Welcome to Ambu's Capital Market Day 2025. Welcome to all of you here at our headquarters.
A warm welcome to all.
Of you who are watching this online, we have a very interesting day ahead of us.
My name is Andrew Short and we.
Are really looking forward to this day.
Before I go through the agenda, I just want to quickly pay your attention to this slide. I know you are all familiar with our disclaimer. If not, then please. If we look at the agenda for today, then shortly hereafter very pleased to welcome our CEO Britt who will be setting the scene with our new strategy towards endoscopy leadership.
We'll dig a little bit deeper into our attractive markets.
For that we have a number of speakers. We have Bassel and Jesper, but we also have two external speakers, two specialists within each area.
We have Dr. George and Dr. Tareq .
Henrik Skak Bender, our CFO, will also be part of this session.
We'll dig a little bit deeper.
Into our four strategic priorities.
For that we also have a couple of speakers. We have our new President of North America, Scott.
We have Graziela, we have Finn, and we have Sanne.
Finally, we will be going through the financial outlook. For that, we will have our CFO joining us on stage again. Finally, we will have closing remarks by our CEO Britt who will be joining us here on the stage again. With that, I'm very pleased to welcome.
Our CEO Britt who will start the presentation. Welcome, Britt.
Thank you, Vanes.
Thank you.
Good morning everyone and a very warm welcome to those of you in the room. A warm welcome to Ambu. It's been two and a half years since we last hosted an event like this in this exact room. Back then, it's not a secret that we were navigating through very challenging times. Today, I'm super proud to say that this chapter is behind us. We have turned the page. Today, you should be seeing a new Ambu where we are uniquely positioned in the market that we operate in, where your investment is stronger and more focused than it has ever been. Today is going to be very much around what comes next.
We'll launch our next era of our strategy and we'll talk about the market opportunities that we have in front of us, our strong portfolio, and our organization and leadership that is strengthened to what you've seen before. We have been making progress on delivering a scalable platform that can also facilitate the growth that we have communicated last night. Let me start by taking you through what you should take with you from today. You should see that we have delivered. You should see that we have delivered on our turnaround, that we are now entering the next era with a focused and ambitious strategy, that the overall market is shifting towards single-use as the standard of care, and that we are set to lead this shift. This is also why it makes a lot of sense for us to increase our growth ambition.
Let's start by looking at our growth profile because we do remain a high growth medtech company. If we compare to our peers, we are growing more than double what our peers are growing, and we have done that for many years. In the past five years, our CAGR was 14% compared to 6% for the global medtech average. If we compare with the top quartile of the medtech average, this was 11%. We are even growing higher than the top quartile. This has been driven by our Endoscopy Solutions area where we have been growing 28% CAGR and which now represents 60% of our total business. Needless to say, I'm super proud of our colleagues who have delivered this growth. Our colleagues, people at Ambu, are united and they are driven by a very strong purpose.
This is a purpose that is deeply rooted in our more than 85 years of history. It centers around innovation, where we are rethinking solutions to save lives and improve patient care. Innovation is also what has led to our success in endoscopy. Just to remind you about some of the benefits of endoscopy, it's procedures that are performed to enable both faster and more precise screening, diagnosis, and treatment. It's making it possible to drive better and faster decision making and interventions. It has become a common approach for many patients worldwide. The numbers speak for themselves. In the U.S., Europe, and Japan, every year, more than one in 10 goes through an endoscopy procedure. Globally, this is over 150 million people. Many of these undergo endoscopy multiple times a year. What are the expectations for our future?
Basically, we see an aging population that is driving a growing need for endoscopy. On top of this, when we look at chronic diseases, more than 65% will by 2050 be suffering from at least one chronic condition. In addition, there is a shift toward minimally invasive procedures, which is expected to account for around 80% of the procedures that are done by 2050. All these trends are very positive for single-use endoscopy. There is even more that is pointing towards single-use endoscopy as the new standard of care. That is some of the challenges that the health systems are facing. Just to mention a few of them, one is healthcare workforce shortage that we see already happening today. There are fewer resources needed when patients are treated with our solutions.
Health budgets are under pressure, and there is a transition in where patients are treated, towards being treated outside the hospitals. In the U.S., around 60% of the hospital revenue today is coming from patients being treated outside the hospital. Our single-use solutions have benefits to help with these challenges because there are more procedures with a single-use endoscope that can be done with the same level of resources. It is simply more efficient. Also, it is with better economics, and on top of this, it leads to stronger clinical performance, which at the end of the day is what matters the most. We engage with thousands of customers every day where we are reminded about the differences that we make for our customers. What you see here, that's our customers and that's those that we are making a difference for.
If we look at the hospitals and clinics, this is where the procedures are performed, and we engage both with the administration at the hospital level, but also with the clinicians who are actually doing the work. These are the ones that we sell to. Clearly, it's all about the patients and how we can help the healthcare professionals to the benefit of the patients. This is basically what we have been proving that we can do. We have been first with a single-use endoscope in most of the areas that we are active in. Thus, we have created the single-use market and therefore we are market leaders today in the U.S., our largest market. The example that you see up here, we have, for example, led the single-use penetration in bronchoscopy to today a penetration of 25%. There's more to go after.
In a customer survey that we did earlier this year, clinicians in the areas that we are active in were convinced that they could, with the current solutions that they use, go even higher than the numbers that you see up here. They basically believe that 70% of all procedures can be done with a single-use scope today. This means that based on our current penetration rates that you see up here, we have a lot of way to go to get to this penetration. Hopefully, it's clear with some of these examples that we have a very unique opportunity and there's so much more for us to do in the market we operate in. With this in mind, I'm very proud to introduce now our next -era strategy. Before I do this, you may ask why do you need a new strategy now?
