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Hi, and welcome, everyone. Mentice released their Q4 2022 report this morning. And with us today are the company's CEO, Göran Malmberg; and the company's CFO, Gunilla Andersson, who will present the report. After that, we'll follow up with a Q&A.
So without further ado, please, Göran, go ahead.
Thank you so much. Pleasure to be here. So I will take you through the presentation. First, before I go into the details, I just want to say that I'm very pleased with the general development from any aspect of the business in 2022. Of course, we could have seen or could have appreciated a bit higher top line result. But I think the -- there's a lot of positive factors here that we will talk about.
So we can see it in 2022. We have been able to get the hospital business back on a normal level or higher level than we've seen before, and now back to a level of 40% of our business, which is really main base of our business going forward.
So that's the combination of the hospital business, health care business and the strategic alliances business that now is about 40% of total business or order intake. And then in the same thing, we can see that the development we have on the device market is really strong on all areas.
In 2022, we were not able to deliver growth compared to 2021. And the one that have followed us probably have seen that we had an extremely strong 2021 where we grew more than 50% compared to 2020. So I think this is a logical reaction in 2022.
But what really makes me positive for the future is the development we have on, I would say, virtually all major medical device companies and both existing and new or the remaining competitive accounts. So that's really a good base for coming into 2023. And last comment before moving to the slides is the combination of the different product areas we have now with the legacy product from Mentice combined with the physical simulation product from the acquisition we did in 2020.
And then the most recent addition of the precision medicine solution from -- we acquired from Galgo, Spanish company called Ankyras that presents an extremely attractive proposition to the market and really unique solutions -- a set of solutions that no one else can offer.
So anyway, that was just a quick backdrop to what we do before we go into the details. So if we look at the Q4, it's a slight delay was also -- we can see that the order intake in the quarter has increased with 20% or so. And again, we had a very strong Q4 in 2021, record quarter in 2021. So this is a strong Q4 from an order point of view.
If you look at the health care as I said, it's almost 4x last year in the fourth quarter. And the APAC region, also significantly up compared to last year. Overall, in the quarter, we have larger orders from CMA, which is this Chinese government authority in the health care sector. I'll talk a little bit more about that later on. Early in the quarter, we got an order from account, it's the first Ankyras based order. And then in the end of the quarter, we got multiple larger hospital orders, and 2 of them from the U.S. where we announced the core health and orders from multiple hospitals in [ Core ] Health Group, $540,000. But in addition to that, we have another one of similar size from an unnamed use system available, premier ones in U.S.
And then you can see that the order book is moving up from around SEK 80 million in 2021 to SEK 126 million, exiting out of 2022, which is a significant increase. And you can see here, we reduced SEK 68.7 million for the fourth quarter, which is on par with the same quarter last year, but the order book increase here, obviously, if you look at the order intake and the order book increase, you can see the correlation to the introduction net sales results.
We did produce a positive EBITDA in the quarter, a similar level to last year. And we can see that the initial reaction to the cost savings and the focus on profitability, we initiated in the mid part of the year, has been resolved in the fourth quarter, where we -- for the first time in several years had positive EPS and also positive cash flow where we generate SEK 26 million for the quarter.
So we're moving into the full year highlights. The total order intake grew up to 252, up from 205, so it's a 23% growth year over year. Obviously have a currency effect in this number. Here, again, you can see that the hospital base business grew almost 3x, 193% from some SEK 24 million, SEK 25 million, up to over SEK 70 million. As I said before, if you add assay to this, those 2 together is about 40% of our total order intake. So those are really tightly connected since it both addresses the same end client.
We, as stated, performed the acquisition of the Ankyras in the precision medicine side, which we'll talk a bit more about later. And we added new capabilities to what we did, both cloud-based and online simulation. Really, I can say, result of the requirement -- the change of requirement during the pandemic where the requirements lever to conduct completely roadshow sessions having multiple positions joining in from their own location and allow them to participate in the simulation session and moving the control between these people, but still provide a relevant training session or session going through a specific case. So this is a really interesting opportunity going forward that we're really starting to explore during the year.
