Ambu A/S
CSE:AMBU B
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Ambu A/S
Earnings Call Analysis
Q3-2024 Analysis
Ambu A/S
In the earnings call, Ambu's executives celebrated a strong third quarter, with the company experiencing a total revenue of DKK 1.383 million, corresponding to a 15% organic growth, and a 15.7% growth when factoring in favorable exchange rates. This continued the positive momentum from the previous two quarters, prompting the company to increase its full-year financial guidance to 12-14% organic growth with an EBIT margin of 11-13% and a free cash flow of DKK 450 million.
Regionally, America led the growth followed by Europe, with all regions showing double-digit increases. The primary growth driver was the Endoscopy Solutions segment, which saw a 21.6% growth over the first nine months. The legacy Anesthesia and Patient Monitoring business also performed well, growing by 6.4% in the same period, partially driven by price increases.
Ambu made notable advancements in expanding their product offerings and market presence. The introduction of the aScope 5 Uretero and aScope 2 Duodeno 2 in both the U.S. and European markets were highlighted as significant milestones. These products are expected to extend the company's market momentum. The Endoscopy Segment's performance was buoyed by significant demand outside of pulmonology, with over 20% growth cited.
Ambu continued to improve its profitability, with an EBIT margin before special items at 12.9% and a free cash flow of DKK 163 million for Q3. They focused on scaling manufacturing and improving operational efficiency. The company's gross margin saw improvements, with enhanced product mix and price increases driving the margin expansion. Despite the need to invest more in its commercial and IT infrastructure, the company maintained a positive cash flow.
Ambu has been actively working on organizational transformation under their 'One Beat' program to enhance scalability in preparation for future growth. They also prioritized sustainability by reducing CO2 emissions by 10% per tonne of manufacturing and shifting to bioplastics in their product handles.
The company acknowledged risks, such as potential loss of contract volumes due to price increases, but overall maintained a positive outlook. They emphasized maintaining a strong cash flow and using their financial strength to explore inorganic growth opportunities. The executives were optimistic about continuing their growth trajectory, leveraging both new product launches and existing products, particularly within the high-gross-margin Endoscopy Solutions segment.
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Hello, everyone, and welcome to the Ambu presentation of our Q3 2023 and '24 Financial Results. I'm Britt Meelby Jensen. I'm the CEO of Ambu. And with me today, I have Henrik Skak Bender, our Chief Financial Officer.
On the agenda today, I'll start providing an overall update on the business, and then I'll hand over to Henrik to go through the financials, and then we'll end with a Q&A session.
So jumping right into the numbers. We delivered in Q3 2023, '24, a total organic revenue growth of 15%. If we look at how that is split into the different segments, starting with the Endoscopy Solutions segment, we grew 18% in our endoscopy business in the quarter and 21.6% in the full 9 months of this fiscal year.
When we look at profitability, our EBIT margin before special items ended at 12.9% and on the free cash flow, we delivered DKK 163 million for the quarter. So overall, a strong quarter that we are very excited about, continuing the strong quarter-over-quarter momentum as well as being driven by a very strong offering to our customers and thousands of dedicated employees, who do a great job every day for Ambu to progress our ZOOM IN strategy.
So talking about our ZOOM IN strategy, let's look at the progress on the different fronts because we do continue to see progress on all 4 areas. Starting with our customer solutions, we are very happy and excited to announce that in the quarter, we had approvals of 2 new solutions that we will bring to our customers.
The first one is our ureteroscope, our aScope 5. Uretero, which we now have approved both in the U.S., both with our aBox 2 and aView 2 Advance. We also got -- we also have the European approval of that product since some months. So we are now excited about the progress, which I'll come back to later.
Another milestone we had was that we had our aScope 2 Duodeno 2 approved in Europe, we had -- or in the U.S., sorry, we had -- we now have in April of this year, sorry, we had the FDA approval. And now we also have the approval in Europe, so that product is approved in both areas, also something that I'll come back to.
Moving on to our continuous focus on execution. Henrik will talk about this later, but overall, very strong momentum in improving our profitability, which remains a key focus. And also the focus we have on strengthening the scalability and efficiency in our business continues to be a key focus area.
On the people side, we continue to focus a lot on how we work and how we deliver value. In this quarter, we welcomed a new colleague to the executive leadership team, Graziela Malucelli, who joined Ambu as the new Chief Operating Officer on the 10th of June. At the same time, we have also Rummana Hasan, who had been with Ambu as the Chief Marketing Officer for 7 months, left the organization in the period.
Overall, in Ambu, we have a program that we call One Beat that is focused on that organizational transformation. And we are continuing with a lot of progress in that in how we, again, optimize the scalability of our organization to prepare for future growth, which is our key focus as a company.
Sustainability is an area that is very high on our agenda as well. Our focus is twofold: one, on the net 0 reduction where we have made good progress on the CO2 per tonne of manufacturing, which we decreased by 10% over the previous year.
One other thing that is a strong focus for us is how we help our customers also be more sustainable. One of the things we have done here is that we have introduced bioplastic in all the handles of our scopes, that is close to being rolled out across the full portfolio. And at the same time, we are advancing the use of that material into more products, most likely the laryngeal mask in our anesthesia portfolio.
Let's look a bit more at the numbers. In the quarter, the 15% growth amounted to DKK 1.38 billion. If we look at how the revenue is split across the segments, 10.9% growth in anesthesia and patient monitoring and 18% of growth in Endoscopy Solutions. With this, we continue to increase the Endoscopy Solutions as the total -- as the percent of total revenue, which is now at 59%, and then 41% of our business is anesthesia and patient monitoring, which a year ago amounted to 43%.
If we take a closer look at the segments, starting with anesthesia and patient monitoring, we had a very strong year. It's quite a while since we reported double-digit growth in this area. And after the first 9 months, we are at 6.4%. So if we take a step back and look at this portfolio, 1-year ago, when I stood here, we talked about the uncertainty moving into this financial year of whether we would see growth at all. The key reason for this was that we knew we were going to implement significant price increases across multiple segments, and we were not sure how the customers would respond.
The combination, which is the key driver of the growth we have now of a good response, meaning that we have not yet lost significant volume with these price increases is one key driver of the 10.9% growth in the quarter. Another key driver is that we have overall seen favorable market growth when it comes to procedure activity. Those are the 2 main reasons why we can deliver this strong growth.
