瑞银美股医疗行业美国医疗供应与设备行业策略分析201942333页

GlobalResearch23April2019USMedicalSuppliesandDevicesUBSEvidenceLabOrthoSurveyWave4:SYKandZBHtoGainShare;SomeEarlyRosaInterestWave4SurveyKeyTakeaways:Volumes,Robotics,ShareShiftsWearepublishingtakeawaysfromWave4ofourorthosurvey(196USsurgeons,fielded1Q19).Surgeonscontinuetoexpectvolumetrendstostaythesame(47%)orgetbetter,(47%)vs.just6%thatexpectworse,in-linewithpriorsurveys,pointingtoastablevolumeenvironment.Askingthedoctorsaboutsupplydisruption,therewereonly3mentionsofZBH,asignthatsupplyissueshaveshakenout.WecontinuetoratesharesofSYKNeutralandZBHBuy;thatsaid,weseethesetupsintobothcompanies'resultsaspositive.SYKreportsafterthecloseon4.23,ZBHinthemorningon4.26.Specifically,forSYK,wethinkinvestorsexpectorganicgrowth7%givenguidancefor6.5-7.5%fortheyear,4Qorganicgrowthof8.6%,andbullishcommentsfrommanagementduringthequarter.ZBHexpectationsarelowergivennewproductsarenotyetfullylaunchedandithas1lesssellingdayinthe1Q.Wemodelorganicgrowthadjustedforsellingdaysat+0.2%;thiswouldbe+0.8%adjustingforlostbonecementrevenue.WeexpectSYKtobeatandnoteZBHexpectationsaresufficientlylowthatweviewanin-linequarterasgoodenough.SYKLeadinginExpectedShareGains,FollowedbyZBH;JNJandSNNTrailSYKperformedthebestwithregardtoexpectedkneesharegainsinthesurvey,with30%ofresponsesvotingforSYKtogainthemostshareover12monthsvs.12%votingtolosethemostshare,a+18%spread.ZBHwasnextat+8%(26%for,18%against),followedbySNN+7%(15%for,8%against)andJNJ-6%(15%for,21%against).Thesetrendsweresimilarinhips,whereSYKperformedthebest(+20%net),followedbyZBH(+8%),JNJ(+4%),andSNN(0%).Net,netweseeoverallvolumestabilityasgoodforthespaceandmarketsharetakeawaysaspositiveforZBHandSYK,neutralforSNN(coveredbyIanDouglas-Pennant,Neutral),andaslightnegativeforJNJ(coveredbyCarterGould,Buy).RoboticsDominatingtheConversationInaskingaboutnewproductsthatareexciting/practicechanging,robotics/MAKOwerethe#1answerbyfarat30%;navigation/visualizationwere17%of,showinghowfocusedthemarketisontheseinnovations.Surgeonsarepredictingthatroboticusewillriseto20%oftotalkneesin3yearsvs.~7%inthelast12months;theexpectationforroboticpenetrationatthreeyearshasincreasedincrementallybyWave.SYK'sMAKOiswellaheadofSNN'sNavioorZBH'sRosaintermsofphysiciansplanningtobeginusingtheproduct.MAKOusersaremostlysatisfiedandearlyfeedbackonRosawasgoodwith4positiveresponses(nonegative)highlightingeaseofuse,theabilitytochangeplanseasilyintra-operatively,andreliability.Overall,22surgeonssaidtheyhadinterestinusingRosa,upmodestlyfromthelastWave(17).HospitalsPushingBackonCosts;InsurersonProceduresHospitalscontinuetopushbackoncosts,usingcontracting,negotiations,vendorconsolidation,andpricecapstolowerimplantcosts.Thisseemstobeimpactingallvendorsroughlyequally.Insurersarealsopushingbackmoreonprocedures,requiringmoredocumentation.Weseetheseasmarketdragsbutnotmeaningfullydifferentthanpriorsurveys.EquitiesAmericasMedicalSuppliesMatthewTaylor,[e-mail][e-mail][phone]YiCheng,[e-mail][phone]IanDouglas-Pennant,[e-mail][e-mail][e-mail][phone]USMedicalSuppliesandDevices23April20192UBSEvidenceLabOrthopedicSurgeonSurveyResults–Wave4Methodology:UBSEvidenceLabconducteda15-minuteonlinesurveyof196USOrthopedicSurgeonsinDecember,2018andJanuary,2019.Toqualifyforparticipation,thesurgeonsmustconducttotalkneeandtotalhipreplacements.SomePositiveSignsintheUBSEvidenceLabOrthoSurveyaroundMarketGrowthInWave4,42%ofdoctorssurveyedexpecttheirvolumestoget'somewhatbetter'overthenext12monthswith5%'significantlybetter',42%'thesame',6%'somewhatworse'andnoanswersfor'significantlyworse'.ThiswasverysimilartotheresultsfromWave2(Jun2018)andWave3(Oct2018).WenotetheUSorthomarketgrowsintheLSDrange,andthedatafromWave4pointstovolumesgettingbettermorethanworse,whichwethinkisgoodenoughtosuggestthemarketisatleaststable.Figure1:PatientTrafficNext12MonthsSource:UBSResearch,UBSEvidenceLab8%8%5%45%47%42%43%45%47%4%2%6%0%10%20%30%40%50%60%70%80%90%100%Wave2Wave3Wave4SignificantlybetterSomewhatbetterThesameSomewhatworseBetter-WorseUSMedicalSuppliesandDevices23April20193EfficiencyImprovementsDriveVolumesThesurgeonswereaskedinWave4whytheythoughtvolumeswouldbebetter.Thebiggestcategorieswere:a)efficiencyorstaffingimprovementsinthepractice(practiceexpansion,bettermarketing,improvingreputation,streamliningpatientmanagement,andbetterscheduling);b)staffingchangeslikehiringaPA,scribe,nurse,orotherdoctortoimproveworkflow;c)somecitedbaby/boomeroranagingpopulation,ord)grea