We can see, as I mentioned, in my first talk that we have really, I would say, exciting expansion within both existing customers and new customers where we really tapping into what I would refer to as the remaining competitive accounts in this industry. So it really bodes well for the next future here.
Net sales for the year first time moving above SEK 200 million, as I said in the report. We passed SEK 100 million in 2017 to about 6 years ago, and now we moved over SEK 200 million with about 18% growth. And for the full year, we present a slightly negative EBITDA, but with radically improved operational cash flow and the cash position at the end of the year was SEK 47 million compared to SEK 12 million.
So we look at a little bit more details on the order before I hand over to Gunilla. So we can see that for the full year, the Asia Pacific region really carried -- with the EMEA region carried the growth for the company. And that's where we have the -- that's the unit growth. While the U.S. region had a slower year, but that's really worked out well this year with the strong business we've seen from APAC and EMEA.
And as mentioned already, health care and strategic alliances, everything we do towards hospitals really down too much, much more relevant mix where this is about 40%, and then 60% for industry while during the pandemic and really 2021, we had over 80% for medical devices, which is not where it should be. We should be around this level of 60% to 65% for medical device. And then maybe eventually going forward, if we can move that slightly down below that would be good. But the ultimate market is clearly the health care market while we know that the industry can grow significantly over the next couple of years.
We saw a decline in the device industry, as I said, but it's really a reaction to 2021. We also saw that quite a large amount of orders move into beginning of '23, and we have already received orders of a value of about SEK 25 million in the first part of this year or up until now in 2023.
So that's really a quick update on the order side. We will hand over to Gunilla for the net sales reflections.
Thank you very much, [indiscernible]. And for net sales, we saw the growth in the quarter to come in at 1.4%, not very high, but at the same time, this quarter last year was on a very high level, And this is the comparison we have, and it's 17.8% for the full year. We have in here a currency impact of about 8% in the 17.8%. So about half and half organic growth and currency. We see the strong growth for SA in the quarter and also for all business areas for the full year. We see the slower quarter for medical device. And as Goran already mentioned, this is then mainly due to really high numbers for 2021, but also that both orders and deliveries moved into 2023.
The APAC is the only region where we have negative growth in both the quarter and the full year. And this is really due to the COVID restrictions that we've seen in China, but also a bit of a delivery delay in the Siemens Health in robotics order.
Talking about order book, which is the relation between our order intake and net sales. We saw that growth with close to 50% in the end of the year, so order book at SEK 126 million. We also see that SEK 78 million of this is actually for 2023. And as much as SEK 39 million for the first quarter of 2023, which is, of course, then the same number as we talked about before with orders on MDI that went over the closing of the year.
When we talk order book, we talk into our segments. Segments is the way we look upon sales into products. Press button -- here we can see a bit of a graph on how the development on this one been looking like. And the big development and the big growth is in the subscription recurring sales, which is now at 43.9. This, of course, is based upon the model that we have changed since 2019, where we start to sell still our hardware mainly as an investment, but we sell the software that you use in that system on subscription, so over 2 or 3 years.
And this is also then very visible in the annual recurring revenue table you see in the bottom or the graph you see in the bottom. We are now at the SEK 52 million, with is a growth of 96% versus 2021 Q4. And it's really driven by software licenses recurring, as you can see, going to 35 to 19 in 2021 Q4.
We are also starting to measure monthly recurring revenue, and that is now about SEK 4 million a month.
Yes, you can take next page, Goran. Again, segment, that we look upon our sales into the products we're looking at. When we refer to system sales for CapEx, that is CapEx, of course, it's the customer's CapEx. And this means that they buy it and put into the balance sheet. Whilst when they rent those systems from us or they buy the licenses in the software on a recurring basis, of course, it's a cost in the P&L So this is then growing a lot when it looks -- we look into the 2022 full year, 96% growth. And also the quarter is a really good quarter at 79%.
