Ambu A S Ord

Good morning everyone and a warm welcome to this morning's call where we are going to announce our full year 22-23 financial and business results for Ambu. My name is Britt Milby Jensen, I'm the CEO of Ambu and with me today I have our CFO Thomas Frederik Smit. The agenda for this morning's call is that I'll go through a business update first. I'll hand over to Thomas for a financial update. And then I'll come back and share our outlook for 2023-2024. And then after that, we'll open up the floor for questions. So starting with our highlights, overall we had a very strong year in 22-23 with a lot of progress on many fronts. Highlighting the three main financial results, starting with the organic revenue growth where we had for the full year 7.6% organic revenue growth and for the fourth quarter an organic revenue growth of 14.1%. If we compare with what we delivered last year, this is almost a doubling of our organic revenue growth compared to the 4% last year. Then moving on to our EBIT margin before special items, we ended the year with 6.3% margin, and that's also more than doubling compared to last year where we finished at 2.7%. Then moving to our free cash flow, we are proud to announce today a positive free cash flow of 192 million DKK for the year. I guess you all remember the last year where we finished with a negative cash flow close to half a billion Danish kroner. We were at that time in a serious situation and we have been very determined to turn this situation around and therefore I'm very pleased with the results that we are reporting today on free cash flow. It's also one year ago since we launched our ZoomIn strategy, and on that we have also had solid progress on a number of fronts. If we start with our innovative solutions and our abilities to serve our customers, we have made progress in our offering to customers. In pulmonology, we throughout the year launched a full range of products within our newest and most advanced single-use bronchoscopy portfolio, the ASCOPE5. If we look at our systems that supports endoscopes across the different therapy areas, we have also, during the year, had advancements with our AVU2 advance, adding features to that throughout the year. In urology, a high growth segment, we have launched Ascope 5 Cysto HD. And then in GI, which I'll come back to later, we had in the recent quarter two important approvals, the CE mark of our gastro large in Europe, and then the FDA approval of our colonoscope. Moving on to our focus on execution, we have continued to improve how we execute throughout the year across the entire business. We launched a transformation program one year ago in connection with the strategy, and we have continued to have improvements on our cost and efficiency. We have also reduced complexity, and an example of that is that we have exited 40 markets where we had no profits and very low sales in the individual markets. So that is behind us now. which means that we are now selling to 60 countries instead of the 100 countries that we were selling to before. So we are still in all major markets. Then when it comes to pricing increases, in particular in anesthesia and patient monitoring, In our focus to improve profitability across our business, we have had a dedicated focus to bring up prices at different levels, including solid double-digit price increases on some contracts and some products. And I'm also very pleased with how we have made good progress on that during the year. Then focusing on the people and culture side, we have had a strong focus on improving throughout the year how we work as an organization, reducing our complexity and providing clearer direction setting on what our priorities are internally. Then we have launched our new purpose and we have launched updated values to be clear about how we as one AMBU work together. Also we have strengthened our executive leadership team. Most recently we have announced a new CFO that will join us January 1st. Overall, when it comes to people, it's our colleagues at AMBU worldwide that has provided the strong results that we are announcing today. I'm very pleased about the progress we have made. It has been a year of change, which has been required on several dimensions, and I'm extremely proud of how the organization has responded to this. Then comes sustainability. Sustainability is an area that we elevated as a focus area around a year ago, and where we have also made very strong progress. I'll come back to that a bit later in my presentation. But overall, some highlights are the SBTI targets that we have submitted for... for 2030 submitted this year. And then we have also launched the first scope in the world where we use bioplastic, something that we are very proud about and that is only one of the full portfolios so far. So looking at the results, we have, as mentioned, delivered 7.6% growth and reported growth 14.1% in the quarter. We saw a quite heavy impact on the exchange rate in the fourth quarter, so the reported growth for the fourth quarter was 8.3% and 7.4% for the full year. On EBIT margin, we had in the fourth quarter 7.7% was where we landed, and that corresponds to a 6.3% for the full year. Then moving into our endoscopy segment, our focus segment that now contributes to 56% of our total revenue. Overall in the year, we grew our endoscopy revenue with 15%. What we said one year ago when we gave the guidance was that we expected this to be higher growth in the second half of the year compared to the first half of the year. And that's where we're also reporting today a strong 25% growth for the fourth quarter. If we look at what is driving the growth, I'd like to highlight the urology and ENT areas, which have grown a lot this year, and then at the same time also pulmonology, where we have seen a growth in the last half of the year, also again as we predicted when we started the year. Then moving into the two segments that we report on. Firstly, we report on everything excluding pulmonology. And this is urology, ENT, and GI. And this area with 1.2 billion DKK in revenue for the full year, this now makes up 45% of our total endoscopy revenue. What has driven an impressive growth of 38% for the year and 37% in the fourth quarter has primarily been a very strong growth in our urology business, driven by a mix of new customers that are being added and then also serving our existing customers more than we have done previously. A lot of the growth has come from our U.S. organization, but we also see strong momentum elsewhere, in EMEA particularly. On ENT, we also maintain a high growth level, and this is also a lot related to our U.S. business, and we see the growth there coming from fees, procedures, and also improvements in our systems that are adding features that benefits our ENT customers. Then coming to GI, and I'll come back to this later, we also see the launch of Ascope Gastro continuing to progress nicely. Our focus is very much on specific niches as previously communicated. Significant part of these are in the OR, so outside the suites. And we continue to see good momentum and progress, and not least, very good feedback on the product performance, which we are very happy and proud about. Then moving to our largest segment, which is pulmonology. And this one looks a little more busy than the previous one. But let's just start with the highlights here that overall for the year, we grew 2% on the revenue in pulmonology. And if we look at the fourth quarter, we grew 16%. We said when we started the year that the first part of the year would still be affected by a period of normalization after Corona. We saw the inventories that our customers had bought during the Omicron wave but that were not used still impacting the sales in the first half of the year where the customers still had inventory that they had to use. But the good news is that we believe that we are behind this. So now we are fully normalized when we look at our business. What we have tried to illustrate on the graph here is an illustrative estimated impact of corona, because we did see a huge demand driven by corona over the past years of our bronchoscopes. And this, again, is normalizing. But when we look at a CAGR on a four-year horizon, it still was at 12.5%. And if we go one year back, because we had the triathlons by back in 