Thursday 13 August 2015

Medtronic's Micra Pacemaker: Game-Changer, or Business As Usual?

The Incumbent Market
Pacemakers are indicated for use in some patients with arrhythmias (irregular heart beats) where electronic pacing is helpful; for example, pacemakers are the most common treatment for bradycardia (a slow heartbeat) and over 1 million are implanted each year around the world.

Pacemakers require a skilled cardiologist to implant the device under the skin near the collar bone and then affix the leads to whichever areas of the heart need pacing. The leads are a weak feature of pacemakers as they sometimes fracture, and the risk of infection from implanting a large foreign object into the body is also substantial.

Depending on the patient's particular arrhythmia, either single- or dual-chamber pacemakers are indicated. The price of a pacemaker can run from $3,000 - $7,000, but the average price seems to be about $4,000. Assuming that average price holds around the world, the pacemaker market is worth about $4 billion per year in new device sales alone.


The Disruptor
Medtronic has developed the Micra, a vitamin pill-sized 'Transcatheter Pacing System' only 1/10th the size of a traditional device. While
Medtronic Micra TPS
much of the engineering for this device has likely occurred across international borders, the Indian market and Medtronic's long-standing presence there was a big part of the company's motivation to develop this technology. 

In a 2010 TEDMED talk Dr. Oesterle, SVP for Medicine and Technology at Medtronic, explained that, "Right now, in the United States, for our population, we have somewhere in the region of 3,000 cardiologists who are trained in implanting pacemakers." By contrast, there are only about 1,000 implanters in India, for a population of more than one billion. By providing a technology that aligns better with the skill sets of more physicians, pacemaker technology can be delivered to more patients. That's good business for Medtronic. 

The benefits of the Medtronic Micra TPS include cosmetic invisibility, implantation directly into the heart, minimally invasive and easier implantation procedure, and a lead-less form factor. The device's battery life is estimated to be nearly 10 years and, once positioned, it can be easily repositioned and retrieved if necessary. The device was awarded the CE Mark in Europe after initial findings from Medtronic's global clinical trial were positive. 


Could Medtronic's Micra TPS Succeed in The U.S.?

Medtronic could go one of two marketing routes with this device. On the one hand, they could market it disruptively as a pacemaker that performs less well on some dimensions (it's only indicated for single valve right atrial fibrillation representing about 10% of those who need a pacemaker in the U.S. per year), but better on others (less invasive, less risk of lead fractures and infections, and easier to implant), and costing less than incumbent models in the hopes of expanding the market size by targeting the needs of those who've been over-served or left out altogether by existing offerings. 

In this scenario, the 'rebar' Medtronic could target initially would be the 10% of patients indicated for single-chamber rather than dual-chamber pacemakers. Over time the technology would likely progress to the point of overtaking traditional pacemakers on most relevant dimensions and provide Medtronic, and potentially St. Jude's who is also developing a lead-less pacemaker called the Nanostim, with a huge competitive advantage as the smaller form factor becomes the normal therapy for most patients indicated for heart pacing. There would also be a very attractive increase in the volume of international sales as Medtronic offers the smaller, more easily implantable device at accessible price points around the world. I also wonder whether physicians could treat arrhythmias indicating dual-chamber pacemakers by implanting two Micra devices: One in each chamber, further increasing the volume of sales. Another potential source of significantly increased volume of sales are additional pacing applications enabled by the 'deep miniaturization' research Medtronic has been doing to build Micra. Dr. Oesterle mentions some of these applications in his TEDMED speech, and they are very exciting, including things like neurological pacing for mood disorders. 

On the other hand, Medtronic faces short-term financial pressure to recoup expenses incurred in the development of Micra that could amount to over $100 million according to one observer who estimated that Medtronic will probably charge in excess of over $10,000 per device and will seek a new, higher reimbursement code from CMS. This is business as usual and it's the kind of behavior that's been driving our healthcare costs to unsustainable levels in the U.S. 

Even if the latter scenario reflects Medtronic's pricing strategy for Micra in the U.S., the company should seriously consider selling the Micra TPS at very low prices in emerging markets like India. The promise of increasing access to life-saving pacing technologies by simplifying the implantation procedure will be squandered if the price remains an insurmountable barrier for most patients. 