We see here in this table that the only part, which has a decline both actually in the quarter, but also for the full year, is the software licenses as we sell them together with the system on a perpetual basis, so for CapEx. But that is not because we don't sell software to our systems, of course, it's because we sell them at the recurring model, meaning customers are then paying for those softwares over time over the years. This is then, of course, as well linked to the order book that we looked at before as well.
So this is the kind of really change in the business that we want to see. We want more and more of our customers to buy software from us on a license basis.
Last but not least, then, looking at the real key figures, with everything on one page. We can then see the order intake and the latest numbers we already presented before. And here, we also see a comparison to the same quarter and full year 2021. And yes, we had an impressive growth in Q4 2021, 47.3%. So to be able to actually beat that even if it was only with 1.5%, is something really good. We have not loosened the market at all. It's just we are comparing with a very, very strong Q4 '21.
And here, we can also look at our gross margins, which we have been able to increase a lot during the year. Part of it is, of course, currency, but the main reason is price increases and a change in mix where we actually sell more licenses on the basis of very high margins on the software sales.
EBITDA, as we've been saying, is on the similar level as Q4, 2022. But we see as well hear that, of course, the move of orders and sales into 2023, gives us a bit of shortcut for 2022 Q4, which we will then have a profit in 2023. We're really happy with the positive cash flow, both for the quarter and that we are better than last year also year-to-date.
And over to you, Goran, to make the final conclusions on the numbers.
Thanks, Gunilla. I mean, it's really a summary. I mean, continued top line growth, as I said, first time over SEK 200 million. We see a growth in orders up to SEK 250 million for the year. We see the early positive effects from the efficiency program with positive EPS or earnings in the fourth quarter. And really, what's been a focus of us over the last half year is to make sure we get the positive operating cash flow, obviously, with the market conditions, we know that's key. And that's also very nice to see that we achieved that in the fourth quarter. And the overall improved gross margin year over year is something we also very pleased with, and we will continue working on those. I mean, regardless if you see the price structure, the way we sell products, and really make sure we can continue that work. So all in all, this is a really positive view of the -- of both the fourth quarter and the full year.
So we have some more general slides, but I can see that we -- what would you say -- Christian, should we stop here and take questions? I think we spent 10 to 20 minutes.
Thank you so much for a great presentation. I think to start off the Q&A, just a general question, you mentioned really tough comps in this Q4 because really strong quarter in fourth quarter in 2021. Do you think that is the last quarter with really tough comps. So how should we look at that going forward?
Sorry, I have a hard time hearing you, the last -- that was the last one you said. Sorry about that.
The question was Q4 2022, the last quarter was really strong comparisons in the prior year's quarter or should we expect that for a couple more quarters going forward?
No, I -- yes, I don't know I can pass that to you, Gunilla, what would you say. I mean it's -- I think that's hard for you to say.
Yes, I think that -- what we can say is that we have really good quarter. First quarter of last year, if you go back and look into our quarterly reports. We then have some slower quarters in 2, 3 and 4, but I don't think we want to make any sort of forecast into the future.
No. I mean we have -- I mean we are working -- obviously, you can say that the move over to the recurring revenue more and more reduce the risk of bulkiness, and the ambition, obviously, is to reduce the seasonal effect we have had for many, many years where we have the 2 large portion of our business in the end of the year.
And that obviously been very difficult to manage, when you have 40% or more in the fourth quarter. Our ambition is obviously to smoothen that out over the year. But given that we are dependent on larger orders, we work with larger clients and changes in their plan, product plan, product launch plan, it's -- since many cases are in our control. So we will continue to see lumpiness. So it is going to still be hard to just compare one year to another year. So I'm not sure that is an answer to your question.
Definitely. And we also got a question about your cost base going forward. You mentioned other external costs were decreased significantly. How should investors look at development of cost moving forward?
Would you like to start, Gunilla, and I can continue?
Yes, we launched a program that is then reducing costs. And it's a program that is not only for one quarter, it's continuing into 2023. We also are working very hard to gain efficiency and we run a project where we then want to make the company's processes more efficient. So that is also going to give impact during 2023.