18-19, it's actually also close to 12%. So we have seen a good uptake. What I'd like to highlight here also is our Ascope 5 portfolio, because this one we launched as the best performing single-use endoscope to date. It was targeted initially at the Bronx suites in the hospitals where they do the most advanced procedures, but we also see the demand in other segments in the hospital, which is driving good momentum and which is very promising for our future in pulmonology. Then moving to our anesthesia and patient monitoring business. For the year we saw a decline of 1% in this business and if we look at the fourth quarter we had a 2% organic growth. This segment has been impacted. If we look at The graph here, we have three years where it was more or less flat. And then because between 2021 and 2021-22, we saw some supply chain contractions due to COVID. So last year, we have a very high comparable because of the stockpiling and the backlog that impacted that year. And now we have continued to be on the same level where they had the inventories at the customer level going into the year. And we expect to continue to also have a fully normalized business year where we, as previously communicated, have taken some strategic initiatives to also improve our profitability in this area, some of them also impacting our revenue growth. But this is what I'll come back to some of the balance that we are making between growth, which is our key focus, but also improvements in profitability. If we look back to endoscopy and look at the portfolio that we have in the market right now, what you see here is our full portfolio and products in development across the four segments that we operate in. The red or pink dot represents products that are already in the market. The blue dot represents products or solutions that have been approved during the fiscal year we just exited. And then we have the green dots that are products in development. Overall, I think there are two areas that I would like to highlight. And one is pulmonology, where we continue to be focused on our video laryngoscope in development, but where we also have a new program here, which is our next generation bronchoscope, which is a scope that is... supposed to continue the success of our Ascope 4, which will coexist in the market with the more advanced Ascope 5 Bronco. The other thing that I would like to also draw your attention to, which is new here, is under the system where one thing is that we continue to have advancements on our system which benefits our endoscopes across the different areas. But we have also in the past couple of years done work within AI. And recently we launched our AI solution in bronchoscopy for training purposes. So basically we have a bronchoscopy positioning system that allows new healthcare professionals to use it as a training where you can basically, with our AI solution, see in what parts of the body has the endoscope been. So you're certain to make sure that you have... looked into all relevant parts of the body when using AI. So we have a lot of other features in development where AI can benefit our customers going forward. This one is for now for training purposes and not yet approved by regulatory bodies, but it's already in the hands of customers with very good and positive feedback. So I talked about GI and that I wanted to return to GI. And as mentioned, we had in the quarter two new solutions approved. We had our GastroLarge, so the first gastroscope with a 4.2 millimeter working channel, which improves the suction function, which is very important for gastroenterologists. Then we also had a project approved by the FDA, our colonoscope, a project that has been in development for a number of years now. We continue to be very excited about the GI market and potential in this area. As you can see to the left of this graph, the total market in terms of procedures is over 68 million procedures that are annually performed within gastroenterologists. Right now, with our portfolio consisting of Ascope Duo 1.5, Ascope Gastro, and now GastroLarge and our Colonoscope, and the niches that we are targeting, we are only targeting 5.5 million of these procedures. As we have also previously said when we launched our new strategy, we reshuffled our commercial resources and took some focus away from GI to focus on the more immediate revenue drivers in pulmonology, urology, and ENT. So for GI, we have a much more limited commercial focus right now. It's an area that we see being very attractive for AMBU on the long-term horizon. It's an area when we visit customers and engage with key opinion leaders that we see significant unmet where we believe that we can address those with our solutions. it's also an area where we didn't get it right in the first place so we have moved even closer to our customers to make sure we fully understand their needs and therefore we are very excited to continue to focus in this area but again with a balance of resources so we take a very niche based approach commercially just in the same way as we did when we launched our bronchoscope some 15 years ago So hopefully that clarifies our focus. We still have two solutions in development in this area, a cholangioscope and then our DUDENU2, so the second generation, which is built on the same system and platform as the other endoscopes we have in the market, and where we also aim to take a much more niche-based, stepwise approach when that comes to market. Then I also said I would return to sustainability. And let me just talk about the achievement that we are very proud about in that we have, as the first company in the world, launched the bio-attributed plastic handle in our gastrolage that is on the market. And this is only the first step because during the next fiscal year, we expect to use the same material for all our scopes. And we aim to be done with that in around a year from now. So this is faster than what we set as a target for ourselves, but we believe our commitment to the sustainability agenda is extremely important. The material that we are using here will actually reduce the carbon footprint by 70%. And given that the handle takes up a significant part of the plastic used in the endoscope, this is something that will have a meaningful reduction and something that we get very good response from with our customers. And turning to why we're doing this, it's twofold. It's first of all because we have a strong commitment to sustainability ourselves, but it's also because we see increasingly that this is a focus for our customers. Our customers also want to be more sustainable, and we actually believe by being leading in our area that this is also a competitive advantage. We see this being a criteria in an increasing amount of tenders. We see this also being something that is introduced in more and more countries. So we are very excited about this step. But this is only one of many things that we are doing. If we just look at a few other areas that we have focused on in sustainability, we submitted our near-term targets for SBTI, not only Scope 1 and 2, but now we also have a plan for Scope 3. We also continue to improve on the energy sources that we use, and we increased our share of renewable energy by 1.3 percentage points this fiscal year compared to last year. And then we have a number of things that we do to continue to optimize our production. Not only does Ascope 4 now have a 55% lower CO2 footprint than Ascope 1 had when we launched that, but we also focus on other measures. Examples mentioned here is reduction in water consumption and total waste over 7% on both of these individually in the year. Where others has a strong focus on net zero, our focus has been expanded also to focus on the products and packaging, exactly because this is something that our customers find important. The bioplastic in the handles of all our scopes is just one example that I just talked about. We are also taking initiatives on our packaging for high volume products that we have in our portfolio. And then we are offering recycling programs in our main markets, something that we are learning from and expanding because we want to help our customers also be more sustainable. So with that update, I'll now hand over to my colleague, Thomas, who will go through the financial results from the year.

