medical device companies: opportunities in 2010
TRANSCRIPT
Medical Device Companies: Opportunities in 2010
Panel I: Medical Device Investment Market
Rakesh Mehta, JP MorganKirk Nielsen, Versant VenturesRay Zemlin, Goodwin Procter LLP
Medical Device Companies: Opportunities in 2010Medical Device Investment Market
Rakesh J. Mehta
October 2009
Agenda
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Medtech Market Update
Medtech M&A Update 5
M E D T E C H O V E R V I E W
30%
40%
50%
60%
70%
80%
90%
100%
110%
120%
130%
140%
1/3/07 5/10/07 9/14/07 1/19/08 5/25/08 9/29/08 2/3/09 6/10/09 10/16/09
Relative stock price performanceRelative stock price performance
Note: Market data as of 10/16/091 Large cap universe includes ABT, ACL, BAX, BCR, BDX, BSX, COV, JNJ, MDT, SNN, STJ, SYK, ZMH2 Mid cap universe includes AMMD, BEC, BLUD, COO, EW, EYE, GPRO, HAE, HOLX, HSP, IART, IMA, ISRG, KCI, MASI, MNT, NUVA, RMD, SIRO, STE, VAR, XRAY3 Small cap universe includes ABMD, ALGN, ANGO, ARAY, ARTC, CPTS, CYBX, DSCP, ELOS, EVVV, GB, GIVN, HNSN, ICUI, MMSI, OFIX, PODD, SMA, SONO, THOR,
TOMO, VNUS, VOLC, WMGI, ZOLL4 Micro cap universe includes ANPI, ASPM, ATEC, ATRC, ATSI, BMTI, CAMH, CMN, CRDC, CRY, CSCX, CUTR, CYNO, DRAD, DXCM, ELGX, ETRM, EXAC, HDIX, IFLO,
KNSY, LMAT, MAKO, MEND, NMTI, NSPH, NXTM, OMRI, PMII, RTIX, SNCI, SPNC, STXS, TSON, VASC, VTAL, XTNT
Small cap3
(23.7%)
Mid cap2
13.7%
Large cap1
(7.5%)
Micro cap4
(31.9%)
S&P 500(23.2%)
Returns S&P 500 Large cap Mid cap Small cap Micro cap
1-week 1.5% (0.4%) 1.2% (2.0%) 2.6%1-month 1.8% 1.1% 2.8% 0.9% 3.7%3-months 15.6% 6.8% 24.4% 18.0% 21.8%6-months 25.7% 18.6% 35.5% 35.1% 60.4%2009 YTD 20.4% 8.5% 50.2% 17.7% 50.1%LTM 14.9% (4.4%) 27.8% 11.2% 20.2%Since 1/3/07 (23.2%) (7.5%) 13.7% (23.7%) (31.9%)
Medtech sector performance
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1.0x
1.3x
1.5x
1.8x
2.0x
2.3x
2.5x
2.8x
3.0x
3.3x
3.5x
3.8x
4.0x
1/3/06 6/24/06 12/14/06 6/5/07 11/25/07 5/15/08 11/4/08 4/26/09 10/16/09
Medtech forward revenue multiples
Historical FV / NTM revenue multiplesHistorical FV / NTM revenue multiples
Small cap3
1.9x
Large cap Mid cap Small cap
EV / NTM revenue Mean Median Mean Median Mean Median
Current 2.8x 2.6x 2.9x 2.6x 2.1x 1.9x Average 3.4x 3.1x 3.3x 2.8x 2.8x 2.4x % change (31%) (20%) (25%) (19%) (36%) (29%)
Source: FactSet as of 10/16/091 Large cap universe includes ABT, ACL, BAX, BCR, BDX, BSX, COV, JNJ, MDT, SNN, STJ, SYK, ZMH2 Mid cap universe includes AMMD, BEC, BLUD, COO, EW, EYE, GPRO, HAE, HOLX, HSP, IART, IMA, ISRG, KCI, MASI, MNT, NUVA, RMD, SIRO, STE, VAR, XRAY3 Small cap universe includes ABMD, ALGN, ARAY, ARTC, CPTS, CYBX, DSCP, ELOS, EVVV, GB, GIVN, HNSN, ICUI, MMSI, OFIX, PODD, SMA, SONO, THOR, TOMO, VOLC, WMGI, ZOLL
Mid cap2
2.6x
Large cap1
2.6x
Large cap median since 1/3/06 - 3.1x
Mid cap median since 1/3/06 – 2.8x
Small cap median since 1/3/06 – 2.4x
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1.0
2.0
3.0
4.0
5.0
05/01/00 07/06/01 09/11/02 11/17/03 01/22/05 03/30/06 06/05/07 08/10/08 10/16/09
Historical FV / NTM revenue multiples since 5/1/00Historical FV / NTM revenue multiples since 5/1/00
