Ambu A S Ord

Hello everyone and welcome to the AMBU presentation of our Q3 2023-2024 financial results. I'm Britt Milby Jensen, I'm the CEO of AMBU and with me today I have Henrik Skagbender, our Chief Financial Officer. On the agenda today, I'll start providing an overall update on the business, and then I'll hand over to Henrik to go through the financials, and then we'll end with a Q&A session. So jumping right into the numbers, we delivered in Q3 2023-24 a total organic revenue growth of 15%. If we look at how that is split into the different segments, starting with the endoscopy solutions segment, we grew 18% in our endoscopy business in the quarter and 21.6% in the full nine months of this fiscal year. When we look at profitability, our EBIT margin before special items ended at 12.9%. And on the free cash flow, we delivered 163 million Danish kroner for the quarter. So overall, a strong quarter that we are very excited about continuing the strong quarter over quarter momentum, as well as being driven by a very strong offering to our customers. and thousands of dedicated employees who do a great job every day for Ambu to progress our zoom-in strategy. So talking about our zoom-in strategy, let's look at the progress on the different fronts because we do continue to see progress on all four areas. Starting with our customer solutions, we are very happy and excited to announce that in the quarter, we had approvals of two new solutions that we will bring to our customers. The first one is our ureteroscope, our Ascope 5 uretero, which we now have approved both in the US, both with our A-Box 2 and A-View 2 Advanced. We also have the European approval of that product since some months, so we are now excited about the progress, which I'll come back to later. Another milestone we had was that we had our Ascope Duodeno 2 approved in Europe. We had, or in the US, sorry, we now have, in April of this year, sorry, we had the FDA approval, and now we also have the approval in Europe, so that product is approved in both areas. Also something that I'll come back to. Moving on to our continuous focus on execution, Henrik will talk about this later, but overall very strong momentum in improving our profitability, which remains a key focus. And also the focus we have on strengthening the scalability and efficiency in our business continues to be a key focus area. On the people side, we continue to focus a lot on how we work and how we deliver value. In this quarter, we welcomed a new colleague to the executive leadership team, Graciela Meluselli, who joined AMBU as the new chief operating officer on the 10th of June. At the same time, we have also Romana Hassan, who had been with AMBU as the chief marketing officer for seven months, left the organization in the period. Overall, in Ambu, we have a program that we call One Beat that is focused on that organizational transformation. And we are continuing with a lot of progress in that, in how we, again, optimize the scalability of our organization to prepare for future growth, which is our key focus as a company. Sustainability is an area that is very high on our agenda as well. Our focus is twofold. One, on the net zero reduction where we have made good progress on the CO2 per ton of manufacturing, which we decreased by 10% over the previous year. One other thing that is a strong focus for us is how we help our customers also be more sustainable. One of the things we have done here is that we have introduced bioplastic in all the handles of our scopes. That is close to being rolled out across the full portfolio. And at the same time, we are advancing the use of that material into more products, most lately the laryngeal mask in our anesthesia portfolio. Let's look a bit more at the numbers. In the quarter, the 15% growth amounted to 1.38 billion DKK. If we look at how the revenue is split across the segments, 10.9% growth in anesthesia and patient monitoring and 18% of growth in endoscopy solutions. With this, we continue to increase the endoscopy solutions as the percent of total revenue, which is now at 59%, and then 41% of our business is anesthesia and patient monitoring, which a year ago amounted to 43%. If we take a closer look at the segments starting with anesthesia and patient monitoring, we had a very strong year. It's quite a while since we reported double-digit growth in this area. And after the first nine months, we are at 6.4%. So if we take a step back and look at this portfolio, one year ago when I stood here, we talked about the uncertainty moving into this financial year of whether we would see growth at all. The key reason for this was that we knew we were going to implement significant price increases across multiple segments and we were not sure how the customers would respond. The combination, which is the key driver of the growth we have now, of good response, meaning that we have not yet lost significant volume with these price increases, is one key driver of the 10.9% growth in the quarter. Another key driver is that we have overall seen favorable market growth when it comes to procedure activity. Those are the two main reasons why we can deliver this strong growth. When we look ahead, we would like to flag that there is still some risk in losing contract volumes. In other words, sometimes we know instantly when we lose a contract due to price because they will go with another vendor. In other cases, we may still be on the list, but it will take a while before the customer may react on the price increase that we have seen. So that is something that is important for us to flag. But overall, strong feedback and strong momentum in this business overall, fairly equally distributed across the two segments, anesthesia and patient monitoring. So let's look at Endoscopy Solutions, our main growth area as a company. We reported 18% growth in the quarter. If we look at the first nine months of the year, we are growing by 21.6%, amounting to, for the first nine months, 2.368 billion DKK. This growth represents solid growth across all the segments that we are in, and it's also helped by, as for anesthesia and patient monitoring, a good market growth when it comes to a number of procedures. Pulmonology now represents roughly half of our total endoscopy revenue, and we have seen a good growth in this segment. And then ENT and urology are two segments that continue to grow with very solid double digit numbers. In gastroenterology, we continue to also see a growing revenue, mainly driven by our A-scope gastro and our A-scope gastro large. If we look at pulmonology, so the segment that we have been in for the longest, we grew 9.9% in the quarter. And when we look at it year to date, we are at 13.9% growth overall. If you look at the graph here, you will also see that the growth or the revenue that we report in Q3 is slightly lower than what we see in Q2. And that is simply due to the fact of flu season where our bronchoscopes are used. So Q2 typically is a fairly strong quarter where we see positive impact by the flu. What we are very pleased about is that we see a continued momentum in this business with AScope 5 continuing to gain traction and reporting very good growth. If we look at the other segments that we report together, so endoscopy solutions excluding pulmonology, we grew 27.6% in the quarter. And if we look at the first nine months, we are growing by 31.5%. So significantly above market growth in this segment. Again, across the different segments, ENT, which is very much driven by our US colleagues, we continue to see a very strong growth trajectory with a good mix of new customers coming in and strengthening our revenue and our usage with existing customers, partly related still to the expansion into the fees indication that we had last year. Urology is also an area where we continue to see very strong growth. It's still Ascope 4 system that is growing, but with new products coming into the urology space, which we have only been in for less than five years, we are very excited about the outlook here. And then last but not least, the GI. We see GI as an area that is still relevant for AMBU that holds long term potential where we have taken away a number of commercial resources compared to where we were two plus years ago. But we still see with this niche by niche approach, very good momentum and growth. So let's look at some of the new solutions that we have approved in the quarter, starting with our Ascope 5 Euridro. This is a product that we have tested right now and we are towards the end of the phase that we call our controlled market release, which is basically a phase where we, after approval, engage with hospitals both in Europe and the US and use for the first time the product in real-life patient cases to see the response. We have had very good response in this phase. We have made some minor improvements of the product based on the feedback and we are now towards the end of the controlled market release phase and we are approaching what we call the launch of the product in the coming months. This is a product that is launching into a market where there's already some single use providers and where the market has already converted a large part of the market into single use. So we are very excited to tap into that and also leverage the relationships that we have with existing customers, as well as our strong presence now in urology, which we didn't have when we launched the Cystoscope. Then we have our Ascope Duodeno 2 solution, and those who have followed AMBU for some years will know that this is the area where we, with the first generation, put a huge amount of resources behind the first generation and didn't live up to our own expectations. What we have done since is that we have gone back, made significant improvements, leveraged the new technology platform that we have and that we use across all scopes and some of the software advancements that we have developed and then in close collaboration with customers made significant improvements in a number of areas. We were very excited to both get the FDA approval in April and most recently the CE mark in Europe. And we have started the controlled market release. So we do have numerous cases being performed with our duodenoscope in real life patients. And the results so far are very positive. With the history we have, we want to make sure that we take the thorough time to review this. Also due to the fact that the ERCP procedures where this scope is used are procedures characterized with very high complexity. So we want to make sure that we have exactly the right understanding of the usage of our product. So far so good, and when we move into the commercial launch phase sometime well into the next fiscal year, we will do it with a very different approach as we did previously, because we are not going to allocate the same amount of resources, but we are going to take a step-by-step approach, gradually expanding the usage. Again, back to the point I made before, that GEI is an area that we are very committed to, but we see that more as a long-term potential. So with these two new approvals, taking a step back and looking at the full portfolio that we have, we are expanding our portfolio when it comes to products being in the market across the different segments. And I think what is worth noting is that pulmonology where we started some 16 years ago, we are now expanding into a very strong portfolio that our commercial colleagues can leverage with the customers, with the video laryngoscope being a new addition that will come into our portfolio in the not so distant future. Then I want to point out urology that I just talked about. We went into this as a new segment only with the ASCOPE 4 system. But now we have expanded into the ASCOPE 5 system, the more advanced version for more advanced procedures requiring better image quality than with ASCOPE system 4. And then also with the ureteroscope, we are building a strong portfolio in this segment. If we then look to the left side, something that we increasingly focused on is our systems or the software. And because we are the company with the broadest endoscopy portfolio, we also have a lot of opportunities to leverage the technology platform and the software that right now comes on the AVU2 Advanced and the ABOX2, where all our scopes fit into one of these platforms. And the software and the setup on those two platforms is quite similar in many ways. This allows also for our customers to very easily adopt new patients. Most recently, the example I put around urology, where we come out with a ureteroscope that will be easy to plug into the AVU2 Advanced in the US that the customers are already very familiar with. Also, we are looking into some of the technology that is coming up out there to better and better use software to improve the image quality and other features that has benefits for our customers. And we will continue to focus increasingly on the software side to make sure that we can leverage that technology to bring an even better customer experience to our customers. So with this, I'll hand over to you, Henrik, to go more into our financials.