Basically, what I told you a few minutes ago was that we have turned the company around from a challenging situation. When we three years ago sat down to develop what became our ZOOM IN strategy to deliver profitable growth, it was all about focus and execution because we had to get our growth and margins up and it worked. In less than three years, we have delivered new solutions for our customers. We have improved our execution. In two years, we increased our EBIT margin with more than 9 percentage points. We have also progressed on sustainability, becoming a leader in how we help customers drive this agenda. We have made tangible improvements across the organization. It is working. Let me also show you some of the numbers to prove this.
Since we launched the ZOOM IN strategy, we have increased our revenue growth to around 14%, which is the number that you have seen. After the first nine months of our fiscal year, we have improved our EBIT margin to over 13% and we have also turned our cash flow around to go from a high leverage to basically having no debt today. With this fast turnaround, we started to discuss how we can further accelerate our growth because we have a lot of learnings, we have a lot of momentum, and we don't want to stand still. We started to discuss how it is that we can further advance our growth. We do believe that we have unique opportunities to do so. This is why it is time for us to ZOOM AHEAD .
Healthcare systems worldwide are under pressure.
Rising patient volumes, cost constraints, and staff.
Shortages demand breakthrough solutions that redefine the future of care. As the pioneers in single-use endoscopy, championing innovative and efficient solutions, this is Ambu's moment to lead in the global endoscopy market. Our long-term aspiration is clear: to achieve global endoscopy leadership, powered by our proven approach and deep.
Customer insights. We are committed to partnering.
With health systems worldwide to expand access to care and elevate patient outcomes.
Our next -era strategy, ZOOM AHEAD , marks.
Our first step on this bold journey.
Across the four major endoscopy, respiratory, urology.
Ear, nose, throat and gastroenterology. We will pursue market leadership driven by breadth of solutions, transformative technology, and sharp differentiation. We will empower health systems to deliver smarter, faster, and improved care to more patients. As we ZOOM AHEAD , four strategic themes steer our direction. We will improve customer outcomes and efficiency, deliver integrated and high-impact solutions, build a scalable, profitable growth platform, and fuel a culture of empowerment and growth. Our new era marks a turning point, one where bold ambition meets global impact. We are not just imagining better care, we are delivering it. This is our time to lead and to make a lasting impact on health care worldwide.
Yeah, so this is it. This is our ZOOM AHEAD strategy where we are entering a new strategy era with an aspiration to deliver global endoscopy leadership over time. For us, this marks a defining moment in our growth journey to basically raise the bar for endoscopy globally. What you see here is our strategy model where on one side you have our strategic choices and on the right side here our priorities to succeed. Let me go through these, starting by some of the strategic choices we have made because in order to focus we have made some choices across the portfolio. Our two key segments are respiratory and urology. The first mentioned is a renaming of pulmonology to respiratory. This is done basically as a result of our evolution of our portfolio into airway management. Thus, we believe it's a more inclusive term.
Winning in these two segments is about expanding our leadership position and leading the move to single-use becoming the standard of care. We have ENT and in ENT it's about growing. In ENT it's about establishing a leadership position and driving revenue growth. Unlocking GI is more of a long-term ambition. We believe in the transition to single-use in GI, but it has not yet taken off meaningfully and single-use is less penetrated in this area than in the other areas. In endoscopy, we are the best positioned to lead this transition as we have led this in the other areas that I just referred to. It may take some time. At the same time, it's also a huge opportunity for us where we can address some of the same challenges that we have addressed in the other areas. We also aim to advance Endo Intelligence.
This is what we have so far referred to as digital solutions and systems. The new name reflects our shift to more AI-enabled performance enhancing technologies. You'll hear more about this later today. We have anesthesia and patient monitoring and these are still meaningful to Ambu and we will continue in these areas our focus on growing profitably. Let's look at the right side of the strategy model. We have our four strategic themes. These are our enablers for success and these are about customer centricity, where we want to improve customer efficiency and outcome. It's about innovation to deliver integrated and high impact solutions. It's about our business platform building a scalable, profitable platform. It's about our people driving a culture of empowerment and growth. Let me take you through the key topics under each of these headlines, starting with customer centricity.
This is all about improving our customer outcomes and efficiency. Our focus will be to focus on clinicians and how we can deliver better integrated solutions that target both the clinicians, but also what the health systems are looking for to expand their patient access. Our solutions are built on the same platform across all the areas that we operate in. That means they can be used across, which is a significant benefit. We prioritize targeted execution, targeted commercial execution, supported by more data on customers and also strengthening how we differentiate and the data and value documentation around that. Finally, based on our strong progress on sustainability, we'll continue to lead the sustainability agenda by helping our customers to be more sustainable and to reduce their emissions and waste, supporting their sustainability targets.
One specific example of how far we have come is what you see next to me up here. These chairs that you see here are basically made from material from our endoscopes. They have been collected in hospitals and recycled as part of our Recircle program, which you'll hear more about later today. Let's talk about innovation, because this is about delivering integrated and high impact solutions, making sure that we continue to be bold in our approach, delivering breakthrough innovation that improves the efficiency that I've talked about for our customers and advancing our patient outcomes. We'll do this by deploying transformative technology. What we do is we continue to improve the different parts of our endoscopes and basically apply the innovation that we deliver across the full portfolio of endoscopes.
We do this partly in house, but partly also through strategic partnerships which are happening in innovation, but also across the value chain. To succeed with our ambitious growth plan and also to succeed with our margin expansion, we will have to build a sustainable, profitable platform. This is already ongoing and we'll continue to do this by also ensuring that we have diversified, resilient operations with a flexible supply chain. You'll hear later from Graziela how we leverage our scale from being the largest to also being close to customers, not least to our biggest market, North America. We will further enhance our productivity, making sure that we have end-to-end cost effectiveness.
This is where I should also remind you that we are not done with the transformation program that we launched with our ZOOM IN strategy two and a half years ago, meaning that there is still room to further improve effectiveness from some of the initiatives that we identified back then. Lastly, we are focusing on our infrastructure where we also believe we have potential to make this more future proof. Last but not least, our success is about our people and our ability to create a culture of empowerment and growth. This is what we do by leveraging the values that we have defined and that live in our organization and continue to make sure we have a nimble way of working so we can execute strongly as we grow and fast react to changing market dynamics.