Source: FactSet as of 10/16/09; recession data from National Bureau of Economic Research1 Large cap universe includes: ABT, ACL, BAX, BCR, BDX, BSX, COV, JNJ, MDT, STJ, SYK, ZMH2 Mid cap universe includes: AMMD, BEC, COO, EW, HAE, IART, ISRG, MNT, RMD ,SIRO, BLUD, STE, VAR, XRAY3 Small cap universe includes: ABMD, ALGN, ARTC, CPTS, CYBX, DSCP, GB, ICUI, MMSI, OFIX, SONO, THOR, VITL, WMGI, ZOLL4 Micro cap universe includes: ASPM, ATSI, CAMH, CMN, CRY, ELGX, EXAC, IFLO, KNSY, NMTI, RTIX, SNCI, SPNC, VASC, VTAL
Small cap3
1.9x
Mid cap2
2.6x
Large cap1
2.6x
Micro cap4
1.6x
Large cap mean 3.4x
Mid cap mean 2.7x
Small cap mean 2.3xMicro cap mean
2.0x
Recession:March 2001-Nov.2001 (8-
months)
Valuation Trough: Jan. 2002 - Jul.2003 (18 months)
Valuation Trough: Oct. 2007 - Current (23 months)
Current Multiples
Recession: Dec.2007 –
current (22 months)
Medtech forward revenue multiples: historical macro perspective
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Agenda
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Medtech Market Update
Medtech M&A Update 5
M E D T E C H O V E R V I E W
EV / Revenue
Target Acquirer Date Trans. value LTM FTM Commentary / Rationale
Sept-09
Sept-09
$450
$400
na
na
na
na
The acquisitions of Evalve and Visiogen provide Abbott with next-generation technologies to broaden its existing product portfolio in the cardiovascular and ophthalmic device spaces, respectively
Large commercial infrastructure and global footprint enable Abbott to quickly gain share in emerging patient care markets that utili ze newly-acquired technologies
Jan-09 $2,744
2.4x 2.3x Acquisition moves Abbott into the global ophthalmology marketplace 149% premium to previous day’s close, but only 88% of the 52-week high AMO had been negatively affected by economic downturn and high leverage
Sept-09
May-09
$194
$425
1.9x
4.3x
1.9x
3.8x
Adds BIS brain monitoring technology and $100 million+ in sales to Covidien’s $1,370 million respiratory and monitoring solutions business
Expands presence in vascular market (complements 3/09 Bacchus Vascular acquisition) and fits in with its strategy of becoming a leading partner with vascular surgeons and interventional radiologists while adding $100 million+ of sales and 15%+ top-line growth to Covidien’s $530 million vascular business (growing ~6%)
Jun-09
$150 na na Broadens ev3's neurovascular portfolio for the treatment of cerebral aneurysms Chestnut’s Pipeline Embolization Device (PED) is one of 2 marketed flow-diversion devices;
will immediately contribute to revenue and allow ev3 to capture market share and fuel growth
Feb-09 Blocked
$261 na 22.1x Structured as a 50% cash / 50% stock transaction designed to leverage the strength of Thoratec’s balance sheet, while preserving capital for Heartware’s future programs
Strong research and development engine will significantly bolster Thoratec’s pipeline
Feb-09
Feb-09
$700
$325
14.0x
na
7.4x
na
Acquisitions give Medtronic a strong head start into the transcatheter aortic valve market
Together, the CoreValve and Ventor acquisitions may block other consolidators from entering the market in a meaningful way over the next 5 years
Jan-09
Sep-08
$225
$380
na
11.0x
na
7.9x
Made two acquisitions in the AFib space within 6 months; provides Medtronic with the ability to offer both RF and Cryo balloon-based technologies
Leapfrogged leaders with best-in-class next generation technology
Dec-08
Dec-08
$250
$300