Thank you very much, Britt. And before I go into the financials, I also just want to start by reiterating what Britt said. We are very happy with Q3. And obviously, that is also why we, on the 10th of July, decided to increase our guidance. And I'll come back to also our view on the guidance later on in the presentation. So looking at Q3, then as Britt said, we landed a total revenue of 1.383 million DKK, corresponding to a total growth, organic growth of 15%, adding to that a positive impact from FX of 0.7, bringing the total combined growth to 15.7%. Very happy with the overall results and a continuation of the momentum that we've seen in Q1 and Q2, now into Q3. Looking at the regions, we're also seeing a continuation of the strong growth in Americas. Now also a continuing growth in Europe, even though that was one of the areas we, as you may have noted in Q2, we're looking a little bit for how would they develop in Q3, but really strong development. So overall, on a regional basis, we're also very happy with how we see double digit across all of our regions. Looking a little bit further then on growth overall for the first nine months, we now are just above 4 billion in total. And split by segments, as Britt said, obviously the main growth driver is our endoscopy solutions growing at 21.6%. Next to that, our legacy business, anesthesia and patient monitoring, growing 6.4%. This is a very solid growth momentum and something that basically brings us, you could say, ahead of our expectation on the long term, being a 10% CAGR growth across the years, if you look across the two-year period since we launched ZoomIn. Obviously then looking at decomposing the growth, it's also important to say we are right now still a little bit in a rebalancing mode and therefore like we communicated in Q1 and Q2, interesting thing in Q3 was obviously to see what is our pulmonology performance and even though a 9.9% growth in pulmonology is down a bit versus Q1 and Q3, it's actually really, we feel, solid continued growth considering that we had strong comparables for Q3, and we also have the same for Q4 in pulmonology last year. Similarly, as Britt also said, obviously we are very much following the growth momentum in our anesthesia and patient monitoring business since a substantial part of the overall growth is driven by price increases. It is also a positive market development, as Britt said, which of course we expect to continue, but we are monitoring it and therefore also very much looking to what should we expect going forward. Last but not least, under industry solutions, I think it's also important to highlight our very strong growth outside pulmonology. The above 20% growth in Q3 that Britt also referred to, which right now is a combination of a very strong offering, but obviously also first mover advantages on some of our products. We are very much looking forward to now having the Urito product in the market, which will hopefully enable us to extend that momentum further going forward. Then turning to earnings, I think another really solid quarter for us and an extension of a really, really solid quarter in Q2 and also a solid quarter in Q1. If you decompose how our margin expansion of about 5.3 percentage points is split across gross margin and OPEX, we're very happy to see our gross margin going up. I'll come back to some of the drivers of this later, but overall, obviously, the price increases are a key factor of that, but also scalability in our manufacturing footprint, meaning that even though our Anastasia and page monitoring business is growing faster than we expected, we're still able to actually lift our cross-margin versus last year. Second to that, we also had a decreasing OPEX ratio in Q3, despite making a number of investments in our organization and in the long-term foundation, which I'll also come back to. So a very satisfactory Q3 also in terms of margin. If we double-click on gross margin, as I said, this is a continuation of a number of quarters where we've managed to increase the margin quarter by quarter. And again, here in quarter three, we're seeing still a combination of positive product mix. The endoscopy solution segment obviously have a higher gross margin than the anesthesia and patient monitoring segment, so that growing faster is helping us. Second, the price increases are lifting our anesthesia and patient monitoring segment. And last but not least, both the combination of scale in our production costs, meaning particularly our indirect production costs, but also tailwind from currencies are also helping us right now. Then looking at OPEX, we had an increase actually in OPEX ratio between Q2 and Q3, and this is driven by two main factors. One, we are investing more in our commercial organization, which we also communicated both in Q1 and Q2, mainly focused on ensuring we get more salespeople, more customer-facing people who can deliver our existing products, but also new products to the customers, and ensure that we have a strong footprint in the face of the customer. We're still in the ramp-up phase of that, but are seeing really solid and strong momentum there, and also a lot of interest from the market and from candidates in joining Ambu, which is really positive to see. Secondly, we've also deliberately made a number of investments a little bit in Q2, but now more in Q3 on IT systems, on some of the infrastructure elements of building the AMBU for the future, building the foundation for the future, something that I'll also come back to. But that is why you see the administration and IT costs going up in Q3. Lastly, in terms of financial performance, I think one of the key, key performance metrics for us is still managing a solid cash flow. And Q3 was another testament that we are now really on a continuation of a very strong trend. Last year in Q3 and Q4, a big part of the positive cash flow was us managing our network and capital better. Still, we have a close eye on network and capital, but as you can see from the graph, in Q3, network and capital was almost net zero. in terms of change for the quarter, and the real strong cash flow was therefore mainly driven by strong earnings and still slightly lower CapEx than expected. For us, this is a great testament to building a much stronger business, building a much stronger balance sheet, something that is very, very useful for our journey going forward. So again, decomposing cash flow. I think if we look at the network and capital ratio, we're now at a state where we are close to and the range of what we also communicated would be our long-term target range, around 20% network and capital ratio. Underneath, we've been very, very selectively investing in making sure we have the right inventory levels at all of our high runner categories. And now also in connection with product launches, have the right level of inventory to support a strong launch. Secondly, CapEx is still at a lower level. As you can see, it's gone a bit up since Q1, but similar level as Q2. We are expecting that to go up a little bit further as we continue to invest more in the foundation and invest more in R&D. And then lastly, again, looking at the EBITDA line, this is a great testament to where we are in terms of executing on the zoom-in strategy, obviously also helped by strong organic growth, but really focused on making sure we also manage our margin and expand our margin along the way. So taking a step back or step up in terms of where we are since we launched the overall zoom-in strategy, now back in the first half of 2023, I think it's fair to say that we're now at a stage where we've moved a very long way. And frankly also, from our perspective, probably a little bit ahead of what we expected when we launched the plan. The first phase was really about scoping the program, then launching it, and then executing quick wins. And back in Q1, I talked about the deliberate decision to extend the quick win phase, so to speak, because we believed that there was more to gain still, something that I believe you can now see both in terms of growth, but in particular, in terms of margin. We will still execute on those quick wins and they will still have an effect going forward, but we also now more and more looking at what is the foundational things we should do to ensure that we can continue and extend and expand on the growth journey we are on to build the AMBU