Medistim ASA

OSE:MEDI

Earnings Call Analysis

Earnings Call Transcript 2023-Q3

[Kari Krogstad, executive]

Okay. Good morning, everybody, and welcome to Medistim's Third Quarter Presentation for 2023. My name is Kari Krogstad. I'm together with CFO, Thomas Jakobsen, we are here to take you through the results.

So with this, let's move on and look at the highlights for the quarter. So the third quarter provides solid financial results for Medistim. And we are looking at revenues at NOK 124.1 million, a growth of 6.5% over the same quarter last year. And also an EBIT result of NOK 33.5 million, which is a little bit lower than the same quarter last year, but still solid margin.

If we look at the contribution from our own products and third-party products, we see that our own products this quarter is increasing by 5.4% in Norwegian currency and the third-party products is actually delivering a quite good growth at 13.9%. Within our own portfolio, it's very encouraging to see that the imaging sales is up for this quarter. It has seen a little bit of slowness there, so far this year. So that's good to see that this is developing a little bit better.

Flow sales is also up 3.9%, Vascular sales is up 7.7% and also Cardiac sales is up 4.9%. Of course, it's always very important for us to continue to follow the currency neutral results. And if we look at the Medistim sales in total, we are looking at a 3.1% decline for the quarter. For own products, this decline is 5.6%. And here, it's very important to note the large regional variations that we're looking at.

So for Americas, currency neutral, it's down 10.3% for the quarter. And here, the explanation is the same as we've seen across the year, that we see a little bit more slowness in the finalization of sales projects that we're working on. The pipeline is still very good. And we're also seeing less capital sales from the U.S.A. So this is influencing the sales development for the year so far.

I would like to just put into context the fact that we are comparing our U.S. and Americas numbers, to very, very strong previous years. So, in 2020, we had 22% currency-neutral growth from Americas. And in 2021, we had 28% growth. So we're also maybe normalizing a little bit from an extraordinary high growth in the territory.

For EMEA, it's very encouraging to see that for the second quarter in a row, we are looking at very solid currency-neutral growth, 32% this quarter. Previous quarter, we had 27% growth. So this is looking very solid. And it's also important to note that this growth is coming both from our direct markets, such as Germany and Spain and also from several of the larger distributor markets. So it's really good performance across the board.

Also, we see that Imaging sales is providing growth in the EMEA region for the quarter. When it comes to Asia Pacific, this is as we have reported, a territory where we are going through some significant change this year. So we've seen a very high sales increase actually in the first half of the year, which has been due to our previous distributor in the territory that has -- well, we've been a change from a distributor sales setup to go in direct ourselves. And of course, in this transition, it's very normal to see that the former distributor takes the opportunity to complete their sales projects and also then filling up the inventories in the sub-distributors within the territory, and it's China in particular that we are talking about.

So for this third quarter, we are seeing that inventories seem to be pretty much filled up and that influences the China sales, which is then also influencing the total Asia Pacific territory sales. So this was to be expected. It might be interesting also to note that, regarding Flow probes, you can see a 15% decline in number of Flow probes sold for the quarter. This is following a very strong quarter -- the second quarter, again, related to this change and transition that we're going through in Asia Pacific. They had or influenced a very high growth of Flow probes sales in the second quarter.

So now it's a bit down, again due to Asia Pacific. So in total, it's not really a big change with regard to volume sales inflow. When it comes to the EBIT, I already mentioned the result, the margin is being kept at a high level. Thomas will go more into the details with regard to the P&L and the expenses. But I'd like to stress that Medistim is absolutely following our strategy of keeping very high activity in the market.

We have been visiting our customers a lot, not only in Cardiac, but as you are also aware, we are building a market presence in Vascular, that requires a lot of activity out at the hospitals and also with regards to conferences and marketing activity. Of course, also the expense level is influenced by our going direct, both in China and in Canada in the period.

If we then take a look at the year-to-date September results. Again, we're looking at strong financial results, clearly helped by the favorable currency. Reaching NOK 390.7 million for the period, providing 11.6% growth. And here, we see that all product sales is increasing by 12.9%, while third party after 3 quarters is up 4.9%.

And due to the good development we saw in Imaging for the third quarter, now year-to-date, the Imaging sales is, well, reasonably flat with the previous year's period. Flow sales is good, up 19.7%. Vascular sales is up 15.3% and Cardiac is up 12.4% in Norwegian currency. Then when we are adjusting for the currency effects, we are looking at the total sales growth for Medistim at 1.2%. And our own products, the total growth was, well, 0.5%. And again, differences between the regions here, Americas year-to-date, down 5.2%. But as I said, we are comparing to very, very strong historical numbers here.