3.1x
na
na
na
Radi added products to bolster vascular closure business and provided a key pipeline growth driver with the pressure measurement guidewire, PressureWire Certus
MediGuide provided innovative navigation system technology platform with applications across the AFib and Cardiology divisions
Dec-08 $1,120 2.9x 3.1x Allowed J&J to strengthen presence in aesthetic and reconstructive medicine at a time when
the overall market for aesthetic procedures, including breast augmentation, was weakening Mentor expected to operate as stand-alone business unit through Ethicon
$ millions$ millions
Source: Company filings, equity research
Consolidators have aggressively been using acquisitions to enhance their growth profile
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Strategic acquirors evaluate a variety of value drivers
Sustainable business model
Current pre-revenue deals
Sales ramp
Novel technology
Profitability
IP protection
Pipeline
Robust clinical trials
Blockbuster markets ($1bn+)
Blockbuster markets ($1bn+)
Sustainable business model
Current pre-revenue deals
Sales ramp
Novel technology
Profitability
IP protection
Pipeline
Robust clinical trials
Typical device markets
($500mm - $1bn)
Typical device markets
($500mm - $1bn)
Buyers are looking for home run opportunities
Buyers are looking for scale businesses or opportunities that fit into their current distribution while quickly adding growth to the top-line and profit to the bottom line
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$450
$400
$150
$325$300
$250 $240
$725
$333
$246
$166
$260
$160$200
$850
$237
$300
$225 $240
$215
Abbot t/ Eval ve Abbot t /V i s i ogen
ev3/ ChestnutM edi cal
M edt r oni c/Ventor
Technol ogies
M edtr oni c /Cor eVal ve
M edt r oni c/Abl at i onFr ont i ers
St . JudeM edi cal /
M edi Gui de
St . JudeMedi cal / Radi
M edi cal
Systems
J&J/ Sur gRx M edi ci s/Li poSonix
Bausch & Lomb/ eyeoni cs
Cytyc/ Adi ana
Kyphon/ Di sc-O-T ech
Kyphon/ St .Fr anci sM edi cal
Technol ogi es
Or thof i x /B l ackstone
M edi cal
T ycoHeal thcare/
Conf l uent
Sur gi cal
Hol ogi c / R2T echnol ogy
Hol ogi c / Sur os C.R. Bar d/V enetec
T er umo/Mi cr oV ent i on
M edt r oni c/T r ansneur oni x
Cytyc/P r ox i ma
T her apeut i cs
Private medtech M&A transactions ($mm)Private medtech M&A transactions ($mm)
Total median: $246
Note: Excludes asset sales, acquisitions by sponsors, transactions with total deal value <$100mm and diagnostics transactions; Figures represent total deal value; indicates upfront portion of total deal value
Source: Company filings and press releases1 Milestone payments undisclosed
$350
2009 2008 2006 2005
Summary of private medtech M&A activity
$75
$700
$155 $150$100
$525
Upfront median: $239
1
1
NA $60NA
2007
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Notes:IPOs include NYSE/Nasdaq medtech IPOs with gross proceeds >$15mm; excludes in-vitro diagnostics, life science tools and contract manufacturing;M&A includes all announced medtech transactions >$50mm; excludes in-vitro diagnostics, life science tools and contract manufacturing
Source: SDC, Dealogic, and J.P. Morgan
14
2 1
57
20
16
10
13
10
10
22
25
21
17
20
10
2830
37
25
29
22
14
0
5
10
15
20
25
30
35
40
45
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009YTD