190 comments:

  1. This is really very informative article on pacemaker. I am pleased to read it. Pacemakers is the most costly but effective for the patient of bradycardia. Here I agree with you that pacemakers require a skilled cardiologist to implant it.

    ReplyDelete
  2. Racing amusements like Road Burner and NFS Underground are hot recreations that make you notice the hot oil and blazing tires and hear the shrieking. They are engine thundering amusements. a fantastic read

    ReplyDelete
  3. It has become very easy for getting the best creative business cards printed has become very easy. Now, you do not need to visit number of business card printing service providers in order to get the best quality business cards. Official statement

    ReplyDelete
  4. On the off chance that you are hoping to buy a home or renegotiate your current home into a lower rate or distinctive advance program the measure of value you have in the property is one deciding element for what credit programs you meet all requirements for and on the off chance that you can get the best current market rate. our website

    ReplyDelete
  5. You need a business card in order to promote your business, but you need one that stands out from the sea of business cards that are floating around. Vinyl Banners

    ReplyDelete
  6. This sort of imprinting in NYC can be utilized outside. It can be used in the hoardings or boards.Signage/Banners

    ReplyDelete
  7. The website is looking bit flashy and it catches the visitors eyes. Design is pretty simple and a good user friendly interface. Buy Business India

    ReplyDelete
  8. In 1776, Scottish economist and philosopher, Adam Smith wrote the masterpiece, 'The Wealth of Nations'. In this piece, I explain the new rule of Technology of Nations.Thesis writing

    ReplyDelete
  9. In this report I will share with you eleven mistakes new Coaches make that are holding them back from reaching their ultimate goal of having a successful business.claude ergas

    ReplyDelete
  10. Let us look at some of these motivating factors which are drawing the individuals towards this industry and make for themselves a great career path in the healthcare field. MyHealth Care Centre

    ReplyDelete
  11. This comment has been removed by the author.

    ReplyDelete
  12. The genuine thought and hypothesis behind it takes gaming to an unheard of level. What's more, many are astonished that this amusement was produced by an autonomous diversion organization. A few people even confess to needing to play the following diversion that turns out by a similar amusement organization. Click here

    ReplyDelete
  13. These are known as the base inquiries.Base inquiries answers will give the questioner a manual for show when the subject is coming clean.All inquiries are asked in a yes or no way.http://liedetector.uk

    ReplyDelete
  14. Where posters are placed will be the key to how successful they are at fulfilling their purpose but investing in high quality poster printing London services is also crucial. Books, Brochures printing

    ReplyDelete
  15. The latest news from Medtronic and it's smallest pacemaker to date, if you're interested, can be found here.

    ReplyDelete
    Replies
    1. Thank you for the link, that's most interesting! Please report on how the tests go

      Delete
  16. For instance, a few recreations have a terrible agree with players that jump at the chance to battle a ton. prebuilt gaming pc

    ReplyDelete
  17. These articles and blogs are genuinely sufficiency for me for a day.Houston Luxury

    ReplyDelete
  18. This comment has been removed by the author.

    ReplyDelete
  19. Notice how I didn't put "males" after female for strong? That's because males in games are ALWAYS represented as strong and smart.visit my blog

    ReplyDelete
  20. Disaster Recovery (DR) involves a set of policies and procedures that enable the restoration of critical business data and allows the IT infrastructure to be restored to a prior state. Business Law Basics

    ReplyDelete
  21. Sufficiently timetable time to discover, go to (and from) and eat your suppers representing hold up time, kind of eatery and check installment.site

    ReplyDelete
  22. FCPX editors can make contemporary-looking flashback scenes that don't depend on matured film. The Flashback Impact gives film the screen streaks, shading, and gleam of flashbacks found in numerous current sci-fi and activity motion pictures. Final Cut Pro X Effects

    ReplyDelete
  23. The general feeling is that video games do not provide any benefits to the player and especially so in the case of children.
    my favorite video game