Yes, thank you, Britt, and also a warm welcome from my side. So let's jump into the financials. It has been a good year with solid performance and strong progress throughout the year. And where we've delivered 7.6% organic growth, And throughout the full year, with a little bit up and down, but for the full year, limited and modest currency impact from foreign exchange by a modest 7 million, resulting in a reported growth rate of 7.4%. The 7.6% organic growth for the full year has been driven by good momentum in our endoscopy solution business across all regional geographies. And the main growth driver also resulting in an overall Q4 organic growth of 14%. North America grew revenues in endoscopy solutions by 32% in Q4 and 23% for the full year, with continued high growth in urology and ENT. As a result of high comparables, last year anesthesia and patient monitoring remained flat with organic growth respectively of minus 1% for anesthesia and 1% for patient monitoring, resulting in a total growth for North America of 12% for the full year. Europe, full year organic growth of 3%, driven by endoscopy solutions also in Europe, a growth of 16% in Q4, and 5% for the full year. Patient monitoring in Europe declined by 1%, while anesthesia grew 2% for the full year. And rest of the world grew organically by 5%. Also here in this part of the world, we saw positive growth in endoscopy solutions and also patient monitoring, respectively with 18% and 10% for the full year. While our anesthesia business also here declined by 13%. Again, also impacted by high comparables and stockpiling last year. If we then have a look at our EBIT, we have delivered an EBIT margin before special items of 6.3%, resulting in that we have more than doubled our absolute earning compared to last year from 112 million in 21-22 to now 302 million in 22-23. The improved EBIT margin of 3.6 percentage point is a direct result of the activities and initiatives that we have started in the beginning of the year to drive profitable revenue growth and also scale in our operating expenses. And if we have a look at our gross profit and gross margin, gross profit was a total of 2.7 billion, representing also an increase of 6% compared to last year. And our gross margin in Q4 reached 56.8%, also equal to the full year gross margin level of 56.8%. It does represent a decline of 0.7% versus last year, primarily due to higher input prices, but also higher overheads from our scaling of our factory in Mexico. However, also offset by a strengthened revenue mix for the full year. Clear focus of ours has also been in driving efficiencies and scale in our OPEX cost. And that's part of our strategy and also part of the long-term financial targets. In the second half year, we've executed well and also fast to drive scale in our OPEX. So we've reduced our OPEX ratio down from 55% end of last year to 52% at half year, and now down to 49% in Q4. For the full year, it represents an OPEX ratio of 50%, meaning a full 5 percentage point improvement over last year. And that we have achieved by our cost reduction program and lower staff costs throughout the year, from lower freight rates and distribution costs, especially also lowering of air freight. and by driving efficiencies and general cost containment throughout our operating expenses. So very pleasing to see the good progress that we have made in the OPEX scaling, and also, as mentioned, very much aligned with our long-term target of an EBIT ratio of approximately 20%. Cash flow and positive cash flow, of course, is key for us to be able to fund our innovation and therefore, of course, of high importance of ours. And we've been very focused throughout the year to improve our cash flow and to secure that we deliver sustainable, positive cash flow through a more disciplined capital allocation. And through a detailed plan and execution, we've delivered significant improvements in free cash flow quarter over quarter. So starting from an improved, however still negative cash flow in Q1 to a slightly positive cash flow in Q2. to a good and strong cash flow in Q3, and then even further strengthening that cash flow in Q4 to 188 million DKK for the fourth quarter. Therefore, of course, I am particularly pleased and also proud to report a full year free cash flow of 192 million DKK. DKK and an improvement of a full 650 million DKK compared to cash flow last year. That certainly puts the company in a good position from a cash flow perspective, but also from a balance sheet perspective. And the improvement in free cash flow we've achieved by delivering on our improved EBITDA through a drive for profitable growth, efficiencies, and scalability in OPEX, as just mentioned, resulting in a very healthy EBITDA improvement from 6.6% Q4 last year to now 15% for the Q4 2022-2023. We've reduced our inventories from an all-time high inventory end of last financial year of 1.2 billion DKK to now 907 million DKK end of this financial year. So an improvement of more than 300 million within 12 months. Networking capital. Ahead of plan, we've actually achieved our mid-term target of a networking capital ratio of 20% end of this financial year through inventory, as just mentioned, but also better payment terms and improved cash collection. And last, but certainly also not least, we have a lower CapEx spend. This achieved due to a better project prioritization, better planning, and certainly also better cost control. So in conclusion... 2022-23 has been a very good year with strong progress and where we've strengthened our financial position and where we've delivered on our financial targets for the year. And with that, that includes my presentation for the financial year 2022-23 and I now hand it back to Britt.

