瑞银美股医疗行业美国医疗用品和设备行业策略分析201942326页

GlobalResearch23April2019USMedicalSuppliesandDevicesUBSEvidenceLabInside:NeuromodSurveyWave2;MDT,BSX,ABTScoreBest,RaisingNVROPTSurgeonsandCompaniesOptimisticforMoreMarketGrowthWeareleveragingdatafromaUBSEvidenceLabsurveyofspineandneurosurgeons.Thisisthe2ndwaveintheseriesfieldedin1Q19withthe1stfieldedAug-Sept2018.WeestimatetheWWspinalcordstimmarketgrowthslowedtoHSD(+14%ona2yearstack)in4Q18vs.high-teens(mid-highteensstacked)inpriorquarters.Givena9%declineinreportedgrowthfromABTin1Q19,thisgivesussomepauseonneuromarketgrowthin2019;wemodel6%marketgrowthin'19and10%in'20.Surgeonsinthesurveycontinuetoforecaststronggrowth;theaverageimplantgrowthover2yearsexpectedtobe43%(vs.42%inWave1).Majority(85%)ofSurgeonsExpectSCStoCannibalizeSomeSpineSurgeryWeratesharesofMDT,BSX,andABTBuy,notingneuromodisnotthebiggestdriverforthesestocks;feedbackinthesurveywasgenerallypositiveforthesenames.WecontinuetorateNVROSell,butareincreasingourPTto$38basedon2.4xournew2020Esalesof$440MM;ourpriorPTof$35wasbasedon2.2x2020Esalesof$438MM.WhileNVRO'sHF10therapyhaschangedthefaceofneuromodulation,ithasalsospurredcompetitionfromlarge,entrenchedplayers.NVROsharessurgedinlateMarchwiththeappointmentofKeithGrossmanasPresident,CEO,andmemberoftheBoard,replacingRamiElghandour,whosteppeddown.WhilewehaverespectforMr.Grossman'sworkatThoratecandConceptuswehavesomeconcernthatthemarkethasputtoomuchfaithinaquickturnaroundbasedonhisleadership.MDT,ABT,BSXScoredBestonShareGainsSurgeonsdidnotexpecttheirownmixtochangemuchoverthenextyear,butvotedMDTmostoftenasthebiggestsharegainer(+29net),followedbyABT(8)andBSX(6).NVROhadmorevotesforittolosethemostshare(15)thangain(13)foranetscoreof-2.Interestingly,Nuvectra/Saluda/Stimwave/Othernowmakeup10%ofthemixvs.3%inWave1,representingincrementalcompetition.MDT'sIntellisgarneredthemostvotesforitswaveform'sclinicaleffectiveness(29%ofvotes),followedbyBSX(18%),andABT(10%)andNVRO(8%).SurgeonscontinuetoexpectSCStocannibalizespinesurgery,addingtoneuromarketgrowthattheexpenseofthespinemarket.MDTBetterBatteryLife,SlightlyHigherProductIssuesMDTproductswerevotedashavingthebestbatterylife/rechargeburden,followedbyBSXandABT;NVROandsmallerplayersdidnotscorewellonthismetric.Rechargeabledevicescontinuetobepreferredbymoredocsandpatientsthanprimarycellones.11%ofvoterscalledoutMDTashavingproductissues,slightlyhigherthanothermanufacturers,withvotesintheHSD%range.EquitiesAmericasMedicalSuppliesMatthewTaylor,[e-mail][e-mail][phone]YiCheng,[e-mail][phone]USMedicalSuppliesandDevices23April201921)TougherCompsModeratingGrowth4QNeuromodMarketgrowthwas7%WW(14%compadjusted).MarketleaderMDTreported5.7%xfxgrowthinPainTherapies,drivenbyHSDgrowthinSCSfromIntelliswithitsEvolveworkflow.GrowthslowedfrompriorquartersasMDTcompeditsIntellislaunches(US9/17,EU11/17).BSXNeuromodhad19%organicgrowthgivenstrengthofnewproducts(WavewriterSCS,VerciseDBS).AlthoughABT'sNeuromodbusinessonlygrew0.5%in4Q18anddeclined9%in1Q19,itplanstoreaccelerategrowthwithafocusonsalesexecution,newproductslaunchinglaterintheyear/into2020(newablationproduct,newgenerator)andindicationexpansionsfurtherout.ABT's9%declineasthefirstdatapointin1Q19giveussomepausearoundmarketgrowth.NVROgrew10%WWand13%intheUSinthe4Q.HoweverNVROexpects3-6%WWrevenuegrowthin2019,duetohistoricalsalesforceattritionintheUSandunfavorablereimbursementinAustralia.Figure1:WWandUSNeuromodMarketModelSource:UBSResearch,CompanyFilingsWWMarket2012201320142015201620171Q182Q183Q184Q1820181Q19E2Q19E3Q19E4Q19E2019E2020E2021E2022ENVRO$18$24$33$70$229$327$88$96$96$108$387$88$100$103$117$408$440$474$509MDT$1,133$1,192$1,252$1,210$1,143$1,127$332$314$314$314$1,274$340$324$327$335$1,326$1,444$1,545$1,642BSX$367$453$472$501$555$635$169$202$189$219$779$197$235$215$248$895$1,010$1,134$1,267ABT$423$426$437$475$564$808$212$222$212$218$864$193$215$219$231$858$918$982$1,049NVTR$1$9$28$10$12$13$14$48$14$17$18$22$71$101$144$184Total$1,941$2,094$2,194$2,257$2,500$2,925$811$846$823$873$3,352$832$892$882$953$3,559$3,913$4,280$4,651%GrowthNVRO29%39%113%228%43%28%23%16%10%19%0%4%8%9%5%8%8%7%MDT5%5%-3%-6%-1%13%17%19%5%13%2%3%4%7%4%9%7%6%BSX23%4%6%11%14%20%31%23%18%23%17%16%14%13%15%13%12%12%ABT1%3%9%19%43%21%7%2%0%7%-9%-3%3%6%-1%7%7%7%NVTRNANANA616%201%121%109%98%20%72%40%49%44%56%48%42%43%27%Total8%5%3%11%17%19%19%15%7%15%3%5%7%9%6%10%9%9%CompAdj.6%1%7%14%18%17%14%14%16%11%12%11%8%10%8%10%9%%ShareNVRO1%1%1%3%9%11%11%11%12%12%12%11%11%12%12%11%11%11%11%MDT58%57%57%54%46%39%41%37%38%36%38%41%36%37%35%37%37%36%35%BSX19%22%22%22%22%22%21%24%23%25%23%24%26%24%26%25%26%27%27