During its Q218 results presentation, Bonesupport provided an update on its US commercial platform. It is working to secure distributor contracts so that sales can commence as soon as Zimmer’s exclusivity period ends on 20 October 2018. In Europe, (where all three products are marketed) trauma surgeons are showing strong interest in CERAMENT G and V. Positive outcomes from the CERTiFy (CERAMENT BVF) and FORTIFY (CERAMENT with antibiotics) studies should drive adoption in this large market. In the meantime, Bonesupport is increasing sales efforts in Europe. Our valuation is SEK1.16bn or SEK22.8/share (vs SEK22.2/share).
Written by
BONESUPPORT |
Taking control of the US market |
Q218 financial results |
Pharma & biotech |
3 August 2018 |
Share price performance
Business description
Next events
Analysts
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During its Q218 results presentation, Bonesupport provided an update on its US commercial platform. It is working to secure distributor contracts so that sales can commence as soon as Zimmer’s exclusivity period ends on 20 October 2018. In Europe, (where all three products are marketed) trauma surgeons are showing strong interest in CERAMENT G and V. Positive outcomes from the CERTiFy (CERAMENT BVF) and FORTIFY (CERAMENT with antibiotics) studies should drive adoption in this large market. In the meantime, Bonesupport is increasing sales efforts in Europe. Our valuation is SEK1.16bn or SEK22.8/share (vs SEK22.2/share).
Year end |
Revenue (SEKm) |
PBT* |
EPS* |
DPS |
P/E |
Yield |
12/16 |
104.6 |
(108.4) |
(4.22) |
0.0 |
N/A |
N/A |
12/17 |
129.3 |
(126.7) |
(3.21) |
0.0 |
N/A |
N/A |
12/18e |
113.8 |
(164.0) |
(3.26) |
0.0 |
N/A |
N/A |
12/19e |
210.9 |
(128.6) |
(2.54) |
0.0 |
N/A |
N/A |
Note: *PBT and EPS are normalised, excluding amortisation of acquired intangibles and exceptional items.
Taking US marketing into its own hands
Following the termination of the US distribution agreement with Zimmer Biomet in May 2018, management is building its own distributor network in the US and is confident that at least 18 distributors will be ready to start selling CERAMENT BVF end-October 2018. No revenue guidance has been provided yet, but we believe that there could be a certain level of retention of existing customers as surgeons who work with CERAMENT tend to be loyal to the product, according to the company. Bonesupport plans to support its distributor network by providing training through its own US S&M team, which should be expanded from 14 to 23 this year. The commercial team in Europe will also be boosted by 13 new hires this year.
Financials: Sales down due to Zimmer destocking
Q218 revenues were SEK28.2m versus to SEK37.1m in Q217. The decrease came from reduction in US sales (40.9% y-o-y), due to the termination of the Zimmer distribution agreement causing cancellation of June orders, which will last into Q318, as Zimmer is destocking now. As previously, we expect only marginal sales from the US distributor during Q318, if any. Sales in Europe grew 18%, but the company mentioned that this was still hindered by sales rep vacancies, suggesting better growth ahead. Gross margin in Q218 was 87.4%, similar to 87.2% in Q217. Total operating expenses in H118 were SEK59.9m compared to SEK50.2m in H117. This was due to a ramp up in S&M with new hires and distribution. The Q218 results leave us comfortable with our estimates; we therefore make no changes. We estimate net cash of SEK368m will be sufficient to reach profitability by 2021.
Valuation: SEK1.16bn or SEK22.8/share
We value Bonesupport at SEK1.16bn or SEK22.8/sh versus SEK1.13bn or SEK22.2/sh previously as we roll our model forward. Key near-term catalysts include the CERTiFy study results in H218, and the Q418 financial results, which will detail the first quarter of US sales through Bonesupport’s own commercial platform as well as sales dynamics in Europe.