So thank you, Thomas. And before opening up for questions, let me go through our financial guidance for the fiscal year that we already entered strongly for 23-24. So commenting on these numbers, but first taking a step back. If we look at the year that we just left, it was a year that was affected in the macro environment by a lot of volatility on the geopolitical front, on inflation and so forth. And this is something that we expect to continue. But I also think that we have taken the measures needed so we are not that exposed on the geopolitical front. Also, when it comes to our key customer group, we continue to see health systems and hospitals being under pressure, suffering both from human resource challenges as well as financial challenges. And this is also something that we expect to continue, which is both for Ambu and Opportunity, but also that causes some challenges. So with that in mind, we feel very confident to put out an organic revenue guidance for the year that we have started now of 7 to 10% organic revenue growth. This growth we expect to be driven by our key focus area endoscopy solutions, which we expect to grow by 15%. If we compare these with our long-term targets that we set out in March, our long-term CAGR over a five-year period for the total revenue was plus 10%, and for endoscopy, 15% to 20%. So we are with the 15% at the lower end of this. Also, when we look at our growth, and this is important to note, some strategic initiatives that we have taken related to our anesthesia and patient monitoring business, we talked about these in the last quarter as well, exiting countries, product discontinuations, that actually is baked into the outlook but would have had or does impact the outcomes. the revenue by one to one and a half percent. But again, included in our guidance. Then when it comes to EBIT margin, we also have a long term target of 20% potentially to be offset by opportunities to invest. Here we expect and we are very committed to increase from the 6.3% that we existed this year with. So we are guiding for 8 to 10% next year. And then last but not least on our free cash flow, we continue to improve that and our guidance is to be above a free cash flow of 270 million for the year. driven by both a higher EBIT margin and also continuous saving from our cost reduction program. So let me finish by concluding that we strongly believe that we are an interesting company with a very attractive potential. We are in endoscopy in an attractive, fast-growing market for single-use endoscopy, where there are significant unmet needs that we can target and also a focus on more patient safety. So the single-use benefits in terms of workflow improvements, patient safety, health economics and sustainability resonates well. And we are well positioned with the largest single-use endoscopy portfolio to win in this area. And with our dedication in sustainability that we talked about today, that should be a competitive edge in the years to come. We have a scalable business model that is also a key focus in our transformation program. We built on a strong legacy of high innovation know-how and continue to expand our capabilities. We have scalable production facilities and a strong global commercial infrastructure with our own presence in all major markets. We launched an exciting transformation journey that we are continuing to have as a focus for the next couple of years. And with a strong balance on growth as our number one, but also improving profitability, we confirm also our long-term targets and are looking forward to deliver on these in the period to come. So that concludes Thomas and my presentation, and I'll now hand over to the operator to open up for the Q&A session. Thank you.