IPOs M&A
Medtech IPO and M&A activity since 1997Medtech IPO and M&A activity since 1997
Market conditions are expected to continue to drive M&A activity
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An noun ce Offer price pre mium to Date Acq uiror Target 1 da y 1 mo nth 52-wk h ig h
1 0/09 /09 Kimb erle y-C lark
I-Flow 7.6 % 35.4 % 1.6%
0 9/28 /09 Covidien Aspect Med ical
56.5 % 84.6 % 4 9.8%
0 9/09 /09 Syn ero n Ca ndela 51.1 % 130.9 % (6.6 %)
0 7/29 /09 Covidien Power Med ical
2 58.6 % 246.7 % (66.4 %)
0 5/08 /09 Covidien VNUS 36.0 % 40.6 % 2 3.4%
0 2/12 /09 Tho ra tec He artW are 93.6 % 109.7 % 2 3.1%
0 1/12 /09 Ab bott AMO 1 48.6 % 274.1 % (11.6 %)
1 2/01 /08 J&J Men tor 92.0 % 83.4 % (24.1 %)
0 9/25 /08 M edtronic CryoC ath 97.1 % 94.4 % 1.2%
0 9/16 /08 Ge tinge Da tascope 11.7 % 12.5 % 5.3%
0 7/24 /08 Ge neral Ele ct ric
Vital Signs
28.4 % 29.2 % 1.9%
0 4/7/0 8 KC I LifeCell 18.2 % 26.3 % 1.1%
0 1/15 /08 W arb urg Pin cu s
LifeCore BioMe dica l
32.4 % 29.2 % (13.9 %)
1 2/21 /07 Ph ilips Re sp ironics 24.3 % 30.7 % 1.0%
0 7/23 /07 Teleflex Arrow 20.4 % 19.3 % 3.2%
0 7/16 /07 Bla ckston e DJ Ort hope dics
19.4 % 25.1 % 0.3%
0 6/03 /07 Qia gen Dig ene 37.6 % 38.4 % 1 4.9%
0 5/20 /07 Hologic Cytyc 32.8 % 32.7 % 2 6.8%
0 5/16 /07 W arb urg Pin cu s
Bausch & Lom b
5.7 % 13.4 % (3.7 %)
0 5/14 /07 Cardinal Viasys 35.5 % 30.1 % (1.0 %)
0 4/04 /07 I nverness Biosite 9.7 % 52.1 % 9.7%
0 2/12 /07 Cytyc Adeza 54.5 % 60.9 % 0.9%
0 1/05 /07 AM O IntraL ase 11.1 % 14.3 % 7.6%
0 6/05 /06 A merican M edical Syste ms
Lase rscope 44.8 % 44.1 % (28.3 %)
0 4/12 /06 Dana her Sybron 12.6 % 18.5 % 0.4%
1 2/16 /05 J&J Animas 34.6 % 44.1 % 2.0%
1 0/16 /05 St . Jude ANSI 34.3 % 24.7 % 1 6.7%
M ean 48. 5% 60. 9% 1.3 %
M edian 34. 3% 35. 4% 1.2 %
US healthcare control premiums1US healthcare control premiums1
Precedent premiums
Precedent premiums – Medtech dealsPrecedent premiums – Medtech deals
Selected transactions2Selected transactions2
Public medtechM&A activity
post-credit crisis
34%
41%
26%
43%
25% 27
%
34%
48%
24%
28% 29
%
36%
34%
30% 32
%
2005 2006 2007 2008 1H09
One-day One-week One-m onth
Source: J.P. Morgan; Dealogic Enterprise static data as of June 30, 2009Premiums deal list source: Dealogic Enterprise Static as of June 30, 2009Note: US target rank eligible deals greater than $10mm1 Premiums based on one-day, one-week and one-month prior to announcement. Includes public deals where initial
stake is <50% and final stake is >51%2 As of 10/16/09
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This presentation was prepared exclusively for the benefit and internal use of the JPMorgan client to whom it is directly addressed and delivered (including such client’s subsidiaries, the “Company”) in order to assist the Company in evaluating, on a preliminary basis, the feasibility of a possible transaction or transactions and does not carry any right of publication or disclosure, in whole or in part, to any other party. This presentation is for discussion purposes only and is incomplete without reference to, and should be viewed solely in conjunction with, the oral briefing provided by JPMorgan. Neither this presentation nor any of its contents may be disclosed or used for any other purpose without the prior written consent of JPMorgan.