    ReplyDelete
  24. Mmm.. good to be here in your article or post, whatever, I think I should also work hard for my own website like I see some good and updated working in your site. 5000 postcard printing

    ReplyDelete
  25. This can cost a great deal of cash. Before you go searching for more games, investigate the games you as of now have and attempt all the diverse modes. Best Xbox One External Hard Drive [2018]

    ReplyDelete
  26. Guitar Hero is by far one of the most fun Xbox games that you can own. When you play Guitar Hero you get an actual plastic guitar that you can use to play your favorite songs Xbox live gold gratis

    ReplyDelete
  27. These games includes: Battletoads, Super Mario Bros, Sonic, Mega man, first person shooter games, roleplaying games, online games (such as Adventure Quest), and plenty of other hit games out there. https://unblockedgames500th.weebly.com

    ReplyDelete
  28. In opposition to this conviction, there are numerous benefits in enabling kids to play certain kinds of games.google feud answers

    ReplyDelete
  29. This comment has been removed by the author.

    ReplyDelete
  30. Many people hardly find any time to play games which means their physical and mental ability will comparatively lower than a sportsman who stays fit and plays game regularly. Most games need physical and mental stimulation to be played effectively.3ds roms

    ReplyDelete
  31. This comment has been removed by the author.

    ReplyDelete
  32. Even if you don't need a loan to get started, that doesn't mean your business will - or should remain debt-free.Contabilitate Iasi

    ReplyDelete
  33. This comment has been removed by the author.

    ReplyDelete
  34. Waooow!!! Magnificent blogs, this is what I wanted to search. Thanks buddy
    http://electronicdartboardreviews.com/

    ReplyDelete
  35. Waow this is quite pleasant article, my sister love to read such type of post, I am going to tell her and bookmarking this webpage. Thanks Gamestorrents

    ReplyDelete
  36. The hard drive is the computer component responsible for storing your files and programs. When buying a hard drive for your gaming computer, consider these three main features: speed, size, and the type of interface.
    trichefortnite.fr

    ReplyDelete
  37. There are a sure number of gatherings (or "loads"), and each gathering contains a specific number of articles (a typical beginning cluster of NIM is 3 stacks containing 3, 4, and 5 questions individually).Apps for PC

    ReplyDelete
  38. Of these Options, the DMR is the most accurate, the Battle Rifle deals the most damage when not zoomed in, and the Light Rifle deals the most damage when zoomed in.fornite hack

    ReplyDelete
  39. I went over this website and I conceive you have a lot of excellent information, saved to my bookmarks (:. china sourcing agent

    ReplyDelete
  40. This comment has been removed by the author.

    ReplyDelete
  41. Positive site, where did u come up with the information on this posting?I have read a few of the articles on your website now, and I really like your style. Thanks a million and please keep up the effective work.
    drawing game online

    ReplyDelete
  42. Thanks friends, for providing such enlightening data.business cards print at 55printing

    ReplyDelete
  43. I wanted to thank you for this great read!! I definitely enjoying every little bit of it I have you bookmarked to check out new stuff you post. auto insurance services in tyneham

    ReplyDelete
  44. This comment has been removed by the author.

    ReplyDelete
  45. Research into the advantages and disadvantages of video games are being led by different bodies incorporating colleges in a few sections of the world and the outcome is that the professionals exceed the cons in regard of advantages. كلمات سر gta v

    ReplyDelete
  46. Many of the soccer games are now available to play online League of Legends read now

    ReplyDelete
  47. Nice post! Research into the advantages and disadvantages of video games are being led by different bodies incorporating colleges in a few sections of the world and the outcome.

    ReplyDelete
  48. Great work! That is the kind of info that are meant to be shared around the net. Disgrace on search engines for not positioning this submit higher! Come on over and seek advice from my site . Thanks =) harga minyak

    ReplyDelete
  49. Most are fighting based thus savagery isn't totally missing. These games are not reasonable for kids. A few cases are Advanced Wars I and II, Civilization V and Crusader Kings II.best minecraft servers

    ReplyDelete
  50. This comment has been removed by the author.