We also focus on advancing specific strategic capabilities such as in the area of AI and software to make sure that we can grow in the future. All of this is only possible through leadership, something that I'm very passionate about, leading as one where we drive a shared mindset around our purpose, around our strong ambitions and accountability to at the end of the day deliver strong financial results. Talking about leadership, we have a great team to deliver on our growth, ambition and strategy. Since our last capital market day we have welcomed great talent into the team with plenty of experience. You'll be able to see for yourself later today where you'll meet all of my colleagues from the Executive Leadership Team on stage. Let me end my presentation by outlining what you can count on us to deliver in the coming years.
We are in an attractive market where we are leading a shift towards single-use, which is a market that is expected to grow with over 20% every year with the broadest portfolio and a strong platform. We are already market leaders in this market and we have a strong position to grow from with solutions that make a real difference for our customers such as enabling them to treat more patients with the same resources while driving better outcomes. We have and will further strengthen our scalability to deliver rapid continued growth. This also means that we believe that we have a very clear path to deliver strong double-digit growth and margin expansion and this is based on the strong foundation that we today increase our long-term target for our organic revenue growth.
We have extended our strategy period by two years to our fiscal year 2029/2030 and we plan to deliver organic revenue growth of 11% -1 3% in the period. We maintain our organic revenue growth on endoscopy at 15% -2 0%, but I should say that we have much more confidence in where we are today than we had two and a half years ago and we target an EBIT margin of over 20% by fiscal year 2029/2030 and we are on plan as well to deliver around 20% EBIT margin by 2027/2028, allowing for potential trade-offs with growth investments as we have previously communicated. I am very happy to hand over to my colleague Bassel who will take you through how we see this attractive market.
Thank you.
Hello everyone. My name is Bassel Rifai. I'm the President of Ambu in Europe and Asia. I joined the company in 2021 and I remember being up on stage here two and a half years ago with some familiar faces and sharing back then how we saw the market opportunity and our position. I have to say, fast forward two and a half years, I think like Britt, I'm very proud of what we've achieved as a company and I'm even more excited about the potential we have ahead. Speaking of ahead, I'm going to start by talking about what we see as the market opportunity in single-use endoscopy. I'll go through the overall market and also how we're positioned within that market. There are three main things I want you to take away from this session.
Number one, as Britt also said, is that single-use endoscopy is an attractive, large, fast-growing market. A market that's going to grow 20% CAGR to reach more than DKK 15 billion over the coming five years. The second one is that Ambu is the clear world leader in this market through a proven ability to build and scale. The third one is that we're very well positioned to continue to lead in the future. Let's start with the market. As I go through these numbers, one thing that you're going to see is that the numbers are refreshed compared to two and a half years ago. That's because something that we focus on as a company, something that we believe we're good at, is we recognize in a market creation environment there's a lot of new information becoming available.
It's very important for us to continuously collect structured feedback from customers and then update our market intel based on what's happening. A lot has happened in the single-use endoscopy market. The net result of all that is that compared to two and a half years ago, we see single-use endoscopy as an even larger market with even more potential for us to grow in the coming years. Let me walk through how we look at it. If we start on the right side of the slide, you'll see that overall we look at single-use endoscopy as a DKK 190 billion market opportunity at full single-use conversion potential. That means if you were to take the full 150 million procedures that Britt talked about earlier happening all over the world in endoscopy, and then transition them to single-use, that would represent a DKK 190 billion market.
You'll see that that market today is only 3%- 4% penetrated, which means that, you know, with all our successes over the past 10, 15 years in building this market, there's still significant headroom for future growth even beyond the strategic horizon. We break it down into the four areas Britt spoke about earlier. We have respiratory, which is the market that we started in. It's a market that's DKK 15 billion and 20% penetration. We have urology, which is our other stronghold and even larger market, DKK 35 billion at lower penetration, 10%. We have the two segments which are earlier on in their adoption curves, the ENT market, which is DKK 20 billion at 2%- 4% penetration, and then GI, which is the largest segment in endoscopy, DKK 120 billion segment, which is less than 1% penetrated.
It's a very large market opportunity that's early in the stage of the transition from reusable to single-use. Of course, the question is, how do we look at this kind of potential unfolding over time? This is basically the way that we see it, which is that if you start on the bottom left, today, single-use endoscopy represents more than DKK 6 billion market. When we ask customers, as Britt mentioned earlier, when we ask customers what do they see as the future potential of single-use in respiratory, urology, ENT, they say 70%. They say that at some point in the future, not time bound, at some point in the future, 70% of procedures in single-use endoscopy or in respiratory, urology, ENT will be done using single-use endoscopes. When that happens, the single-use endoscopy market will be a DKK 50 billion market.
If that 70% ever became 100%, and if the respiratory, urology, ENT also included GI, then that DKK 50 billion of course becomes the DKK 190 billion full potential I mentioned earlier. Finally, speaking more to the near term, when we model how single-use endoscopy is growing, we see a market that's growing 20% CAGR over the coming five years, which means it's a market that's going to go from DKK 6 billion today to more than DKK 20 billion in five years' time. We believe that that's a realistic and risk-balanced view. Just to dive into what's kind of behind this 20%, when I mention it's more realistic and risk balanced, one of the reasons for that is that we see more growth coming than we thought in the past, coming from respiratory, ENT, which are categories that are more well established in their growth trajectory.
It doesn't even include the potential that we have in GI. If we go into the drivers of the 20%, broadly, we can break it down into two different areas. One is endoscopy growth, which is how much procedure volume growth is happening overall in the endoscopy market, and that's about 5%. That's driven by macro factors like aging population, access to care, shift to less invasive procedures, and focus on earlier diagnosis. Those macro factors drive 5 points of overall growth in the endoscopy market. There's 15 points which is driven purely by the transition from reusable to single-use endoscopes. The majority of that is actually driven by existing solutions that are already on the market, and then a smaller amount is driven by new solutions that are yet to be launched.
