瑞信虚拟糖尿病会议要点
Equity Research Americas
U.S. Medical Supplies & Devices CS Virtual Diabetes Sessions: Key Take-Aways and Insights 16 June 2020
Research Analysts Matt Miksic 212-325-4381
matt.miksic@credit-suisse.com
Vik Chopra 212-325-1749
vik.chopra@credit-suisse.com
European Pharma Team 44 207 888 0304
creditsuisse.pharmateam@credit-suisse.com
DISCLOSURE APPENDIX AT THE BACK OF THIS REPORT CONTAINS IMPORTANT DISCLOSURES, ANALYST CERTIFICATIONS, LEGAL ENTITY DISCLOSURE AND THE STATUS OF NON-US ANALYSTS.
US Disclosure: Credit
Suisse does and seeks to do business with companies covered in its research reports. As a result, investors should be aware that the Firm may have a conflict of interest that could affect the objectivity of this report. Investors should consider this report as only a single factor in making their investment decision.
6/16/2020
6/16/2020
Credit Suisse 2020 Virtual Sessions Executive Summary
We hosted a series of virtual sessions over two days during this year’s American Diabetes Association Annual Scientific Sessions. Key take-aways are summarized below and on the following slides:
– Take-aways for CGM and Pumps Were Mostly In Line – DXCM remains the leader in CGM for T1 PWDs, despite ABT’s Libre being the revenue leader in the category and gaining more adoption in T2. TNDM remains the leader in share gains in automated insulin pumps, followed by PODD, both of which continue to take share from MDT. MDT is making changes and investing in its pipeline, as described in its business update on 6/15, but the company still has more work to do before it can improve its competitive positioning in each of these core markets;
– Updates on Emerging Diabetes Technology Segments – Our sessions with Companion Medical and Nemaura provided an update on two key emerging categories in Diabetes Technology: Smart Pens and non-invasive CGM for pre-diabetes and T2. The early growth of Companion’s InPen is impressive and suggests strong potential demand for this category. The pathway and commercial model for pre-diabetes remains early and less defined, but Nemaura’s offering and approach is differentiated and compelling, in our view;
– Take-Aways from Expert Wrap-Up Call: For devices, Dr. Pajvani sees the Libre 2 approval as incremental, and expects a substantial competitive push into T1 vs. DXCM as being a longer process, driven by additional real-world evidence. He sees significant growth in InPen at his center, and sees pump trends in line with the comments above. On the drug side, Dr. Pajvani sees weekly insulin as a meaningful development, found PFE’s early oral insulin data interesting and believes that payors are still the key decision makers when it comes to prescribing drugs. (Please see slide 9 for replay details.)
Credit Suisse Securities (USA) LLC, Matt Miksic 2
ADA Wrap-Up Expert Call: Devices
ABT Libre 2 iCGM Approval Should be Positive, But Real-World Data Will Be Key: Dr. Pajvani believes that the recent approval of Libre 2 should be incrementally positive, assuming the device is priced within the same range as Libre (which it is expected to be). Until now, our expert believes its lower cost to the patient has been a key driver of Libre uptake. Dr. Pajvani also sees ABT’s low price point and simplicity as key to making it the device of choice for T2 PWD. Generally speaking, Dr. Pajvani recommends Libre
to his T2 patients, and recommends DXCM for his T1 patients.
2020 ADA Sessions Highlight Incremental Improvements in CGM and Pumps: Our expert has been impressed with the continuous, incremental technological improvements in the major and emerging diabetes technology platforms on the market, which was further validated by data presented at this year’s ADA. Dr. Pajvani sees MDT’s Minimed 780G as an improvement, and views the trial results as positive in adults and especially adolescent patients. However, he does not expect 770G/780G to drive a substantial change in MDT’s market share, due largely to its reliance on the Guardian sensor, which has a history of lower user satisfaction vs. DXCM, and key limitations like the requirement of fingerstick calibration. Dr. Pajvani’s patients are very satisfied with TNDM’s t:slim pump with Control-IQ, consistent with the real- world data and satisfaction data presented at ADA. There is a fair amount of anticipation among patients for the PODD Horizon/DXCM integration (and wide disappointment over the delay), and sees PODD uptake improving when that closed loop system becomes available (expected in 2021). Lastly, on SENS, Dr. Pajvani has seen limited interest and only a small percentage of his patients use Eversense. Drawbacks for the implantable sensor include fingerstick calibration and a relatively short 90-day duration;
TNDM’s Advanced Interface, Hybrid Closed Loop and DXCM Integration Drives Conversions: Dr. Pajvani expects that TNDM’s easy-to-use interface, Control-IQ closed loop algorithm and integration with the widely popular DXCM sensor as key drivers of pump adoption. In addition, the company’s software upgradeable platform is attractive to patients, as well. (Please see slide 9 for replay details.)