    ReplyDelete
  51. Pretty nice post. I just stumbled upon your weblog and wanted to say that I have really enjoyed browsing your blog posts. After all I’ll be subscribing to your feed and I hope you write again soon! blog for RC crawlers

    ReplyDelete
  52. I'm glad I found this web site, I couldn't find any knowledge on this matter prior to.Also operate a site and if you are ever interested in doing some visitor writing for me if possible feel free to let me know, im always look for people to check out my web site.
    john faraday

    ReplyDelete
  53. You made some decent points there. I looked online for the problem and found most individuals will go coupled with using your site. incasso credifin-nederland.nl

    ReplyDelete
  54. This comment has been removed by the author.

    ReplyDelete
  55. thank you for your interesting infomation. g2a cashback codes

    ReplyDelete
  56. Thank you for some other informative blog. Where else could I get that type of information written in such an ideal means? I have a mission that I’m just now working on, and I have been at the look out for such information. high quality Automatic Recirculation Valve

    ReplyDelete
  57. Your blog provided us with valuable information to work with. Each & every tips of your post are awesome. Thanks a lot for sharing. Keep blogging,
    secrete

    ReplyDelete
  58. I like your post. It is good to see you verbalize from the heart and clarity on this important subject can be easily observed... toon blast cheats

    ReplyDelete
  59. You will love the graphics and the various gaming choices. You can choose whether you play classic or newest games friv 250

    ReplyDelete
  60. Bizarre this publish is totaly unrelated to what I was searching google for, but it was indexed at the first page. I guess your doing something right if Google likes you enough to position you at the first page of a non comparable search. www.trainingroomsg.com

    ReplyDelete
  61. Or then again perhaps you purchased a perplex amusement for a man who adores activity compose games. Unblocked Games 333

    ReplyDelete
  62. It sounds easy - the cars and logs are in horizontal rows, and the direction they move, the number of logs and cars, and the speed can vary. Happy Wheels Unblocked

    ReplyDelete
  63. When I originally commented I clicked the -Notify me when new comments are added- checkbox and now when a comment is added I get four emails sticking with the same comment. Could there be in any manner you are able to remove me from that service? Thanks! AMREP Vendor Inspection Services

    ReplyDelete
  64. I don't have any idea about pacemaker before. Your article gives clear about pacemaker. My father are suffering irregular heart beats, I hope this will help for him. Many Many thanks

    ReplyDelete
  65. PlayStation is in exceptionally free psn code generator propelled reassure that depends on creative and exceedingly propelled highlights.http://www.pcmunkey.net/

    ReplyDelete
  66. In any case, on account of this little gathering of virtuosos who strolled the initial steps into the video gaming transformation, we can appreciate numerous long periods of fun and diversion today (keeping aside the formation of a great many occupations amid the previous 4 or 5 decades).http://unblockedgamesdadu.weebly.com/

    ReplyDelete
  67. Omaha Hold'em poker rules, Seven Card Stud poker rules, and many more. The rules associated with every sort of poker games are quite different pokerku19.net

    ReplyDelete
  68. I have been a role-playing gamer for about thirty years and I fell in love with only two systems that I probably can't name because of article writing guidelines clash royale gems generator

    ReplyDelete
  69. The vast majority of these games are played with Flash or Shockwave. These games take into account everybody regardless of he is a male, female, child or grown-up. go now

    ReplyDelete
  70. Online games additionally have diverse assortments. In a few games, the players need to sit in one place and play, while in a few games the entire body gets included. Games like moving, hopping and so on will be a blend for both physical and mental action. www.kedaicasino.net

    ReplyDelete
  71. The equipment ought to incorporate a great primary memory and furthermore a realistic preparing memory known as GPU.boosting cheap overwatch

    ReplyDelete
  72. i would love to do figure skating every week, this has been my hobby and a mild form of exercise for my body’ микрозаймы онлайн на карту

    ReplyDelete
  73. Thank you for your article post.Much thanks again. Really Cool. visit blog

    ReplyDelete
  74. It gives me the aggregate customization https://www.brainteasingriddles.com/ of my own desire with each edge I can turn it.