So just for clarification, you primarily look to increase efficiency. But in terms of investments in future growth, you're still making it, so to speak.
Yes. I mean we are still careful adding costs, adding more staff. We want to -- we have said that before we want to get into balance. I mean I think we have demonstrated that we are -- it was on balance for Q4, but we want to see that balance stabilizing before we really initiate growth from an organizational point of view again. But we're clearly investing in the future. We're investing in new products, in the market or so. But from an organizational growth standpoint, we will hold off for that at least for another quarter.
Got it. And you also mentioned your revenue mix from -- and order intake from different customer groups, in your report, you wrote that medical device customers are facing some issues with logistics and supply chains. Can you just elaborate a little bit more on -- does it have any effect on you? And going forward, when do you see those issues resolving, so to speak?
Yes. I mean it's -- that's based on the cyclic effect. But in 2022, we have seen a couple of our clients have different kind of problems, 1 or 2 clients have material supply related issues, which required them to postpone some of their projects and product launches. While in another example, a company had a regulatory-related delay, which also impacted us. So clearly, those situations would impact us as it kind of delay of the project.
But I think the benefit we have is that we are spending on risk over large amount of clients. So also large amount of large clients. So in any given year, if you go back and look at the details, for top clients is never the same top 5 clients from the year to another year. So I think we have at least 10, maybe upwards to 15x, I can generate an order intake of more than SEK 10 million in a year. So I think we are providing some insurance or some mitigating some of that risk. But obviously, those delays would impact us short term.
Understood. Also talking about gross margin. This quarter was really strong, 89%. Do you think over time that's representative of what you aim to be going forward? Or what would you say?
I think the gross margin in the quarter of close to 90, I think is on the high side. I mean, Gunilla have said in the beginning of the year that we aim to be 83, 84, maybe upwards to 85. I think the 89 is probably not realistic to believe we will maintain that but with that said we do other things with our product structure where we are improving cost efficiency.
We're also looking at price adjustments. We just did a 7% to 9% increase of the prices in euro, and we are continuing doing that to improving our efficiencies. So we aim to keep it on a high level. I think 89 is a little bit too aggressive. But if you can stay between 84 and 85, 83, to 85, that's a realistic level.
Got it. And you mentioned the Ankyras acquisition. Could you talk a little bit more about the state of the business? And especially, you mentioned that you send an application for FDA approval, when do you think you might get that FDA approval and what effect would it have on the business and sales, so to speak?
That's obviously written in the start, right? So -- but the FDA has a requirement to get this through in 3 months, but every question that generate something back to us will stop that clock. So I mean it's hard to say, but our expectation is that we should have an approval in the U.S. around midyear, June, July or something like that, could be after the summer. But somewhere around May, midyear, I think is a realistic expectation but it's not our control really. But we believe we have a strong application and we are applying as a predicate device, we are copying a previous application that we can sort of piggyback on.
So I think the risks are not that large that we will run into issues. And the impact -- I mean, we all now have a full approval in Europe. We're going full speed here in Europe. We had the accounted deal, another deal early in Q4. We have a large amount of discussions in Europe. So the focus initially is on Europe, but we already initiated and discussed -- initiating discussions in U.S., right now with our clinical advisers and our scientific advisory board in the space.
There is a lot of interest. And I think that we can really make something happen, but it's really dependent on when we get the approval. But if things go as we expect, we hope to launch this in one of the larger conferences during the summer.
Right. And talking a little bit more about recurring revenues versus CapEx sales on both systems, but also for software. Where do you think the distribution between CapEx and recurring will end up long term?
That is the good question. I mean I think that we still would have a large system component for the next couple of years, I clearly managed to move into the software-only solution, the cloud-based solution as we want to. We can manage as our ambition is to really move out software-owned solutions to physicians and hospitals, I think we can move faster over to only our OpEx-related business, the ambition long term for me to be over 50% software. But I think the next coming year, I would assume that we will continue probably with the levels we have today. I don't -- on the top of head, it's about 50% in systems, right now was slightly less than 50%...