Increased trial activity in Europe
CERTiFy and FORTIFY studies are progressing as planned. According to management, a positive CERTiFy study outcome in tibial plateau fractures treated with CERAMENT BVF would add convincing data to support the product’s wider use and even taking market share from autograft. FORTIFY is Bonesupport’s most important study, as it will gather controlled clinical data with CERAMENT G (entamycin) and V (ancomycin). This will support an FDA PMA filing for CERAMENT G, which will allow Bonesupport to market the product in the US, but will also be used to increase sales of these products in Europe, where they are already being sold and perform well. The status of these trials is shown in Exhibit 1.
Exhibit 1: Overview of ongoing clinical studies
Product |
Study title |
Location |
Number of patients |
Trial readout (estimated) |
Indication |
Status |
CERAMENT BVF |
CERTiFy |
US |
136 |
Top-line data H218 |
Compares CERAMENT BVF with autograft for tibial plateau fractures (trauma). |
Patient follow-up ongoing. Last patient was enrolled in December 2017. |
CERAMENT G |
FORTIFY |
US |
230 |
2020 |
Part of the surgical repair of severe tibia fractures. |
Patient recruitment ongoing. Launch of CERAMENT G in US estimated 2020 (upon positive trial result). |
Chronic Osteomyelitis study |
France |
200 |
TBC |
Evaluate the effect of CERAMENT G in patients suffering from chronic bone infections. |
Preparation phase |
|
CERAMENT G & V |
Diabetic Foot study |
Italy |
35 |
2018 TBC |
Evaluating the effect of CERAMENT G and V for patients with diabetic foot. |
Enrolment and treatment completed |
Revision Arthroplasty Study |
Germany |
40 |
TBC |
Evaluating the effect of CERAMENT G and V for patients receiving revision arthroplasty in the hip or knee. |
Planning phase |
Source: Bonesupport
Management provided expectations of a significant uplift in sales after 2019, possibly 40%+. We take this as an indication only, but it certainly adds to our expectations for a quick rebound of the top line. The CERTiFy results are expected in H218, positive results from which are expected to drive adoption of CERAMENT BVF in the US and European markets. Additional growth may come from new product launches (first agreement with Collagen Matrix signed). Sales growth in Europe will come from increased sales of CERAMENT BVF, G and V, helped by increased number of sales reps and targeting the large trauma market.
Valuation
Using DCF-based model we value Bonesupport at SEK1.16bn or SEK22.8/share versus SEK1.13bn or SEK22.2/share previously, due to rolling our model forward, which was partially offset by a lower cash position. We keep our estimates and valuation assumptions unchanged, as described in our initiation report in June 2018. Key near-term catalysts are:
■
the CERTiFy study results in H218;
■
the Q418 financial results, which will detail the first quarter of US sales through Bonesupport’s own commercial platform as well as sales performance in Europe; and
■
any new investigator-initiated studies and an update on the progress of building the independent distributor network in the US.
Bonesupport will conduct its capital markets days in Stockholm on 19 September and in London on 20 September.
Exhibit 2: Assumptions, projected cash flow and DCF valuation
(SEKm) |
2018e |
2019e |
2020e |
2021e |
2022e |
2023e |
2024e |
2025e |
2026e |
2027e |
||
EBIT* (risk-adjusted) |
(167.5) |
(131.5) |
(67.7) |
78.0 |
149.2 |
193.8 |
215.2 |
211.4 |
204.3 |
195.2 |
||
Tax** |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
||
D&A |
1.6 |
1.8 |
2.0 |
2.2 |
2.4 |
2.6 |
2.8 |
3.0 |
3.2 |
3.4 |
||
Change in WC |
0.9 |
(35.7) |
(45.1) |
(57.6) |
(36.1) |
(26.3) |
(18.4) |
(4.4) |
(2.9) |
(1.9) |
||
Capex |
(0.3) |
(0.3) |
(0.3) |
(0.3) |
(0.3) |
(0.3) |
(0.3) |
(0.3) |
(0.3) |
(0.3) |
||
Operating FCF |
(165.3) |
(165.7) |
(111.0) |
22.3 |
115.2 |
169.8 |
199.2 |
209.6 |
204.3 |
196.4 |
||
NPV (SEKm) |
||||||||||||
Free cash flows FY18–27e |
183.9 |
|||||||||||
Terminal value (2.0% growth rate assumed) |
605.8 |
|||||||||||
Total NPV |
789.7 |
|||||||||||
Net cash (end-Q118) |
368.0 |
|||||||||||
Valuation |
1,158 |
|||||||||||
Valuation/share (SEK) |
22.8 |
|||||||||||
Discount rate |
10.0% |
|||||||||||
Tax rate (long-term) |
22% |
|||||||||||
Source: Edison Investment Research. *EBIT here includes risk-adjusted cash flows associated with CERAMENT G launch in the US in 2021. **Tax loss carry forwards (SEK604m at end-2017) offset taxes during our forecast period.