That's also why we say that when we look at this 20%, we're very comfortable and it carries less risk compared to when we were looking at it even two and a half years ago. Of course, everything we've been talking about so far is just the endoscopes. On top of that could come adjacent categories which we choose to participate in. The key number in all this is the 15%. What is it about the single-use endoscopy that's driving so much growth? What is it about efficiency, economics, clinical performance, and sustainability that's driving so much traction in this market? Let's start with the first two, efficiency and economics. What customers are finding is that when they switch from reusable to single-use endoscopes, their health systems become more efficient and lower cost.
The evidence on this is getting bigger and bigger, so it's very robust and customers are starting to accept it or understand it more and more and see it for themselves in terms of efficiency. A simple example is that customers spend a third less time between procedures when they switch to single-use. Customers are able to do in some cases double the amount of procedures that they were doing in the past because they're spending less time between procedures, they're repurposing rooms that were once used for reprocessing and now for endoscope reprocessing. Now they're doing it for patient care. Overall, they see a significant improvement in efficiency and patient throughput when they switch to single-use. On top of that, they're doing it at a lower cost.
That's because when you take in the all-in cost of reusable endoscopes, capital equipment, service contracts, repair, reprocessing, labor equipment, and compare that to the cost of a single-use endoscope in a typical environment, in cystoscopy a customer will see a 10% drop in their overall costs and in bronchoscopy a 13% drop. Customers are finding it to be more efficient and less expensive to use single-use compared to reusable. When it comes to clinical performance and sustainability, we're also seeing now that customers are starting to choose single-use endoscopes because of clinical performance. That's something that hasn't always been the case. In fact, if we go back a few years, customers would choose single-use endoscopes because of convenience and then they were forced to make a compromise in terms of performance.
Now, as we've continued to advance single-use technology, we've reached a point where single-use endoscopes are performing on par, or in some cases even superior to the reusable counterparts. That means that customers are able to choose a single-use endoscope and achieve all the same efficiency and cost benefits and make no compromises on clinical performance. Finally, in sustainability, a few years ago this was an area that was more of a barrier for us. Now as more and more evidence is coming out on the true full lifecycle impact of reprocessing reusable endoscopes, customers are also finding that when they transition to single-use endoscopes, they can reduce their overall CO2 equivalence by 20% according to the most recent studies. Across these four factors, efficiency, economics, clinical performance, sustainability, it's driving the transition from reusable to single-use in the attractive market that we see today.
The question is, how are we positioned within that market? That comes back to my second key message for the session, which is that we've established ourselves as the clear world leader in the single-use endoscopy market. We have a proven track record. We know how to build and scale new segments in this market. Bronchoscopy is an excellent example of this. We started the bronchoscopy market 15 years ago by understanding in specific sites of care what are our customer needs, then working with innovation to address those needs, working with manufacturing to scale, building our commercial infrastructure to strengthen our relationships with customers. We iterated on that flywheel for more than a decade so that today more than 20% of the market is transitioned to single-use. That's basically a playbook that we apply every time we enter into a new segment.
The net result of that is that we are the clear world leader in single-use endoscopy. I mentioned my third message is that we're very well positioned to continue to accelerate in the future. That's because when we ask customers why do you choose Ambu? The answers they give are exactly aligned to the growth drivers I mentioned earlier, the things that are most important to them. Number one, clinical performance, the top purchasing criteria. That's an area where we continue to excel. Number two, economics. Not only are customers seeing the benefit of single-use endoscopes, but they're even willing to pay a premium for their preferred provider. That's also what we see in the market. We command a premium because of the value we deliver to customers. We command a premium when we introduce new next-generation technologies. Finally, endoscopy portfolio breadth and efficiency.
Customers are looking to standardize overall in their health systems. When customers think about standardizing in single-use endoscopy, they think about Ambu. Now why is standardizing so important? If you're a hospital department, you ask yourself, how many different endoscopy providers do I want to have in my department? How many different sets of inventory do I want floating around? How many different times do I want to train my staff, which often have high turnover, on how to use the different endoscope systems? If you're hospital procurement, you ask yourself, can I consolidate my volumes and get a better deal? Can I reduce my number of suppliers? Can I save on the amount of capital equipment I'm buying for all the different endoscope platforms? It's true for endoscopy, it's true overall for health systems. They're looking to standardize their providers.
When health systems think about standardizing in single-use endoscopy, they think about Ambu. We're the only company in the world, the only major player in the world that can offer the full suite, the full portfolio across respiratory, urology, ENT, and GI, and we're also the only company in the world, major company, and this is becoming more important to our customers, that offers a platform that can integrate our endoscopes into their electronic health records, and that's something that customers are becoming more focused on in the coming years. This is a key reason why we're well positioned to accelerate growth in the future. I'm going to hand it over to Jesper in a second to dive deeper into each of the four segments, respiratory, uro, ENT, and GI. I'll be back on after lunch to talk more about Endo Intelligence and sustainability.
As I wrap up, I just want to reinforce what I said at the start, which is that we see single-use as a very attractive, fast-growing market, a market that's going to grow 20% CAGR over the coming five years and with plenty of future potential to grow. Ambu is extremely well positioned as the world leader in that market with a proven ability to build and scale, and we have a very strong position going into the future. With that, I will hand it over to Jesper.
Thanks, Bassel. Right, thanks a lot. My name is Jesper and I am the CMO in Ambu. I joined Ambu in May and I've worked for about 18 years in different medical device and medtech companies in country and regional roles. I've headed up a number of different global functions as well. I'm really proud that my role in Ambu is to make sure that our innovation roadmap and our market offerings are really what position us well, both for our own future growth, but also for driving customer value outside of all the inspiring people. The main reason I joined Ambu is because I could see it was a place where you could be in service of a company, but also be in service of a change for the better in the healthcare system.