    ReplyDelete
  75. Thanks for a very interesting blog. What else may I get that kind of info written in such a perfect approach? I’ve a undertaking that I am simply now operating on, and I have been at the look out for such info. online games for girls

    ReplyDelete
  76. This comment has been removed by the author.

    ReplyDelete
  77. So nicely Describe about the Medtronic's Micra Pacemaker. it is really helpful for us to know about it thank you unblocked77

    ReplyDelete
  78. These gaming consoles are simply utilized for gaming which is little and light in weight. generator

    ReplyDelete
  79. The website is looking bit flashy and it catches the visitors eyes. Design is pretty simple and a good user friendly interface. Dragon City Hack

    ReplyDelete
  80. I admire what you have done here. I like the part where you say you are doing this to give back but I would assume by all the comments that this is working for you as well. xbox live gold deals

    ReplyDelete
  81. wow, great, I was wondering how to cure acne naturally. and found your site by google, learned a lot, now i’m a bit clear. I’ve bookmark your site and also add rss. keep us updated. Eric

    ReplyDelete
  82. Joystick is one sort of the gaming fringe which is utilized by the players in the games for their gaming abilities. increase followers on twitch

    ReplyDelete
  83. This article gives the light in which we can observe the reality. This is very nice one and gives indepth information. Thanks for this nice article. coin master free spins

    ReplyDelete
  84. The appearance of ever-quicker PC equipment and specific illustrations cards, alongside always productive rendering calculations and information structures, is starting to relax the contrasts between the designs motors of various classes. dragon city more

    ReplyDelete
  85. I would like to say that this blog really convinced me to do it! Thanks, very good post. Healthcare Marketing Agency

    ReplyDelete
  86. PDF files are being used more and more by both individuals and corporations. As a result of this they are finding their way onto the internet more often. So here are some cool PDF niche backlinks tips and tricks. If implemented correctly these tips and techniques will get your PDF more exposure on the search engines and also use the PDF's to pass link juice to important pages on your sites.

    ReplyDelete
  87. Finally! I am able to hack my toon blast game. Using this tool :https://toonblasthacks.website/

    ReplyDelete
  88. Really I enjoy your site with effective and useful information. It is included very nice post with a lot of our resources.thanks for share. i enjoy this post. fortnite free v bucks generator

    ReplyDelete
  89. On the off chance that you are aiming to enhance the count intensity of your child or little girl, at that point you ought to present to them those educational toys which are loaded with Math Puzzle, questions, tests, and so on. online quiz

    ReplyDelete
  90. Wow nice, But not a nice as my eyebrow tattoing skills in melbourne.

    ReplyDelete
  91. Its a great pleasure reading your post.Its full of information I am looking for and I love to post a comment that "The content of your post is awesome" Great work.
    Bigo Live Cheats

    ReplyDelete
  92. As the name infers, it is a diversion in which the player sees the activity through the eyes of the character he is speaking to and includes the utilization of guns or rifles to murder the foe. unranked smurfs

    ReplyDelete
  93. Essentially, it has adaptable lighting of 16.8 million hues which demonstrate to it the like breathing example.fifa55za.com

    ReplyDelete
  94. The mode that has turned into a most loved of many is the high hazardous mode which removes every typical weapon and leaves players meandering around the guide discovering projectile launchers and rocket launchers and a couple of other claim to fame weapons to win with. fortnite rare skins

    ReplyDelete
  95. At the point when kids play activity pressed, quick paced, or savage video amusements, specifically, they progressively need all the more dominant pictures so as to react candidly to the diversion. school unblocked games

    ReplyDelete
  96. This comment has been removed by the author.

    ReplyDelete
  97. Wenn Sie nach unbegrenztem Geld und PR suchen, um Ihre GTA 5-Aktivität zu überprüfen, besuchen Sie meine Website : Gta 5 Geld Hack

    ReplyDelete
  98. Thus a portion of the unblocked superfighters significant highlights in the greater part of the games depend on phenomenal new ideas which have never been idea.