for the future. And therefore we are now moving more and more into this phase three of really looking at what is the foundation we need for the future to both support the growth and support the margin expansion. And when looking ahead, it's always good to look a little bit back and say what have we really succeeded with in terms of accelerating execution, in terms of driving some of the initiatives that were launched back in 2023. And a way of looking at it at least is looking at what are the drivers of our margin expansion if you look at the full nine month period for this financial year. And looking at the graph on the left, it's clear to see that we're working both on expanding our gross margin and expanding our OPEX. Double-clicking on a gross margin, it's really back to driving a stronger focus on pricing. We're doing that both in our endoscopy business, of course, in particular in connection with launch, but also now, as we've talked about a lot in the anesthesia and patient monitoring business, frankly, more successfully than we expected when we started, but also very mindfully managing how do we make sure to continue this drive and make it a continuous effort to manage price. Second is really making sure that we have a strong product mix and of course support the high growth segments, but also manage our product mix within each of the categories. Right now as Endoscopy Solutions is growing faster than anesthesia and patient monitoring, that alone is also helping our cross margin. Last but not least, as you also heard us talk about before, we have a strong manufacturing footprint. We also still have a manufacturing footprint which is not fully utilized. Of course, that's positive when you're on a growth journey, but it also means that we are still seeing a continuation of the journey of expanding or making sure we have a better utilization of our manufacturing footprint, of expanding our sales and offerings within the existing footprint we have, and that will also support our gross margin. It has already. and it will continue to do so going forward. Secondly, we are seeing a number of effects also helping scalability in OPEX. We still, right now, have a significant cost in terms of distribution, which is part of our selling and distribution costs, something we are working on with better inventory management, with better planning with our customers, something we believe we can still manage better going forward. We have a number of initiatives running on how do we scale our administration, and that's also why we are right now investing in the foundation to be able to scale even further. And last but not least, we also work on how do we scale our global commercial network and R&D, mindful that we also really want to make sure that they support the continuous growth. Looking at the first nine months, you can say we have expanded our margin more by scaling our OPEX, and we believe this is a journey that will continue. And looking at how will we go from the 12% towards our long-term financial target of 20%, potentially adjusted for strategic opportunities along the way. But looking at that gap from where we are today to 20%, we still believe that OPEX will be the main driver of the two of closing that margin gap. And therefore, that's also something we are very deliberately now, you could say, incorporated in our plans in terms of how we move forward, still supporting growth, but also very much making sure we manage the margin expansion journey. So what do we mean by investing more in the foundation? What does that mean building the AMPU for the future? Well, for us, it can at least be all down to at least four key areas where we're right now very much focusing on making the right investments. The first area is back to what we talked about already back in Q1 of building a stronger commercial setup, both bringing more salespeople, but also a strong setup around the salespeople. That will require costs on the short term, as it will take time to bring the right people on board, train the right people, and make sure that they can continuously drive sales. It's a very explicit focus of ours, of course, particularly in the segments where we're seeing high growth, so within endoscopy solutions, and right now in particular also supporting the upcoming product launches particularly the ureteroscope. Secondly, it's really ensuring that we run a global, strong, agile, but also lean operation, managing our manufacturing footprint, but also managing our supplier base and driving more efficiency in our distribution setup. Thirdly, it's investing in our IT landscape. AMBU has grown fast, and we believe there's more to be gained in terms of automation, in terms of working better globally, and therefore really driving continuous effort of investing in the right things to drive better scalability in our business. And last but not least, it is really making sure that with all of the three above and while making these investments, we still also make sure that we invest in the core that will drive further innovation and organic growth going forward in R&D capabilities, in really understanding our customers at an even deeper level, and making sure that we tie our innovation very much to the customers in a customer-driven way, both looking at new technologies, software, like we described before, but also looking at AI. So this combined will mean that we are right now working on how do we incorporate all of these investment areas, all of these investments in the foundation in our future plans. We still believe we have lots of margin expansion to do and these will not hamper them, but this will mean that we will selectively make these investments over the coming years to make sure that we really can support the longer term growth journey. And therefore, on that growth journey, we've talked a lot about organic growth, rightfully, and since the start of ZoomIn, that has been the main focus. With a stronger balance sheet, with a stronger margin, with a much firmer grip on our cash flow, we also feel now is the time to openly state that, of course, we're also looking at inorganic opportunities. It's very, very important for us to reiterate the point that organic growth and growth overall is the main focus of our strategy. Obviously now coupled with a focus on also margin expansion, but inorganic growth is certainly a vehicle to accelerate the organic growth journey with very deliberate focus on how can we look at technologies or companies that can support our growth journey on that way. A premise for even looking at M&A, of course, is that you have your balance sheet under control. And therefore, on the left side, you'll see on the graph, just looking at our net interest bearing debt to EBITDA level, we've managed to now deliver significantly with strong performance. And obviously, that opens for a different view on how M&A can be part of our long-term growth strategy. Of course, we will look at this under the guidance of our gearing level, guidance, you could say, of gearing up to max two and a half X EBITDA, which is what we also communicated in our capital markets day, and also under the guidance of our dividend policy, but still that leaves quite a room for looking at opportunities. What opportunities will we look at? Well, again, as I said initially, we will look at opportunities that support organic growth, value-adding acquisitions within existing business areas or in clear adjacencies to accelerate the growth or technologies that can accelerate the growth. It's still early days, but given our situation, we all felt today was the right time to communicate that this is an ambition we're actively looking in and also actively investing management and resource time into. So ending on this year then, more specifically, and coming back to what I said when I started the financial review, we're very happy to reiterate that we upgraded our financial guidance on the 10th of July. So our guidance for the full year now is 12 to 14% organic growth, 11 to 13% EBIT margin, and plus 450 million free cash flow. Overall, we feel we are on a strong momentum. We feel Q3 is another testament to that strong momentum. And we also feel now with our financial strength that we can allow ourselves to look even broader in terms of how we can extend that momentum. Thank you very much. That ends my presentation and I will hand it back to the operator.