Today I get to cover our business area strategies for respiratory, for urology, for ENT, and for GI, really elaborating on what Britt opened up with. Whilst we have a lot of ground we'll cover, I have three overall main messages. The first one is that the single-use endoscopy opportunity is substantial in each of the business areas. You heard from Bassel just now and I'll delve a little bit more into that. The second message is that Ambu is well positioned to drive growth and capitalize on those opportunities already today. The third one is that we see a lot of runway, still a lot of runway to still drive further adoption and further growth in the future. Let's start with respiratory, sort of the place where it all began for Ambu, where we pioneered single-use endoscopy and established that market standard.
It's also our largest business area and it's one where we still see significant runway for growth in this market. We're better placed than any other company to win if we start with the underlying drivers of the market we play in. There's lots of them. They are really the drivers that underpin the demand for endoscopy and therefore support our long-term growth. The impact is profound. Conditions like lung cancers, chronic respiratory diseases, respiratory infections like influenza, they affect millions of lives every single year. That's really what compels the healthcare system and us to act, right? It's really that that has resulted in the very exciting market opportunity we see in respiratory. Two key points about that market that we've been instrumental in building. Firstly, it's a DKK 15 billion market opportunity, as Bassel also outlined.
The vast majority of these procedures, they can be serviced with Ambu solutions today. It's also a place where we can see we still have a lot of runway in terms of single-use adoption. When we view the split on this market, we can see that about two thirds of it sits in the ICU and the OR, and about a third sits in the bronchosuite environment. So far, single-use has proven particularly well suited for the ICU and the OR segment. Why is that? That's because if you're treating patients in that segment, you want flexible solutions, you want them to be easily available, and you want them to be easy to use. That's really what enables you to provide optimal care in those environments.
As our solutions become more and more advanced, we do also predict that we will be able, over time, in the suite environment to service those more advanced procedures in that space. Both our traditional strongholds in ICU, OR, and the suite environment therefore represent major and exciting opportunities for Ambu, with plenty of runway to still pursue. If we delve into how we service that market, how we service that market is we bring solutions to that market today in respiratory that comprise the broadest and most advanced portfolio in this industry. That portfolio includes, as you can see up on screen, a broad range of single-use bronchoscopes, as well as our video laryngoscopes and one lung ventilation solutions.
They're all powered by the one Ambu endoscopy platform, just like all of our single-use endoscopy solutions are, and that full solution we bring to market places us well to drive growth in that market today. We also understand that to unlock the next wave of growth, we need to stay ahead of the innovation curve still and drive strong commercial execution. To really strengthen that leadership position we command today, we need to make sure we pioneer what we call intelligent care with our Endo Intelligence platform that Bassel will also talk about later today. That can, for instance, be with clinical training softwares. We will build an enhanced presence in the suite environment with solutions that really cater to that space. Like I said, it's increasingly advanced procedures. An example of a product that does exactly that is aScope 5 Broncho .
Let's take a look at that, and then subsequently I'll also cover the newest member of our respiratory family, namely SureSight. When we start with aScope Broncho 5, there's a fair amount of content on the slide. When you have innovation as a cornerstone in your strategy, I think the main point is that we have a track record in Ambu of driving and demonstrating that we could unlock growth and single-use adoption with that innovation. You heard about aScope Broncho 5 a little bit earlier, but it's really a product today that is recognized by clinicians as the best performing single-use bronchoscope out there. It performs on par with or better than a number of the reusable scopes and is certainly far and away the best single-use option out there, for instance, on a number of parameters, for instance on image quality.
We can see that clinical leadership really also reflected in the numbers. The applicability of this product means that it's really driving rapid adoption since we launched it a few years ago. We can also see that the innovation we've been able to drive with aScope 5 Broncho enables us to command a price premium today, reinforcing our market leadership. With that, let's also take a look at SureSight. SureSight is just exciting. The product's exciting and the potential it holds for Ambu is exciting. As a lot of you will be aware, it was actually only back in January that we brought this solution to market. Even though I've only been in the company since May, somehow it just seems like it's been around for a long time already.
When we came out of the development process with this entry into the video laryngoscopy segment, we really entered with a strong solution and into a market opportunity where the preferred intubation method is really becoming video laryngoscopy. About 50% of those intubations now are performed with VL and that means that we're looking at a significant market opportunity even in the U.S. alone, as you can see up on slide, and an opportunity that is growing 15% - 20%. The product in itself places us very, very well to capture an exciting and emerging opportunity in the market. I think what we're equally excited about is the fact that this product is more than its standalone impact, it has a synergistic relationship with our bronchoscopes.
When we use SureSight and, or rather when our customers use SureSight and aScope bronchoscopes together, use them simultaneously in our dual view functionality, what do you get? You get a number of clinical and efficiency related benefits. As a clinician, you can intubate faster, you can position better, ultimately leading to better outcomes. Our customers are really recognizing these benefits. We're quite encouraged by the momentum we're seeing since the SureSight launch, both in the product itself, but certainly also in our overall respiratory business. That doesn't just have to do with financials. We can also see really strong new customer acquisition as well as the fact that we're able to build moats around our existing customers. I think you can say that with the SureSight launch, we're really neutralizing the main competitive issue we saw in this market.
When you have momentum, you have to capitalize on it, you have to keep innovating. I think the next cap off of that rank will be our launch of SureSight Mobile for the emergency services segment that will be launched this fiscal year 2025/2026. We're excited about that one too. It's not the only innovation avenue we're pursuing. If you will have heard in both Britt's section and later on today, innovation is core to our strategy, both in the short term and in the long term. When we look at that innovation direction for respiratory, we really focus on three overall main tracks. Firstly, we'll develop the next generation of bronchoscopes. We predict that they'll be able to enable the most advanced procedures. With our portfolio, we'll enhance our Endo Intelligence platform with, for instance, like I said, AI-enabled clinical training.
