Medistim ASA

OSE:MEDI

Earnings Call Transcript 2024-Q3

[Kari Krogstad, executive]

Good morning, everyone, and welcome to Medistim's Third Quarter and Year-to-Date September Financial Results Presentation. So, my name is Kari Krogstad and together with CFO, Thomas Jakobsen, we will be very happy to take you through the results.

And just before we get started here, just want to remind everyone of our track record and our ambition, which is to continue to deliver profitable growth as we've seen that we've done in the past. So with a growth in sales of around 10% annually. But let's look at the third quarter results. So in this third quarter, we are delivering 7% growth in Norwegian currency. And taking into account the currency effect here, we see a total sales growth of 5.3%. So this means that sales growth has been gradually increasing during the first quarter this year, both in Norwegian currency and currency neutral.

But the most encouraging development this quarter is the robust recovery from our Americas sales region. So we can see that Americas is up by 17.3% currency neutral this quarter. EMEA is a little bit down this quarter, but as we will see on the next slide, they are still growing well year-to-date. Asia Pacific, down this quarter now not due to the transition that is going on in China, but actually due to lack of sales to Japan this quarter. So I will come back to that.

When it comes to our operating profit and the EBIT, we can see that, that is slightly down. However, the EBIT margin is normalizing as we can see over the past several quarters. And I need to remind everybody that this lower EBIT compared to the quarter last year, but also year-to-date is largely due to the product mix this quarter, but also from the cost from establishing the new direct market operations that we have been talking about.

Year-to-date, we are looking at a growth in Norwegian currency of 5.3%, also a little bit of currency help here. So currency neutral, we're looking at 3.7% growth. And now due to the great performance in the third quarter, Americas is showing a 6.3% growth year-to-date, which is great to see. EMEA, as already mentioned, showing the highest growth in percentage so far this year at 6.8%. Asia Pacific, still down. Of course, we talked a lot about the transition we're going through in China because we have changed from using distributors to going direct with our own setup in China. But this quarter, as I mentioned, and also then year-to-date, we are actually more impacted by very low sales to our distributor in Japan so far this year.

Very nice to see that our third-party products had great growth both in the quarter and now 14% up year-to-date. Same comments really with regard to the EBIT. EBIT now at 25.6%. So getting in the right direction here. And as already mentioned, the running operating costs are at a higher level due to the new organization we have established not only in China, but also in Canada and Sweden and the fact that we have doubled the shifts in production. So we have a higher cost there.

So with that introduction, I will let Thomas take us through the numbers.

[Thomas Jakobsen, executive]

Thank you, Kari. I will take us through the financial P&L and our balance sheet as usual. Kari will take -- have some further comments related to revenue with regard to split and product mix. So I'll go directly to the expenses and cost of goods sold. And the explanation for increased cost of goods sold, Kari touched upon with regard to the growth in third-party product sales. It's 17% growth this quarter and with a [ 14% ] gross margin on third-party products, this obviously impacts cost of goods sold and also impacts the gross margin in percent.

Salary and social expenses increases this time, not due to the direct establishment of Canada and China because that was already in place in the third quarter last year, but partly because of our newly established Swedish office, but also other hirings throughout the organization.

Other operating expenses increases also partly due to the fact that we have a direct operation in Sweden, but also recruitment expenses and some use of consultancy. And last but not least, our 40-year anniversary has also impacted a little bit on other operating expenses.

EBITDA ends at NOK 37.1 million. Depreciation is at the same level as last year. And our operating profit or EBIT ends at 31.9%. That's 24% EBIT margin compared to last year's NOK 33.5 million and 27%.

Net finance is negative, and this is due to foreign currency and Norwegian kroner against U.S. dollars and euros. Pretax profit ends at NOK 30.6 million and profit after tax ends at NOK 23.4 million compared to last year's NOK 26.1 million.

If you look at the numbers so far this year, when it comes to cost of goods sold, we have 2 effects. One thing is that the positive effect with direct operations on one side and on the other side, the negative effect on gross margin percent with a nice development that we had in third-party products. Don't get me wrong, we like growth in third-party products as well, but it's an explanation for why the gross margin improvement is only 0.5 percentage, and the same explanation as for the quarter.