Ladies and gentlemen, at this time, we will begin the question and answer session. Anyone who wishes to ask a question may press star followed by one on their touchtone telephone. If you wish to remove yourself from the question queue, you may press star followed by two. If you are using speaker equipment today, please lift the handset before making your selections. Anyone who has a question may press star followed by one at this time. One moment for the first question, please. The first question comes from Richard

undercrumbs with hundles pumpkin please go ahead right good morning and how good a good day and thank you for for taking my questions so two questions for me please first if you could elaborate a bit on your assumptions for organic growth in the pulmonology segment as well as for the core business for 23 24 just to get a sense of sort of the bridge and your internal assumptions for this segment.

The bridge... Yeah, for the organic growth. So on the core business, basically, if we look at anesthesia and patient monitoring, our focus, as we have said, is that we have a focus on driving more profitable growth in this segment. So that means that we still have contracts that are coming up where we see a need to take significant price increases to remain on a profitable ability level and there's some uncertainty related to these because we don't know how they will end up and also it will be a little unsure pending the final conclusion on these when that will have an effect in the market we have seen then when it comes to our endoscopy business strong growth in pulmonology and that part of the business returning to growth. We have seen that in Q4, and we also expect growth in pulmonology as we move into next year. And then you can say the key areas of growth, urology and ENT, last year we expect those to continue to grow, and then the GI area will be more a gradual ramp-up based on the niches that we are targeting. So I think that's... That's the overall how we see it. In pulmonology, maybe I should also add that the ASCOPE 5, as I alluded to, we do see strong momentum on this. And as we see the demand both in the suite and outside the suite, that will also be a contributor to the growth in the fiscal year that we are entering.

Just a quick follow-up then. You do expect growth in the core business somewhere between 2% and 3% or how should we think about next year? Because you do have the pruning effect and rationalization effects you mentioned as well.

Yeah, no, thanks for that. And as you've also noted, we haven't guided on this. And you can, of course, calculate with the math of 15% of endoscopy. And then it's plus, minus, around negative. And that uncertainty actually relates to some of the bigger contracts that remain uncertain at this point. So this is something that we are going through now in order to be more profitable in the future. We still believe that the 2% to 4% CAGR that we have communicated as part of our long-term guidance will continue, but we do not want to limit ourselves in this fiscal year for making some of the right decisions also in order to drive profitability. So this is why we are not specific on that. specifically guiding on this area. In Q4, just also to be fully clear, we said that we will potentially be negative, but that was, I mean, we don't see anything more specific than that, and that is still potentially as we talked about in Q3.

All right, and just a final question. If you could elaborate on your sort of um assessments of gross margin improvement for for the next fiscal year as well that would be would be helpful some of the puts and takes and sort of the magnitude of the uh improvement you're you're thinking about on the gross margin uh that'll be final one for me please

Yeah, and as you have also noted, last year we put out some soft guidance around our gross margins, and we have decided not to do that this year. But you could say the EBIT margin improvements, how we look at that will be a mix of gross margin improvements and also improvements in the OPEX ratio you can say that and what is driving the gross margin is of course it's an area that we continue to focus on on our transformation journey and then it's also product mix related which is also where of course given the other uncertainties I talked about on the anesthesia and patient monitoring side those are of course also impacting this area. But what we are, of course, looking at is a higher endoscopy sales, which has a favorable impact on on the cross margin. So I think I cannot be more specific on that at this point.

All right, that's clear. Thanks for taking my questions.

The next question comes from Christian Ryam with Danske Bank. Please go ahead with your question, Mr. Ryam.

Yes, good morning, Britt and Thomas, and congratulations on the solid free cash flow performance here for the end of last year. I have a couple of questions to the pulmonology subsegment. So you mentioned several times that you're seeing good performance and strong momentum for the new Bronco 5. Can you help us with a bit of specification on the magnitude of this? So, Pulmonology overall, I think, delivered about 2% organic growth for the year. Can we essentially expect that that was driven by the Bronco 5 or how significant is the product at this stage? And then a second question on the pulmonology outlook for 24. So you of course show on one of your slides in the presentation today that the pulmonology business has on average grown something like 12% annually over the last five years. Is that a similar kind of growth outlook that you're envisioning for this business for 2024? Or where should we think about that basically between, say, positive and up to these 12%? That's my two questions. Thank you.

Thank you, Christian. And let me comment on this. So when we look at the, if we take the last one first on the outlook, so what, as you rightly said, we showed like looking backwards and taking out some of the COVID effect, we had a CAGR of around 12%. If we look ahead, we are not commenting specific on what we expect on pulmonology, but we do expect a continuous growth as we have normalized post-COVID. And that is driven by a mix of ASCOPE 5 and the rest of the portfolio. And I think what we look more at is the different segments that we are in, where we do see growth coming in the ICU OR, which has been our key segment so far. And then we also, of course... I mean, are moving into the Bronx week. But we're not commenting on these specifically in detail. But what we do find interesting, as we have seen this year and expect to see as we move forward, and this goes specifically for the U.S., is that we see a need for some of the procedures that were previously done by our ASCOPE 4, that they are moving to ASCOPE 5 as a better solution because of the positive effects feedback. Also, I will say when we look at the totality and maybe that can give you some flavor on the pulmonology market and the limited data we have access to market share data for the US specifically, we have seen looking at some of the data from one of the last GPOs representing roughly 30% of the market, we have seen in the recent period and the recent quarters an increase in our market share overall, which makes us very comfortable. And I think that's a result, you can say, of our improved offering with Ace Group 5, but I think it's in particular also of an effect of the stronger focus that we have on pulmonology compared to the last couple of years. You remember that we put some more commercial resources behind that last year. I don't know if that answers. I don't give you any specific numbers on our outlook on pulmonology, but if that gives you some flavor of how we think about it.

