Good morning, and welcome to the earnings call at Oncoclínicas. At this moment, all of our participants are connected as listeners. And later on, we will begin the session with Q&A when instructions for participation will be provided. If you need any support during the earnings call, please do request the support of one of the operators by selecting star 0. It would be important to remind you that this earnings call is being recorded. I will now pass on the word to Mr. Bruno Ferrari, the founder and chairman of the board at Oncoclínicas. Please, Dr. Bruno Ferrari, you may proceed.
Thank you very much. Good morning, everyone. Thank you for your presence in our first earnings call for the market. It is a great honor and satisfaction to be here with you today talking more about our performance and our results.
We are very much honored with the confidence of our investors through this IPO process we went through. And now as we became a publicly held company, this just reinforces our desire to really win. We will be able to expand our purpose and take care of the lives of each patient as if it were our own. We are sure that we will grow even more to be able to work towards the health and success of oncology, the cure and care, and respect for our patients and partners. About our third slide here, I am going to talk about the Oncoclínicas IPO on August 10th. We participated in the ceremony for the beginning of the negotiations with our shares in B3.
It is a reason of major pride for us to have conducted the company in this important milestone in its history, which certainly will bring in major challenges, but also huge opportunities up ahead. We are confident that we will be able to advance and expand even more with our national presence and our participation, especially in the journey and experience of our patients. We have a company that has a capital structure that is very robust to face all of the different opportunities that appear with the extension of strategic programs such as our genomic medicine program. Additionally, I will talk about all of our acquisitions that were signed in this quarter.
We have signed the acquisition of [ CAM/CLION Group], which is one of the most traditional medical groups in the Salvador region, made up of a multidisciplinary team to service entirely the oncology patients distributed in five units in the city of Salvador and Lauro de Freitas. This acquisition is super important because it consolidates our position of leadership in the city of Salvador. We have also signed the acquisition of Cebrom, which is the leader in oncology support in the city of Goiânia and in the region. Its activities are distributed between three different units that have the biggest and most modern structure for oncology treatments that is integrated and also has radiotherapy technology. This acquisition really sets the beginning of Oncoclínicas presence in the state of Goiás, one of the most prosperous regions in the country.
Finally, but not least important, we have also signed the acquisition of UMC Hospital in Uberlândia. This hospital has one of the most modern structures in the hospitals in the Mineiro region, with 130 operational beds currently and expansion under progress for another 100 beds, with the forecast to be delivered this year still. The hospital is going through its capacity of 230 beds. The consolidation of an acquisition of UMC with this cancer center that is a reference, and all of these acquisitions are still subject to approval from CADE and other preceding conditions. This is our initial message, and now I want to pass on the word to Luis Natel, our CEO. He will be talking about our main highlights and the results. Natel, please.
Thank you, Bruno. Thank you, everyone. Good morning. I am really happy to talk to you as investors and in our first earnings call.
I am going to pass on to slide four, and I want to talk about the main highlights of the results in the second quarter of 2021, where we continue to have consistent growth in the volume of procedures, growing 27% compared to the second quarter of 2020. I would also like to highlight the growth of 32.6% in the net revenue compared to the same period before. Highlighting that in 2020, we already had a significant growth compared to 2019, which is different than the overall health sector. We are growing from a base that is already growing at an accelerated pace, so it is growth upon growth. Monitoring our performance in the revenue, we also had a significant expansion in our EBITDA adjusted margin, reaching 17.7%. In absolute numbers, the EBITDA adjusted in the period was BRL 113.3 million in the second quarter of 2021.
This represented a growth of 51.9% compared to the second quarter of 2020. These numbers are extremely impressive. Now I want to pass on the word to our CFO and our IR director, Eric Alencar, that will be presenting a little more detail to you on this. Eric.
Thank you, Natel. Thank you, Bruno. Thank you, everyone. It is a pleasure to be with you. On slide five, we are going to present our operational results and financial results. With a special highlight on the record results at Oncoclínicas with 93,000 procedures, with 27% greater than the second quarter of 2020. Besides BRL 7,500 in the average ticket, 6% higher than the second quarter of 2020. In the first semester of 2021, we reached a level of 183,000 procedures, 20% higher than the first semester of 2020.
In regard to the average ticket, we had a 10% growth in the semester comparison. On slide six, on the left side graph, we have the growth of the net revenue, which in the second quarter of 2020 reached BRL 640 million with a growth of 33% compared to the same period last year. On the right side graph, you can see the consistent growth of the revenue in this semester, where the net revenue added up to BRL 1, 255 million, 34% higher than the first semester of 2020. I want to remind you that differently than the rest of the health sector, our growth in 2021 are compared to a base that is also very solid and consistent of over 20% that we have had in 2020 compared to 2019, demonstrating the resilience of oncology growth even in the pandemic period.