Thank you very much. We will now begin the question and answer session. Anyone who wishes to ask a question may press star and one on their telephone. You will hear a tone to confirm that you have entered the queue. If you wish to remove yourself from the question queue, you may press star and two. Questionnaires on the phone are requested to disable loudspeaker mode while asking a question. We have a first question from the line of Niels Granholm Leth from Carnegie. Please go ahead.

Good morning and thank you for taking my questions. First question would be on OPEX spending. So we saw quite a jump in admin cost in quarter three. Would this be the run rate for admin costs going forward, or could we even see admin costs coming up in the next quarter? And then I would have a question, I would say more on the long-term side, and now that growth in your pulmonary segment is predominantly going to be driven by the more advanced bronch suite procedures. How do you see the long-term conversion potential here relative to the ORICU segment where the conversion seems to be approaching some level of saturation? And I guess that the reason I'm asking here is that several Surgical robotic companies such as Intuitive Surgical are now stepping up their entry as regards to robotic bronchoscopy in the bronch suite. So how do you see the conversion potential in the bronch suite? Thank you.

Do you want to take the first?

I can certainly do that and you can take the question on pulmonology. So thank you for the question Niels. In terms of OPEC spending, you are right, it's quite a jump, particularly in admin costs, more than 30 million between Q2 and Q3 in absolute terms. As we also stated in the announcement, we are or have been in Q3 making extra investments in several projects, both strategy projects, but also IT-related projects. And therefore, this is not a new normal for admin costs, just to be very clear. It is really investments for the future. And therefore, we're not expecting this to go significantly up. What we are deliberately, as I also stated in my foundation investment overview, focusing on is how to invest more in the commercial organization while optimizing distribution, but more in the commercial organization, customer-facing people, and how do we invest more in IT. So those are the two areas that over time you'll see more investments in.

