瑞信美股医疗保健行业牙医调查显示牙科需求仍然不足201912830页

DISCLOSUREAPPENDIXATTHEBACKOFTHISREPORTCONTAINSIMPORTANTDISCLOSURES,ANALYSTCERTIFICATIONS,LEGALENTITYDISCLOSUREANDTHESTATUSOFNON-USANALYSTS.USDisclosure:CreditSuissedoesandseekstodobusinesswithcompaniescoveredinitsresearchreports.Asaresult,investorsshouldbeawarethattheFirmmayhaveaconflictofinterestthatcouldaffecttheobjectivityofthisreport.Investorsshouldconsiderthisreportasonlyasinglefactorinmakingtheirinvestmentdecision.28January2019Americas/UnitedStatesEquityResearchHealthcareTechnology&DistributionD[e-mail],[e-mail]@[e-mail]s:Dentaldemandstilllacksbite■4QDentalpracticevolume,revenuegrowthonparwith3Qtrend:Accordingtoourproprietarysurveyof75USdentalpractitioners,47%ofpracticesexperiencedpositiverevenuegrowthin4Q,rising0.5%(weightedavg.),consistentwithourinitial3Qsurvey.Newpatienttraffic(+1.0%)wasthemostmeaningfuldriverofpracticerevenues,followedbypricing(+0.9%),bridges/implants(+0.8%),andpreventativecare(+0.6%).Anencouragingdynamic,respondentswereincrementallymoreoptimisticonNTMtrendswith71%expectingimprovingpracticevolume(vs.65%in3Q),whichbodeswellforallourdentalnames.Asacaveat,thisisourseconddentalsurvey,andweexpectmoremeaningfultakeawaystoourdentalcoveragewithgreaterhistoricalcontext.■Equipment–Digitaldentistrydriversw/caveats:WhilerespondentsweremoreoptimisticonequipmentpurchasingovertheNTM,withparticularfocusonintraoralscannersandCAD/CAM,wenotethatpractitionersremainwaryoflargercashoutlaysinananemicdemandenvironment,withdentistslikelylessinclinedtomakeequipmentpurchasesinlightofgrowingmacroconcerns,aswellasnotedreimbursementpressures.Thatsaid,wehighlightpositivecommentaryonDentsplySirona’s(XRAY,Outperform)CERECoffering,notingitsconvenienceandeaseofuse,despitecontinuinglowoverallpenetration.WhileweviewXRAYasaturnaroundstoryLTandareoptimisticoninnovationopportunitiesinanIDSyear,weacknowledgeexecutionriskassociatedwithsalesforce,R&D,andcoststructureinitiatives.Intermsofpromotionalactivity,severalrespondentshighlightedmoreaggressivediscountingforALGN'siTero,whileXRAYequipmentpricingwasnotedasrelativelyunchanged.■Supplychain,DirectDist.,Amazonupdate:HenrySchein(HSIC,Neutral)andPattersonCompanies(PDCO,Outperform)werenamedasprimarydistributorsby40%and17%ofrespondents,respectively.Themajority(80%)issatisfiedwithitsprimarydistributor,and86%donotworkwithGPOs,anunsurprisingdynamic(differsfromVet).Whileonly6%ofstandardmedicalconsumables(e.g.gloves,cottonballs)arepurchasedthroughAmazontoday,respondentsexpectpurchasesthroughAmazoncouldgrowto14%in3-5years.Intermsofdirectdistribution,respondentscurrentlypurchase22%ofconsumablesdirectfrommanufacturers,with12%expectingtopurchasemoredirectlyoverNTM.28January2019DentalUpdate2■Clearalignersremaininfocus:Themajority(68%)ofclearalignerusersexpectdemandtoriseovertheNTM,withvolumelikelysupportedbyarisingbaseoftrainedpractitioners.AlignTechnology'sInvisalign(ALGN,Outperform)remainsthemarketleader,with60%ofourentirecohort(88%ofclearalignerusers)offeringInvisalign.Whileconcernsovercompetition,DTC,andASPshaveweighedonALGN’ssharesoflate,weviewthereisroomforseveralplayersinahighlyunderpenetratedclearalignermarket,andweviewALGNiswellaheadintermsofinnovation,withseveralrespondentshighlightingitsrecentlylaunchedmandibularadvancementoffering,anunderappreciateddynamic,inourview.28January2019DentalUpdate3DentalSurveyTakeawaysWecommissionedasurveyof75practicingdentistsdispersedacross21statesintheU.S.,withthehighestnumberofresponsesinNewYork(13),California(9),Florida(9),Massachusetts(6),andIllinois(5).Ourrespondentsrangeacrossanumberofspecialtiesincludinggeneraldentist(48),orthodontist(15),periodontist(7),pedodontist(3),andoralandmaxillofacialsurgeon(2),withanaveragetenureof23years.Abouthalfofourrespondentsworkassolepractitioners(38),whilemostotherparticipantsworkwithmultipleotherdentistsatasinglepracticeownedbydentists(27).Ofnote,3respondentsworkforaDSOordentalmanagementorganizationaffiliatedgrouppractice.Onaverage,ourrespondentssee123patientsonaweeklybasis.4QSnapshot:Relevantcompanysurveyhighlights■DentsplySirona(XRAY,Outperform):Overall,thesurveyresultsaremixedforDentsplySirona,whereweareforecasting4Q18revenuestofall3.1%,drivenbya2.7%riseinconsumablesand-11.4%growthinEquipmenttoreflectongoingdistributor-levelinventoryshifts.WeremainoptimisticonXRAY’ssalesforceexecutionpush,where33%ofrespondentscurrentlypurchaseconsumablesdirectlyfromthecompany,with12%expectingtopurchasemoredirectlyfromthemanufactureroverthenexttwelvemonths.WealsoviewXRAY’srecentlyrevisedstrategy,whereithasforegoneitslongstandingapproachtopromoteamorecomprehensivechairsideCAD/CAMsystems(scanner+mill),shiftingfocustowarditsstandalonedigitalimpressionoffering(withalsoadedicatedlabstrategy),offersincrementalopportunitytocaptureshare,particularlyasonly9%ofourcohortofdentistscurrently