Salary and social expenses increases, and this is related to our direct initiatives, obviously, in Canada, Sweden and China, but also the double shift that we implemented during 2023, which we had a full year effect of in 2024. This is also explaining our increase in other operating expenses.

EBITDA ends at NOK 123.2 million. Depreciation is up from NOK 16.6 million to NOK 17.9 million. And as you saw in the quarterly numbers, depreciation was at the same level as last year. And the reason why we have a higher number for the accumulated numbers is that previous development projects has been fully depreciated.

Operating profit ends at NOK 105.2 million, which is an EBIT margin of 25.6%. Net finance ends at positive NOK 700,000. Of this NOK 700,000, we have NOK 1.6 million in interest revenue, which means that NOK 900,000 is related to negative positions on foreign currency. Pretax profit ends at NOK 105.9 million and profit after tax ends at NOK 82.5 million compared to NOK 84.7 million last year.

If you look at the balance sheet, intangible assets increases, and this is related to our 2 major development products -- projects, sorry, with the software project and our project related to automation of production. Fixed assets, there's been no major investments so far this year, and therefore, we have a reduction.

Inventory ends at NOK 160 million by the end of the quarter. This is up compared to the inbound level for the year, but down compared to the inventory level that ending in the first half, which was at NOK 164.4 million. Customer receivables has a good development. We increased sales, but reduced the outstanding amounts. And we have a solid cash position. I will comment further on that in the setup of cash and how that's been utilized throughout the year.

Equity is solid, ends at NOK 105 million and more than 80% equity. Long-term debt is related to our lease obligations, NOK 7.5 million is related to long-term lease obligations and NOK 1.6 million is related to extended warranty revenues. And we have no interest-bearing debt as such.

Key figures with a little bit weaker EBIT, the earnings per share is obviously down compared to same period last year. The accumulated number is also slightly down compared to last year. But still, we have a very solid earnings and a very solid equity share.

Cash flow. We have a solid cash flow from operation ends at NOK 77.6 million. Investments, this is related to our 2 major development projects. And in this period, we've invested NOK 15.5 million in these projects. Cash flow from finance is related to 2 things. The first thing is dividend of NOK 82 million and the remaining amounts are related to our lease obligations. And because of this dividend payment, we have a negative cash for the period of NOK 26.5 million, pretty much the same as the same period last year, and our cash position ends at NOK 127.3 million.

And with that, I leave the word further to Kari for a business update. Thank you.

[Kari Krogstad, executive]

Okay. So let's start looking at the unit sales of our Flow and Imaging systems this quarter. So we can clearly see that we're still struggling to really sell a lot of our imaging systems, which is the higher-priced version of our device. Just reminding everyone that we are selling flow-only systems, but you can also upgrade later a flow system to a Flow and Imaging system. So it's really an opportunity to sort of postpone the possibility to add the imaging modality.

So due to the more challenging macroeconomic situation we've seen, we have experienced a declining trend in the unit sales of our imaging system through 2023 and also so far this year. So 15 fewer units sold this quarter. Of course, we have a pretty strong comparable for this specific quarter. Good to see that Americas is at least up by 1 unit, but we see that it's pretty weak in Europe, Middle East and Africa region. These 10 units, the majority of these are actually due to weaker sales through our distributors. And I'm pointing out on this because it's always very important for us to see that we are succeeding in the markets where we are direct and of course, where we have the biggest control.

Asia Pacific is also down, partly effect of the China transition, but actually half of this is also lack of sales to Japan. When we sell a lower amount of imaging systems, it is natural that we're also seeing an effect on the number of imaging probes sold in the same period. So this quarter, 11 units down, and it's coming from all the regions.

When we're looking at the flow-only systems in units, that is also a bit down this quarter, although at least Americas is up by 4 units. And in EMEA, we are seeing a decline. But again, the majority of these systems comes from the distributor markets. Of course, not what we like to see, but still. Asia Pacific also down by 2 units due to Japan.