When we look ahead, we would like to flag that there's still some risk in losing contract volumes. In other words, sometimes we know instantly when we lose a contract due to price because they will go with another vendor. In other cases, we may still be on the list, but it will take a while before the customer may react on the price increase that we have seen. So that is something that is important for us to flag. But overall, strong feedback and strong momentum in this business overall, fairly equally distributed across the 2 segments, anesthesia and patient monitoring.
So let's look at Endoscopy Solutions, our main growth area as a company. We reported 18% growth in the quarter. If we look at the first 9 months of the year, we are growing by 21.6%, amounting to for the first 9 months, DKK 2.368 billion. This growth represents solid growth across all the segments that we are in. And it's also helped by [indiscernible] anesthesia and patient monitoring, a good market growth when it comes to a number of procedures.
Pulmonology now represents roughly half of our total endoscopy revenue. And we have seen a good growth in this segment. And then ENT and Urology are 2 segments that continue to grow with very solid double-digit numbers.
In gastroenterology, we continue to also see a growing revenue, mainly driven by our aScope Gastro and our aScope Gastro Large.
If we look at pulmonology, so the segment that we have been in for the longest, we grew 9.9% in the quarter. And when we look at it year-to-date, we are at 13.9% growth in overall.
If you look at the graph here, you will also see that the growth -- the revenue that we report in Q3 is slightly lower than what we see in Q2. And that is simply due to the fact of flu season where our bronchoscopes are used. So Q2 typically is a fairly strong quarter where we see a positive impact by the flu.
What we are very pleased about is that we see a continued momentum in this business with aScope 5 continuing to gain traction and reporting very good growth.
If we look at the other segments as -- that we report together, so Endoscopy Solutions, excluding Pulmonology, we grew 27.6% in the quarter. And if we look at the first 9 months, we are growing by 31.5%. So significantly above market growth in this segment.
And again, across the different segments, ENT, which is very much driven by our U.S. colleagues, we continue to see a very strong growth trajectory with a good mix of new customers coming in and strengthening our revenue and our usage with existing customers, partly related still through the expansion into the fees indication that we had last year.
Urology is also an area where we continue to see very strong growth. It's still aScope 4 Cysto that is growing that. But with new products coming into the urology space, which we have only been in for less than 5 years. We are very excited about the outlook here.
And then last but not least, the GI, we see GI as an area that is still relevant for Ambu that holds long-term potential where we have taken away a number of commercial resources compared to where we were 2-plus years ago. But we still see with this niche-by-niche approach very good momentum and growth.
So let's look at some of the new solutions that we have approved in the quarter, starting with our aScope 5 Uretero. This is a product that we have tested right now, and we are towards the end of the phase that we call our controlled market release, which is basically a phase where we, after approval, engaged with hospitals, both in Europe and the U.S. and used for the first time the product in real-life patient cases to see the response.
We have had very good response in this phase. We have made some minor improvements of the product based on the feedback, and we are now towards the end of the controlled market release phase, and we are approaching what we call the launch of the product in the coming months.
This is a product that is launching into a market where there's already -- for some single-use providers and where the market has already converted a large part of the market into single-use. So we are very excited to tap into that and also leverage the relationships that we have with existing customers as well as our strong presence now in urology, which we didn't have when we launched the cystoscope.
Then we have our aScope Duodeno 2 solution and those who have followed Ambu for some years will know that this is the area where we, with the first generation, made a huge -- put a huge amount of resources behind the first generation and didn't live up to our own expectations.
What we have done since is that we have gone back, made significant improvements, leverage the new technology platform that we have and that we use across all scopes and some of the software advancements that we have developed. And then in close collaboration with customers, made significant improvements in a number of areas.
We were very excited to both get the FDA approval in April and most recent, the CE mark in Europe, and we have started the controlled market release. So we do have numerous cases being performed with our duodenoscope in real-life patients and the results so far are very positive.
With the history we have, we want to make sure that we take the thorough time to review this, also due to the fact that the ERCP procedures where this scope is used, or procedures characterized with very high complexity. So we want to make sure that we have exactly the right understanding of the usage of our product.
So far, so good. And when we move into the commercial launch phase, sometime well into the next fiscal year, we will do it with a very different approach as we did -- in previously because we are not going to allocate the same amount of resources, but we are going to take a step-by-step approach, gradually expanding the usage. Again, back to the point I made before that GI is an area that we are very committed to, but we see that more as a long-term potential.
So with these 2 new approvals, taking a step back and looking at the full portfolio that we have. We are expanding our portfolio when it comes to products being in the market across the different segments. And I think what is worth noting is that pulmonology, where we started some 16 years ago, we are now expanding into a very strong portfolio that our commercial colleagues can leverage with the customers with the video laryngoscope being a new addition that will come into our portfolio in the not-so-distant future.
Then we -- I want to point out urology that I just talked about. We went into this as a new segment only with the aScope 4 Cysto. But now we have expanded into the aScope 5 Cysto, the more advanced version for more advanced procedures requiring better image quality than with aScope Cysto 4. And then also with the ureteroscope, we are building a strong portfolio in this segment.
If we then look to the left side, something that we're increasingly focused on is our systems or the software. And because we are a company -- we are the company with the broadest endoscopy portfolio, we also have a lot of opportunities to leverage the technology platform and the software that right now comes on the aView 2 Advance and the aBox 2, where all our scopes fits into 1 of these platforms. And the software and the setup on those 2 platforms is quite similar in many ways.
This allows, also for our customers, to very easily adopt new patients, most recently the example I put around urology, where we come out with the ureteroscope that will be easy to plug into the aView 2 Advance in the U.S. that the customers are already very familiar with.
Also, we are looking into some of the technology that is coming up out there to better and better use software to improve the image quality and other features that has benefits for our customers. And we will continue to focus increasingly on the software side to make sure that we can leverage that technology to bring an even better customer experience to our customers.
So with this, I'll hand over to you, Henrik, to go more into our financials.
Thank you very much, Britt. And before I go into the financials, I also just want to start by reiterating what Britt said. We are very happy with Q3, and obviously, that is also why we're on the 10th of July, decided to increase our guidance, and I'll come back to also our view on the guidance later on in the presentation.
