000 – prosthetic legs. 

The average cost of an upper limb prosthesis (hands, forearm or shoulder) with microprocessor control is about 3.1 million rubles, and a similar leg prosthesis (shin or hip) is about 3.2 million rubles. / 

At the same time, manufacturers also offer simpler traction prostheses. The cost of such prostheses from the most innovative manufacturer of LLC "Motorika" starts from 250,000 rubles, draws the attention of the general director of the company Motorika – Andrey Davidyuk. The most expensive bionic prostheses can cost up to 8 million rubles, he added.

Every disabled person in need of a prosthesis has the right to receive technical means of rehabilitation (TSR) from the state — the costs of such products are covered by the budget of the Social Insurance Fund (FSS). Annually for these purposes, depending on the need and taking into account the cost of consumables  materials and products themselves are laid a certain amount of funds. In 2022, 37.3 billion rubles were allocated for the provision of citizens of the TSR, which is 4 billion rubles more than in 2021, and the next year the amount of 44 billion rubles has already been laid. As specified by Kommersant in the Ministry of Labor, if necessary, the budget of the FSS can be increased — as happened, for example, in 2021, when the cost of products increased due to rising prices and the fund was additionally allocated 9.5 billion rubles for the purchase of TSR. The department does not directly associate this subsidy with the COVID-19 pandemic, but it cannot be excluded that the global cataclysm still indirectly affected the price increase.

Currently, the number of people using prostheses in Russia is 58 thousand people. As the Ministry of Labor clarified to Kommersant, the state's share in providing people with TSR is 98.4%. "That is, the overwhelming  most citizens with disabilities use state support mechanisms: provision of TSR in kind, compensation for self—purchase or an electronic certificate," the Ministry of Labor reported. In some cases, prostheses are purchased by charitable foundations.

The main manufacturers of prostheses in Russia are LLC Motorika, GC Salyut – Ortho, JSC KRET, FSUE Moskovskoe PrOP of the Ministry of Labor of Russia, Angiolain, Istok-Audio, Stentex, NPP MedInzh, Hearing aid factory Rhythm, FSUE CITO, NPF Ortho-Cosmos, Otto Bock, Lintex, Konmet, Aurika, Osteomed-M, HARDWARE Manufacturing, Protex Center and others.

LLC Motorika, founded in 2015 and registered in the Skolkovo Research and Production Park, is a manufacturer of new generation prostheses. Receiving financial support from venture funds the company entered international level.   The manufacturer of prosthetic arms and legs "Motorika" plans to place bonds on the Moscow Exchange for the first time by the end of 2023.

In 2022, Motorika's revenue under IFRS doubled – from 307 million to 594 million rubles. The OIBDA indicator increased from 1.6 million rubles in 2021 to 87 million rubles in 2022, the company recorded a net profit of 82 million rubles for the first time (in 2021 it had a loss of 8.1 million rubles). Thus, the placement of a bond loan will allow the company to attract up to 50% of its annual revenue. 

According to the expert, the company's entry into the public debt market will allow it to increase awareness and attract interest in its innovative developments and achievements.  "In 2021-2022, Motorika increased sales of prostheses by 4.5 times, and by the end of the first half of 2023, the indicator reached the volume for the whole of 2022," the company representative added. The attraction of additional funds was required by Motorica against the background of the development of a new direction – prosthetic legs, the launch of which the company announced in June.

The need for lower limb prostheses is often higher, draws the attention of the representative of the Bureau of Medical and Social Expertise. In particular, it is associated with chronic diseases such as diabetes mellitus or various diseases of the peripheral nervous system. In such cases, "the longest thin and thick nerve fibers of the lower extremities that are most extended and removed from the center are most often affected," he noted.

Now there are difficulties with components for the prosthetic industry, said Mikhail Terentyev, chairman of the All-Russian Society of Disabled People, State Duma deputy. "For bionic prostheses that can partially perform the functions of lost limbs and be programmed, semi-finished products, materials, special resins, sheet plastics are needed,  crystals, chips, which, unfortunately, in most cases have to be purchased abroad," he says.

Motorika, LLC is the Russian leader in the development and production of high-tech bionic prostheses with the largest market share, emphasizes Rustem Kafiatullin, director of the debt capital department of Sinara Investment Bank, a representative of one of the organizers of the issue. He calls the company a unique player in the medtech industry with long-term growth and development prospects. 

The company expects to occupy more than 25% of the prosthetics market in Russia by 2030, Andrey Davidyuk said. "Motorika" has started the release of a microprocessor-controlled foot module, then it is planned to release a knee module, says Davidyuk. All nodal elements and body parts are printed on a 3D printer, he said.

If we talk about the so-called traction prostheses (which can carry out one movement, for example, compression with fingers. – "Vedomosti"), then they are made entirely of domestic parts. And more complex bionic prostheses, which allow for various movements by reading nerve impulses on the user's body, include about 10% of foreign elements – micro motors, chips, etc., he explains.

The production of the knee module is also being launched by the PKK company (the developer of Skolkovo, working under the Kinez brand), its CEO Ruslan Saitgareev told Vedomosti. "The Russian production of Kinez-1 is competitive and does not depend on foreign suppliers. The components are manufactured at a factory in the Moscow region.   The large–node assembly is in the Skolkovo Technopark," he noted.

According to Saitgareev, the manufacturer plans to launch the first batch of Kinez-1 devices on the market in the near future. So far, knee modules from the RPC can be used as one of the parts of a composite mechanism in which the second main component – a prosthetic foot – will be provided by another manufacturer. This will be determined by MOSPROP, but in the future the PKK plans to produce not only knee modules, but also feet, Saitgareev added. 

Now the main part of the leg prostheses used in Russia are the developments of foreign manufacturers, much more domestic developers are concentrated on prosthetic hands, a representative of another major developer MaxBionic draws attention.

The production of prostheses in Russia gives great advantages to their consumers. Prostheses built on semi-finished products and modules of foreign production, according to the regulations of their manufacturers, require periodic maintenance and repair in the manufacturing country. In this case, even if the prostheses were issued to patients before the start of the SVO and subsequent sanctions, difficulties arise with delivery and repair terms for their owners and suppliers during maintenance. Prostheses of domestic production, respectively, are serviced within the country.

In order to sufficiently provide those in need with bionic prostheses in the short term, it will be necessary to establish uninterrupted supplies of the necessary electronic component base from friendly countries. And in the medium term of the next few years, it is necessary to create its own domestic mass production of crystals, microelectronics and complex composite materials," Sergey Kazimov shared his opinion with Kommersant.- Head of the physiotherapy department of the Medscan Rehabilitation Center.

THE VOLUME and DEVELOPMENT OF THE MARKET OF REHABILITATION PRODUCTS BY SEGMENT IN 2021 

Source: Research of the Innovation Agency Moscow, June 2023

	TOTAL in BN RUBLES	MASTERED in %
MOBILITY	392,89	15, 8
VISION	227,96	50, 9
HEARING	163,63	6,9
COGNITIVE IMPAIRMENT	52,63	8,1

Source: https://gxpnews.net/2022/10/rossijskij-rynok-protezov-v-2023-godu-mozhet-stolknutsya-s-pritokom-klientov/ ; https://hightech.plus/2022/06/21/zapros-na-svoe-kak-razvivaetsya-rossiiskii-rinok-bionicheskih-protezov ; https://gxpnews.net/2022/10/rossijskij-rynok-protezov-v-2023-godu-mozhet-stolknutsya-s-pritokom-klientov/ ;