Finally, a graph showing some growth here. So the number of flow probes that we have sold this quarter is up by 17.5%. Really strong increase in the Americas, EMEA and Asia Pacific also up. Of course, this is a reflection of utilization. So we always are happy to see growth in our number of flow probes. Also, when we look at the year-to-date numbers here, it's around 8%. So very positive development in flow probes also for the year.

Diving a little bit into the various regions here. So starting with Americas. As pointed out, currency neutral, revenue up 17.3% for the quarter and also taking the year-to-date sales up to 6.3% for the region. And you could see that it's the total number of systems sold as capital that is helping us here. It's up by 5 units, both for the quarter and the year-to-date. And also, all of these units were sold in the USA, where we get the best prices, and that's also very positively impacting the revenues.

Also want to remind us that although Canada had a slower quarter in Q3, they started the year really, really strongly and are still doing really well year-to-date with NOK 10 million in sales so far. Also, our smaller region in Latin America is showing good development year-to-date. So looking a little bit further into Americas here, so we can see why we are getting the 17.3% currency neutral growth from Americas. We see that the capital sale of MiraQ systems is up by 5 units, and that means a lot for the revenues. In addition, we have one system also outplaced on a lease contract.

When it comes to the number of procedures, we can see that, that is much more flat and it's not really following the growth in revenue. So we can see that the flow procedures for the quarters, [ slow ] growth of 2.3%, 5.1% year-to-date. Imaging procedures really down, of course, as a consequence of our -- yes, the lagging sales of units of the imaging system. So the procedures will also follow in that regard. So that means it's pretty flat in total for the quarter, 2.3% growth so far this year.

So -- and also looking at the year, yearly number of procedures here, we see that 2022 and '23, while it was a growth now the last 12 months so far, 2024, it looks pretty flattish on an annual basis. So this is not really what we want to see, and we are making initiatives in order to work more closely with our customers in order to make sure that we are securing routine growth, routine use of our system every time when we are selling a new device.

We are adding new customers, although not as many as we did in the same period last year. So 5 new customers this quarter, 16 new customers so far this year. Asia Pacific, currency neutral, revenue down 14% for the quarter, 22% year-to-date September. So this growth was challenged by a very strong first half last year. Then we had exceptional high sales of systems to our distributor for China prior to Medistim going direct in the second quarter of '23.

But we're also seeing this year weak sales to the distributor in Japan. I've already mentioned that several times. And in contact with our distributor, they are not giving any feedback with regard to any less interest in the market or any change in use or interest or in number of [ CABGs ]. So it's probably the ebbs and flows of the business, and we are expecting to see uptake in sales to Japan and the distributor there in the next period.

Yes. I also want to point out that for the quarter, we actually see pretty decent sales from our direct operation in China with almost NOK 5 million in sales for the quarter versus less than NOK 1 million in the same quarter last year.

Europe, Middle East and Africa, currency neutral, revenue is down 8.7% for the quarter, but 6.8% up for the year. And very important to note that we see the strong development in our direct markets coming from all of them, Spain, U.K., Germany, Scandinavia, everyone is doing really well. And looking at the direct markets in total, we see currency neutral growth of 11% for the quarter, 22% year-to-date. So this is really strong and encouraging.

For third-party products, they have also done really well so far this year, growing 17% for the quarter, 14% year-to-date. As we know, it's a highly diversified product portfolio. There's a few of our agencies that have been performing very well this -- for this year, Mentor, Icare and A.M.I as examples. But we also see good contributions from the new agencies, Peters Surgical and TisgenX as well. So this is very good.

So this is summarizing the revenue performance by region in Norwegian currency. So Americas up 19%; APAC down 12%; EMEA down 6.9% in Norwegian currency for the quarter and then taking us to the 7% growth.

Looking at our own products and the split between the Cardiac and Vascular business segments. So we see that the development in Cardiac is pretty flat. This is a consequence of lower sales of imaging devices, obviously, and also a little bit on the flow side. In Vascular, though, we are continuing to see increasing growth. So 22.6% growth in the Vascular portfolio and 20.9% so far this year is continuous signals that we are making progress in this strategically very important segment for Medistim.