So looking at Q3, then, as Britt said, we landed a total revenue of DKK 1.383 million corresponding to a total growth -- organic growth of 15%, adding to that a positive impact from FX of 0.7, bringing the total combined growth to 15.7%. Very happy with the overall results and a continuation of the momentum that we've seen in Q1 and Q2 now into Q3.
Looking at the regions, we're also seeing a continuation of the strong growth in Americas. Now also a continuing growth in Europe, even though that was one of the areas we -- as you may have noted in Q2, we're looking a little bit for how would they develop in Q3, but really strong development. So overall, on a regional basis, we're also very happy with how we see double digit across all of our regions.
Looking a little bit further then on growth. Overall for the first 9 months, we're now at just above DKK 4 billion in total. And split by segments, as Britt said, obviously, the main growth driver is our Endoscopy Solutions growing at 21.6%. Next to that, our legacy business, anesthesia and patient monitoring growing 6.4%. This is a very solid growth momentum and something that basically brings us, you can say, ahead of our expectation on the long-term, being a 10% CAGR growth across the years, if you look across the 2-year period since we launched ZOOM IN.
Obviously, then looking at decomposing the growth, it's also important to say, we are right now still a little bit in a rebalancing mode. And therefore, like we communicated in Q1 and Q2, interesting thing in Q3 was obviously to see what is our pulmonology performance. And even though a 9.9% growth in pulmonology is down a bit versus Q1 and Q3. It's actually really, we feel solid continued growth considering that we had strong comparables for Q3 and we also have the same for Q4 in pulmonology last year.
Similarly, as Britt also said, obviously, we are very much following the growth momentum in our anesthesia and patient monitoring business since a substantial part of the overall growth is driven by price increases, it is also a positive market development, as Britt said, which, of course, we expect to continue, but we are monitoring it and therefore, also very much looking to what should we expect going forward.
Last but not least, under Endoscopy Solutions, I think it's also important to highlight a very strong growth outside pulmonary, the above 20% growth in Q3 that Britt also referred to, which right now is a combination of a very strong offering, but obviously also first-mover advantages on some of our products. We are very much looking forward to now having the uretero product in the market, which will hopefully enable us to extend that momentum further going forward.
Then turning to earnings. I think another really solid quarter for us and extension of a really, really solid quarter in Q2 and also a solid quarter in Q1. If you decompose how our margin expansion of about 5.3 percentage points is bit across gross margin and OpEx, we're very happy to see our gross margin going up. I'll come back to some of the drivers of this later, but overall, obviously, the price increases are key factors of that, but also scalability in our manufacturing footprint, meaning that even though our anesthesia and patient monitoring business is growing faster than we expected, we are still able to actually lift our gross margin versus last year.
Second to that, we also had a decreasing OpEx ratio in Q3 despite making a number of investments in our organization and in the long-term foundation, which I'll also come back to. So a very satisfactory Q3 also in terms of margin. If we double-click on gross margin, as I said, this is a continuation of a number of quarters where we've managed to increase the margin quarter-by-quarter. And again, here in quarter 3, we are seeing still a combination of positive product mix.
The Endoscopy Solutions segment, obviously have a higher gross margin than the Anesthesia and Patient Monitoring segment. So that growing faster is helping us. Second, the price increases are lifting, our Anesthesia and Patient Monitoring segment. And last but not least, both the combination of scale in our production costs, meaning particularly our indirect production cost, but also tailwind from currencies are also helping us right now.
Then looking at OpEx, we had an increase actually in OpEx ratio between Q2 and Q3. And this is driven by 2 main factors: one, we are investing more in our commercial organization, which we also communicated both in Q3, Q1 and Q2, mainly focused on ensuring we get more salespeople, more customer-facing people, who can deliver our existing products but also new products to the customers and ensure that we have a strong footprint in the face of the customer. We're still in the ramp-up phase of that but are seeing really solid and strong momentum there, and also a lot of interest from the market and from candidates in joining Ambu, which is really positive to see.
Secondly, we've also deliberately made a number of investments a little bit in Q2, but now more in Q3 on IT systems, on some of the infrastructure, elements of building the Ambu for the future, building the foundation for the future, something that I'll also come back to, but that is why you see the administration and IT costs going up in Q3.
Lastly, in terms of financial performance, I think one of the key performance metrics for us is still managing a solid cash flow. And Q3 was another testament that we are now really on a continuation of a very strong trend.
Last year, in Q3 and Q4, a big part of the positive cash flow was us managing our net working capital better. Still, we have a close eye on net working capital, but as you can see from the graph, in Q3, net working capital was almost net 0 in terms of change for the quarter. And the real strong -- this really strong cash flow was therefore mainly driven by strong earnings and still slightly lower CapEx than expected.
For us, this is a great testament to building a much stronger business, building a much stronger balance sheet, something that is very, very useful for our journey going forward.
So again, decomposing cash flow, I think if we look at the net working capital ratio, we are now at a state where we are close to or in the range of what we also communicated would be our long-term target range, around 20% net working capital ratio. Underneath, we've been very, very selectively investing in making sure we have the right inventory levels and all of our high runner categories and are also in connection with product launches, have the right level of inventory to support a strong launch.
Secondly, CapEx is still at a lower level. As you can see, it's gone a bit up since Q1, but similar level as Q2. We are expecting that to go up a little bit further as we continue to invest more in the foundation and invest more in R&D.
And then lastly, again, looking at the EBITDA line. This is a great testament to where we are in terms of executing on this ZOOM IN strategy. obviously also helped by strong organic growth, but really focused on making sure we also manage our margin and expand our margin along the way.
So taking a step back or step up in terms of where we are since we launched the overall ZOOM IN strategy now back in the first half of 2023. I think it's fair to say that we're now at a stage where we moved a very long way. And frankly, also, from our perspective, probably a little bit ahead of what we expected when we launched the plan.
The first phase was really about scoping the program then launching it and then executing quick wins. And back in Q1, I talked about the deliberate decision to extend the quick win phase, so to speak, because we believe that there was more to gain still, something that I believe you can now see both in terms of growth, but in particular, in terms of margin.
We will still execute on those quick wins, and they will still have an effect going forward. But we're also now more and more looking at what is the foundational things we should do to ensure that we can continue and extend -- and expand on the growth journey we are on to build the Ambu for the future. And therefore, we are now moving more and more into this Phase III of really looking at what is the foundation we need for the future to both support the growth and support the margin expansion.
