1.1 Definition and scope of study

Medical gases are mainly used in hospitals for treatment, pain relief, anesthesia and respiratory function.

The medical gases sub-segment is included in the broader industrial gases segment: manufactured gases produced by the distillation of air. These include oxygen, nitrogen, argon, helium, hydrogen, carbon dioxide and other rare gases. Thanks to their physical and chemical properties, they are used in the majority of industrial sectors: health (therapeutic gases for anesthesia, intensive care, pneumology, surgery, etc.), food and beverages (oxygen, nitrogen, argon, helium, hydrogen, carbon dioxide and other rare gases).), the food industry (soft drinks, for example), metallurgy, electronics, petrochemicals, etc.

Medical gases are grouped into three categories:

Medicinal gases (Oxygen (_O2), nitrous oxide (_N2O), nitric oxide, etc.);
Medical device gases (CO2, N2O, etc.);
Non-status gases.

The medical gases market is dominated by international industrial gas producer and distributor groups, leaving very little room for new entrants. Most of the independent players have been bought out by the major groups, as part of their diversification strategies over the last 10 years. The various players in the medical gases sector are therefore players in the industrial gases sector more generally, who are focusing on international growth. This growth is achieved through the conquest of emerging markets and major R&D efforts.

The global medical gases market is estimated at 14.34 billion dollars in 2023and should record an average annual growth rate of8,30 %over the period 2024-2032, reaching a value of29.29 billion in 2032. [EMR]

The French market has also been dynamic and growing for several years. This growth is reflected in theincrease in AMO spending on medical gases: CPAP (Continuous Positive Airway Pressure) treatment with 862 million euros in 2021,oxygen therapy with 422 million euros and assisted ventilation devices with 320 million euros. [CEPS]

The French market leader is Air Liquide Santé - France, an Air Liquide subsidiary specializing in the manufacture of medical gases. This subsidiary reported sales of€166.79 million in 2021. The main challenge facing the market for medical gas producers is to be able to adapt to various contemporary issues, such as the increase in chronic diseases and global warming. [Air Liquide]

Growth is being driven in particular by an aging population and an increase in chronic diseases, combined with favorable government initiatives and better access to healthcare in developing countries. Finally, the Covid-19 pandemic has had a real positive impact on this market, considerably increasing demand for oxygen and other medical gases to treat the disease.

1.2 A growing global market

The global medical gases market is valued at $**.** billion in **** , and is expected to grow at a CAGR of *. **% over the period ****-****, reaching a value of $**.** billion in ****.

Estimated size of the medical gases market World, ****, in billions of US Source: ****

The market is therefore booming. This growth is notably ...

1.3 A healthy French market

Sales of medical gases are driven by consumption in the healthcare sector. Each year, the Comité économique des produits de santé (***), the French health products economic committee, reveals the reimbursable amounts for respiratory assistance in France. This data is a very good indicator of the size of the medical gases segment ...

1.4 Impact of Covid-19 on the sector

sales trends for industrial gas production activities

Industrial gas manufacturing activities are recorded in the Insee nomenclature under NAF code **.**Z: Manufacture of industrial gases. According to Insee, this sub-class includes :

The manufacture of liquefied or compressed inorganic industrial or medical gases: Elementary gases ; Liquid or compressed air ; Refrigerant gases ; Mixed ...

2.1 Demographic trends should boost the sector

Global demographics

The United Nations predicts that by ****, the number of elderly people (***) in the world will have doubled, from *** million in **** to *.* billion. Their share of the world's population would thus increasefrom*,* % à **,* %.

France's aging population: already a reality...

Proportion of French population aged ** or over France, ****-****, in % Source: ****

...which ...

2.2 The uses of the main medical gases

Each medical gas can have different properties. According to Linde Healthcare France, there are three main uses for medical gases:

Therapeutic indications : use of the gas as a medicine; Specific medical use; Facilitating a medical/paramedical procedure.

According to the same source, we can draw up a table of the main ...

2.3 Different types of care requiring medical gases

Traditionally, medical gases are supplied to healthcare facilities including:

Hospitals ; ePHAD ; clinics.

Air Liquide supplies around **,*** hospitals and clinics with medical gases. Some laboratories also use them. Medical gases are also used in emergency medicine, particularly in first aid.

Many patients cared for by PSADs (***) require respiratory assistance:

The development of ...

2.4 Focus on a few pathologies requiring the use of medical gases

Acute pulmonary embolism

Number of cases of pulmonary embolism by age group France, ****, in number of cases Source: ****

The graph above represents the number of people treated for acute pulmonary embolism (***) in France in ****, by age group. In that year, around **,*** people aged ** and over were treated for pulmonary embolism, out ...

3.1 Medical gas production: a sub-segment of industrial gas production

Sales of industrial gas production activities

The French industrial gas manufacturing business is listed by INSEE under the NAF **.**Znomenclature code: "Manufacture of industrial gases". INSEE gives this market size for ****: it amounted to *.** billion euros. This figure can be used to estimate the size of the medical imaging market in ...

3.2 Close proximity of production sites and high transport risks

Industrial gas production sites in France

TheUrssaf database also provides a regional breakdown of companies registered under NAF code **.**Z.

Medical gas production sites of major industrial gas groups

The most active medical gas production sites in France are often subsidiaries of major industrial gas groups.

The sector leader is the ...

3.3 Medical gas distribution networks

Medical gas distribution networks enable medical gases to be delivered in the best possible conditions, mainly to healthcare establishments (***), but also to laboratories.

In France, there are three players specializing in this type of service:

Tonnoir Fluides Médicaux RESOGAZ - Medical fluids and specialty gases for hospitals and laboratories MGM ...

3.4 The homecare market: a booming market for industry players

In ****, Les Echos estimated the home medical assistance market at €*.* billion, with an average annual growth rate of *% in recent years. According to the Fédération des prestataires de soins à domicile (***).

The Federation also gives a breakdown of these sales by activity, the * main segments being :

CPAP(***) ; oxygen therapy and ...

4.1 Highly regulated product types

Three categories of medical gases

The omedit-paysdelaloire.fr website explains that medical gases are grouped into three categories:

Medicinal gases: (***) Ventilation, oxygenation, anesthesia, pain relief Oxygen (***)

The quality of medicinal gases is based on the specifications and methods of the European Pharmacopoeia monographs, where they exist, otherwise on those described in ...

4.2 Highly polluting products that will have to adapt to the energy transition

One of the sector's future challenges will be to integrate into the energy transition, with the use of less polluting products such as hydrogen.

A study published at the end of **** in The Lancet claimed that each surgical operation emits an average of between *** and *** kg of CO* due to a ...

5.1 Strict standards

General regulations

The French Public Health Code (***) regulates the packaging and distribution of medical gases in France.

The regulations make it compulsory to

A label on the cylinder body identifying the gas contained; The presence of an instruction leaflet, as well as a Summary of Product Characteristics (***) in the case of ...