Looking at the split between Flow and Imaging products. So as already alluded to, it's the imaging products that they are struggling. If we look at the flow products in total, we see 15.9% growth for the quarter and 10.9% growth for the year-to-date. So pretty solid there, but it's really imaging that is -- that we're struggling with at the moment. So down both for the quarter and year-to-date.

And then we are looking at the split between the recurring and the capital sales. So you will remember that recurring revenues for Medistim is the total of sales of TTFM probes, but also paper procedure, smart cards and also lease income versus then the sales of devices. So this quarter, this percentage of recurring revenue is about 73%.

When we are -- well, implementing our strategy, we are taking into consideration the situation in the various geographies. So in the strong Medistim markets, and when we say strong Medistim markets, we're talking about markets where we have a high market share and market penetration with our flow technology for CABG, so cardiac use. And of course, we have many good examples of markets in this category. So Japan, China, the Nordic countries, Central Europe, not only Germany, but also Spain, Austria, Switzerland and so on. So there's several markets there.

Here, it is important for us, of course, to work on the big installed base we have for flow and convert imaging. Right now, we're not succeeding with that. But looking a few years back, we had really great growth from the imaging, and we're expecting that growth to come back. There's no signals from users alluding to any lack of interest in the technology.

In the same market, it's also important to go after the Vascular opportunities because, of course, in some of these markets, we have, well, almost fully penetrated the hospitals with regard to flow systems. And then it's very natural that we are also going more actively after the Vascular opportunities. And we can see that in these markets, we have really great examples of good uptake of Vascular procedures.

When it comes to developing markets, where we have a little lower market penetration or share with our flow technology for CABG so far, USA is a good example at about 35%. So it's starting to becoming a strong market. U.K. also coming up now with about 10% of the procedures and France and Italy as well as really up-and-coming markets. Here, it is very important for us to grow the adoption in these underpenetrated markets. And the way we're working on that is really much through clinical marketing, of course, helped by guidelines. And as we will see increased focus on education as we see this as critical to get the routine use that I also mentioned before.

Product innovation for ease of use is also important. We are in these markets, going after completely new customers with no experience in the use of flow technology. So as the product needs to be as easy to use and easy to fall in love with as possible. And it's important that we are continuing to develop the products in that direction.

And we have some emerging high-growth economies. And we pointed a lot to India as a very interesting example, a large market, about half the size of the USA at the moment, but growing much faster. So we really want to have a foothold here. And then it's important for us to be able to deliver flexible pricing and business models that are suiting these specific markets. So we have a core model, which is an entry-level solution for these more price-sensitive markets.

I mentioned our endeavors in Vascular surgery, and I would say we are making inroads there month by month. And last but not least, of course, we will continue to expand our direct market coverage as the time goes by as we're seeing that we are getting the best outcomes and results from these direct markets.

So, then I will finish off with some pictures from a couple of occasions where Medistim this year have been celebrating the fact that the company is actually 40 years old. And of course, there have been celebrations both internally, but also out together with our key opinion leaders and surgeons. And I also want to take this opportunity to really send some warm thanks to my colleagues in Medistim, both past and present, and also to distributors and other business partners. But I would say, first and foremost, thanks to the surgeons and to the medical community that have really trusted us with the ability to deliver the devices they need in order to save lives. So great year for us, and we are continuing the celebrations and looking forward to the next decades.

So with that, we are opening up for questions.

[Unknown Attendee]

Yes. And we have a few questions coming in here. The first one is on Japan. Last quarter, Japan was highlighted as sales are behind normal levels. Therefore, no sales at all to Japan is not reassuring. Can you give any insight into this development?

[Kari Krogstad, executive]

Yes. First of all, I think this is, of course, a business-to-business relationship. So the sales from Medistim to a distributor will never be a direct reflection of what's going on in the end-user market. That's important to keep in mind. Then a second point is that the visibility that we have at any point to, let's say, the inventory situation at the distributor and even their pipeline, that varies. Some distributors are very transparent, some distributors are less transparent. So we don't always have the control of really seeing all of this.