And when looking ahead, it's always good to look a little bit back and say what have we really succeeded with in terms of accelerating execution, in terms of driving some of the initiatives that were launched back in 2023. And a way of looking at it, at least is looking at what are the drivers of our margin expansion, if you look at the full 9-year period -- or 9 months period, sorry, for this financial year.
And looking at the graph on the left, it's clear to see that we are working both on expanding our gross margin and expanding our OpEx. Double clicking on the gross margin, it's really back to driving a stronger focus on pricing. We're doing that both in our endoscopy business, of course, in particular, in connection with launch, but also now, as we've talked about a lot in the anesthesia and patient monitoring business, frankly, more successfully than we expected when we started, but also very mindfully managing how do we make sure to continue this drive and make it a continuous effort to manage price.
Second is really making sure that we have a strong product mix and, of course, support the high-growth segments, but also manage our product mix within each of the categories. Right now, as Endoscopy Solutions is growing faster than anesthesia and patient monitoring, that alone is also helping our gross margin.
Last but not least, as you also heard us talk about before, we have a strong manufacturing footprint. We also still have a manufacturing footprint, which is not fully utilized. Of course, that's positive when you're on a growth journey. But it also means that we are still seeing a continuation of the journey of expanding or making sure we have a better utilization of our manufacturing footprint of expanding our sales and offerings within the existing footprint we have, and that will also support our gross margin. It has already, and it will continue to do so going forward.
Secondly, we are seeing a number of FX also helping scalability in OpEx. We still, right now, have a significant cost in terms of distribution, which is part of our selling and distribution costs, something we are working on with better inventory management, with better planning with our customers, something we believe we can still manage better going forward. We have a number of initiatives running on how do we scale our administration, and that's also why we are right now investing in the foundation to be able to scale even further.
And last but not least, we also work on how do we scale our global commercial network and R&D, mindful that we also really want to make sure that they support the continuous growth.
Looking at the first 9 months, you can say we have expanded our margin more by scaling our OpEx and we believe this is a journey that will continue. And looking at how will we go from the 12% towards our long-term financial target of 20%, potentially adjusted for strategic opportunities along the way.
But looking at that gap from where we are today to 20%, we still believe that OpEx will be the main driver of the 2 of closing that margin gap. And therefore, that's also something we are very deliberately now, you could say, incorporated in our plans in terms of how we move forward, still supporting growth, but also very much making sure we manage the margin expansion journey.
So what do we mean by investing more in the foundation? What does that mean building the Ambu for the future? Well, for us, it can at least be boiled down to at least 4 key areas where we're right now very much focusing on making the right investments.
The first area is back to what we talked about already back in Q1 of building a stronger commercial setup, both bringing more salespeople, but also a strong setup around the salespeople. That will require costs on the short-term. as it will take time to bring the right people on board, train the right people and make sure that they can continuously drive sales.
It's a very explicit focus of ours, of course, particularly in the segments where we're seeing high growth. So within Endoscopy Solutions. and right now, in particular, also supporting the upcoming product launches, particularly the ureteroscope. Secondly, it's really ensuring that we run a global, strong, agile, but also lean operation, managing our manufacturing footprint, but also managing our supplier base and driving more efficiency in our distribution setup.
Thirdly, it's investing in our IT landscape. Ambu has grown fast, and we believe there's more to be gained in terms of automation, in terms of working better globally and therefore, really driving continuous efforts of investing in the right things to drive better scalability in our business.
And last but not least, it is really making sure that with all of the 3 above and while making these investments, we still also make sure that we invest in the core that will drive further innovation and organic growth going forward, in R&D capabilities, in really understanding our customers at an even deeper level and making sure that we tie our innovation very much to the customers in a customer-driven way, both looking at new technologies, software, like we've described before, but also looking at AI.
So, this combined, will mean that we are right now working on how do we incorporate all of these investment areas, all of these investments in the foundation in our future plans. We still believe we have lots of margin expansion to do and these will not hamper them, but this will mean that we will selectively make these investments over the coming years to make sure that we really can support the longer-term growth journey.
And therefore, on that growth journey, we've talked a lot about organic growth rightfully. And since the start-up ZOOM IN, that has been the main focus. With a stronger balance sheet, with a stronger margin, with a much firmer grip on our cash flow, we also feel now is the time to openly state that, of course, we're also looking at inorganic opportunities.
It's very, very important for us to reiterate the point that organic growth and growth overall is the main focus of our strategy. Obviously, now coupled with a focus on also margin expansion. But inorganic growth is certainly a vehicle to accelerate the organic growth journey with very deliberate focus on how can we look at technologies or companies that can support our growth journey on that way.
A premise for even looking at M&A, of course, is that you have your balance sheet under control. And therefore, on the left side, you see on the graph, just looking at our net interest-bearing debt to EBITDA level, we managed to now delever significantly with strong performance. And obviously, that opens for a different view on how M&A can be part of our long-term growth strategy.
Of course, we will look at this under the guidance of our gearing level -- guidance, you could say, of gearing up to max 2.5x EBITDA, which is what we also communicated in our Capital Markets Day and also under the guidance of our dividend policy. But still, that leaves quite a room for looking at opportunities.
What opportunities will we look at? Well, again, as I said initially, we will look at opportunities that support our organic growth, value-adding acquisitions within existing business areas, or in clear adjacencies to accelerate the growth or technologies that can accelerate the growth. It's still early days. But given our situation, we also felt today was the right time to communicate that this is an ambition we're actively looking in and also actively investing management and resource time into.
So ending on this year then, more specifically. And coming back to what I said when I started the financial review, we're very happy to reiterate that we upgraded our financial guidance on the 10th of July. So our guidance for the full year now is 12% to 14%, organic growth, 11% to 13% EBIT margin and plus DKK 450 million free cash flow.
Overall, we feel we are on a strong momentum. We feel Q3 is another testament to that strong momentum. And we also feel now with our financial strength that we can allow ourselves to look even broader in terms of how we can extend that momentum. Thank you very much.
That ends my presentation, and I will hand it back to the operator.
[Operator Instructions] We have a first question from the line of Niels Granholm-Leth from Carnegie.