On slide seven, we highlight the costs and expenses in the period. On the graph to the left, you have the quarterly comparison without adjustments, with a 50% growth between the first semester of 2021 and the first semester of 2020, impacted mainly by the extraordinary items like the provision for the long-term incentives, which is not a cash effect and is already backed up by our treasury shares. Excluding the effects of these extraordinary items in the graph to the right, you can see that the costs of expenses grew at 26% of the period, and you can see that the ratio between the net revenue dropped 6 percentage points, reaching 82% in the first semester of 2021, reflecting this reduction of cost and expenses in regards to the net revenue, which is the fruit of the scale gains in the expense lines.
On the next slide, on slide eight, we are presenting the EBITDA. The adjusted EBITDA in the second quarter of 2021 was BRL 113 million, 52% higher than the second quarter of 2020, with an adjusted margin of 17.7%. In the semester, the growth was even greater. In the comparison with the previous year, the increase was 95%, reaching BRL 224 million with a margin of 17.8% compared to the net revenue. The net income was BRL 195.9 million, which is the fruit of the extraordinary expenses with long-term incentives, which is a non-cash expense and supported by our treasury shares. We also had a drop in the net income attributed to minority shareholders, going from BRL 9.1 million- BRL 2.4 million in the second quarter of 2021, mainly due to the purchases of stock in many different clinics as presented in the release.
On slide nine, we are going to talk about our debt. Our schedule for amortization is very well distributed in the next five years, reaching a peak of payment in 2023, where we will have an amortization of BRL 363 million. In 2021, we are going to have BRL 107 million of debt banks to [amortize]. On the graph below, on the same image of the net debt, the company reached in the second quarter BRL 979 million with a leverage financially of 2.3x the adjusted EBITDA in the past 12 months. It is important to mention also that subsequently, due to the IPO, the rate of the debt in the company was modified with a cash net position in the company.
Since the main use of proceeds from M&A are adjustments of the capital structure with this income of BRL 1.7 billion is a significant factor ensuring major solidity in our group. On the next slide about the cash flows in the first semester of 2021, the cash position before the IPO went from BRL 640 million- BRL 348 million, mainly due to the funding activities such as the amortization of debts, payments for acquisitions, participation of controlled shareholder entities, and also the consumption for the payment of partnerships of BRL 50 million and the occasional down payment of BRL 57 million for the purchase of drugs. I am going to end this part of the presentation. Now we are available with Bruno and Natel to answer all of your questions.
Thank you. Ladies and gentlemen, now we will begin the session with the Q&A. If you have a question, please select star one. If you want to remove your question from the queue, select star two. Our first question comes from Emerson Vieira from Itaú. Please, Emerson, you may proceed.
Good morning. How is it going? Thank you for getting my question. The first question is to understand the dynamic of the top line for the second semester. We understand that if you consider the strong base, but if you could maybe reconcile what you consider in regards to seasonality, with this accelerated or even an increase in the volume, and if we should see some kind of a stronger contribution of M&A.
Emerson?
How much should this contribute also?
Just a minute, Emerson. We cannot hear you. Your volume is very low. Could you please repeat your question?
What is going to be the top line in the second semester? Understand the ticket dynamics, and how you are looking at this scenario up ahead. We had a growth year-upon-year in this quarter. Now we want to understand if you imagine any kind of deacceleration in the second semester also. I think those are the two questions we had.
Emerson, this is Alencar. It is a pleasure to speak with you, but we were only able to hear the second question with the dynamics of the average ticket. Do you think you could please repeat the first question once again? Because it was very low, we were not able to hear you.
Of course. Yes, I can repeat it. Well, let us go. The first question is about the top-line dynamic. I want to reconcile this a bit with what we should expect in the second semester, considering the seasonality, possibly, and also if the volume should be a little bigger in the second semester, or if the impact of the ticket should also accelerate this due to the adjustments in the price of the drugs that take place in April.
The first point is really understanding the mindset for the second semester in regards to the top line organically, and the second point is what should be the contribution and how much you expect in the closing for the three operations, CLION , Cebrom, and UMC, and how much these should contribute to the top line so that we can reach a revenue level that is close to what you guys were indicating in the period of the IPO.
Just really understand how comfortable you are to deliver that number. The second point is to understand the ticket dynamics. We have had a ticket growing 6%, so very healthy, but still lower than what we expected. We wanted to understand the ticket dynamics in the short term. I think that is pretty much it.