The picture up on screen is actually from one such solution. Lastly, we will of course also evaluate adjacencies and explore them so that we can continue to accelerate single-use adoption in this space and consolidate our leadership position in the market. We see a lot of opportunities still in respiratory and Ambu is well positioned to win in this space and extend that leadership position. The way we do that is by advancing our innovation and driving our commercial execution. What that does for us is really grow market leadership and single-use adoption. I spoke about leading intelligent care with Endo Intelligence, which Bassel will come back and talk more about later today. It's a way to further differentiate our solutions. It's a way to drive customer connectivity, which Bassel also briefly touched upon.
Lastly, we'll grow in the suite environment, building on a strong base we already have in ICU, NOR, and with the solutions to fit. As a result, we project a future in respiratory where we have extended our number one position in the market and we've driven single-use bronchoscopy to really being the standard of care. Those two are two very significant outcomes for this company and they will represent significant growth drivers for the company, placing us well on a winning trajectory. You shouldn't just take my word for it. I think it would be great to listen to one of our users, one of our customers. I'm very pleased to finish up the respiratory session by welcoming Dr. George Christidis to the stage. He is a Consultant in Thoracic and Head and Neck Anesthesia at Guy's and St.
Thomas' Hospital in London where he also leads the Success in Single Lung Ventilation course. He's also an Honorary Senior Lecturer at King's College. I guess you can say then that he's really part of shaping the future of respiratory care. It gives me great pleasure to welcome Dr. Christidis to the stage.
Thank you. Good morning everyone. A little bit of a different talk for me today. Anyone who knows me, my name as I was presented is Dr. Christidis. I work at one of London's biggest tertiary centers for thoracic head and neck. I've been with my training and being a consultant, I've been there for almost 12 years. Just a little bit of a background. We are the largest, if not the second largest, tertiary referral center in London. We see a very big amount of head and neck. Difficult airway cases and thoracic cases come through the door a lot of times combined. We are a very heavy robotic surgical robotic training center. We have quite a few visitors coming from all over to see us. There is a lot of interaction in theater and in terms of training and education.
I run the one lung ventilation course internationally and I deliver education for trainees and for training nurses to use our products. Why am I here today and why have I been asked to be here today? There are quite a few anesthetists out there. Why? Because I drive innovation. That's always been my key, a key component in my delivering care to patients. I generally have seen a lot of evolution come over the years. Since I started delivering thoracic anesthesia over 12 years ago. I started using Ambu products when they were still challenging projects, as with all of our other endoscopes, because we were all learning how to use all these bronchoscopes and all these video laryngoscopes that were out there. None of us really knew what to do with it. I have been part. I have followed this evolution over the years.
Why am I here today? To tell you how one screen, one screen alone can connect care with continuous visualization. Something we've been fighting as anesthetists, those of us that actually believe in this. To develop and further educate people over the years. Why I believe the role of airway visualization tools, including, improves health and care. Health care and ensures patient safety. Patient safety is a key word here. The benefits and challenges of single-use endoscopy, which I am a very heavy advocate about. I do apologize in advance because some of the images and the videos may be a little bit graphic, but I'm a firm believer that if you don't talk with evidence, it's best not to talk. This is why I'm here. This is the catchphrase, connecting care with continuous visualization. This is exactly what this product does. This is a case in the operating theater.
That's the surgeon I work with, Mr. Andrea Bille. He's a robotic thoracic surgeon and he trains quite a lot in other countries. We've had visitors coming and a lot of times we've been in this scenario that you see there. More often than not people are asking, what is that? What is that in your screen? Like, how are you linking this? How are you talking? This is why this slide is very important to me. This is a robotic case.
This.
We were coming out of the pandemic, patients were having delayed scans and this patient's cancer had eroded into the bronchus. Something that wasn't identified because in the previous scan it wasn't there. While he was operating, something wasn't going right. I was using a VivaSight continuous visualization tube that you'll see. He said, would you do a bronchoscopy. I did what you can see there, there's a split screen. I did a bronchoscopy and there it was, there was a cancer in the bronchus. We converted to open. While he did open, he was then asking me to continue with my bronchoscopy so he could see roughly where it was because it wasn't very evident from the outside. You can see we've opened the chest there, there's the open part, but there's me on the inside trying to guide. This tried to guide him.
This helps in having a conversation. This links teams, this is how teams come together. This is a surgeon and an anesthetist making a shared decision. This is the evolution of the screen. Previously we had one screen years ago. You could either connect a bronchoscope to it or you could connect a VivaSight double lumen. Over the years, then came the screen where you could split the screen and you could connect to the bronchoscope with the double lumen tube. Then came even more enhanced images on that and then the aScope 5 came out so you had an even better visualization of what you were looking at. Only behold, the video laryngoscope came out finally. That completed everything. This is the complete airway solution.
You start from intubation using the video laryngoscope or the bronchoscope, or both of them together, as we'll see with the difficult airway guidelines. That takes you up to going through the vocal cords, what we call the voice box. From there on, you will either ventilate or isolate the lung. There you can use the single lumen VivaSight tube or the double lumen tube. Both of these are video enabled devices. They have a camera at the tip that enables continuous visualization of the airway. Finally, once you're through, you're looking at whatever you're looking at there, and that's great. You may need to inspect, diagnose and treat. Therefore you can use the bronchoscope and split the screen again with your tube.
This is the solution from the nose to the mouth to the voice box to what we call the trachea here as it divides into the two lungs and then further into the lungs. That's your complete airway solution. From a clinical perspective, why do I care so much? The main two categories to talk about are theater ergonomics. For those of us that do robotic head and neck and robotic thoracic surgery, robotics is taking over the market now and most surgeries haven't been done robotically. For those that maybe didn't know, you could have your knee replacement done with a robot now, so God knows what's next. However, there isn't enough space for more than one drip stand. You need to think about ergonomics. There's not enough space. Surgeons have a lot of equipment in that room. Anesthetists have one tiny stand, as usual.