I have to say I did expect to see sales picking up to Japan this quarter. At the same time, our distributors are claiming to have a good pipeline for the fourth quarter. So I remain optimistic that we will see an improvement in the next period.

[Unknown Attendee]

The next one is on the USA. It's great to see that USA is picking up pace, but there is no real growth in number of procedures. How come?

[Kari Krogstad, executive]

Yes. Okay. I think I touched upon that, but yes. So I think, first of all, 17% growth currency neutral for the quarter is very encouraging. So I'm sort of celebrating that a little bit. Having said that, I'm not happy with the level of growth that we're seeing from the number of procedures. I mean, we should see a higher growth in the number of procedures, and we need to see that in order to keep sort of the market pace as we've seen traditionally over the years. So we have a sales process where it is mandatory for us to really making sure after sale that we are paying attention to the customer, being present in the operating room, making sure that everybody is fully trained. And when I say everybody, that's usually a big team of both several surgeons, operators, perfusionists, many, many stakeholders that has a say. It's also a great opportunity to sell to more surgeons than the ones that we have sold to in the beginning. So we are intensifying our efforts in order to making sure that this is happening.

[Unknown Attendee]

And the third one is on R&D. R&D spend has over time increased at Medistim and is now at NOK 24 million so far in 2024. This is high for Medistim. Can you elaborate on why R&D spend is increasing?

[Kari Krogstad, executive]

Yes. Well, first of all, it's a very deliberate development. I think if we look back a few years and look at our total R&D spend in percentage of the total sales, we are probably looking at a percentage of around 4.5%, which is very low for our industry standard. And over the several years now, we have gradually increased our capabilities in R&D. So we built out this external innovation team, as we call it. So a very customer-centric collaborative team to really catch new ideas and test and pilot with customers, but also developed and expanded our R&D team, especially on the software side.

So I think if we're looking at the year-to-date numbers with regard to our R&D spend, it's probably around 6%, so from 4.5% to 6% over some time period here now. So clearly, we are investing more in our R&D. And this is important because we've seen that it requires more resources, both to just maintain the systems that we have in the market. So if we are going to have any chance of innovating, we really needed to make a change.

And as you're mentioning under the strategy part of the quarterly reports as well, we are currently concentrating on mainly 2 very important product or projects for us. One is the ambition to automate the probe production. which is going to be very, very important. We talked about the fact that we had to install a second shift there in our production. So it means it's a very manual process and the only way that we can really grow capacity on production is by adding more people. So it's not a sustainable solution for the future. So this is a very important project.

And the second very important project is a significant software upgrade that will give our customers new features and definitely a much improved customer experience from using our technology. And this has also been -- we've been working on it for a long time, and I can say that it is approaching market launch in the very near future. So I would say these have been deliberate and very important investment for the company.

[Unknown Attendee]

And we have several questions on the same topic coming in from the web here. Do you have any plans of going direct in more countries with the success you have had in that? And yes, Japan and EMEA is mentioned herein from several [ countries. ]

[Kari Krogstad, executive]

Yes. So yes, we definitely have a list of countries, which are desirable for going direct. Right now, we do want to just make sure that we are sort of in the good side and have full control after the 3 direct projects that we did last year, making sure that everything is running smoothly in China. Of course, this is a different culture, and we do want to make sure that we have the setup and everything is running smoothly.

Sweden is not so challenging, and they are doing great already. Canada as well being handled by our U.S. team from the management side. So probably not in the next 6 months, but we do have a list of countries that it's natural to look at. And it typically -- it's typically countries where we have a solid business already, but where there are remaining growth opportunities and also where we think that our own team can have a better chance of succeeding and growing faster than a distributor.

[Unknown Attendee]

Thank you. That was the questions.

[Kari Krogstad, executive]

Okay. So with that, we thank you for listening and participating this morning and look forward to seeing you again for the next quarter's presentation. Thank you.