Boston Scientific Expands Neuromodulation Portfolio with Acquisition of Valencia Technologies

# From Sacral Nerve to Tibial Nerve: The Pathway Expansion Behind M&A

Boston Scientific's layout in the field of urological neuromodulation shows a clear logic of path expansion.

In 2024, the company entered the sacral nerve stimulation (SNS) market through the acquisition of Axonics. SNS involves implanting electrodes to stimulate the sacral nerves and is currently one of the mainstream treatments for refractory bladder dysfunction, but it has a relatively high level of surgical complexity and cost.

Valencia's eCoin Represents Another Technical Pathway—Tibial Nerve Stimulation (TNS). This approach indirectly modulates neural pathways related to bladder control by stimulating the tibial nerve at the ankle. Compared with SNS, its characteristics include:

• Shallower implant position (subcutaneous ankle)
• Minimally Invasive Surgical Approach
• Smaller device size (coin-sized)
• Automatic periodic stimulation, without frequent operation by the patient

In the traditional pathway, tibial nerve stimulation is mostly administered through percutaneous tibial nerve stimulation (PTNS), requiring patients to visit the hospital multiple times for treatment. eCoin, through an implantable form, transforms this therapy into a long-term, automated intervention.

Through this acquisition, Boston Scientific has achieved technical coverage from SNS to ITNS, filling the product hierarchy of neuromodulation at different levels of invasiveness.

# Clinical Positioning of ITNS: Between Conservative Treatment and Implantable Treatment

The ITNS technology represented by eCoin is located in the middle layer of the current treatment pathway for bladder dysfunction. In clinical practice, related diseases are usually treated step by step along the following pathway:

1. Behavioral Intervention and Pharmacological Treatment
2. Percutaneous Tibial Nerve Stimulation (PTNS)
3. Sacral Nerve Stimulation (SNS)

The emergence of ITNS has further subdivided the treatment pathways:

• For patients with insufficient efficacy of PTNS but not yet in the SNS stage, provide a transitional solution.
• For patients who are intolerant or unwilling to undergo SNS surgery, alternative options are provided.

According to the clinical trial results disclosed by the company, eCoin achieved a patient response rate of approximately 68% (≥50% reduction in UUI episodes) in the study. However, it should be noted that the currently available data is primarily derived from corporate disclosures, lacking large-scale controlled studies, and its long-term efficacy and cost-effectiveness still require further validation.

# M&A Logic: From Single-point Products to a Layered System

From an industry perspective, this acquisition reflects a strategic shift by Boston Scientific in the neuromodulation field, namelyFrom a single product layout to the construction of a "hierarchical treatment system".

By integrating the existing product portfolio, its neuromodulation map for urology has roughly formed three levels:

• Mild Patients: Medication and Non-invasive Treatment
• Moderate Patients: Tibial Nerve Stimulation (ITNS)
• Severe Patients: Sacral Nerve Stimulation (SNS)

The potential value of this system lies in:

• Covering a Wider Patient Population
• Extend the Full-cycle Management Capability for Patients
• Provide More Treatment Options to Enhance Doctor Reliance
• Increase Product Penetration Within a Single Department

At the same time, due to its simple surgical procedure and flexible application scenarios, ITNS theoretically has the potential to penetrate into outpatient or day surgery settings, which may lead to changes in the channel structure.

# Conclusion: Information Boundaries and Variables to Be Observed

Despite the clear logic behind the acquisition, there are still certain boundaries in the current information:

• The transaction amount was not disclosed, making it difficult to assess the valuation level and financial impact.
• The competitive and substitutive relationship between ITNS and SNS has not been fully clarified.
• Long-term efficacy, safety, and real-world data are still limited.
• The commercialization path under different payment systems remains to be observed.

Therefore, this deal is more about the early layout of emerging technology pathways, and its ultimate market performance still needs to be validated by subsequent clinical and commercial data.