Ann: Patient treated in Spain proceeds to successful resection, page-10

The system wide stuff is explained by the company: so they have an approved product they can market, sell and use, but reimbursmeent by governments is a lengthy process that will require further trials. Its essentially the opposite to the USA where FDA is rigorous but once FDA approve, reimbursement follows very quickly.

However, in Europe the product can be funded different ways: private payors; charities; private health insurance companies; research grant funders for its use in research studies; and finally through internal hospital funds (indirectly via the provincial governments). The last is like an ex-gratia, where the clinicians ask/beg the hospital/province that this is an important procedure, or they have some discretionary funds at their disposal.

In fact the last is how it is happening in Australia and NZ. Charitable funding to hospitals so that clinicians can use this for patients with pancreatic ca which has very few options.

If the GI surgeons get behind this, it will be extremely positive. If they feel it either increases the number of patients who can have surgery, or makes that surgery easier, then I think I can see a situation where patients referred to a surgeon will be recommended oncosil as a regular pre-surgical procedure (separate to the chemo regime run by the oncologists).

Spain is either keener, or the company has good relationships there, or the individual centres want to increase their reputation as leaders. I expect Germany will, in the medium run, take over the mantle as high users. Sometimes in continental Europe the clinicians still have more power, rather than in UK where the bureaucrats are totally in control.

The EV for Oncosil is about 40-45 million USD. Its completely ridiculous. Approved, marketed and selling its product in EU, NZ, Australia and Singapore.