Exhibit 3: Financial summary
SEK000s |
2014 |
2015 |
2016 |
2017 |
2018e |
2019e |
||
December |
IFRS |
IFRS |
IFRS |
IFRS |
IFRS |
IFRS |
||
PROFIT & LOSS |
||||||||
Revenue |
|
|
40,961 |
61,755 |
104,599 |
129,301 |
113,813 |
210,917 |
Cost of Sales |
(6,374) |
(9,507) |
(16,312) |
(16,871) |
(17,072) |
(31,638) |
||
Gross Profit |
34,587 |
52,248 |
88,287 |
112,430 |
96,741 |
179,280 |
||
Research and development |
(17,020) |
(18,999) |
(38,233) |
(60,636) |
(69,731) |
(69,731) |
||
EBITDA |
|
|
(38,055) |
(52,614) |
(87,399) |
(97,898) |
(165,866) |
(129,663) |
Operating Profit (before amort. and except.) |
(38,267) |
(52,817) |
(38,267) |
(52,817) |
(87,601) |
(98,146) |
||
Intangible Amortisation |
(1,036) |
(1,089) |
(1,144) |
(1,139) |
(1,328) |
(1,506) |
||
Exceptionals |
0 |
0 |
0 |
0 |
0 |
0 |
||
Other |
(1) |
0 |
0 |
0 |
0 |
0 |
||
Operating Profit |
(39,304) |
(53,906) |
(88,745) |
(99,285) |
(167,495) |
(131,482) |
||
Net Interest |
(11,770) |
(5,509) |
(20,821) |
(28,600) |
2,156 |
1,405 |
||
Profit Before Tax (norm) |
|
|
(50,037) |
(58,326) |
(108,422) |
(126,746) |
(164,010) |
(128,570) |
Profit Before Tax (reported) |
|
|
(51,074) |
(59,415) |
(109,566) |
(127,885) |
(165,339) |
(130,076) |
Tax |
8 |
(140) |
(625) |
(1,007) |
(1,007) |
(1,007) |
||
Profit After Tax (norm) |
(50,030) |
(58,466) |
(109,047) |
(127,753) |
(165,017) |
(129,577) |
||
Profit After Tax (reported) |
(51,066) |
(59,555) |
(110,191) |
(128,892) |
(166,346) |
(131,083) |
||
Average Number of Shares Outstanding (m) |
2.5 |
2.5 |
23.5 |
25.8 |
39.8 |
50.5 |
||
EPS - normalised (SEK) |
|
|
(20.32) |
(2.49) |
(4.22) |
(3.21) |
(3.26) |
(2.54) |
EPS - normalised and fully diluted (SEK) |
|
(20.32) |
(20.32) |
(2.49) |
(4.22) |
(3.21) |
(3.26) |
|
EPS - (reported) (SEK) |
|
|
(20.74) |
(2.53) |
(4.26) |
(3.24) |
(3.29) |
(2.57) |
Dividend per share (SEK) |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
||
Gross Margin (%) |
84.4 |
84.6 |
84.4 |
87.0 |
85.0 |
85.0 |
||
EBITDA Margin (%) |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
||
Operating Margin (before GW and except.) (%) |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
||
BALANCE SHEET |
||||||||
Fixed Assets |
|
|
5,756 |
5,892 |
5,091 |
8,591 |
8,986 |
9,581 |
Intangible Assets |
5,091 |
4,934 |
4,469 |
5,244 |
6,171 |
6,750 |
||
Tangible Assets |
382 |
588 |
442 |
3,099 |
2,567 |
2,583 |
||
Investments |
283 |
370 |