    ReplyDelete
  99. https://www.mycrackedgame.ooo/2019/04/get-unlimited-free-psn-codes-generator.html

    ReplyDelete
  100. While on the subject, let's not forget Sports games such as NHL 13, and FIFA Soccer 13 and Arcade games such Chicken Shoot 1, Toy Story Mania and Angry Birds to name a few.mordhau aimbot

    ReplyDelete
  101. Hi there! Thanks for the article! Good info and stuff

    ReplyDelete
  102. i love reading this article so beautiful!!great job! recover lost bitcoins

    ReplyDelete
  103. Very nice blog and articles. I am realy very happy to visit your blog. Now I am found which I actually want. I check your blog everyday and try to learn something from your blog. Thank you and waiting for your new post. Bangladesh Cricket

    ReplyDelete
  104. Thanks for great post! Important information for me.

    ReplyDelete
  105. This comment has been removed by the author.

    ReplyDelete
  106. Yes the game is changing at a rappid rate. Now I'm delivering the latest Fortnite Aimbot compatible with Battle Royale Season X. Also you can generate your vbucks as many you want. Try out Fortnite Cash.

    ReplyDelete
  107. I have been reading out a few of your posts and i must say nice stuff. I will surely bookmark your site. aloha browser for pc

    ReplyDelete
  108. We have enough capabilities to exterminate termites and combat all kinds of household insects and also possesses the best and latest devices and uses German injections completely eliminate termites depending on ornamental specialists eliminates the termite insect, cockroaches and bugs do not worry from today may get rid of this nightmare as quickly with the company You are now with Best Termite Control Company Dhahran Termite Control Company Khobar News Bug Control Company Khobar Mice Control Company Dammam Advantages of our termite control company in Dammam:
    شركة مكافحة حشرات

    ReplyDelete
  109. Meet Joey Ticket, the lowest fee guarantee for mobile vouchers! This mobile voucher can be purchased with your mobile phone or with a credit card.  소액결제현금화

    ReplyDelete
  110. Thanks a lot for your informative article.
    fortnite v bucks generator free v bucks hack v bucks

    free free v bucks generator, free v bucks ps4,free v bucks codes,

    v bucks gift card
    fortnite giveaway
    fortnite v bucks prices
    fortnite code free
    generate v bucks
    free fortnite redeem code
    fortnite v bucks free

    If You Need Fortnite V Bucks Free, Please Visit Following Links.

    Get Free Fornite V-Bucks Codes

    Get Free V-Bucks Generator

    ReplyDelete
  111. Besides, it gives extremely simple control which can be tweaked individually setting. free games

    ReplyDelete
  112. This comment has been removed by the author.

    ReplyDelete
  113. Nice nice nice!!!
    Here you can generate free poker zynga chips:
    https://gamegiftzone.com/free-zynga-poker-chips-generator-hack-tool/

    ReplyDelete
  114. There are many available options for people who want to fix up the home with their own hands. Even if a home improvement loan scares many people, sometimes is a necessary thing. Like in many other cases, a home improvement loan also has good and bad points. These good and bad points influence a lot the decision of the homeowner. It's recommended for homeowners to weigh their decision, because if they jump in this fragile area without knowing too many things about it, it can be very risky. Buy Catia Composer R2020

    ReplyDelete
  115. aa den stora boken… [...]p Have you noticed any performance problems with the wordpress platform? I ha oj[...]… solidworks price malaysia

    ReplyDelete
  116. dog crates made from ABS Plastic can withstand those aggressive dogs~ cheapsoftwaredownload.net

    ReplyDelete
  117. You should always provide any accredited investor funding source for complete resume of your abilities to operate your business on a day-to-day basis. Sometimes, Accredited Investors

    ReplyDelete
  118. that's really great ,you can play the Mod Apk download on https://androidpig.com/ I played it and found it cool

    ReplyDelete
  119. Very efficiently written story. It will be useful to anybody who employess it, including me. Keep up the good work – can’r wait to read more posts. macbook template

    ReplyDelete
  120. You’d outstanding guidelines there. I did a search about the field and identified that very likely the majority will agree with your web page. 먹튀검증

    ReplyDelete
  121. Nice to be visiting your blog again, it has been months for me. Well this article that i’ve been waited for so long. I need this article to complete my assignment in the college, and it has same topic with your article. Thanks, great share. Blog Judi