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Medical Device Companies: Opportunities in 2010
Panel II: Regulatory Issues and Developments at the FDA
Lou Mazzarese, Edwards Life SciencesMark Heller, Goodwin Procter LLP
Recent 510(k) & Compliance Trendsby
Mark A. Heller
BIOCOM/Orange County Breakfast Meeting
October 21, 2009Newport Beach, CA
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FDA COMMISSIONS IOM STUDY
• On September 23, 2009, FDA commissioned for $1.3 million IOM “to study the premarket notification program used to review and clear certain medical devices marketed in the United States.”
• The IOM Is a not for profit, non-governmental organization chartered as part of the National Academy of SciencesIts purpose is to provide national advice related to biomedical science, medicine, and health
• Claim 1976 Amendments established the 510(k) process with two goals:
Make safe and effective devices available to consumersPromote innovation in the medical industry
(CONT’D)
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• IOM Committee will answer two principal questions
Does the current 510(k) process optimally protect patients and promote innovation in support of public health?If not, what legislative, regulatory, or administrative changes are recommended to achieve the goals of the 510(k) process?
• Problem with IOM assignment is that the principal substantive question regarding the adequacy of the program is based upon false premises
510(k) was not intended by Congress to be the method to optimally protect patientsIt was not intended by Congress to foster innovationIt was intended to sort devices into groups that would be subject to regulatory controls that would provide the right level of protection to achieve reasonable assurance of device safety and effectiveness and promote innovation by avoiding over regulation
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September 24, 2009 Preliminary Report• Internal procedural errors that undermine the
integrity of decisionmaking• “[P]resence of widespread internal
disagreement and confusion about the legal standard for 510(K) review”
• Questions about “[FDA’s] authority to require clinical data in a 510(k) submission except to compare technology is unclear . . . .”
• No established procedures for Panel reviews of 510(k)s
• Need for an independent internal review
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WHY IS 510(K) CURRENTLY A FOCAL POINT?
