瑞银美股医疗保健行业美国医疗供应与设备糖尿病调查201943038页

GlobalResearch30April2019USMedicalSuppliesandDevicesUBSEvidenceLabinside:DiabetesSurveyWave2:ABTLibreGaining;TNDMFeedbackImprovingHighMarketGrowthExpectationsContinue;Withthepure-playdiabetesnamessettoreport1Qearnings(TNDM4/30ATC,DXCM5/1ATC,PODD5/2ATC,SENS5/9ATC),wearepublishingtakeawaysbasedonanalysisofdatafromWave2oftheUBSEvidenceLabDiabetesPhysicianSurvey(n=152),fielded1Q19(Wave1fielded3Q18).WeratethesharesofABTBuyandnoteimprovingtrendsforitsLibreproductintermsofexpectedgrowthandsharegains;Libreiswinningoneaseofuseandcostwithmorepatientsaskingforitthanotherdevices.WerateMDTBuy,andDiabetes(8%ofrevs.)mattersforgrowth;datainthesurveywasmixedforMDT,whilehighmarketgrowthcouldliftallboatsandthe670Gproductscoredwell,theGuardiansensordidnot,andexpectationsforsharegainvs.lossweremorebalancedvs.thepriorsurvey.PODD(Buyrated)hadmixedresults,butfeedbackdidimproveWave/WaveandwecontinuetolikethesetupgivenconservativeguidanceandaccessandDASHproductcatalysts.WeratesharesofDXCMNeutral;ahealthymarketandgoodproductratingsforG6arebalancedbycompetitiveandpricing/reimbursementrisksdrivenbyABT;weareloweringourPTto$140basedon8xour2020Esalesof$1.5Btoreflecttheserisks.TNDM,alsoNeutralrated,sawthebiggestimprovementinitssharegainexpectationsandproductratingsWave/Wave,reflectingitscombinationwithDXCM(t:slimX2).AhighvaluationandtoughcompskeepusfrombeingmorepositivetherebutweareraisingourPTto$66basedon11xour2020Esalesof$349M.SENS(Sellrated)continuestostruggleinthesurvey.MarketOutlookHealthy;PatientsAskingforLibreOverall,theoutlookformarketgrowthappearshealthywithphysiciansexpectingdiabetespatientsundertheircaretogrowata10%CAGR(vs.13%inWave1,published11/18).CGMpenetrationisexpectedtoincreaseaswell,implyingannualgrowthof~36%forthecategoryvs.32%inWave1.AskingspecificallyaboutLibre,theexpectedgrowthimpliedis29%,upfrom23%.PhysiciansestimatedLibreisusedin20%ofT1patientstoday,growingto24%2yearsfromnow,butwithgreatergrowthintheIIT2(to30%from21%)andT2(to24%from18%)populations.ABT'sLibretoGainShare;DXCM/MDTMixed;PerceivedPriceRiskABT'sLibrehadthehighestnumberofvotesfromphysiciansastheglucosemonitoringdeviceexpectedtogainthemostsharewith58vs.44forMDT,and41forDXCMtotal(25+16forTNDM/DXCM)with9forSENS.Includingvotesforshareloss,thenetscorewasagainmostpositiveforABT(+48)followedbyMDT(+8),DXCM(-9),andSENS(-47).ABTandDXCMscoresimprovedWave/WavewithDXCM'sdrivenbyimprovementinviewst:slimX2(TNDM).MDT'sscoredeclinedWave/Wave,consistentwithourchannelchecksthat670Ghassomeissueswithsensoraccuracy.About53%ofdoctorsexpectthelowcostofABT'sLibretoleadtopricereductionsinCGMdeviceswith30%expectingreimbursementcuts(relativelyunchangedfromWave1).Atthesametime,overallcoverage/accessappearstobetrendingpositively,reflectiveofcoveragewinsformultipleCGMandpumpmakersoverthepast2years.PumpGrowthExpectedtobeSolid;MDTShareGainer;TNDMImprovedImpliedpumpmarketgrowthiswellabovecompanyestimatesandphysicianscontinuetohavethemostenthusiasmforclosedloopsystemsrelativetoanyotherdiabetesinnovations.MDTisstillexpectedtogainshareand670GfeedbackwasgooddespitesomeissueswithGuardian.TNDMfeedbackimprovednotableWave/Wave;PODD'sdidaswellbutwasstillmixed.EquitiesAmericasMedicalSuppliesMatthewTaylor,[e-mail][e-mail][phone]YiCheng,[e-mail][phone]USMedicalSuppliesandDevices30April20192DiabetesMarketGrowthUBSEvidenceLabconducteda15-minuteonlinesurveyof152PCPsandEndocrinologistsinJanuary,2019.Toqualifyforparticipation,thephysiciansmustseeatleast150diabetespatientspermonthandbefamiliarwithatleast2CGMand2insulinpumpbrands.ThisreportleveragesthefollowingUBSEvidenceLabassets:USDiabetesCGM&InfusionPumpSurvey.PatientGrowthStillExpectedataDDCAGRTherespondentstreatanaverageof924diabetespatientsannuallytodayandexpecttheaveragetoincreaseto1,125overthenexttwoyears,representingatwo-yearCAGRof10%.ThiscomparestoanexpectedCAGRof13%inWave1.Figure1:Wave2respondentsexpecta10%annualincreaseindiabetespatientsvs.13%inWave1Source:UBSResearch,UBSEvidenceLabGrowthRelativelyEqualAcrossT1,IIT2,T2PatientsLookingatthesubcategories,thelargestexpectedpatientvolumeincreaseisinInsulinIntensiveType2butwassimilartoT1andT2.IntheIIT2populationphysicianrespondentsseeanaverageof258patientstodayandexpectthistogrow11.5%peryearoverthenexttwoyears.InsulinIntensiveType2currentlyrepresents28%ofthediabetespatientvolumetodayandisexpectedtomakeup29%ofpatientvolumetwoyearsfromnow.Atthesametime,Type1andNon-InsulinIntensiveType2patientsareexpectedtoincreaseby10.8%and9.5%peryearrespectively.WhileType1isexpectedtobeaboutthesamepercentageofthemix(23%)twoyear