But we should expect a run rate of the Q3 level going forward but without any significant growth.

You will expect at least for the next coming quarters it will be flat or actually in some areas even going a little bit down but I will not go in details on each of the underlying components but more reiterate this point that Q3 was extraordinary high because we made extra investments.

And then, Niels, to your question on the pulmonology segment, which I think is a good and relevant one. So if we look, and you are specific about Europe, but if we take a step back and look overall and into the OR and ICU, where we really see that we have had our stronghold so far has been in the ICU segment with our ASCOPE4. In the US, also starting to penetrate into the OR, where there's still also room to grow Then with Ascope 5 that we then launched, we are seeing traction in the suites, but still with a lot of potential to further advance there. And then we are also seeing Ascope 5 being a demand for some of the more complex procedures done in ICU OR that, I mean, that they kept the reusable... So we still see, even though that the market is, this is the most penetrated segment, we still see that the market, you could debate how much is exaggerating, but we still see room to grow in this segment. And then our focus is also to continue, I mean, to address the customer problems even better. So we have our next generation of Ascope 4 in development, which we believe will come out and serve not only some of the same, but also expand the needs that it solves. And then you can say our focus is also looking into pulmonology being our still the biggest single segment that we are in. We are also expanding how we can fulfill the needs with the video laryngoscope, which is at first very much focused on US and the UK, where the market is already well created, but where there is also a lot of potential given that a video laryngoscope in the US, UK is used to an increasing extent. We see good potential for this to happen in Europe as well. Then on my final comment on your robotics and what Intuitive is doing, which we are following very closely, and we also believe that there are some of these trends that are very interesting and where we, being an innovator company, we believe that we still being very close to the customers in how we develop solutions should be able to continue to have a competitive solution out there, which is partly also where our increased focus on software and the capabilities that we can create through software becomes very relevant.

So you think it's fair to assume the same kind of long-term conversion in the Bronx suite as we are currently seeing in the OR, ICU area?

Largely, yes, that's what we think. And then you can say what we are also very focused on is the portfolio that we are offering to these customers and how we also can, by increasing the value that we bring to customers, can gradually expand our revenue and our presence both in ICU and OR going forward.

And I think if I may supplement, it is, I think, important to say we actually still see single-use penetration going up in the OR and ICU. So when you say saturation, you can say there are levels where we're seeing the speed by which this conversion happen going down, but it's important to say we actually still see the single-use penetration going up for some years to come, even in those two segments.

Okay, great. Very quickly, Verity, thank you.

Thank you.

Thank you. Our next question is from the line of Christian from Danske Bank. Please go ahead.

Yes. Hello, Britt and Henrik, and thank you for taking my questions as well. I have two here initially. So first one is on, say, the goal drivers for the endoscope solutions business as we look ahead and particularly into next year. So should the assumption still be here that for 25, the main growth drivers is really the Ascope 5, the Cysto, and the ENT, while we should expect that the Eurethro and the Gastro and other products will take longer time before they really become meaningful growth drivers? Or what is your view on the time horizon there? And then second question is to you, Henrik, and specifically on the cross-margin development and the potential that you see there as you look ahead. So as I understand you, the quarter here was helped significantly by improved leverage on fixed costs. How much additional runway do you have on that, say, specifically improving utilization on the Mexican plant? Thank you.

Thanks, Christian. I'll take the first one and then you'll take the second one, Henrik. Obviously, as you're well aware, we'll guide on the next fiscal year in our November earnings announcement. But if I talk a little bit to address your question, which I think we can, I think what's important to note is that when we bring out new products, it does take a while for that launch phase. And I think you've seen before where we have tried to illustrate the launch phase where we start with the approval of this that we call our controlled market release. So this is where we test the product. And then as soon as we feel comfortable with a real launch, that's then when we go out. And then typically, that's the time where a broader set of hospitals use the product and then it takes a while before they really start to buy in higher volumes because that will often involve the administration and the value committee or whatever it's called in the hospital. So that's also why when we then look to next year to answer your question, you are right that it's very much the existing products that we have that will drive the largest share of the growth next year. I do want to note, though, that the different dynamics with ureteroscope compared to all the other scopes that we have launched, you could say, is that this is the first time that we are launching into a segment where there is already some level of penetration of single use. So we have the leading company here being Boston Scientific, and then we also have Chinese player fusion in that market so that is of course some different dynamics because we come in and we offer a solution based on our system so the same platform with the sister scope so that's of course where the dynamic can turn out a little bit different and some of the same you will see when we get to the video laryngoscope which will be coming later that that will also be tapping into a market that has already been created but it will still be be the majority of the growth coming from the already established products.

Thank you, and going to the next question, Christian, on gross margin expansion, I will not be very specific on exactly what is the sub-component of, you could say, better manufacturing utilization of our key factories, but say instead that, you could say, we see still potential for more for several years, and that means both two, three, and four years where we can actually, you could say, expand gross margin on the basis of a better manufacturing site utilization. That is, of course, mainly driven by our Mexican factory, which is still underutilized, and as we mentioned before, the positive spin on that, of course, is that capacity constraints is not a concern of ours right now, but it does mean it's actually still also in Q3 and will still for next year hampering on a net-net basis our gross margin versus where we should be. I think the other thing I would say is we are also looking at and actually have in this financial year successfully increased our output from the existing factories, also in Penang, where we've been present for 30 years. So I think it's also important for us to say part of the drive and continuous improvement on gross margin is also improving the output on the existing factories, and with that also on some of our legacy products, actually improving the contribution margin for products that we've had in the market for decades.

Great. Thank you very much.

Thank you. The next question is from the line of Martin Renaud from Nordea. Please go ahead.