EMEA is up 13.5%, slow first quarter, very, very strong second and third quarters. And Asia Pacific, down year-to-date 5.1%, very strong first half and then a little bit slower in the third quarter due to very little sales to China.

Yes, EBIT margin kept at a high level, 27.9% versus 29.9% last year. And the explanations for the expenses is really similar to what I pointed out for the quarter. So I think with that, that gives us an idea of the main things that is influencing the numbers so far. And Thomas, let's go through the P&L.

[Thomas Jakobsen, executive]

Thank you, Kari. As usual, I will go straight to the P&L, and Kari will take you through sales numbers per geography and products later on. So I will go straight to the cost and the expenses. And based upon what Kari just told us, one should expect that the cost of goods sold or the gross margin was declining based on the fact that we were pretty flat on sales in the U.S. and down in Asia and up on the third-party products.

But we have had a very strong quarter for Europe and especially our direct operations, contributing positively on the gross margin plus a favorable currency. And as a consequence, our cost of goods sold goes down and our gross margin is actually up from -- is up from just under 80% to actually just around 80%, up 0.8% in total. So that's a good thing.

Salary and social expenses are up. We have a full year effect of new employees affecting this. We also have introduced shift in the probe production during the year, which affects expenses. And last but not least, we're also establishing ourselves in new markets with a direct representation. So this obviously affects salary and social expenses as well.

This is also, the fact when we look at other operating expenses, Kari mentioned it, we have had extensive traveling related to marketing activities also in this quarter, not just within Cardiac, but also towards the Vascular segment where we have very much focused these days.

Again, establishing direct operation in Canada and China also affects other operating expenses because we did not have these subsidiaries last year, and therefore, the expenses is now in addition, when we look at the year -- third quarter numbers.

Last but not least, I'll also mention that we had some additional IT expenses, related to software improvements and updates in this quarter as well. All in all, EBITDA ends at NOK 38.8 million. That's slightly down from last year, which ended at NOK 39.7 million. Depreciation is also a little bit lower than last year, and this is -- the depreciation is related to lease contracts, lease systems, our placements in the U.S., product development and last but not least, IT infrastructure.

All in all, operating profit ends at NOK 33.5 million, that's NOK 0.5 million down from last year. But net finance is slightly positive. And last year, this was negative by NOK 3.5 million. Net finance is mainly related to receivables, that is realized and unrealized gains on receivable positions at the end of the quarter. So all in all, we actually ended up with a pretax profit, which is NOK 3 million better than last year and it ends at NOK 33.6 million.

Profit after tax is -- ends at NOK 26.1 million, which is up from last year's NOK 24.6 million. If you then go to the year-to-date numbers. I'm not going to go through all of the expense lines because we have the same explanation on the larger numbers. Then, what I would like to point out is that when we look at salaries, social expenses and other operating expenses, we have negative currency effects here.

Although we have helped on the top line, we have negative currency effects on these expense lines, and it's totaling to NOK 7 million year-to-date September. Otherwise, even though U.S. has been a little soft this year, and we have this transition period in APAC, we still deliver the best top line ever in Norwegian Krones, and we also delivered the best profit ever in the history of the company after the first 3 months of the year. So I just would like to point that out.

If we then go to the balance sheet, we have intangible assets increasing, and that's mainly related to product development. Inventory is increasing, and we're now having a normal supply chain situation, I would say, and we are at comfortable levels when it comes to securing our critical components. Receivables are down. So with increased sales, we actually have been able to decrease customer receivables. So we have done a good job collecting our receivables during this third quarter. So we're down from NOK 101 million by the beginning of the year, and now we're just over NOK 80 million.

And we continue to improve our cash position after the dividend in May. So we now have a cash position, which has improved and ended in September at NOK 126. 4 million.

Equity and liability, we have no traditional interest-bearing debt from banks. So we're self-financed. Although we do have long-term debt related to lease contracts, in total, the debt is just under NOK 12 million, but the long-term debt related to these contracts is just over NOK 4 million. Otherwise, we have a very strong balance sheet, of course, 80% equity, which is very solid. So with that, I leave the word again to Kari to talk more about sales and business segment update. Thank you.

[Kari Krogstad, executive]

Okay. Then let's move on and take a look at the development of in-unit sales of our Imaging probes and systems. So as I started to mention, we are looking at the third quarter where the Imaging part of the business is looking a bit stronger again, which we, of course, always love to see.