One device, one screen does all, fits all components. It's absolutely fine, doesn't take any space. One thing which I particularly talk about in thoracics is that if you have to emergency undock, and this is something that we do training on, we do drills on this, the robot doesn't come out. All they do is they swing it to the top and essentially kick the anesthetist out of the way. If you need access to the patient, you are crawling under the arms of the Da Vinci robot. That is why having that screen enables you to see what's going on. If you had to do a bronchoscopy blindly, if you were using a blind tube to try and reposition that tube, unless you're very good at yoga, you'd really need some flexibility to achieve that. I personally am not.
In terms of sustainability, obviously, to those of us that matter, single-use, we mostly prefer. I'll explain why. The pandemic had a lot to do with this. Recycling needs to be an option. It's starting to be an option. I think we're going to get there. This is one case that I'm very passionate about. It's continuous visualization of the airway again during unforeseen events. You see that instrument coming through, really shouldn't be there. This is a double lumen tube. That is the left, the entry to your left lung, where the left tube is, is in the left component. The right side of your lung, the right main bronchus, which the surgeons are operating in, and that instrument came in. In this case, he simply forgot to tell me this was an intentional perforation of the bronchus, but he forgot to tell me. Why do I care?
Because if that instrument came even closer to my tube, if anyone can see that hint of blue there, that is the cuff that allows lung isolation. That is how we complete the surgery. If that ruptures, I'm in trouble. That is why I care. This is the image from the robot on the outside, and you can see that this is the perforation. The instrument came through and I can see it here. This is an image from the outside, this is an image from the inside, and these run concurrently. You have one big screen like these TVs, maybe not as big in theater, which demonstrates what they're doing, and then you have mine, which demonstrates what I'm doing. This is why I particularly advocate for continuous visualization of the airway.
It really does not foresee these adverse events, but keeps patients safe from these adverse events affecting them. The clinical benefits that I think when it comes to single-use, if the pandemic taught us anything, and certainly me, because I was on the teams, the intubating teams during the pandemic, it was a very difficult time for clinicians. They limit contact patient with the airway. I do not want to be near any patient's airway anymore. I've done it for many years at my own risk. Now I use video laryngoscopes. Video laryngoscopes are going to start being our go-to technique. This is what the difficult airway algorithms are now advocating. We do not want to come close to patient airways. Difficult airways are more and more common. It's actually quite scary how the incidence of head and neck cancer is increasing, as well as abnormal pathology in the airways.
As I said, video laryngoscopes are a very big part of the difficult airway guidelines, and the algorithms, they are going to be the go-to technique and they will replace direct laryngoscopies. The handheld laryngoscopes, where we have to go very near the patient's mouth, the airway in order to intubate, you can perform video-assisted fiber optic techniques, the hybrid technique. This is very popular and we teach it quite heavily and generally when it comes to. Yes, we've spoken about the single-use secretion management. Another big concern, as you can probably anticipate, head and neck cancers and lung cancers are associated with smoking and a heavy secretion load, not always associated with smoking. One problem we particularly have is that those secretions can thicken up and they can turn into these plugs, these gelatinous plugs that if not treated essentially block off a part of the lung.
What then happens? You take the patient to the recovery room. Patients are struggling to breathe. You need one-to-one nursing, which we all know that with staff shortages it's not that easy. Nowadays you need chest physiotherapy in the recovery room. We get the physiotherapist to come in, we nebulize them with these specific devices. There is even more plastic to use and there are even more time-consuming procedures for the nurses to do. High flow oxygen, which is a bit of a tricky thing, although we do have that facility, and high dependency care, which again comes at a great cost. The faster we treat these, as with anything in healthcare, the less likely you are to impact staff shortages, patient safety, and needing high dependency.
All of this eventually leads to cost, which is what usually healthcare boils down to, because we all want to provide the best care, but we just want to minimize the amount of cost. This is what I mean about the secretions blocking the airway. That's the entry into the right main bronchus into the right lung. You can see that these secretions turned into a gelatinous plug. I will put my hand up and say, I was busy doing other things with this patient who was quite sick, and I let this one go, but I saw it and I managed to clear it all out. Look at the amount of effort it takes to suction all of this out. Imagine having to do this with simply nebulizing in the recovery room, waiting for it to loosen up. It does take a while.
You can see that takes a lot of effort. As someone really said to me recently, out of sight, out of mind. What you see really doesn't bother you, but what you see does bother you. In this case, this is what leads to patient safety. If you treat it and you're not blindsided by it, then that's when you get the best outcomes. This is just to demonstrate in terms of the difficult airway algorithms. We are teaching this very heavily now in all the airway conferences. This is a video laryngoscope on the left. This was a case. I struggled to intubate. I couldn't get the breathing tube in. I used different airway adjuncts. Nothing helped me. One technique we teach is the video assisted fiber optic technique. This is where you use the bronchoscope with the video laryngoscope. Two screens.
That's the bronchoscope, that's the bronchoscope, and that's a video laryngoscope. The idea is, if you cannot get high enough to get into the voice box, by maneuvering the bronchoscope with the lever, you can actually direct it up and then go down. You'll be surprised to hear that we showed a couple of these videos to a couple of my colleagues' kids and they found it quite intuitive because they're so used to playing these games with all these different gadgets that I personally wasn't very attuned to. They didn't find it impressive at all. The only thing they found impressive was looking at this and saying, what is that? What is that? They really didn't care about this bit. That's just to say that all of this innovation comes naturally to the next generation. I'm trying not to stay behind and here I am now again.
Like I said, this is another marriage now. We spoke about the video laryngoscope with the fiber optic scope. Now we're talking about the actual—oh, sorry, how do I go back to that?
There we are.
Now we're talking about the actual double lumen tube and having to do a bronchoscopy during the procedure. This is another case similar to the one before, where we found that the cancer had eroded the bronchus again. This was all coming out from the pandemic realizing that patients were having delayed scans. Unfortunately, till now, it can even take us up to four weeks to have scans reported. That's how busy we are in healthcare, because cancer is on the rise. We are just running and running and it's a rat race to treat these cancers. Any device that offers any innovative way of dealing with these is more than welcome. Finally, I think this is the last bit, the new kid on the block, robotic assisted bronchoscopies. Obviously, this was coming too. In this specific technique, which I really am very passionate about, and I explain why.