Thank you, Henrik, Britt. Congrats with the strong quarter here. I think that you deserve to hear that despite the share price reaction today. I have just two questions as a starting point. The first question would be just to understand a bit of the seasonality here, especially on the pulmonology side. How should we think about the growth trajectory going into Q4? I mean, you have a quite a broad guidance here where you are guiding from basically mid single digit into the lower double digit area for Q4, despite only having one month left. So can you maybe elaborate a little bit on why you do so? And is there also some reflection on what you have alluded to earlier that you are trying to sort of smoothen out revenue a bit so you don't get this very back and loaded year. So we should expect a bit of a slowdown in Q4 reflecting that you have pushed sales a little bit forward here or at least attempted to do so. That would be the first question. The second question is on the margins and the OPEX commentary. I think my understanding of where Ambo is today is that you probably have the most amount of products in pipeline in all of history, or if you can say pipeline, maybe early stage launching. At the same time, you have a tougher comparison base in your very strong product portfolio that you need to keep up with. So is it really the right time to say that you will use your OPEC scalability to improve the margins in the next year, as you say on the slide 23? Or is it perhaps time for you to scale up the distribution and sales force a bit more to sort of make sure that AMBU is also ready for growth in more than just one or two years ahead from here on? That would be the two questions. Thank you.

Yeah, good. Thank you, Martin. I very much like your last comment here. I'll let Henrik comment on that in a second. But maybe from me to your first question around Q4 seasonality, what's to expect? I think it's fair to say, I mean, although we are at the last day of August, at least the last working day, we still don't have the full overview of August yet, just to put that as the disclaimer. Then in terms of what we talk about on seasonality, I think the area where we really see strong impact on seasonality was what I mentioned on the pulmonology side due to the positive impact on the flu level. So we see less seasonality in this quarter fall. We do see some, specifically in Europe, some different... pockets of our business that are impacted by vacation periods and so on. But that's of course something that doesn't come as a surprise. So we can plan for that. In terms of then to your question around what to expect in this quarter, we see momentum in the business that when we look at it, we see that continuing. So we still feel very confident on the growth as we look ahead. Where we still have some uncertainty was what I alluded to on the anesthesia and patient monitoring, where we still, because of these price increases, have not seen the full effect yet. I mean, we do see some customers coming back and then deciding to go with another vendor. some time after we have launched a price increase. So that's where we still have some uncertainty. And then still, I think we've become much better at forecasting on some of the fast-growing products in urology and ENT, but we still see a little bit of uncertainty in these because of the fast growth as to the timing of the big orders. And frankly, we do not want to put out a guidance that makes us tempted to make any decision based on the guidance. Because we do want to sell everything we can that the customers will also use. So that's why we believe that the guidance that we have set out is the one that we will deliver within. We had a strong finish to the year last year. And that's, of course, the comparison when we look at the specific growth rate. Absolutely.

And if I, I've used that to on the first question margin and then the bridge to the second on the Opix commenter, I think therefore smoothing or not smoothing. I mean, if you set that aside, I think our main focus is to drive continuous growth and therefore we are not deliberately moving around orders. Obviously, we are driving sales. And for any salesperson in Ambu, it's very clear what they need to do. At the same time, it's very important for us to reiterate what we've also said in the last two quarters. We are not pulling in orders. We are not encouraging customers to stock up unnecessarily, because we don't think that's right for long-term growth. And we don't think that's right for the customers, nor us. And that's basically what we're trying to manage, and as Britt says, therefore, we don't want to be guided or forced by a specific target and do things that doesn't make sense for the long-term business. And we still wanna repeat what we've said continuously also. Our focus this year is very much on rebuilding trust and making sure we deliver on our promises, and we feel, therefore, it was the right thing to keep the guidance. I also just want to note, we raised the guidance on the 10th of July, so it's not that long ago that we made quite a significant upgrade. I think on your OPEX commentary and coming back to this point of long-term growth, I also just want to come back to Nils' question and make it clear that we are not short-term compromising the focus on growth in exchange of trying to expand margin faster. The first, second, and third focus is growth. I would say profitable growth. We don't want to lose track on it needs to be profitable, but growth is the main strategic focus. It's still important for us to say though, that with that said, we still believe we can drive margin expansion along the way. I talked about the manufacturing footprint already, but on Opix, that also means that our expectation will be yes, the sales force needs to be increased and we need more feet on the ground, also with the new products coming in. But we still wanna prove that we can do that and actually still expand the margin a bit. We do have a very important point, and coming back to this margin expansion journey, is of course this year represents a very big step up in margin. And therefore when we look forward, that will be more of a balanced and gradual step up towards our long-term target, with the main focus on driving growth, making the right investments for the long-term growth, and then still continuously making sure we drive a better margin. I hope that clarifies.

It does. Thank you so much, both Britt and Henrik. Maybe just one quick follow-up on the sales force and the commercial investments that you have taken. When I look at the cost that you have allocated to the selling and distribution, it's not that big of an increase compared to how much you actually grow the top line and also maybe the commentary in the beginning of the year that now you need to step up this commercial force. So when should we start to pencil in that you are hiring the sales force and reinforcing your base here?

Good question, and I would say there are two sides to the answer. I think first of all, we are actually and have already hired a number of people. Obviously, remember Q3 covers up until end of June, so we're looking a little bit back and you can say, In that quarter, we still had a number of salespeople joining throughout the quarter, so they did not have full impact from the start of the quarter, but throughout the quarter, and we'll also see that into next year. So it's happening right now. It takes time to find the right people and also to get them out and get them started, as we said before. The reason why numbers are, in absolute terms, OPEX doesn't go up more than it does in Q3, and actually also... what you'll see into Q4 and the coming quarters will not go up one-to-one with the additional salespeople is that we are optimizing our distribution footprint. And I know we in the past have talked about some of the one-offs in global trade. We deliberately don't talk about it now because we don't think there are many fluctuations from that, but we are very much working on how do we optimize this the absolute increase of just short of 30 million DKK in selling and distribution cost actually covers for a higher increase in selling costs and a decrease in distribution costs.

Makes a ton of sense. Thank you so much, Henrik, for this.