First question would be on OpEx spending. So we saw quite a jump in admin costs in quarter 3. Would this be the run rate for admin costs going forward? Or could we even see admin costs coming up in the next quarter.
And then I would have a question, I would say, more on the long-term side and now that growth in your Pulmonary segment is predominantly going to be driven by the more advanced Bronc suite procedures. How do you see the long-term conversion potential here relative to the OR ICU segment, where the conversion seems to be approaching some level of saturation? And I guess that -- the reason I'm asking here is that several surgical robotic companies such as Intuitive Surgical are now stepping up their entry as regards to robotic bronchoscopy in the Bronc suite. So how do you see the conversion potential in the Bronc suite?
Do you want to take the first, and then I'll take...
I can certainly do that, and you can take the question, Britt, on pulmonary. So thank you for the question, Niels.
In terms of OpEx spending, you are right, it's quite a jump, particularly in admin costs and more than DKK 30 million between Q2 and Q3 in absolute terms. As we also stated in the announcement, we are -- or have been in Q3, making extra investments in several projects, both strategy projects but also IT-related projects. And therefore, this is not a new normal for admin costs, just to be very clear. It is really investments for the future. And therefore, we are not expecting this to go significantly up.
What we are deliberately, as I also stated in my foundation investment overview focusing on is how do we invest more in the commercial organization, while optimizing distribution, but more on the commercial organization, customer-facing people and how do we invest more in IT. So those are the 2 areas that, over time, you'll see more investments in.
But we should expect a run rate of the Q3 level going forward, but without any significant growth?
You will expect, at least for the next coming quarters, it will be flat or actually in some areas, even going a little bit down. But I will not go in details on each of the underlying components, but more reiterate this point that Q3 was extraordinary high, because we made extra investments.
Okay.
And then, Niels, to your question on the Pulmonology segment, which I think is a good and relevant one. So if we look and you asked specific about Europe, but if we take a step back and look overall and into the OR and ICU, where we really see that we have had our stronghold so far has been in the ICU segment with our aScope 4, in the U.S. also starting to penetrate into the OR where there's still also room to grow.
Then with aScope 5 that we then launched, we are seeing traction in the suites, but still with a lot of potential to further advance there. And then we are also seeing aScope 5 being a demand for some of the more complex procedures done in ICU OR that -- I mean, that they kept the reusable to pursue.
So we still see, even though that the market is -- this is the most penetrated segment. We still see that the market -- you could debate how much is it saturating, but we still see room to grow in this segment. And then our focus is also to continue I mean to address the customer problems even better. So we have our next generation of aScope 4 in development, which we believe will come out and serve not only some of the same, but also expand the needs that it solves.
And then you can say our focus is also looking into pulmonology being our -- still the biggest single segment that we are in. We are also expanding how we can fulfill the needs with the video laryngoscope, which is at first, very much focused on U.S. and the U.K., sorry, where the market is already well created, but where there is also a lot of potential given that video laryngoscope in the U.S., U.K. is used to an increasing extent, we see good potential for this to happen in Europe as well.
Then on my final comment on your robotics and what Intuitive is doing, which we are following very closely. And we also believe that there are some of these trends that are very interesting. And where we being an innovator company, we believe that we're still being very close to the customers and how we develop solutions, should be able to continue to have a competitive solution out there, which is partly also where our increased focus on software and the capabilities that we can create through software becomes very relevant.
So you think it's fair to assume the same kind of long-term conversion in the Bronc suite as we are currently seeing in the OR ICU area?
Lastly, yes, that's what we think. And then you can say what we are also very focused on is the portfolio that we are offering to these customers and how we also can -- by increasing the value that we bring to customers can gradually expand our revenue and our presence, both in ICU and OR going forward.
And I think, if I may supplement Niels is, I think important to say, we actually still see single-use penetration going up in the OR and ICU. So when you say saturation, you can say there are levels where we are seeing the speed by which this conversion happened going down, but it's important to say we actually still see the single-use penetration going up for some years to come even in those 2 segments.
Our next question is from the line of Christian Ryom from Danske Bank.
I have two here initially. So first one is on, say, the growth drivers for the Endoscope Solutions business as we look ahead and particularly into next year. So should the assumption still be here that for '25, the main growth drivers is really the aScope 5 Cysto and ENT, why we should expect that the uretero and the gastro and other products will take longer time before they really become meaningful growth drivers or what is your view on the time horizon there?
And then second question was to you, Henrik, specifically on the gross margin development and the potential that you see there as you look ahead, so as I understand you the quarter was helped significantly by improved leverage on fixed costs, how much additional runway do you have on that, say, specifically improving utilization on the Mexican plant?
Thanks, Christian. I'll take the first one, and then you'll take the second one, Henrik.
So maybe on -- I mean, obviously, as you are well aware, we'll guide on the next fiscal year in our November earnings announcement. But if I talk a little bit to address your question, which I think we can. I think what's important to note is that when we bring out new products, it does take a while for that launch phase. And I think you've -- you've seen before where we have tried to illustrate the launch phase where we start with the approval of this, that we call our controlled market release. So this is where we test the product. And then as soon as we feel comfortable with a real launch then when we go out. And then typically, that's the time where a broader set of hospitals use the product.
And then it takes a while before they really start to buy in higher volumes because that will often involve the administration and the value committee or whatever it's called in the hospital. So that's also why when we then look to next year, to answer your question, you are right that it's very much the existing products that we have that will drive the largest share of the growth next year.
I do want to note, though, that the different dynamics with ureteroscope compared to all the other scopes that we have launched, you could say is that this is the first time that we are launching into a segment, where there's already some level of penetration of single use. So we have the leading company here being Boston Scientific. And then we also have Chinese player [ Pusen ] in that market.
So that is, of course, some different dynamics because we come in and we offer a solution based on our systems, so the same platform with the cystoscope. So that's, of course, where the dynamic can turn out a little bit different. And some of the same you will see when we get to the video laryngoscope, which will be coming later. That will also be tapping into a market that has already been created. But it will still be the majority of the growth coming from the already established products.
Thank you. And going to the next question, question on gross margin expansion. I will not be very specific on exactly what is the subcomponent of, you say, better manufacturing utilization of our key factories. But say, instead that you can say we see still potential for more for several years, and that means both 2, 3 and 4 years, where we can actually, you could say, expand gross margin on the basis of a better manufacturing site utilization. That is, of course, mainly driven by our Mexican factory, which is still underutilized. And as we mentioned before, the positive spin on that, of course, is that capacity constraint is not a concern of ours right now. But it does mean it's actually still also in Q3 and will still for next year, hammering on a net-net basis, our gross margin versus where we should be.