    ReplyDelete
  122. I together with my pals happened to be reading through the best advice from your web blog while all of a sudden developed a terrible feeling I had not expressed respect to the blog owner for those techniques. These young men are already for that reason joyful to learn all of them and have now sincerely been loving them. We appreciate you genuinely really thoughtful and then for selecting these kinds of decent subject matter most people are really eager to discover. Our honest regret for not expressing appreciation to you sooner. 안전놀이터

    ReplyDelete
  123. PartaiQQ adalah situs Judi Poker Online Indonesia Terbaik
    Promo situs PartaiQQ : Bonus Cashback 0.3% Setiap Senin -Bonus Referal 20% Seumur Hidup Minimal Deposit dan Withdraw Rp. 15.000,-

    http://www.rektjobs.com/employers/480769-partaiqqlink

    ReplyDelete
  124. Kesempatan menang dengan bermain domino99 akan lebih besar jika anda menguasai permainan ini dengan baik.
    https://www.applyfirst.ca/employers/490637-partaiqqsite

    ReplyDelete
  125. them to share with you all current and future investment opportunities that are only available to accredited investors. You may never invest in any of these opportunities, but then again, you might! best stocks

    ReplyDelete
  126. Mit Fortnite kostenlos v bucks Generator erhalten Sie unbegrenzt kostenlose V Bucks. Holen Sie sich die meisten Ressourcen und In App Käufe kostenlos mit dem Fortnite V Bucks Hack Generator. Fügen Sie einfach die auf dieser Site gefundenen Codes in das Fortnite v bucks Generator Werkzeug ein. Der Fortnite V Bucks Hack Generator arbeitet schnell und kann sicher verwendet werden. Wenn Sie die Anweisungen zur Verwendung des Fortnite Hack v bucks Generators befolgen, erhalten Sie kostenlos Ressourcen.
    Wir freuen uns, Ihnen den kostenlosen Fortnite V-Bucks Generator für Ihre Konten vorstellen zu können. Wir haben einen unbegrenzten V Bucks Generator für alle Fortnite Spieler erstellt. Dies ist Version 5.2 und enthält eine Option zum Abrufen des kostenlos v bucks Generator, da sich immer mehr Spieler auf Fortnite Servern befinden. Sie alle wissen, wie dringend jeder ein paar V Bucks in Spielwährung braucht. Nutzen Sie unseren V-Bucks Generator online. Sie können es dauerhaft mit maximal 13.500 V-Bucks täglich verwenden.

    ReplyDelete
  127. Can I simply say exactly what a relief to discover somebody who truly knows what theyre speaking about over the internet. You definitely learn how to bring a difficulty to light and work out it critical. The diet should see this and can see this side of your story. I cant believe youre less well-liked since you absolutely provide the gift. 토토먹튀

    ReplyDelete
  128. Wow! Such an amazing and helpful post this is. I really really love it. It's so good and so awesome. I am just amazed. I hope that you continue to do your work like this in the future also poker qq

    ReplyDelete
  129. I found your this post while searching for information about blog-related research ... It's a good post .. keep posting and updating information. แทงบอลออนไลน์

    ReplyDelete
  130. On the off chance that you are somewhat less roused, do get the errand that is most straightforward for you to wrap up first - This will invigorate you and lift up your certainty and inspiration.www.instaentry.net

    ReplyDelete
  131. ketika anda bermain dalam permainan domino99 dipastikan anda harus bermain dalam permainan bandarq dimana bisa menguntungkan anda ketika bermain menjadi bandar.

    ReplyDelete
  132. ketika anda bermain dalam permainan judi online dipastikan anda harus bermain dalam permainan dominoqq dimana bisa menguntungkan anda ketika bermain dalam permainan ini.