Here, we can see that we're selling 28 units this quarter compared to the 22 previous quarter last year. And we can see that this is more or less coming from the EMEA region. So this is helping the strong performance that we are currently seeing from that region.

Also, we are seeing a positive development on the unit sales of Imaging probes, of course, following the system sales. When it comes to Flow probes and Systems in units, you can see that we are selling 10 less capital sales of Flow systems in the quarter. And as I said, Asia Pacific is really the region that is well a bit down this quarter due to the change that we're doing in China. So Asia Pacific, Eastern down with 7 systems for the quarter.

If we're summing up sales of both Flow systems and Flow & Imaging systems sold as capital, we see a slight decline of 4 units this quarter, 5 units less for year-to-date. And looking at the development in number of Flow probes sold, not a dramatic development here. We see very good probe sales, both in Americas and EMEA. But weaker growth in Asia Pacific for the quarter, again, related to the change we are in the midst of in China.

We also would like to make some comments with regard to the correlation between sales in real numbers and also discussing this in units and also currency effects and effects of the channels. So let's go through that. For Americas, we can see Norwegian krone, it's pretty flat for the quarter, slow growth year-to-date. But we mentioned that there's a currency effect here. So taking that into account, the decline is 10.3% for the quarter and 5.2% year-to-date.

And the decline is due to fewer capital sales of systems and Imaging systems in particular, and that will have an effect. Asia Pacific, again, development that we're seeing for the quarter related to the transition that we're going through in China, going from a distributor sales model to establishing an own sales organization.

EMEA, very strong quarter after a weak first quarter, and we can see that revenues were up by almost 50%, currency-neutral up by 32%. So a really strong period here. Third party, as mentioned, very strong quarter, 13.9% growth and 4.9% year-to-date. So good solid performance from our third-party business as well.

When looking at the revenue performance by product category, we see that procedure revenues is growing slightly at 3.5% for the quarter, 12.6% year-to-date. And this is to be correlated with the number of procedures that increased at a lower pace, 1.4% for the quarter and 3.3% year-to-date. And this is the favorable currency that is explaining the difference.

Flow probes mentioned 15.1% down in units for the quarter and still increasing or being pretty flat with year-to-date. An increase in NOC that we're seeing is driven by the currency and also effects from the price increase that was implemented from January.

Flow systems. The unit sales was down 28.6% for the quarter, down 2.8% year-to-date. And it's the high-level sales through the direct channel and also currency effects that explains the increase that we see in Norwegian currency for the quarter and year-to-date. Imaging systems and probes, we see that the unit sales for the quarter was up 27.3%. High level of sales through distributors explained the lower sales that we're seeing in Norwegian currency. And year-to-date, number of units were down 2.7%, sales in nutshell, a decline.

Yes, implementing the strategy. This has very much been business as usual quarter for Medistim. Of course, we are working on the changes that we are going through in some of the territories. But nothing very extraordinary to report for the quarter. This is our growth strategy.

So I will just take the opportunity to remind everybody about what our growth strategy really is. Of course, it's very much in the coronary bypass segment, the Cardiac segment, it's important for us to take advantage of the large installed base that we have with our Flow systems in several markets. We're mentioning here Japan, the Nordic, Central Europe and more markets, where we have a very solid position. It's very important for us to convert this installed base to a Flow and Imaging based portfolio.

And we are doing that very much helped by the clinical data we generated from the REQUEST study, that has proven to be a great driver for the growth and conversion that we're seeing into Imaging. And we are also working diligently on the product development side to ensure that the usability and the ease of use of our products are maximized. So it's important to ease the conversion from Flow to Flow and Imaging through product innovation and improvements on that side.

When it comes to markets that are more in a developing phase, U.S.A., now with more than 30% market share, well, it's going towards a strong position, I would say. But here, we are always positioning our products and solution based on the Flow and Imaging from day 1. And we are seeing that we are getting good acceptance in the market for the combined solution.

And although the Imaging sales growth has been slower so far this year, we are seeing from all territories and response receiving from customers that the preference among surgeons is definitely to go for the Imaging component from day 1, but it's the funding that is sometimes delaying that opportunity.

We also offer an entry-level solution for emerging price-sensitive and high-growth markets. India is one good example. And here, we have, let's say, a easy conversion of the MiraQ, which is then positioned at a lower price point. And -- so far this year, the LivaNova is working a lot with demonstrations and evaluations and making some progress in the market, not that much reflected in the sales yet, but we remain very optimistic and confident that this partnership will help us to build a position over time in important markets such as India.