I think the other thing I would say is we are also looking at and actually have in this financial year successfully increased our output from the existing factories, also in Penang, where we've been present for 30 years. So I think it's also important for us to say part of the drive and continuous improvement on gross margin is also improving the output on the existing factories and with that also on some of our legacy products actually improving the contribution margin for products that we've had in the market for decades.
The next question is from the line of Martin Brenoe from Nordea.
Henrik, Britt, congrats with the strong quarter here. I think that's deserve to hear that despite the share price reaction today. I have just 2 questions as a starting point. The first question would be just to understand a bit of the seasonality here, especially on the pulmonology side. How should we think about the growth trajectory going into Q4. I mean you have a quite broad guidance here where you are guiding from, basically mid-single digit into the lower double-digit area for Q4 despite only having 1 month left. So can you maybe elaborate a little bit on why you do so?
And is there also some reflection on what you have alluded to earlier that you are trying to sort of smoothen out revenue a bit. So you don't get this very back-end loaded year. So we should expect a bit of a slowdown in Q4, reflecting that you have pushed sales a little bit forward here or at least attempted to do so, that would be the first question.
The second question is on the margins and the OpEx commentary. I think my understanding of where Ambu is today is that you probably have the most amount of products in pipeline in all of history or if you can say, pipeline maybe early stage launching. At the same time, you have a tougher comparison base in your a very strong product portfolio that you need to keep up with. So is it really the right time to say that you will use your OpEx scalability to improve the margins in the next year, as you say, on the Slide 23. Or is it perhaps time for you to scale up the distribution and sales force a bit more to sort of make sure that Ambu is also ready for growth in more than just 1 or 2 years ahead from here on? That would be the 2 questions.
Yes. Thank you, Martin. I very much like your last question -- comment. I'll let Henrik comment on that in a second. But maybe from me to your first question around Q4 seasonality, what's to expect. I think it's fair to say, I mean, we are -- I mean, although we are at the last day of August, at least the last working day, we still don't have the full overview of August yet, just to put that as a disclaimer. Then in terms of what we talk about on seasonality, I think the area where we really see strong impact on seasonality was what I mentioned on the pulmonology side due to the positive impact on the flu level. So we see less seasonality in this quarter 4. We do see some -- specifically in Europe, some different pockets of our business that are impacted by vacation periods and so on. But that's, of course, something that doesn't come as a surprise, so we can plan for that.
In terms of -- then to your question around what to expect in this quarter. We see momentum in the business that when we look at it, we see that continuing. So we still feel very confident on the growth as we look ahead where we still have some uncertainty with what I alluded to on the anesthesia and patient monitoring where we still -- because of these price increases have not seen the full effect yet where we -- I mean, we do see there some customers coming back and then deciding to go with another vendor sometime after we have launched a price increase. So that's where we still have some uncertainty.
And then still, I think our -- we have become much better at forecasting on some of the fast-growing products in urology and ENT, but we still see a little bit of uncertainty in these because of the fast growth as to the timing of the big orders. And frankly, we do not want to put out a guidance that makes us tempted to make any decision based on the guidance because we do want to, I mean, sell everything we can that the product -- that the customers will also use. So that's why we are -- we believe that the guidance that we have set out is the one that we will deliver within. We had a strong finish to the year, last year, and that's, of course, the comparison when we look at the specific growth rate.
Absolutely. And if I've used that to -- on your first question, Martin, and then the bridge to the second on the OpEx commentary. I think, therefore, smoothing or not smoothening. I mean if you set that aside, I think our main focus is to drive continuous growth. And therefore, we are not deliberately moving around orders. Obviously, we are driving sales and for any salesperson number, it's very clear what they need to do. At the same time, it's very important for us to reiterate what we've also said in the last 2 quarters, we are not pulling in orders. We're not encouraging customers to stock up unnecessarily because we don't think that's right for long-term growth. And we don't think that's right for the customers or us. And that's basically what we are trying to manage.
And as Britt says, therefore, we don't want to be guided or forced by a specific target and do things that doesn't make sense for the long-term business. And we still want to repeat what we've said continuously also. Our focus this year is very much on rebuilding trust and making sure we deliver on our promises and we feel, therefore, was the right thing to keep the guidance. I also just want to note, we raised the guidance on the 10th of July. So it's not that long ago that we made quite a significant upgrade. I think on your OpEx commentary and coming back to this point of long-term growth.
I also just want to come back to [ Niels' ] question and make it clear that we are not short term compromising the focus on growth in exchange of trying to expand margin faster. The first, second and third focus is growth. I would say, profitable growth. We don't want to lose track on, it needs to be profitable, but growth is the main strategic focus. It's still important for us to say, though, that with that said, we still believe we can drive margin expansion along the way. I talked about the manufacturing footprint already. But on OpEx, that also means that our expectation will be, yes, the sales force needs to be increased and we need more feet on the ground also with the new products coming in, but we still want to prove that we can do that and actually still expand the margin a bit.
We do have a very important point and coming back to this margin expanding journey is, of course, this year represents a very big step-up in margin. And therefore, when we look forward, that will be more of the balanced and gradual step up towards our long-term target with the main focus on driving growth, making the right investments for the long-term growth and then still continuously making sure we drive a better margin. I hope that clarifies.
It does, thank you so much both Britt and Henrik. Maybe just 1 quick follow-up on sort of the sales force and the commercial investments that you have taken. When I look at sort of the cost that you have allocated to the selling and distribution. It's not that big of an increase compared to sort of how much you actually grow the top line and also maybe the commentary in the beginning of the year that now you need to step up this commercial for us. So when should we start to pencil in that you are hiring the sales force and reinforcing your base here?
Good question. And I would say there are 2 sides to the answer. I think first of all, we are actually and have already hired a number of people. Obviously, remember, Q3 covers up until end of June. So we're looking a little bit back. And you can say, in that quarter, we still had a number of salespeople joining throughout the quarter. So they did not have full impact from the start of the quarter but throughout the quarter and we'll also see that into next year. So that's happening right now. It takes time to find the right people and also to get them out and get them started, as we said before.