ADA Wrap-Up Expert Call: Drugs
Weekly Insulin Is a Meaningful Development. The doctor highlighted the P2 weekly insulin data at ADA was compelling. This showed comparable safety and efficacy as insulin glargine (Lantus). Hypoglycaemia would be the main risk but he saw no increase in the trial with insulin icodec. He noted there is a demand from patients wanting extended release insulin icodec would be a meaningful development given the improved level of convenience. However, he cautioned the basal insulin market remains competitive with lots of options and could limit the market for this type of product.
Pfizer Oral Insulin Data Early, But Very Interesting. The doctor noted the Phase 1 Pfizer data at ADA was interesting. It showed dose dependent improvement in glucose levels and reduction in body weight, that mirrors that what you see in Rybelsus and the subcutaneous GLP-1s. He noted nausea and vomiting could have impacted the outcome of the trial (patients not eating) but given this was a 28 day outcome he needed to see longer-term data as these side-effects from GLP’s are worse in first few weeks and tends to wane over time.
Rybelsus Use is Modest; Preference for Weekly GLP-1. Interestingly, the doctor was not using Rybelsus in as many patients as he thought he might have been. He cited: (1) efficacy not as strong as the weekly injectables, (2) Insurance hurdles so it is not as easy to obtain as was hoping it would be, and (3) patient preference is not there, with people preferring the injections. However, importantly all the Rybelsus patients prescribed by the doctor remain on therapy with patients and prescribers not concerned by hurdles like a 30min empty stomach after taking Rybelsus. The doctor had a clear preference for injectables GLP-1’s, where he preferred Trulicity over Ozempic due to the REWIND (CV outcomes) data being in a more representative patient population, although acknowledged PCP would prefer to use an oral GLP-1 ahead of an injectable GLP-1.
Payers Remain the Key Decision Makers for Prescriptions. While describing his preferences for products, he caveated his choice is completely beholden to the payors with insurance the biggest hurdle for his prescription. This will ultimately take the decision on whether to use a weekly insulin or GLP-1 over an SGLT-2. With the levels of unemployment rising in the US he highlight there is yet to be a shift in more Medicaid. Currently 15% of patients were Medicare.
Tandem Diabetes Care (TNDM)
Cadence of New Products Over the Next 12-24 Months Should Help Sustain Conversions: Management sees the ongoing launch of Control-IQ, upcoming mobile control feature, and t:sport hardware upgrade driving continued share gains, despite the delay in some of its regulatory filings due to COVID-19. For context, TNDM estimates last year ~18-20% of new patient starts were a result of Animas, and given the share of new pump conversions remains approximately the same (~65%), it stands to reason the Animas gains have been replaced in recent quarters by increased gains from MDT.
Adoption of Technology Solutions Accelerated During COVID-19 Pandemic: Technology enhancements around virtual offerings such as training sessions and physician visits moved 100% online compared to ~5-10% pre-COVID. While the company does not expect these levels to persist as government restrictions and shelter in-place orders ease, the mix of online training solutions should remain significant. Patient feedback on virtual training and visits has been positive, citing the convenience of their own home and easing the burden of living with diabetes.
Payer Coverage Expansion: TNDM is focused on expanding coverage through relationships with insurance payers, and aims to reach a 50/50 split between direct contracts with insurance payers and the distribution channel, up from current levels of~30/70. After the company expands its relationships with insurers, mgmt. then expects to begin exploring the pharmacy channel, a route which many of its competitors have already taken. However, in the interim, the company has launched several offerings, which aim to replicate the pharmacy channel such as automated delivery of products.