Yeah, that's still helpful. But can you maybe help us with a bit of a better understanding of the significance of the Bronco 5 at this point? So really whether it has had, say, a meaningful contribution to growth in pulmonology for the last year. So essentially, if it's the reason why we see positive growth in the pulmonology portfolio for 2023.

It's actually a combination. So our growth in pulmonology has not just been driven by ASCOPE 5. It has been a helpful add-on, and it's only towards, you can say, the end of the fiscal year that we saw a stronger demand in the ICU and OR. So overall, when we look at the full franchise, we have seen the growth also on the ASCOPE 4 side.

Okay, great. Thank you very much.

Thanks.

The next question comes from Niels Granholm, left with Carnegie. Please go ahead with your question.

Thank you for taking my questions. The first question is on the timing of your updated ICU-OR pulmonology scope. Could you talk about the timing of this launch, which you call out as being under under the development. And then a couple of housekeeping questions. Could you also talk about your CAPEX ratio for the coming year? Should we expect it to remain at around 7% of sales? And could you also talk to your net financial costs? Thank you.

Thank you. And I'll start with the first and let Thomas handle the financial questions. So if we look at the ICU next generation as we now talk about for the first time externally, it's a project that we have been working on internally and how we operate with our endoscopes that has some synergies to some of the other developments that we have developed. in other areas. We are not, and that's primarily for competitive reasons, we are not commenting on our launch timelines for our new products, but I can say that it's a product that we have in development still with a bit of way to go before we are we're in the market. I think that's as specific as I can be. But it's one where we use some of the newest technology and some of the newest features that we have been working on internally in the company and still also being focused on the cogs and the cost of this product. So we can still have it at a level not too far from the Ascope 4 level. And so it will be

a lower price version compared to the a scope five thomas will will you comment on the yeah yeah no no no good uh thank you uh nils also for the comment so um so on net financial cost uh uh maybe maybe a a a couple of comments uh just uh back back to what what i also presented first and foremost we've uh We've, of course, done a capital increase, as you know, back in March, and that capital increase we've basically used also to lower our debt. Secondly, with the very significant improvement in our cash flow and the positive cash flow, as you also will see in the details of the annual report, we basically don't have any outstanding debt towards the banks anymore. So that also means that the net financial costs We really have been driving down, and we don't really expect anything major within the net financial cost looking forward. So a very good and healthy position from a balance sheet also.

And maybe I can say on your CapEx question, I mean, it was 7% in the past year. We do not guide on CapEx, but I think you can assume it will be around the same level in the next fiscal year. is not completely off.

And so does it mean now that you don't have any bank debt left that you would consider share buybacks in the coming years or potential to become more active in terms of acquisitions?

Yeah, you know, and a very good and relevant question. And I think what is very clear is that, I mean, we our focus is very much on being a growth company and continuing to invest in growth. But at the same time, as I mean, we also focused on increasing our profitability. So that's, of course, where we are right now looking at. I mean, ultimately, our I mean, we have to develop value for our shareholders and only invest in areas where we can see that we have, where we can create an attractive return. So we are not more specific around what our plan is with the new situation of improved cash flow, but it's something we will come back to at a later stage.

Thank you.

The next question comes from Martin Breno with Nordia. Please go ahead with your question, Mr. Breno.

Thank you very much. Martin Breno from Nordia. Two questions from my side, please. First of all, I would just like to understand the guidance and just how you bridge it to the Q4 performance a little bit. I mean, you deliver 25% organic growth in endoscopy solutions in Q4, which is quite nice to see and very comforting to see. But then you guide for 15% organic growth for the next financial year. That's an oddly specific number with relatively low visibility. Could you maybe clarify how you got to that number and whether it should be seen as a flaw rather than the number that we should use as our sort of our point of guidance here. And then on the EBIT margin, you are already at 8% EBIT margin here in Q4. You guide for 8% to 10%. How does that work when you consider the inventory impact that you had in the last financial year, operating leverage and everything else being equal, the profit improvement you should see in the core part of the business. Maybe some more words on that would be very helpful. Thank you.