    ReplyDelete
  133.  It's free to join this site so like minded couples are encouraged to creat a membership.  unicorn dating site

    ReplyDelete
  134. In order to ensure that the financial transactions are carried out in a smooth and hassle-free manner, you need to ensure that you have the right support in the form of a partner bank. cryptocurrence processing

    ReplyDelete
  135. This works best with newer games as older games tend to be already available online for free. The legitimacy of this business venture is often questioned, but without a doubt, this brings in the money. 토토사이트

    ReplyDelete
  136. JANJIQQ situs poker online terpercaya yang sangat populer di Indonesia. JANJIQQ merupakan tempat pembuatan user id pro yang bisa memberikan banyak kemenangan dan keuntungan bagi bettor Indonesia.
    - DominoQQ
    - Situs Poker Online
    - BandarQ
    Adapun permainan judi online yang bisa dimainkan seperti poker online, domino99, aduq, capsa susun, bandarq, bandar poker, sakong dan bandar66, perang baccarat.

    Dengan minimal deposit 15.000 saja bettor Indonesia sudah bisa bermain sepuasnya!!!

    Anda juga berhak mendapatkan keuntungan berupa BONUS CASHBACK 0.3% dan BONUS REFFERAL 20% SEUMUR HIDUP!!!

    Tunggu apa lagi, Daftarkan diri bettors sekarang juga!!!

    ReplyDelete
  137. ketika bermain dalam link https://partaiqq.mobi dipastikan anda harus bermain dalam poker online dimana anda bisa menjadi yang terbaik dan luar biasa.

    ReplyDelete
  138. Mainkan permianan kesukaan anda dominoqq dan bandarqq hanya di sini https://dominoqqme.com/

    ReplyDelete
  139. Bandar judi bola sbobet terbesar dan terpercaya hanya ada di sini http://149.28.153.153/

    ReplyDelete
  140. I already excited while searching on internet and I have found it I would like to chose for PC App for my
    Laptop on it.

    ReplyDelete
  141. dapatkan jackpot di bandar slot online joker123 dan menangkan hadiah hiburan hingga jutaan rupiah http://139.180.184.251/

    ReplyDelete
  142. Love the way this post has been done. Really informative.

    ReplyDelete
  143. Data sgp yang selalu dijangkau para penggemar toto online ada di http://pengeluaransgp88.com

    ReplyDelete
  144. Consequently, you will actually want to settle on a choice on the measure of players to be facilitated to work with the worker and furthermore the volume to be utilized in supporting it.Minecraft Server List

    ReplyDelete
  145. Thank you so much for sharing this amazing information with us. Visit OGEN Infosystem for SEO Services, PPC Services, Digital Marketing Services, Mobile Application Development and Website Development in Delhi, India.
    Website Development Company in Delhi

    ReplyDelete
  146. You need to bring some uniqueness in your currency to distinguish it from the ones that already exist. It has to be innovative enough to create ripples in the market. This is the reason just copying the code is not enough to be on top of the cryptocurrency game. https://binorcoin.com/

    ReplyDelete
  147. Thanks for a marvelous posting! I actually enjoyed reading it, you might be
    a great author.I will be sure to bookmark your blog and will
    often come back at some point. I want to encourage yourself to continue your great posts,
    have a nice day!

    my web page; 부산오피
    (jk)

    ReplyDelete
  148. Hi there, I found your website via Google while looking for a related topic, your web site came up, it looks good. I’ve bookmarked it in my google bookmarks.
    カジノのボーナス

    ReplyDelete
  149. Agen Togel Online paling terpercaya dan amanah!! berapapun JP pasti dibayar! bet receh dapat diskon lagi!

    ReplyDelete
  150. Even if the latter scenario reflects Medtronic's pricing strategy for Micra in the U.S., the company should seriously consider selling the Micra TPS at very low prices in emerging markets like India. yellow and black salwar suit , black shalwar kameez girls

    ReplyDelete
  151. permainan yang seru dan banyak bonusnya ada di hkpools

    ReplyDelete
  152. ingin menang dengan mudah hanya disitus mpo slot.
    http://139.162.43.253/

    ReplyDelete
  153. Prediksi togel jitu terpercaya hanya di AUTOJP4D. buruan kunjungi kami di https://autojp4d.com/

    ReplyDelete
  154. This is so cool and awesome. Thanks for sharing! Dream Wedding Alberta

    ReplyDelete