Nemaura Medical (NMRD)
Unique Approach and Solution to Diabetes Management: Dr. Faz Chowdhry provided and overview and update of Nemaura’s business strategy. NMRD aims to help PWDs better manage their condition through the periodic use of CGM to establish and understand patterns in their glucose levels without necessarily wearing a CGM every day of the month. The company is targeting segments of the T2 and pre-diabetes populations which it believes do not need (or may not want) CGM every day to generate improved health outcomes and cost savings for the patient, provider and payer.
U.S. Expansion and Market Breakdown: The company’s SugarBeat CGM device is CE Marked and expected to be available in the UK and Germany within the coming months. In addition, the company also plans to launch by the end of the year in the US under the “General Wellness” category, since that designation would not require FDA approval (given the non-invasive, needle-free design of the adhesive sensor). The T2 and pre-diabetes populations represents ~122 mil people in the US alone (34 mil and 88 mil, respectively). Additionally, the company plans to participate in the CDC’s National Diabetes Prevention Program (DPP), which aims to reduce the burden of pre- diabetes and Type 2 diabetes. Following the wellness introduction of SugarBeat, the company plans to submit a PMA application for SugarBeat CGM within the next 12 months for FDA approval.
Collecting Data Will Likely be a Key Component: Since CGM is underpenetrated in T2 and virtually unused in the pre-diabetes segment, the generation of usage and outcomes data should help to drive additional value for NMRD. Once the company has accumulated enough domain data for these populations, management hopes to be able to push notifications, recommendations and alerts to users in to help further improve outcomes.
Companion Medical (Private)
Brief Overview of InPen: Sean Saint, CEO and Co-Founder of Companion Medical provided an update on the company’s InPen smart insulin pen. The system includes a smart insulin pen connected to an integrated diabetes management app which helps users calculate personalized insulin doses based on different foods and meals, receive missed dose alerts, track active insulin and also send reports from their phones directly to caregivers.
Smart Pens Emerging to Create a Key Insulin Delivery Category: Mr. Saint sees four categories of insulin delivery: legacy pens, basic patch pumps, smart pumps and smart pens. While legacy pens are easy to use and inexpensive, they do not offer the features that pumps and smart pens can provide. Mr. Saint sees smart pens as having the dose calculation, management and tracking features of a pump at a lower cost. By Companion’s estimates <5% of intensive insulin PWDs use pumps,
leaving
a
substantial opportunity for penetration by both pumps and smart pens.
Pharmacy Distribution Model Makes InPen Easy and Affordable For The User: Companion Medical has a pharmacy distribution and reimbursement model, which the company, making it easy and inexpensive for patients and providers. Companion has made the commitment for providers and PWDs that patients will not pay more than $35/year out of pocket for InPen.
Go-to-Market Strategy Targets Early Adopters: Companion plans to target the ~5,000 endocrinologists in the U.S., which make up the majority of prescribers, and over time sees further expansion in to primary care providers. The company has <30 direct sales reps currently and has seen rapid growth over the past year since its launch in the US.
Bigfoot Biomedical (Private)
A Full Suite of Solutions On-Deck, Late 2020/Early 2021 Launch Expected: CEO Jeffrey Brewer provided an update on Bigfoot Biomedical’s progress and strategy. The company’s plan is to offer PWDs a suite of integrated solutions, which consist of a sensor, insulin pen, meter, and mobile app that are all designed to communicate seamlessly, while reducing the burden of living with diabetes, beginning with its Unity system. Bigfoot plans to commercialize in late 2020 or early 2021, pending approval of its FDA submission, which is planned for this summer. Notably, the company’s Unity solution incorporates the Libre 2 CGM sensor.
Multiple Daily Injection (MDI) Market Less Crowded and More Attractive: Bigfoot views the MDI market is the more accessible given the relative lack of smart solutions on the market. Management estimates the MDI market to be a ~$9 bil opportunity for Unity. While the company remains committed to a closed loop automated insulin delivery system solution over time, management appears to be leaning in the direction of partnering with a pump manufacturer rather than attempting to launch another pump of its own.
Simple Solutions to Difficult Problems Could Help Drive Adoption: Mgmt believes that a lack of uniformity in the diabetes industry increases the burden on patients and in turn hinders user adoption. Bigfoot expects its offering to remove the majority of traditional issues PWDs face since all of the company"s technologies are integrated and easy to use. In addition, since the company plans to offer a variety of diabetes management solutions, it sees itself as well-positioned leverage outcomes data and domain data in the category to optimize insulin dosage calculations and recommendations and to improve outcomes across different patient populations.