With regard to Vascular surgery, we can see and I reported that we are continuing to see growth in the Vascular field, perhaps not to the same extent as we saw in the 2 previous years. Again, this is related to, for instance, the U.S. development, where we're seeing less capital sales and also less sales of imaging systems, and that will also influence the sale of the Vascular portfolio as such.

Expanding our direct market coverage. Yes. So far this year, we've gone direct, both in Canada and China and more countries will come also in the future. The one market that we always follow a little bit closer is the U.S., and today, the U.S. sales is actually accounting for about 50% of the sales of our own products. So clearly, this is a very important market for us.

And based on the historical numbers, as you can see here, today or based on the 2022 numbers, we can claim to have more than 30% of the CABG procedures being performed in the U.S. as our share. Still, we know that we have a decline, now currency-neutral for the quarter and year-to-date, again, related to the lower capital sales.

Number of procedures, and these numbers is a little bit different from the numbers we looked at previously. Here, we are counting both procedures from the PPP, the paper procedure accounts and also the lease accounts and also from sales of capital probes. And here, we see that Flow probes are at the same level as last year for the quarter, a little bit down year-to-date. And Imaging probes on the other hand, a little bit down for the quarter and flat year-to-date. So more or less at the same level as last year we could say.

I mentioned the decline in capital sales, so 9 units in Q3 compared to the 13 units sold in Q3 last year, and 32 units sold so far this year compared to the 40 units sold last year. Last but not least, we are continuing to win new customers. And this is, of course, maybe the most important piece of data and information from the U.S. So 7 new customers for Q3, 25 new customers so far this year. And with that, I'm yes, opening up for questions.

[Unknown Executive]

Yes. And we have some questions coming in from the web. The first one is on the inventory. Inventory is becoming very high at Medistim, and inventory is today approximately 1/3 of your balance. Why has the inventory been growing so much? And is this a level we can expect to see in the future?

[Thomas Jakobsen, executive]

I guess this was mine, Kari?

[Kari Krogstad, executive]

Yes.

[Thomas Jakobsen, executive]

Well, I mentioned that we have a pretty comfortable inventory levels when it comes to critical components and a normal supply situation. So going forward, I would say that we now are at a level which we are comfortable with when it comes to inventory.

So the development in inventory given that the estimations we have on sales and orders that we have to place for critical components are coming in at about the level that we expect. And I think this is a level of inventory that you could also expect going forward for Medistim. That means that we will not see this large increase that we saw from the end of 2022, up until now in September this year.

[Unknown Executive]

And then we have a couple of questions on China. I think I will go with one of them because they're touching into the same. When do you believe that China is back to growth? I guess consumable sales should be less effective?

[Thomas Jakobsen, executive]

Kari, I'll leave this one for you.

[Kari Krogstad, executive]

Yes. So the third quarter is the first quarter where we are really -- well, entertaining this market through our own organization. And of course, as I said, we are seeing that the sub distributors that we are also now working with inside of China, they have their inventories pretty much filled up and that is the -- what we're seeing for the third quarter, that there's no need for additional product supply in this particular period.

At the same time, we have, of course, to work with these distributors for a while now, and we know that there are interesting projects in the pipeline here. We believe that there will be certainly an improvement through our own organization in the fourth quarter. To what extent, I mean, that remains to be seen.

And then I think that going through 2023 and now entering into 2024, I think the effects of this inventory buildup situations will -- will decline and be soon gone.

[Unknown Executive]

Thank you. The last one is on Europe. Sales in Europe has been strong the last couple of quarters. What are the drivers for the growth and what markets are the standout markets?

[Kari Krogstad, executive]

Yes. Then -- as I said, I mean, it's really good to see that the performance is quite evenly distributed. It's coming both from our direct markets; Germany, Spain, even U.K. and also from the distributor market. So it's really a little bit all over the place that we were seeing good performance and that's reassuring.

I pointed to Imaging, as one of the reasons why we're seeing good development from Europe, in particular, for both the second and the third quarter. We did hear some feedback from the market with regard to lack of staff. And I think I mentioned this in previous presentations as well. So this could be sort of a question mark. Would this be a factor that would influence, I mean a lower activity level in the operating rooms and so on. And I guess, so far, we -- at least we cannot see this affecting our sales, and that's a very good thing.

[Unknown Executive]

Thank you. That's it.

[Kari Krogstad, executive]

Okay. Then thank you, everyone, for attending, and we will be back for the fourth quarter. Thank you.