Yes. We have about -- of our revenue now being recurring. So we see that growing a little bit, but not up to 50% in the coming year.
So that would clearly the fact that take longer time, but that clear to my ambition.
Got it. And we also received a question for clarification regarding the cost base. For your external expenses went down by about SEK 7 million, but personnel expenses seem to have increased by about the same amount. So can you just explain that a little bit more and we expect cost base on a net effect to end up usually?
Gunilla, a question you know.
Yes. The personnel expense had some increases that was linked to the variable part of the salary that we pay. And also some movements from the operational expense into personnel expense. So I would rather look at SEK 4 million to SEK 5 million savings in the OpEx line as the part of that saving went into the personnel cost. So 4 to 5 is my sort of number.
Really clear. And then we also got a question about cash conversion. As you talked about cash conversion would be strong in Q4. And the question is about how should we expect cash conversion going forward? How should we look at free cash flow, for example, during the whole year of 2023?
Yes, we are most definitely working very hard to secure that we have positive cash flow over the year. What we were able to do during Q4 was to really get paid for some quite old receivables. We actually got paid SEK 13 million of those old. Of course, that's a onetime off. You really don't have another SEK 30 million really old to get in Q1. But what we are working much closer to our customers for the moment and also securing that the payments from our customers is happening on due dates so that we don't end up with so much long overdue payments.
So that's the kind of guidance I can give.
Right. And just for clarification. So do you expect working capital to kind of stabilize at a level, for example, as a percentage of sales that is now? Or do you expect any more reduction, for example, in working capital?
I would expect about the same level.
Got it. I will just go through the questions here. Yes. So we also got another question when it comes to monetizing your installed base. Obviously, now, you still have very significant systems component, also CapEx system component. But could you elaborate a little bit more on what are the most important ways that you can capitalize on your installed base long term?
It's multiple things. But I mean, obviously, every new additional module or procedural functionality we have. So if you look at the industry installed base as an example. If you look at the large client that might have 60 or 70 systems running a fleet of systems, if we can roll out a new procedure module, we are selling that software license to be placed on every single system. So that is generally the cycle we see.
We also have a structure where we regularly update the simulation hardware and hence, have a possibility to upgrade the hardware. That's also a good opportunity for the repeat business from the platform.
Obviously, the hospital market where we have between 600 and 700 hospital clients, that's -- we have all the software there is software as a service base so recurring. So there you have the recurring component for software, obviously, but as well there, the opportunity to upgrade the simulation hardware every 4 or 5 years. So it's obviously very important that we continuously work with our customer base and have a strong link to make sure that we utilize our software and they're pleased with what we do. But then with that, I think we have a really good ability to increase the amount of repeat business.
And talking about your installed base and selling a simulator, for example, as CapEx or leasing it to customers. Can you talk a little bit about reasons for customers to increasingly choose the leasing model instead of buying the systems out right?
It's really depending on the kind of client and also, in some cases, client to clients. But if you look at the industry side, we have seen an increasing amount of clients that prefer to use OpEx, hence, having long-term rentals or leasing structure rather than investing upfront. So that we have seen over the last, say, 3, 4 years. And an increasing amount of clients doing that. But it's a bit from client to client. In the hospital side, we see a reason for the hospital to actually own the hardware. I mean, we're using the coffee machine example. I mean, we think it's a good idea for the client to own our platform. And then they will buy the coffee capsules, if you may, or the software component.
So that's the structure we have selected. But we clearly look into situations where weather might be relevant also to provide the harbor piece on a time-based way to [indiscernible], but we are not quite there yet.
Can I add something here? I think Several of those customers where we sell this rental model to them, they also buy hosting from us. So this means in reality that the systems stay within our premises and then we send them to the different places where the customer wants them. So many of those customers that rent those systems, they also have a kind of moving fleet where they want those systems to be over the year, which is why that also drive them to choose this model because it's beneficial for their model as well.
So the whole thing itself, we manage the logistics for the client, but we also then offer service to -- service or maintain the system every time it returns to our office. So that's an additional component or a product component we also have here.