Speaker Bio & Wrap-Up Call Replay Info
Biography: Utpal Pajvani, MD, PhD is currently an endocrinologist and an Associate Professor of Medicine at Columbia University Medical Center. Dr. Pajvani"s research focuses on the role of developmental pathways in the regulation of Type 2 Diabetes, and the use of existing therapeutic agents in other scientific areas in novel applications to ameliorate obesity-induced insulin resistance. He received his M.D. and Ph.D. degrees from the Albert Einstein College of Medicine, and completed his residency training in Internal Medicine and fellowship in Endocrinology, Diabetes & Metabolism at Columbia University.
Replay Details for our ADA Wrap-Up Call: Domestic: (855) 859-2056/International: (404) 537-3406; Conference ID: 7090315
Background and Overview of Diabetes Technology and Related Digital Health
84.0 27.0
Diabetes: Large and Expanding Market
Insulin Intensive Therapy (IIT) T1 and T2 Population in the U.S. Represents ~3.2 m il PWD: The IIT population of PWDs has been the primarily target market for diabetes technology and related digital health for the past 20 years. The early years of adoption were generally focused on the tech-savvy and the affluent, given the scarcity of mobile technology and lack of insurance coverage in the early days of the technology. However, with the proliferation of mobile technology and gradual improvements in insurance coverage, the adoption of CGM among insulin intensive people with diabetes (PWDs) has increased to 20-30% of the ~3.2 mil IIT PWDs in the U.S. (including flash glucose monitoring, i.e., Freestyle Libre).
Non-Intensive T2 Population Em erges as Im portant New Frontier for Diabetes Technology: As penetration of the IIT population continues, other non-intensive groups of PWDs, are now coming into focus. There are ~27 mil Non-Intensive T2 PWDs in the U.S., and ~84 mil people with pre-diabetes, which represent a substantial cost burden for insurers (1 in 4 healthcare dollars spent in the U.S. is spent on a PWD 5 ), and improvements in diabetes management for these patients can reduce adverse health events and reduce costs. We expect, as health economic models and pricing levels are worked out between manufacturers and payers, that these additional segments should support healthy growth for CGM over the long term.
3.2
Intensive T2 Non-Intensive
Prediabetes
Source: Credit Suisse Estimates, Company Reports, Dexcom
6/16/2020 11
Flashing Red: Growth in Diabetes and Related Diseases Increasing Demand for Effective Innovative Solutions Diabetes (~31 Mil U.S. PWDs +
~85 mil with Pre-Diabetes)
2017 Hypertension (75 Mil U.S. Patients)
Obesity (160 Mil U.S. Patients)
1995
Source: Copyright 2016. Robert Wood Johnson Foundation. Used with permission from the Robert Wood Johnson Foundation, Credit Suisse estimates
6/16/2020 12
~6x Faster
Over the Last 15 Years
Diabetes Grew ~4x Faster Than
U.S. Population Growth Rate From 1980 to 2000
US Healthcare and Productivity Cost ($B)
Growth of Diabetes and Related Costs Motivating Payers, Employers and Regulators to Expand Access • Diagnosis of new U.S. PWDs grew 4x faster than the population from 1980-2000, and accelerated to 6x the population growth rate over the past 15 years – Thirty million Americans were diagnosed with diabetes, or around 9% of the population. Of these 30 mil U.S. patients, approximately 95% are Type 2 (insulin resistant) and the rest are Type 1 (insulin dependent). According to the CDC, 1 in 4 PWDs are unaware of it, suggesting the need for further education and awareness.
• Rising cost of care is m aking diabetes a priority for payers and em ployers – Total direct medical costs of care for diabetes in the U.S. was ~$237 bil in 2017 (up ~25% from 2002), and ~1 in every 4 dollars of U.S. healthcare spend goes to PWDs (not counting the long-term costs of cardiovascular, musculoskeletal, psychosocial and vision-related ailments.) In addition to direct costs, the CDC estimates the disease caused ~$90 bil in lost productivity in 2017, which equates to ~50bp of U.S. GDP growth.