Thank you very much. I will split this into three parts, and I will pass through each one with you, Emerson, and then Natel and Bruno can also contribute with some aspects of the strategy. Historically, the market for oncology really increases. I am going to talk about the procedures, and then I will talk about the average ticket. It increases the amount of procedures in the second semester. You can notice this historically due to the dynamics. If you look at the previous years in Oncoclínicas, it is a lot stronger in the second semester, even organically.
Before we talk about M&A, it is a lot stronger than the first semester. What you can imagine is really an increase in the amount of procedures. When it comes to ticket, I think what you mentioned already makes a lot of sense. First, there is volatility from quarter- to- quarter. In a year, the growth was 10%, and you can expect within what we were expecting or more this year. The average ticket in the third and fourth quarter will suffer with the related increases related to the CMED adjustments between 7% and 8% for oncology. When it comes to procedures and average ticket, you can expect an increase in the third quarter. When it comes to M&A, the three operations are in CADE, the antitrust organization. All of the process was just waiting for approval from CADE.
Cebrom will just have the publishing from the antitrust body. We have the legal 15-day period, and then after we will be able to sign. In September and October, we are going to start accounting this. The expectation is that this will also be for September, October, the two other operations that are in the final CADE phase. It just depends on the regulator, but so far so good. This will really help us in the number of procedures and tickets, as we had already mentioned to you. I think that is pretty much it. Things are moving exactly within what was planned and what we had committed to with you and mentioned with you during the entire IPO process.
Perfect. Excellent.
The seasonality aspects are important, of course, with greater clarity as well in regards to how the M&As are going to be incorporated as well.
Our next question comes from [Hinam Tata] from Citibank. [Hinay], you may proceed.
Hello. Good morning, everyone, and congratulations initially on the IPO and the results. Bruno, Natel, and Alencar. Just a follow-up here about the seasonality. I want to know if there is any kind of specific part related to the non-payment or if it is something natural in the business. If there are some specific considerations about this. Also a bit in the presentation, you talked about long-term incentives and the accounting effects. But should we see some kind of effect in the next quarters, or was everything pretty much covered in this period?
This is a question regarding the disallowances. [Hinam], how is it going? I hope everything is okay.
The disallowance at Oncoclínicas is low. There is a little more volatility because you have a very low base. Quarter- by- quarter, this tends to vary a bit. That is why we always look at the semester, and this has some effects, of course, in the gross margins. But this is not something that in the second semester will get better. What is going to get better in the second semester is really the part with the tickets and procedures. What you are going to see probably is these variations in the allowances, disallowances, because we follow this fuller, and if some payment is delayed, we have to account for this. In regards to phantom shares, as we mentioned, this is a non-cash aspect. The shareholders before the IPO provided 28 million shares in the treasury.
They diluted this, and this is already what kind of supports the payment of the phantom shares. This is a non-cash effect that is already provisioned for in the dilution of the actual IPO. We consider these 28 million shares in the dilution of the pricing, and now it was priced at [BRL 19.92]. With some price variations, maybe this would have to be adjusted in the market. Before the IPO, the shareholders.
Okay, thank you very much, and congratulations on the result.
Thank you, [Hannah]. We would like to remind you, ladies and gentlemen, that to submit a question, just select star one. Please wait while we collect the next questions. Our next question comes from webcast from [Carlos Ejiden in Condur]. What are the characteristics of the assets you are searching for in the next acquisitions? Thank you very much.
Well, good afternoon. These are assets that are quality assets focused on oncology, basically. Our life is oncology and everything related to clinics or oncology-related entities are within our pipeline for acquisitions. These are always assets that are within our line. As we mentioned during the IPO process, for example, we are always searching for a main focus on having a clinical primary team in line with our values and our spreads and our main objectives. Once these are identified, these are the assets we are always searching for. We have these assets that can complement all of our care and our program of having our Oncoclínicas interconnected to some more higher complex centers such as the UMC, which allows for us to control in-house all of the patient's journey. Perfect. Thank you. That is exactly it.
Well, thank you. We would like to let you know, once again, that if you have a question, just select star one. Please wait while we collect the next questions. Ladies and gentlemen, since there are no other questions, we are ending the session for Q&A. Now I am going to pass on the word once again to Dr. Bruno Ferrari for his final remarks. Please, Dr. Bruno, you may proceed.
Well, once again, me, Natel and Alencar want to thank, and everyone at the company, really, we want to thank you so much for your presence in our earnings call. Thank you so much for your questions submitted, and we hope to have answered them and addressed the main points. Now we are finishing our presentation here for the earnings call, and we will remain available to all of you. Thank you very much and have a wonderful day. Thank you, everyone.
Thank you, Bruno. Thank you, Natel and Eric. Have a great day. Bye-bye. The earnings call for Oncoclínicas is officially finished. Thank you so much for your participation, and have a wonderful day. Thank you so much for using Chorus Call. You may disconnect now.