Then we also got a question about geographic sales and more specifically APAC. As you already mentioned, I think in the report, there was a COVID wave in China. So in general, how much visibility do you have? When can orders in China be delivered? Are those already all scheduled, so to speak? Or is there some uncertainty because you don't know when the COVID wave will subside, so to speak?
No. I think we have a pretty good visibility to that. I mean we have -- as Gunilla said, we have a delay on the Siemens robotics side with their approval or regulatory approval in China. But besides that, I think China is back to I would say, a normal structure. And with the CMA order from the government authority we took in the end of Q4 for $1.1 million that we expect to deliver during the second quarter.
So that's -- I think China is operating in a fairly normal way. Obviously, without knowing what's going to happen in the future. But right now, that seems to be under control.
And we also got a question regarding the distribution of different segments. So MDI hospital clients and strategic alliances. You mentioned that right now, distribution around 60% MDI might be representative long term. Can we expect similar growth in all segments over the long term or do you still expect, for example, hospital clients and strategic alliances to grow a little bit more and thus become a more significant part of the revenue mix?
No. I mean, that's -- I mean, the significant growth or very significant growth we had from hospitals and SA in '22 is obviously to -- 2 parts contributed to the pandemic effect we had in 2021. So we can obviously not expect that growth to continue in '23 or onwards. So I think we will see some cyclicity clearly, but I think we will have a more moderate or -- I know we will have a more moderate growth on the hospital side this year.
And obviously, without setting expectations, we looking over multiple years, we see that the imposes going up. So I think we probably will expect the industry to take a slightly larger responsibility for our growth in 2023 than hospitals and SA. But we have a positive outlook for hospitals for the year also.
Got it. And then looking at both medical device industry customers, but also strategic alliances. You already touched a little bit in the presentation. But in general, do you think -- which of the following 2 is going to be the more significant growth driver? Is it increasing revenue from existing customers as they, for example, launch new devices? Or is it going to be taking a new large clients, so to speak?
It's really a mix, Christian. I mean we got one or a couple of significant new clients in 2022, that was announced in mid-year where we have an initial order last year for about SEK 20 million. That client is now referred to as an existing client. That will be a significant part of the next coming years.
We have some older clients like [indiscernible] and others that will continue the top 5 clients over the coming years as they have been in the previous 5 or 10 years. But we also see a handful, maybe 2, 3, 4 completely new clients for us, which is still competitive that we expect to start to work in '23 and '24. So so it's going to be a mix.
Got it. We also received a question regarding both growth and M&A. So do you maintain your guidance of around 30% annual growth over the long term? And also as much as you can say about how do you judge your current M&A prospects?
I mean for me, the M&A ambition has not changed. Obviously, our ability to execute on that with the current market cap or the share price, it's hard to combine. But we continue that work, and we have the same ambition to complement what we do with new acquired technologies. So hopefully, we getting back to a more normalized situation in the market, so we can get back to that plan.
But our underlying work is clearly continuing. I can't really comment. I mean, we are not changing our long-term term expectations or our financial targets for either net sales or EBITDA, those still stands. I can't really comment on the outlook for 2023 right now.
Got it.
Can I just make a comment on the comment I did on Ankyras and FDA. Obviously, I can't set any expectation for when we're going to get approved. So you asked the question and you got my opinion, but I mean it's not in our control at all when that is happening. So just give a little clarification to that.
Definitely. Got it. You also mentioned that you saw really strong growth in the EMEA region. Is that -- can you just clarify, is that more of a pandemic rebound, so to speak? Or do you also expect solid growth in the future?
That's clearly a pandemic rebound mainly on the hospital side. We saw growth on the industry side. In 2022, it is mainly hospital-driven. We see solvency [indiscernible], but not at the level we did from '21 to '22, which was a rebound, yes.
Got it. Really clear. I think that concludes all the questions that we received. So thank you so much for a great presentation and a great Q&A, and we look forward to following Mentice in the future.
Thank you.
Thank you.