• Expanding beyond ‘insulin intensive’ patients to larger patient populations – Much of the growth in diabetes devices has focused on intensive and regular users of insulin injections (typically Type 1 and Type 2 PWDs using multiple daily injections or MDI), which represent ~3 mil people in the U.S. As awareness of diabetes continues to rise, and the risks facing people with ‘prediabetes’ of developing T2 diabetes, we expect CGM to gradually expand over time into other larger populations, including non-intensive T2 (~27 mil U.S. PWDs) and prediabetes (~84 mil people in the U.S.). 30 350
25 300
20 250
200
15
150
10
100
5 50
0
1980
1985
1990
1995
2000
2005
2010
2015
0
Diabetes Heart
Cancer Obesity Arthritis
Diabetes Population, U.S.
Disease &
Stroke
140
147
174
190
327
Sensors and CGM
Source: Company
Dexcom Remains Widely Admired Market Leader for IIT – G6 remains the preferred sensor by many educators and the preferred ‘traditional’ (i.e. external) sensor for providing real- time alerts for T1 patients concerned about their blood sugar moving out of range. That said, the hope among providers and patients is that all of these sensors will get more accurate and more affordable. Dexcom plans to continue to lead on both fronts with the G7, its widely anticipated next gen sensor;
Abbott’s Libre 2 Finally Cleared – Many providers and PWDs appreciate the simplicity, form factor and lower cost of ABT’s Libre, but current feature set and limitations prevent the product from enabling PWDs to completely rely on the system for alerts and alarms, especially for pediatric patients or where there’s a concerns of missing a low or hypo event. New features of Libre 2 like alerts and alarms and improved accuracy could change the way Libre is used by patients and care providers, but we expect this will take some time and experience in the community and real-world data;
Senseonics Eversense Holds ‘Future Promise’ for PWDs – Fully implantable sensor has its fans, but most educators and PWDs expect greater adoption when the sensor is approved for longer periods like 6 months or 12 months. Despite the accuracy and other benefits, coverage and logistics for implantation remain near-term obstacles;
Medtronic Viewed as Having More Work to Do in Standalone CGM – Improvements seen as important include ease of placement, failure rates, size and other aspects of the Guardian 3 which PWDs have found frustrating. MDT has a plan for improvement, including its new Zeus and next generation Synergy sensor, but it’s a ‘show me’ CGM system for now.
Pumps and Hybrid Closed Loop Systems
Pump Share Trends Continue to Favor Tandem and PODD – On the automated insulin front, providers and PWDs continue to see share generally moving away from MDT to Tandem and Insulet, driven largely by usability and preference for the Dexcom sensor;
Around Half as Many New Pump Users are Opting for MDT, vs. 2-3 Years Ago – With the integration of Tandem’s pump with Dexcom’s sensor and the launch first of Basal IQ algorithm and then Control IQ last year, MDT’s share of new pump users has been cut roughly in half or lower to around 1/3 or lower among the educators we’ve spoken to over the past year. Tandem is capturing more than half of new pumpers, with Insulet capturing the remainder (~20-30%).
MDT’s Move Towards Interoperability Remains Early – Most providers and PWDs are encouraged by MDT’s step towards interoperability unveiled last year at ADA and its continued commitment to improving its product portfolio and solutions for PWDs. While the practical manifestation of this strategy may be still take time to play out, it was a noticeable change in posture from the manufacturer, and opens the door to potential future adoption as those features roll-out and the company’s sensor offering improves.
Source: Company
Pumps and Hybrid Closed Loop Systems
Emerging Innovators Making Progress – Innovators such as Companion, Bigfoot, TidePool, Diabeloop, and Beta Bionics continue to progress along their pathways to commercialization and expansion. Companion continues commercialization of its Bluetooth-enabled insulin smart pen, and a handful of the other emerging players are progressing to regulatory clearances and regulatory approvals. We expect new products approvals, label expansion and widening partnerships to remain an important growth driver in diabetes tech over the next several years;
Focus on Improvements in Training and Support for PWDs – There is a significant focus on emphasizing peer groups, online interaction, group training and other methods for improving uptake and sustained adoption of technology. Further emphasis of reaching underserved populations and communities remains a key focus for diabetes, including remote areas and minority populations;
Source: Company
Joint Efforts Among Regulators, Providers and Patient Advocates – Population health efforts to help drive access, adoption and improving outcomes are on the rise. Key initiatives such as the National DPP (Diabetes Prevention Program) and similar state-wide efforts continue to gain traction and support. The CDC’s Diabetes Self-Management Education and Support (DSMES) service model is another important initiative targeting improving care and outcomes for PWDs. We expect the expansion of these programs, combined with widening coverage among providers, to drive continued demand and adoption of diabetes technology, contributing to continued strong growth in this market.