• Congressional Perceptions and Pressure• Public Interest Group Perceptions and Pressure• So-called Whistleblowers• The Media• Inconsistency within FDA• Common Criticisms
Can market if you are as good as the worst device on the market -- ?Can market if you are as good as a preamendment device, i.e., a 33+ year old device -- ?Very little transparency into decisionmaking
• Over-utilizationFailure to put in place class II controlsFailure to call for preamendment PMAs for Class III devices
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Premarket Notification/510(k): Creation • Medical Device Amendments of 1976
Premarket RegulationClass I Devices – General ControlsClass II Devices – Performance StandardsClass III Devices - PMA
Preamendments Devices Classification by RulemakingClass II Standards by RulemakingClass III PMAs by Rulemaking
Classification of Post-Amendments Devices Automatic classification/PMASENSENOT AN APPROVAL
Implementation Led to Regulatory Gap No standards Few PMA regulations
510(k) became the only premarket review for class IIs and preamendments class IIIs
(CONT’D)
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Thoughts On 510(k) • 510(k) as a classification tool is effective, efficient and
necessary; significant change in this classification method for “new” devices will likely create large and uncertain resource demands
• Ultimately the real concern with the 510(k) process is its use as a surrogate for PMAs and performance standards/now special controls
• Currently, FDA is addressing the preamendments PMA issue to ensure either the reclassification or the submission of PMAs for preamendments Class IIIs
• Reclassified preamendments Class III devices will have special controls to qualify for Class II regulation
• For higher risk Class IIs, FDA could selectively reopen classification regulations and include special controlsfor each such type of device that requires them to provide
• In sum, effective implementation of FDA’s current authority can address the alleged major deficiencies of the 510(k) process; amendments to the FDCA will not achieve much
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Regulatory Environment• More aggressive compliance effort
Dr. Hamburg’s speech to FDLIFDA must be quick and visible, i.e., publicize enforcement actions483 responses – as of 9/15/09 – 15 working days for response to ensure the timely decision to and issuance of warning lettersLimit Chief Counsel’s review of Warning letters to significant legal issues to expedite issuance FDA will not delay the issuance of a warning letter to review responses that are submitted more than 15 working days after receipt of a 483Prompter Enforcement – Enforcement action even prior to a WL in appropriate cases; discontinue the issuance of multiple WLs (CONT’D)
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• Device compliance contextAggressive on recallsAggressive on press releasesLittle room for negotiations
“The Perfect Storm”
Product Problems
Consumer Activism
FDA Turmoil
Political Oversight / Pressure
Legislative Initiatives
Product Problems
Vioxx
Defibrillator Lead Fractures
Heparin
Lead Contamination
Peanut Butter; Pistachios; etc
Consumer Activism
Media Coverage
Public Citizen – Sidney Wolfe
National Research Center for Women & Families– Diana Zuckerman, PhD
FDA Turmoil
New Administration
New Commissioner
CDRH Leadership Challenge
FDA’s “Disgruntled 8”
510(k): GAO Report; FDA and IOM Reviews
Political Oversight / PressureWaxman:
– Unseats Dingell as Chairman, Energy and Commerce– Anti 510(k); Anti PMA Pre-emption
Dingell – Stupak:– Calls for total FDA overhaul– “….sr. mgrs. coerced FDA experts to modify reviews…”– “…FDA employees are too close with industry…”
Pallone:– Committed to change 510(k)– Anti Pre-emption
Legislative
New Medical Device Bill: FDA OverhaulImport Safety
– Increased User Fees; Increased Facility Inspections Comparative Efficacy
– Influence on Reimbursement and FDA approval processPre-emption Challenge
Split FDA: Foods from Drugs and Devices
510(k) Attack
510(k) Attack
GAO Report; FDA and IOM Reviews
Likely Targets for reform:– Up-classification for higher risk Class II 510(k) products
to Class III (PMA) status.
– Restrictions to JTF process
– Significantly Increased Clinical Data requirements
Some New Faces
Joshua Sharfstein
Jeanne Ireland
Ann Witt
Peter Lurie
Meghan Scott
Some Past Affiliations
Waxman
Waxman
Waxman
Public Citizen
Amer. Assoc. for Justice– Trial Attorneys
“….The Past is Prologue…”
1962: Thalidomide
– Legislation: Kefauver Harris Amendments
» Drug Lag Legislative Reform
1976: Heart Valves, Tampons, Ventilators
– Legislation: Medical Device Amendments
» Device Lag Legislative Reform
Opportunities
Stay Alert: ……Strategic Awareness / Positioning
Don’t Go It Alone:…… D.C., AdvaMed, Consultants
Utilize Competitive Skills / Advantage
Engage: Become part of the solution.