180 |
248 |
248 |
248 |
||
Current Assets |
|
|
39,864 |
105,741 |
183,718 |
588,093 |
335,326 |
216,242 |
Stocks |
9,295 |
15,032 |
14,489 |
22,079 |
15,164 |
28,102 |
||
Debtors |
9,005 |
17,600 |
20,242 |
20,678 |
26,702 |
49,485 |
||
Cash |
18,386 |
68,881 |
141,501 |
533,367 |
281,491 |
126,686 |
||
Other |
3,178 |
4,228 |
7,486 |
11,969 |
11,969 |
11,969 |
||
Current Liabilities |
|
|
(26,544) |
(91,305) |
(69,742) |
(145,725) |
(47,105) |
(47,105) |
Creditors |
(22,341) |
(28,418) |
(44,639) |
(47,105) |
(47,105) |
(47,105) |
||
Short term borrowings |
(4,203) |
(62,887) |
(25,103) |
(98,620) |
0 |
0 |
||
Long Term Liabilities |
|
|
(62,593) |
0 |
(84,763) |
(173) |
(173) |
(173) |
Long term borrowings |
(62,593) |
0 |
(84,599) |
0 |
0 |
0 |
||
Other long term liabilities |
0 |
0 |
(164) |
(173) |
(173) |
(173) |
||
Net Assets |
|
|
(43,517) |
20,328 |
34,304 |
450,786 |
297,034 |
178,545 |
CASH FLOW |
||||||||
Operating Cash Flow |
|
|
(41,187) |
(58,941) |
(70,184) |
(95,060) |
(152,382) |
(152,789) |
Net Interest |
(4,674) |
(6,302) |
(11,640) |
(11,737) |
2,156 |
1,405 |
||
Tax |
(62) |
(49) |
(109) |
(737) |
(1,007) |
(1,007) |
||
Capex |
(424) |
(497) |
(67) |
(2,344) |
(329) |
(329) |
||
Acquisitions/disposals |
0 |
0 |
0 |
0 |
0 |
0 |
||
Financing |
0 |
119,606 |
103,714 |
504,833 |
0 |
0 |
||
Other |
(10,433) |
587 |
4,091 |
7,993 |
(1,695) |
(2,085) |
||
Dividends |
0 |
0 |
0 |
0 |
0 |
0 |
||
Net Cash Flow |
(56,780) |
54,404 |
25,805 |
402,948 |
(153,256) |
(154,804) |
||
Opening net debt/(cash) |
|
|
(8,370) |
48,410 |
(5,994) |
(31,799) |
(434,747) |
(281,491) |
HP finance leases initiated |
0 |
0 |
0 |
0 |
0 |
0 |
||
Other |
0 |
0 |
0 |
0 |
0 |
0 |
||
Closing net debt/(cash) |
|
|
48,410 |
(5,994) |
(31,799) |
(434,747) |
(281,491) |
(126,686) |
Source: Bonesupport accounts, Edison Investment Research
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The FDA’s sign off on Celyad’s first clinical trial design for its allogeneic NRK CAR T-cell therapy (CYAD-101) is an important milestone. The study, possibly staring in Q4 2018, mirrors the current colorectal SHRINK trial a combination of autologous CYAD-01 therapy with FOLFOX chemotherapy. This gives Celyad the lead in a mass-market solid cancer where allogeneic therapy is likely to be essential. The indicative value has been increased to €1,090m (€89 per share) from €1,040m (€84 per share) pending further data.