Where Does Diabetes Sit on the S-Curve?
We view Med Supplies and Device m arkets as typically being in one of three m ajor categories, each having a unique set of characteristics in terms growth, risk, margins, cash flows and value creation. We view Diabetes Technology as a ‘High- Growth’ market, putting it on the steep part of the ‘S-surve’ 1 :, along with Structural Heart and Robotic Surgery.
High-Growth – Established markets (typically >$250 mil in annual sales), growing at an above-average growth rate, (typically >8%). Examples of High-Growth markets include:
TAVR,
Diabetes,
Robotic
Surgery, AFib ablation and Regenerative Medicine.
Emerging Growth – Smaller markets, often driven by an innovative or disruptive technology and growing rapidly (in some cases >100%), but still early in terms of market development. Examples include: Leadless pacemakers (e.g. Micra), Ischemic stroke and fully implantable blood glucose monitor (e.g. Eversense).
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Time (Years) Core Growth – Large mature markets, often highly penetrated and consolidated to 3-4 competitors, with growth rates driven largely by population-growth, plus- or-minus pricing pressure net of new product mix (typically <3% growth in total). Examples include hip and knee replacement, coronary stents and pacemakers. Core (Mature) High-Growth
Emerging
Market Size
Emerging-Growth
Positives: -
Low Mkt Penetration -
Fewer Competitors -
Pricing Power
-
Oppty to Lead New Mkt -
Specialist Engagement
Negatives: -
Mkt
Development Costs -
Clinical Risks
and Costs
-
Reg/Reimb Costs/Risks
-
Adoption Risk
Op Margin/CF Profile:
-
GM May Be Sub-Par
-
Under-levered
Op Ex
-
Start-Up Cap Ex
-
Often CF Negative
The Major Phases of the MS&D Life-Cycle
Each phase of growth along the life-cycle of a new medical device market has pros and cons, and for each phase there are implications for modeling and projections for manufacturers and the overall market. While there are many idiosyncratic factors that can affect the growth and development of a new markets, the following is a representative overview of the most common major factors we encounter:
High-Growth
Positives: -
Early Mkt Penetration -
Limited Competitors -
~Flat Pricing
-
Speed of Innovation Can Extend Mkt Lead
Negatives: -
New Mkt Entrants -
Risk of Being Overtaken
-
Pricing Pressure (in Mid- to Late Cycle)
Op Margin/CF Profile:
-
Improving GM -
Improving Op Leverage
-
Rising
Asset Absorption -
Increasingly CF Positive
Core (Mature)
Positives: -
Stable Consolidated Mkt -
Stable Op Ex and CF
-
Easing Pricing Pressure
-
Stable Market Share
Negatives: -
Slowing Growth -
High Penetration Levels
-
Risk of Disruption
Op Margin/CF Profile:
-
Optimized GM -
Optimized Op Leverage
-
Optimized Absorption -
Optimized FCF
SH, RS and Diabetes Remain in Disruption Sweetspot, Digital Health to Accelerate in 2020 and 2021 Our Key Disruptive Themes of Structural Heart, Robotic Surgery and Diabetes Remain on the Steep Segment of the S-Curve and we expect continued rapid growth for the next 5 years; We Expect Key Emerging Digital Health Segments to Accelerate in 2020 and 2021, including Artificial Intelligence and Machine Learning, Digital Surgery, Implantable/Wearable Monitors and Digital Brain/Body Interface technologies
Targets of Disruption Conventional Hips & Knees Open Heart Surgery
Core (Mature)
‘Disruption In Progress’ Robotic Surgery Diabetes
Structural Heart
High-Growth
Implantable Monitors Leadless Pacemakers
Emerging-Growth
New Disruptive Innovation Digital Health
- AI/ML
- Digital Surgery - Implantable/Wearable Monitors - Digital Brain/Body Interface 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Time (Years) Market Size
Diabetes Sensors/Implantables in the Digital Health Landscape
TeleHealth (Home-Based and Mobile Physician Interaction and Remote Care)
Remote Patient Monitoring and Intervention (8) (Remote/Mobile Patient Monitoring / Patient Care Communications and Engagement