Thanks, Martin, for good questions. Maybe if we start with the guidance, or maybe to start with an overall comment on our guidance. I mean, how we guide. We have, of course, had our careful or thorough internal process, and what we guide on is in line with what we internally see when we put the full picture together. So it is what we consider as being what is realistic for us to deliver on, given the environment that we have and given some of the uncertainties we have, be it external uncertainties in both macro environment, but also health systems. And then internally, you can say, what are our major uncertainties? That's basically also two things. It's some of the decisions that we make to balance profitability in anesthesia and patient monitoring. And then it's also some of the new launches where it's still... for our new launches, I think we have learned the hard way. And we have also tried with our capital market day to put some more transparency around what happens when we have new launches and that gradual ramp up. So these are some of the uncertainties that we build in. Having said that, i think you need to be a bit careful comparing the q4 with the full year we have some some swings quarter over quarter in our business basically because a lot of our business is related to contracts so we sometimes have some orders that are related to bigger bigger contracts i think with the 15 percent endoscopy growth that we put out we actually excited about that. And we also believe that this is what we as a business can deliver on. And that also brings us on track for the long-term targets that we have set out. So that's how we see that. Then you can say when it comes to our EBIT and the 8% to 10%, We also still, you can say, have some quarterly swings on our cost side. But more importantly, you can say we continue to see inflation. It has gone a bit down compared to where we were a year ago. But you have to remember also that the inflation is still one that affects our cost, but where we are not to the same extent able to put that on our customers at the same speed. A lot of that because a lot of the business is tied up on contracts. But I would also say on this one, and as we are continuing also our transformation program, we are very dedicated to get to a significantly higher level as is also in our target. So that's how to think about it. But again, I mean, we have some quarterly swings and one should be careful concluding on those and extrapolating those to a full year. I hope it gives some clarity.

It does, definitely. Thank you. Just one follow-up, maybe. In your best assessment, how much of the 15% is going to come from the red dots? on your slide 10, so what's the solutions in market and how much of the growth will actually come from new solutions in the market, like how much is baked in from new solutions coming to market here?

No, and that's exactly a very good question, because I think the majority of the revenue and the growth will still come from, you can say, the red dots of the products that are already in the market. Then as we bring new products into the market, the dynamics that we see, because once a product, one of our endoscopes is approved, it's really the first time with the approval that we are able to test it, if you will, or to use it in humans. So that means that when we have an approval, it takes a couple of months before we really are in full commercial launch mode because we are testing it in a smaller group of patients before going broader. And then you can say once we then go to the commercial launch phase, we have also some months of negotiations with the hospitals or the GPOs before the sales really starts. So that's one thing that means that there's a time lag from when we have an approval until we see revenue. Then something that we are also taking a slightly different approach on than previous is that we are... a little bit more stepwise when it comes to country rollout. So we are making sure that whatever feedback we have that requires some adjustments that we get that early before we roll it out too broad. So that basically does mean that the ramp up time for the new launches takes more time. And that's also what we have now built into our forecast that we are not too aggressive or too optimistic on our forecasting for the new solutions. It doesn't mean that we are less ambitious on those, because we do think that we have attractive products in the pipeline that will fuel our longer-term growth, but we are just a little more careful on our forecasting for the early phases.

So just, sorry, last follow-up for me, and then I promise to jump back in the queue. But just the way you phrase it, and correct me if I'm wrong here, but it sounds like The 15% is more or less entirely based on the products that you already have in market because you don't really have the visibility in the new products. So any faster than anticipated take up in the new products would be sort of upside to the 15%. Is that fair to say?

I'm not coming on the exact bit, but you can say it's correct that a key part of the 15% growth is from existing products. Yes.

Okay. Thank you very much.

Your next question comes from David Addington with JP Morgan. Please go ahead, Mr. Addington.

Hey, guys. Thanks for the questions. So most have been asked already, but I've got a couple of more technical ones. So just on CapEx, your CapEx was $80 million in the first nine months, but for the 12 months, it was only $71 million. So I just wondered what was going on there to get negative CapEx in the fourth quarter. And then secondly, just around R&D capitalization and amortization. The delta was about 60 million for this year, with capitalization being higher than amortization. Just wondered in terms of how you're thinking about capitalization versus amortization of that R&D this year. Thanks.

I think these, thanks a lot, David, for the questions. I think these are more questions for you, Thomas.

Yeah, thank you, David. So with the first question you had was around the CAPEX. Maybe I just will come back to the second one. I'm not sure if I got that 100%, but let me maybe just answer the first question. What you're referring to, of course, I assume, is what you see in the cash flow overview of the total of 71 million for the full year from a cash flow perspective. It is, of course, a net number, as you are aware of. So, of course, there also will go some sale or disposals out of that number. But let us come back on that topic also. The second question, I'm not sure if I understood that completely. Could you just repeat the second question?

Yeah, maybe I just want to get a feel for how you're feeling about capitalization of R&D versus amortization. Should we see more normalization or should we expect capitalization to still exceed amortization?

Okay, no, good, understood then. So, of course, we don't make any changes within our accounting policy. So that, of course, will mean that we will continue to capitalize, obviously, primarily our R&D expenses. So you will continue to see an increase also next year of the depreciation and less so on the amortization. but it's going to normalize rather than anything else. And that goes back to the capex ratio that we also mentioned about, so roughly the 7%, so it will come to a more normalized level.