The reason why numbers are in absolute terms, OpEx doesn't go up more than it does in Q3 and actually also we'll use what you'll see into Q3 -- 4, sorry, in the coming quarters, will not go up one-to-one with the additional salespeople is that we are optimizing our distribution footprint. And I know we, in the past, have talked about some of the one-offs in global trade. We deliberately don't talk about it now because we don't think there are many fluctuations from that, but we are very much working on how do we optimize this. So the absolute increase of just short of DKK 30 million in selling and distribution cost actually covers for a higher increase in selling costs and a decrease in distribution costs.
Your next question is from the line of Rickard Anderkrans from Handelsbanken.
So first 1 is a bit more high level. So we've seen in the last few years, legacy scope players launching and entering the single-use space. Can you maybe give a comment on the traction and what you're seeing in terms of the competitive dynamic with some of the legacy players entering single use and what you're seeing and hearing on the competitive side from that end. I'll start there.
Yes. Thank you. And I can comment on that. So it's very true, as you say, that the market is getting, I mean where we were first and the only ones, the market is clearly across the segments getting more crowded. And we see slightly different dynamics, definitely different players that enter the different segments we are in. If we take the legacy players, you can say, I think for 5, 6, 7 years, Olympus has talked about entering the space, and they have now partnered up with [ Wassen ], where they have launched a scope, which is, of course, a bronchoscope, which is, of course, one that we see out there, but we have -- we do not see a lot of customers where we are losing against them. And I don't think we see them out there so much yet, you can say.
And then still, if we look at bronchoscopy, it's still in the U.S. specifically and someone in the U.S., [indiscernible] that remains the 1 that we see the most out there. In Urology, if we take that, we have, I mean, Boston Scientific, I mean, they came out with the ureteroscope and they have then also, I mean, partnered with an Asian player to launch a cystoscope. We haven't seen that at all out in the marketplace. And it's also on -- and back to the system benefiting on it is on a very different system and thereby 2 very distinct offerings. So we don't see that a lot.
We see a number of, in particular, Chinese players developing cystoscopes, but we don't see them a lot out in the market yet. And then you can say we see slightly fewer players when it comes to ENT and GI, but still some activity. And I think it's only to be expected. And our focus is really to continue to drive what we are good at to continue to also push our innovation and broaden our offering in the different segments, also the newer segments that we have moved into. And then I mean, deliver on the quality that we have. And we are not losing a lot to competition right now. So we are quite happy and pleased with that.
And then I think also if you take a step back and then you can say the big endoscopy market, it's still only 3% of that market that has converted to single use. So there's still 97% white space. And then you can, of course, debate if you look into subsegments when is what subsegment ready. And that's -- I mean, you've seen some of our perspectives on that earlier. But in total, I would say that there's still plenty of white space to grow into and competition will only help expand the use of single use, which is a good thing for Ambu as well. So I don't know if you have any additional questions, Rickard, but otherwise, that's how we, from the very high level, see it.
No, that's helpful. And just a final quick question from my end. On the core business, you mentioned risks of losing contract volumes there. So when and how will you be notified of this? So essentially, what I wonder is, when will you have more clarity on the vast majority of the customer base. Is this something that will materialize in the coming quarters? Or you feel better visibility? Maybe you could just paint the picture of the visibility into the customer base and timing of more clarity.
It's a good question because, as I think I mentioned, there are 2 different dynamics that we see. There's one dynamic when we go out and bid for a new contract. There, we will instantly know, did we win or did we lose? And then there's the gray area, if you will, where they say, I mean, you're still in, but you're now -- we now have 2 suppliers. And that's where -- in that situation, we will then not know immediately how much will that second supplier that we bring in, get so far in these examples, we have not seen a lot of -- I mean, a lot of volume being lost, but that's, again, where we are monitoring very closely because that can happen.
Then we have the other cases where we have announced a price increase to a customer where -- I mean, they will typically continue to put a couple of orders until someone in the hospital will start to ask whether they should go for another vendor. And then they may either do that for part of the contract or for the full contract. And then, I mean, being close to our customers, that's how we will know about those. And that can take a couple of quarters before this happened. So that's typically the dynamics we see why it's also a bit difficult to be very specific for us to say now this is what happens. I think the only thing that we are happy about and you can say that's so far, so good that we have been able to. I mean, complete the significant price increases that we had in our plans and that we have seen much less volume growth that we were indicating to you in this call exactly 12 months ago that we could foresee.
So you will hear us talk about risks on this Rickard. It's still for some quarters to come. And unfortunately, that's the dynamics as we see them play out.
The next question is from the line of Yiwei Zhou from SEB.
And I have 3 questions here and I do one at a time. Firstly, I just wanted to ask about the ureteroscope. Now it's been a few months since the product of [ Provox ], so what kind of feedback have you received from your customers? Are you comfortable with the product quality now? And also what makes you confident when you confront the competition? And maybe you could also comment a bit that you have had some learnings now. Any segments would you consider as sort of easy entry point.
Yes, I can take that question first. So it's true. I mean we have done -- been in this controlled market release phase for a number of months. And we have I mean we have conducted now over 100 cases with patients, which makes us very comfortable about the product. As I was talking about earlier, we have I mean, we did some minor adjustments, and these are very minor technical adjustments that we -- based on the feedback wanted to do before launching. So I think overall -- overall, I think we are very close to having a product that I think if we look at our product offering that is very solid and very competitive out there. So I think overall, we are quite comfortable about that.
And as I also mentioned, we are in the final stage of that controlled market release. So that means that we -- I mean, we do feel comfortable about the offering. Having said that, I think also it's fair to -- or you should be mindful when you think about our launch and the ramp up that what I talked about earlier that this launch phase does take time. So we are not -- when we launched endoscopes and we were probably some years back, a little more bullish on that, but it does take some time during this ramp-up. And I think that's just important to keep in mind but a very strong offering. We have now very strong customer feedback and we're really excited to bring that out much broader in the very near future.
Perhaps Yiwei, you also asked this easy entry point, and we will not go into a lot of details on it, but I think back to Britt's page on our systems. Obviously, the interesting thing is now we can go to customers we already engage with, with a different product which is a very different way of converting a customer than what we had to first time when we came out with the Cysto product. So the good thing this time is that we have the existing customer catalog, they know us. Obviously, the difference is that they also know our competitors who have market -- or have products in the market. So that's the difference in dynamics.