) Digital/Smart Payor (Digitization of Payor Systems and Implantable/Wearable Sensors (8)
Processes) (Implantable/Ingestible/Wearable Sensors and Diagnostics)
Digital Brain/Body Interface (10) (Neuromodulation / Brain Stim / Brain-Computer Interface) Digital/Smart CRO (Digitization of Clinical Research Systems and Processes) Digital/Smart Regulatory (Digitization of Regulatory Systems and Processes) Digital/Smart Employer/Health Plan Administrator (Digitization of Employer Health
Plan Systems and Processes) Digital Surgery (32) (Robotic Surgery / Enabling Surgical Technology / Smart Imaging/Diagnostic s and Navigation
/ Automation / SaaS) “Digital/Smart Hospital” (Hospital-Based Digital Health Initiatives) R&D/ Manufacturing Clinical/ Reimb Employer/ Payor Hosp/ Provider
Patient/ Consumer Big Data/EMR Infrastructure AI/Machine Learning Digital-Implants (4) (Smart Prosthesis / Automated and Patient-Contr olled Therapeutic Delivery/
AI/BIG Data-Guided Therapeutics / Algorithms and Automation) Patient/Consumer Engagement / Healthcare Gamification / Digital Clinical Trials We’ve Identified Over 60 Private Companies in Med Tech Focused on Digital Health Including ~35 companies focused on Digital Surgery and Digital Implants, ~15 focused on AI/ML, ~15 focused on Implantable/Wearable Sensors and Remote Monitoring, and 10 focused on Digital Brain/Body Interface technologies
Companies Mentioned (Price as of 15-Jun-2020)
Abbott Laboratories (ABT.N, $89.55) DexCom, Inc. (DXCM.OQ, $398.75) Insulet Corporation (PODD.OQ, $184.8) Medtronic Plc (MDT.N,
$93.62) Nemaura Medical (NMRD.OQ, $10.38) Pfizer (PFE.N, $33.36) Senseonics Hldg (SENS.A, $0.4002) Tandem Diabetes Care, Inc. (TNDM.OQ, $82.26)
Analyst Certification
Disclosure Appendix
Volatility Indicator [V] : A stock is defined as volatile if the stock price has moved up or down by 20% or more in a month in at least 8 of the past 24 months or the analyst expects significant volatility going forward.
Analysts’ sector weightings are distinct from analysts’ stock ratings and are based on the analyst’s expectations for the fundamentals and/or valuation of the sector* relative to the group’s historic fundamentals and/or valuation:
Overweight : The analyst’s expectation for the sector’s fundamentals and/or valuation is favorable over the next 12 months. Market Weight : The analyst’s expectation for the sector’s fundamentals and/or valuation is neutral over the next 12 months. Underweight : The analyst’s expectation for the sector’s fundamentals and/or valuation is cautious over the next 12 months.
*An analyst’s coverage sector consists of all companies covered by the analyst within the relevant sector. An analyst may cover multiple sectors.
Matt Miksic, Vik Chopra, Trung Huynh and Jo Walton each certify, with respect to the companies or securities that the individual analyzes, that (1) the views expressed in this report accurately reflect his or her personal views about all of the subject companies and securities and (2) no part of his or her compensation was, is or will be directly or indirectly related to the specific recommendations or views expressed in this report.
3-Year Price and Rating History for Abbott Laboratories (ABT.N)
ABT.N Closing Price
Target Price
Date
(US$) (US$) Rating 17-Dec-18
69.75 82.00
O *
24-Jan-19 70.86 81.00
17-Apr-19 72.88 82.00
11-Jul-19 85.77 95.00
16-Oct-19 81.78 98.00
23-Jan-20 90.73 104.00
06-Mar-20 81.74 94.00
13-Apr-20 85.85 95.00
17-Apr-20 96.01 106.00
* Asterisk signifies initiation or assumption of coverage.
3-Year Price and Rating History for Medtronic Plc (MDT.N)
As of December 10, 2012 Analysts’ stock rating are defined as follows:
Outperform (O) : The stock’s total return is expected to outperform the relevant benchmark* over the next 12 months. Neutral (N) : The stock’s total return is expected to be in line with the relevant benchmark* over the next 12 mo...
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