I think we are aware that we have a slightly higher capitalization of R&D than many other companies, and that's, of course, a point of... attention for us, but also, I mean, we believe that it takes some time before we can normalize and match completely.

That's it. Thank you.

The next question comes from Wei Zhu with SED. Please go ahead.

Hi, it's Wei from ACB. Thank you for taking my questions. I have three left. I'll do one at a time. Firstly, could you maybe give us some guidance for Q1, especially on the endoscopy growth as you did last year?

I think we are not giving any soft guidance for Q1, unfortunately, but I can say we are off to a good start to the year. And again, with full normalization post-COVID, so we don't have those effects weighing in anymore.

Okay, fair enough. And secondly, on the margin guidance and Last year, you had this ramp-up cost for Mexico plan. And for 2023-2024, could you maybe comment on if we still expect the same amount of ramp-up cost? Yes.

So, I mean, we have had, as you say, ramp up costs in the 22, 23 for Mexico. We are not at full capacity where we want to be, but we are doing it gradually. So you can still expect to see some of that. And then we are not giving specific guidance on the amount, but there will still be some ramp up during the year.

Can you say if it would be at the same level or lower than the 2022-2023 level? Because I can see the amount from your notes, financial notes.

And we are not guiding specifically on it, but I'll say it will not be, we do not at this point expect it to be remarkably higher than what we had in the previous year.

Okay. And lastly, you mentioned the Ascopy 5 strong momentum, but could you maybe comment on if it has cannibalized your Ascopy 4 sales? Because as I understand, it is also now penetrating well in the ICU and ORs.

That's a very good question and something that we are monitoring closely. And I will say that we are seeing a limited, but of course, I mean, some level of cannibalization as we're moving into ICU OR, but that's still relatively early days. And you can say, I mean, the good rationale for being present in ICU OR is also because that's where, and all this is specifically targeted U.S. focus, that's also where we see more competition from others. So what we do see is that it's also a way to have the full portfolio. So it's often the customers using a scope for that will use that our customers using competitor products. So we see a limited amount of cannibalization, but some of it. But but then the scope is obviously at a higher at a higher price. The price premium is, as we said, when we launched the product, around 30 percent higher than a scope for. And that's and that's still the case. And then we, of course, using our full portfolio also as we see competition to to have a stronger position.

Okay, maybe just want to follow up here. And so why are you looking at a scope for sales? I guess that's the product where you have faced most of competition. Can you confirm it has now returned to the positive growth?

Yes. So in the last, you can say, in the last quarter that we have had, we have had positive growth on ASCOPE 4 as well. So the 16% growth that we refer to, it's not only driven by the ASCOPE 5.

Okay, great. Thank you very much. I jump back to you.

In the interest of time, we will take... One last follow-up question from Martin Breno.

Thank you very much. I guess I was lucky here. I just wanted to understand a little bit, you know, I'm sorry for being a bit obsessed with slide 10 here, but there's a lot of blue dots on this slide. Could you maybe elaborate a little bit on where you are in terms of capacity? whether there are some products that you have needed to postpone a little bit in terms of the video laryngoscope and the ureteroscope, and whether you see further scopes for product launches in the next fiscal year.

Thanks for that question. And I also do think slide 10 with our portfolio is an important one. You can say overall what we basically did last year was that we focused in. So we had more projects that we were focused on that were not on the slide. So we have focused in. And then you can say some of the approvals that we have had this year, if we take GI with our colonoscope as an example, it's projects that were more or less done last year. It's very clear that we have a prioritization to make sure we also resource the highest priority projects. We do see projects like the video laryngoscope as one that is fully prioritized in our portfolio. The same goes for some of the other key products that we have. Ureteroscope also being one that we are quite progressed with. But it has been a rebalancing of our priorities that we did around a year ago and also adjusting our way of working at the same time i will say and and that's also what i was trying to allude to when it comes to our systems we're looking at a much more integrated approach when it comes to our systems and investing more on the software side to see how can we also make improvements on the system that can benefit across the different segments because we see that some of the demands that are coming from customers can be met by the technology advancements that we do on the systems itself. So that's how you should look at that as a full portfolio where we will do improvements on the on the system that benefits across the different segments. But we are deliberately not more precise on the different products and launch timelines. Unfortunately, we are on track and prioritizing some of the key ones and will continue to do so. And also, we are thinking a bit ahead to make sure that we can continue to be innovative and leading in the segments that we operate in, where we do see competition in some of the segments. We have our new chief technology officer started August 1st, and he's off to a very good start and has a good experience and understanding of of how to operate that. So I feel quite confident in how we work and that we have clarified more priorities, reduced our complexity in how we work so we can get a better throughput and focus on the right solutions for our customers.

That's very helpful. Thank you so much, Britt.

Thanks.

This concludes our Q&A session, and I hand back to Britt Neil B. Jensen.

Thank you to the operator and thanks to everyone for joining us this morning. Thanks for good questions. Hope you'll have a good rest of day, everyone. Thanks for...