Thank you. Your next question is from the line of Rickard Andrew Kranz from Handels Banking. Please go ahead.

Hi and thank you for taking my questions. So first one is a bit more high level. So we've seen in the last few years legacy Scope players launching and entering the single use space. Can you maybe give a comment on the traction and what you're seeing in terms of the competitive dynamic with some of the legacy players entering single use and what you're seeing and hearing on the competitive side from that end. I'll start there. Thank you.

Yeah, thank you, and I can comment on that. So it's very true, as you say, that the market is getting... I mean, where we were first and the only ones, the market is clearly across the segments getting more crowded, and we see slightly different dynamics, definitely different players that enter the different segments we are in. If we take the legacy players, you can say, I think for... Five, six, seven years Olympus has talked about entering the space and they have now partnered up with Vathen where they have launched a scope which is of course a bronchoscope which is of course one that we see out there but we do not see a lot of customers where we are losing against them and I don't think we see them out there so much yet you can say. And then still, if we look at bronchoscopy, it's still in the U.S. specifically and someone in the U.S. that remains the one that we see the most out there. In urology, if we take that, we have Boston Scientific. I mean, they came out with a ureteroscope. And they have then also partnered with an Asian player to launch a cystoscope. We haven't seen that at all out in the marketplace. And back to the system benefits, it's on a very different system and thereby two very distinct offerings. So we don't see that a lot. We see a number of, in particular, Chinese players developing sister scopes, but we don't see them a lot out in the market. And then you can say we see slightly fewer players when it comes to ENT and TI, but still some activity. And I think it's only to be expected. And our focus is really to continue to drive what we are good at, to continue to also push our innovation and broaden our offering in the different segments, also the newer segments that we have moved into. And then, I mean, deliver on the quality that we have. And we are not... I mean, we are not losing a lot to competition right now, so we are quite happy and pleased with that. And then I think also if you take a step back and then you can see the big endoscopy market, it's still only 3% of that market that has converted to single use. So there's still 97% white space. And then you can, of course, debate if you look into subsegments, when is what subsegment ready? And that's, I mean, you've seen some of our perspectives on that earlier. But in total, I would say that there's still plenty of white space to grow into. And competition will only help expand the use of single use, which is a good thing for EMBU as well. So I don't know if you have any additional questions, Richard, but otherwise that's how we from the very high level see it.

No, that's helpful. And just a final quick question from my end. On the core business, you mentioned risks of losing contract volumes there. So when and how will you be notified of this? So essentially what I wonder is, When will you have more clarity on the vast majority of the customer base? Is this something that will materialize in the coming quarters where you feel better visibility? Maybe you could just paint a picture of the visibility into the customer base and timing of more clarity.

No, and it's a good question, because as I think I mentioned, there are two different dynamics that we see. There's one dynamic when we go out and bid for a new contract. There we will instantly know, did we win or did we lose? And then there's the gray area, if you will, where they say, I mean, you're still in, but we now have two suppliers. And that's where, in that situation, we will then not know immediately how much will that second supplier that we bring in get so far in these examples we have not seen a lot of I mean a lot of volume being lost but that's again where we are monitoring very closely because that can happen. Then we have the other cases where we have announced a price increase to a customer where I mean they will typically continue to put a couple of orders until someone in the hospital will start to ask whether they should go for another vendor. And then they may either do that for part of the contract or for the full contract. And then, I mean, being close to our customers, that's how we will know about those. And that can take a couple of quarters before this happens. So that's typically the dynamics. We see why it's also a bit difficult to be very specific for us to say, now this is what happens. I think the only thing that we are happy about, and you can say that's so far so good, that we have been able to complete the significant price increases that we had in our plans, and that we have seen much less volume growth that we were indicating to you in this call exactly 12 months ago that we could foresee.

So you will hear us talk about risks on this record still for some quarters to come. And unfortunately, that's the dynamics as we see them play out.

Very clear. Thanks for taking my questions.

Thank you. The next question is from the line of Yiwei Zhao from SEB. Please go ahead.

Hi. Thank you for taking my questions. And I have three questions here, and I do one at a time. Firstly, I just want to ask about your Retroscope. Now it's been a few months since the product approvals. So what kind of feedback have you received from your customers? Are you comfortable with the product quality now? And also, what makes you confident when you confront the competition? And maybe could also comment a bit that you have had some learnings now. Any segments which you consider as sort of easy entry point?

Yeah, I can take that question first. So it's true. I mean, we have been in this controlled market release phase for a number of months. I mean, we have conducted now over 100 cases with patients, which makes us very comfortable about the product. As I was talking about earlier, we did some minor adjustments. And these are very minor technical adjustments that we, based on the feedback, wanted to do before launching. So I think overall, I think we are very close to having a product that I think if we look at our product offering that is very solid and very competitive out there. So I think overall, we are quite comfortable about that. And as I also mentioned, we are in the final stage of that controlled market release. So that means that we do feel comfortable about the offering. Having said that, I think also it's fair to or you should be mindful when you think about our launch and the ramp up that what I talked about earlier, that this launch phase does take time. So we are not when we launch endoscopes and we were probably some years back a little more bullish on that. But it does take some time during this ramp up. And I think that's just important to keep in mind. But a very strong offering we have now, very strong customer feedback, and we're really excited to bring that out much broader in the very near future.

perhaps you also asked this easy entry point, and we will not go in a lot of details on it, but I think back to Britt's page on our systems, obviously the interesting thing is now we can go to customers we already engage with, with a different product, which is a very different way of converting a customer than what we had to first time when we came out with the Sisto product. So the good thing this time is that we have the existing customer catalog, they know us. Obviously the difference is that they also know our competitors. who have products in the market. So that's the difference in dynamics.

Great, very helpful. And my next question is just to follow up on the growth margin. Henry, you mentioned the sales price increase has also been one of the margin drivers. If you can comment a bit on your contribution margin now for the core business, how should we compare it to endoscopies if they are getting They're very close or steer far below.