Great. Very helpful. And my next question is just to follow up on the gross margin. Henrik, you mentioned the sales price increase has also been one of the margin drivers. If you can comment a bit on your contribution margin now for the core business? How should we compare it to endoscopes, if they are getting very close or is still far below?
Fair question. So our legacy business, anesthesia and patient monitoring obviously have a number of subsegments and some of them within our some of our sensor business, for example, the contribution margin, which is the direct contribution for our product, less the cost of the product for everybody on the call are actually not far from the endoscopy solutions. So the difference is not that big. But if you look at anesthesia and patient monitoring combined, it is still below our Endoscopy Solutions business.
I think what's important to say, though, is when you then look at the gross margin perspective of that, then even though on a relative basis, the percentage contribution margin is lower from our legacy business, if the indirect production cost, the overhead at the manufacturing side are the same.
Then your gross margin contribution might actually still be very positive from our legacy business growth. And therefore, I think that's a very important factor to keep in mind when you look at the growth rates for 2 businesses because as such, I would not consider one being good or bad growth. I would actually consider them combined when I look at how we utilize our manufacturing footprint. And that is one of the reasons why at the strong anesthesia and patient monitoring growth for the quarter is actually a positive gross margin contributor also for the business overall.
Great. Very helpful also. And lastly, on the core business, I recall that you mentioned that the price increase will continue into next year in some segments because the contract expires at different times. So is it fair to assume that when we're looking at the outlook next year, we should also assume that some sort of above normal growth in the core business?
I think it's -- we don't call it core anymore. We think our core is our endoscopy -- at least that's our key focus, but they're just putting that aside. So Anesthesia and Patient Monitoring, we believe that the price impact will continue, I mean to some extent into next year, but then it will also level off in terms of impact.
So we should still expect above normal growth in anesthesia and PMD to be clear.
Yes, particularly for the first 2 quarters, right? Because I think like we commented in Q1 and Q2, the main bigger contracts came into force during the end of Q1 -- sorry, the middle of Q2 and the start of Q3 this year. So when you look at Q1 and Q2 for next year, the comparable basis in terms of growth, there will be an above-market positive contribution from price increases.
The next question is from the line of David Adlington from JPMorgan. Please, go ahead.
Most of them have been answered already, but maybe just 1 on gastro. I was wondering if you can any sort of further color you can share with us on the adoption relative to your expectations and is there anything that you need to see to be more confident in the midterm opportunity?
Thanks, David and very good question on gastro. So I mean, overall, we are quite pleased with I mean with the uptake that we see on gastro, although you could say it's still at -- I mean, relative to the other segments at a much lower level, I think the approach that we have taken and that we took also, I mean, started 2 years ago when we cut back significantly on GI, was that we also, I mean, took a different focus on GI moving much more into the OR and the surgical procedures where we saw some need in some very specific procedures. What we also did at that time was that we shifted because there was so much momentum and we really had created that movement to single use, both in urology, ENT and pulmonology.
We actually have had very few commercial resources behind the GI because we took that step back deliberately and said let's -- let's focus on these segments and then let's learn let's take a niche-by-niche approach. So I would say if we look at the feedback we have on the product performance and the penetration, we are actually quite excited about the potential for these products but of course, I mean, even though we have great products, they don't sell themselves. So that's really where we have been balancing our commercial resources and also as we are in the situation that we're in now, we will continue to balance across the portfolio, but we should be able to also make some different decisions as we move forward, given our financial position. So I hope that makes sense.
It does. Am I correct? -- correctly interpreting that you are willing to put some more investment behind that product as we go forward there?
But still, we are -- still, we are being quite selective. I mean, as you also know, I mean, the number of gastroscope procedures out there, I mean, it's 4x roughly the size of the total pulmonology market when it comes to number of procedures. So we are being very niche-by-niche focused in order to get a meaningful and the relevant uptake.
We have the next follow-up question from the line of Niels Granholm-Leth from Carnegie.
Coming back to your pulmonary segment, I would presume that the OR ICU segment would make up, say, 3/4 of sales or so in this particular category. But would you still expect growth going into next year from OR ICU will grow next year really have to come from the Bronch suite category. And then a second question on new technologies in terms of sterilization and disinfection, I mean we are seeing quite many new technologies popping up in respect to sterilization and disinfection. Are you seeing any hospitals looking at these new and, I guess, more environmentally friendly technologies as an excuse for adopting single-use endoscopes.
Thanks, Niels. Two good questions. On the first one, I mean we -- again, we are not guiding for next year, but you can -- I mean, it's fair to expect that the growth going forward, I mean, will be coming from a mix of the suites and the OR ICU. I think that's the specific I can be. So back to also your question earlier, we don't see the ICU OR market being saturated. We still see growth opportunities and growth coming from those segments. So that's on the first one.
On your second one, on new sterilization and disinfection products or systems coming up, we actually I have not heard of any customer interaction. And we may have had a few where this has come up as being something that has been part of the conversation. But it's, of course, something that we are monitoring closely and that we also see that being different as many customers do buy our products because they like to get a fully sterilized product that has not been used in any patient before.
Having said that, I would also say that some of the benefits that we see and that has been one of the reasons why we have had so strong growth, in particular -- with our cystoscope and in ENT has not been so much around this. It has actually been very much around the workflow in the hospital. So the fact that they didn't have to care about whether the product went through sterilization or the washing as it is now where it's not sterilization, but it has more been that if they were to do many procedures, there would always be a scope available, and they didn't have to have a room available for all the cleaning and so on.
So I don't think the -- I mean, new technologies here will solve that completely. And again, we see that workflow being a very strong driver for switching to single-use going forward. And then our focus continues to be on making our products even more sustainable. We have different new solutions that we are working on. So today, I mean, we are, in many cases, more sustainable than the reusable competitors, and we are also looking to continue to push that agenda much further.
Thank you. Ladies and gentlemen, that was the last question. I would now like to turn the conference over to Britt Meelby Jensen for closing comments.
Thank you very much and thank you to everyone for joining the call today. I'd also like to thank you for very good questions and we'll see you in November when we are ready with our full year results. Have a good day and a good weekend.