Fair question, so our legacy business, anesthesia and patient monitoring, obviously have a number of sub-segments, and some of them within some of our sensor business, for example, the contribution margin, which is the direct contribution for a product, less the cost of the product for everybody on the call, are actually not far from the endoscopy solutions, so the difference is not that big. But if you look at anesthesia and patient monitoring combined, it is still below our endoscopy solutions business. I think what's important to say, though, is when you then look at the gross margin perspective of that, then even though on a relative basis the percentage contribution margin is lower from our legacy business, if the indirect production cost, the overhead at the manufacturing side are the same, then your gross margin contribution might actually still be very positive from our legacy business growth. And therefore, I think that's a very important factor to keep in mind when you look at the growth rates for two businesses. Because as such, I would not consider one being good or bad growth. I would actually consider them combined when I look at how we utilize our manufacturing footprint. And that is one of the reasons why at the strong anesthesia and patient monitoring growth for the quarter is actually a positive gross margin contributor also for the business overall.

Great. Very helpful also. And lastly, on the core business, I recall that you mentioned that the price increase will continue into next year in some segments because the contract expires at a different time. Is it fair to assume that when we're looking at the outlook next year, We should also assume that some sort of above normal growth in the core business

I think we don't call it core anymore. We think our core is our endoscopy, or at least that's our key focus, but just putting that aside. So anesthesia and patient monitoring, we believe that the price impact will continue, I mean, to some extent into next year, but then it will also level off in terms of impact.

So we... should still expect above normal growth in East Asia and the PMB, to be clear.

Yes, in particular for the first two quarters, right? Because I think like we commented in Q1 and Q2, the main bigger contracts came into force during the end of Q1, sorry, the middle of Q2 and the start of Q3 this year. So when you look at Q1 and Q2 for next year, the comparable basis in terms of growth, there will be a above market positive contribution from price increases.

Great, very helpful. I'll jump back to you. Thank you.

Thank you.

Thank you. The next question is from the line of David Edlington from J.P. Morgan. Please go ahead.

Hey, guys. Thanks for taking the question. Most of them have not been answered already, but maybe just one on gastro. I just wondered if you had any sort of further color you could share with us on the adoption relative to your expectations, and is there anything that you need to see to be more confident in the midterm opportunity? Thanks.

Thanks, David, and very good question on gastro. So, I mean, overall, we are quite pleased with the uptake that we see on gastro, although you could say it's still at a, I mean, relative to the other segments at a much lower level. I think the approach that we have taken and that we took also, I mean, started two years ago when we cut back significantly on GI was that we also, I mean, took a different focus on GI, moving much more into the OR and the surgical procedures where we saw some need in some very specific procedures. What we also did at that time was that we shifted, because there was so much momentum and we really had created that movement to single use both in urology, ENT, and pulmonology, we actually have had very few commercial resources behind the GI because we took that step back deliberately and said, let's focus on these segments and then let's learn, let's take a niche by niche approach. So I would say if we look at the feedback we have on the product performance and the penetration, we are actually quite excited about the potential for these products. But of course, I mean, even though we have great products, they don't sell themselves. So that's really where we have been balancing our commercial resources. And also, as we are in the situation that we are in now, we will continue to balance across the portfolio. But we should be able to also make some different decisions as we move forward, given our financial position. So I hope that that makes sense.

It does. Am I correct in interpreting that you are willing to put some more investment behind that product as we go forward from here?

But still we are being quite selective. I mean, as you also know, I mean, the number of gastroscope procedures out there, I mean, it's four times roughly the size of the total pulmonology market when it comes to number of procedures. So we are being very niche by niche focused in order to get a meaningful and the relevant uptake.

Great. Thank you.

Thank you. We have the next follow-up question from the line of Niels Granholm-Leth from Carnegie. Please go ahead.

Great. Thank you for taking my follow-up questions here. Coming back to your pulmonary segment, would presume that the OR ICU segment would make up, say, three quarters of sales or so in this particular category. But would you still expect growth going into next year from OR ICU or will growth next year really have to come from the Bronx suite category? And then a second question on new technologies in terms of sterilization and disinfection. I mean, we are seeing quite many new technologies popping up in respect to sterilization and disinfection. Are you seeing any hospitals looking at these new and I guess more environmentally friendly technologies as as an excuse for adopting single-use endoscopes. Thank you.

Thanks, Niels. Two good questions. On the first one, I mean, again, we are not guiding for next year, but you can, I mean, it's fair to expect that the growth going forward, I mean, will be coming from a mix of the Swedes and the OICU. I think that's as specific I can be. So back to also your question earlier, we don't... we don't see the ICU or our market being saturated. We still see growth opportunities and growth coming from those segments. So that's on the first one. On your second one, on new sterilization and disinfection, products or systems coming up. I have not heard of any customer interaction and we may have had a few where this has come up as being something that has been part of the conversation. But it's of course something that we are monitoring closely and that we also see that being different as many customers do buy our products because they like to get a fully sterilized product that has not been used in any patient before. Having said that, I would also say that some of the benefits that we see and that has been one of the reasons why we have had so strong growth, in particular with our Cystoscope and in ENT, has not been so much around this. It has actually been very much around the workflow in the hospital. So the fact that they didn't have to care about whether the product went through sterilization or the washing as it is now, where it's not sterilization. But it has more been that if they were to do many procedures, there would always be a scope available. And they didn't have to have a room available for all the cleaning and so on. So I don't think the new technologies here will solve that completely. And again, we see that workflow being a very strong driver for switching to single use going forward. And then our focus continues to be on making our products even more sustainable. We have different new solutions that we are working on. So today, I mean, we are in many cases more sustainable than the reusable competitors. And we are also looking to continue to push that agenda much further.

Okay, thank you.

thank you ladies and gentlemen that was the last question i would now like to hand turn the conference over to brit neil b jensen for closing comments thank you very much and thank you to everyone for joining the call today i would also like to thank you for very good questions and we'll see you in november when we are ready with our full year results have a good day and a good weekend