It's a cath lab room in interventional radiology, which is very busy. Can see my pumps. There's one screw screen, there's me, I've just intubated, I'm doing the bronchoscopy and then I hand over to the either the surgeon or the respiratory physician, whoever's doing it. Traditionally, patients with lung metastasis from either colorectal cancer or breast cancer would have lung surgery via either laparoscopic or robotic to have small wedges done. What we now do to avoid surgery is that you use artificial intelligence, which was going to come inevitably. What you do is you superimpose the scans, the CT scans into the AI technology and that tells you how to super identify the lesion and get to it.
Actually, what you're doing is it creates a path whereby the respiratory physician or the surgeon follows and follows and follows it with the bronchoscope and they finally get there through the Da Vinci robot and they can biopsy that lesion, something that was impossible a few years ago. Essentially, this is what we do. That's George Santis, Professor Santis. He's the respiratory physician I work with. Again, this is using the single lumen tube, the VivaSight, and then he does the bronchoscopy or I do it for him and then he takes over and this is again what you see. Essentially, this one device tells us where he is. I can preempt if there's blood or secretions in the airway. He does his bit, I do mine.
Robotic bronchoscopies are definitely a game changer when it comes to biopsying, diagnosing, and I won't say treating lung cancer because I don't treat lung cancer, but definitely when it comes to diagnosis and it does prevent surgery. In terms of single-use, finally, it's what I mentioned before. Essentially, I personally and most of us as anesthetists, we want to minimize contact with the airway. Again, we want to limit the space in the operating room and in the intensive care. We want less bulky products, user friendly. Essentially, what we don't want is reprocessing staff. We don't want even more staff to have to clean even more laryngoscopes and endoscopes. We want portable devices and we want cost minimizing. That's what we try and do. However, in terms of the pressures we're under, obviously there's a cost when it comes to single-use material.
There are sustainability concerns, but again, I think that's been addressed by obviously you can see these chairs and we at Guy's and St. Thomas are going to be one of the first to adopt the recyclable bins, to work with Ambu towards recycling these. In terms of inventory, space as well, because, you know, everything needs space. The one thing I would like to say is that over the years and seeing the evolution from using disposable, reusable to single-use, personally I'd like to know that if someone was going to intubate me, I don't want a video laryngoscope that may have some mucus left over from a previous patient that's dried and then inserted into my mouth.
If I was to ask whether I care more about cost or whether I care about having an infected product in my mouth, I will go for the latter and that's personally me. I don't look at cost and I think there is a drive in healthcare towards just focusing on patient safety and we somehow make it work with cost. Thank you very much.
Thank you, Dr. Christidis. I've worked in medtech and medical devices for many years, like I said earlier, and one of the experiences I will never tire of is listening to our solutions make a real difference in real life. Time to move on to urology. This business area is one of Ambu's major growth engines now and in the future. It's really an exciting area for us in this market. We play in a very sizable market and there are many technologies and therapy areas in urology, but our platform and our innovation pipeline are really what enable us to accelerate single-use adoption by winning in this high potential segment. Again, let's take a look at why that potential is so high. There are many conditions that can lead to urological issues.
They can stem from bladder cancer, kidney and ureteral blockages, and severe UTIs, just to mention a few. Ultimately they are what drives the urology market. The numbers are just staggering. They all affect massive amounts of lives and they create a global disease burden in the process. The human toll in urological issues is quite significant, but so is the financial toll to the healthcare system. It's really those two factors that combine to build the market opportunity that is urology. Let's delve into that for endoscopy. For single-use endoscopy, urology is a DKK 35 billion opportunity. That is, as you would have noticed, more than twice the size of what we see in respiratory. The majority of the procedures can be addressed with the solutions we have in the market today.
I opened up by saying we can talk about a lot of different technologies and therapy areas when we talk about urology, but in Ambu's chosen technologies, that's really a story of cystoscopy and ureteroscopy. Cystoscopy is typically associated with fairly fast procedures. There's lots of them, the volumes are high and they typically take place in the ICU or outpatient settings. Ureteroscopy, conversely, somewhat lower volume of procedures, but also a higher level of reimbursement generally, and they take place in the OR environment. When we view the split of the market opportunity between these two areas, we see that it's about DKK 20 billion for cystoscopy and about DKK 15 billion for ureteroscopy. What these two areas have in common though, is that when we look at global single-use adoption numbers, we're still at a relatively early stage at 10%.
That's interesting because when you work in this space, it really has gone quite fast to get to that level. It also just shows us that there's plenty of runway and we're quite confident that trend will continue because the single-use value proposition just makes sense. In cystoscopy it gives you time efficiency gains, and in ureteroscopy it gives you less downtime due to repairs and cleaning. If you have an exciting market opportunity, you also have to have a market-leading portfolio. That's what we have in Ambu. It's composed of two generations of our cystoscopes as well as our relatively newly launched ureteroscope. Again, they're all powered by the Ambu endoscopy systems. These solutions drive strong growth today, but it's also a dynamic market. We know that to unlock the next wave of growth, we still need to drive further adoption.
From our leading position in cystoscopy, we have to leverage and accelerate based on the foothold we've created in ureteroscopy. Lastly, urology is an incredibly exciting area for our Endo Intelligence solutions. We can do a lot in that space and you'll hear more about that later from Bassel. Seeing as I've said, innovation and portfolio expansion matter. They play key parts of the urology strategy. I think it is important to just call out that we took a major step in that direction when we launched aScope 5 Uretero. That's the newest member of our family in urology. Let's just take a closer look at that solution. There's a fair amount of content on this slide, but what's really the key to take away is that when we talk about reusable options, they often break.
They break, they drive downtime and repair cost and they do that in a market opportunity that's DKK 15 billion. There's just got to be a better alternative than that. That better alternative is aScope 5 Uretero. That's a product where you get leading image quality and maneuverability and that leads to effective kidney stone management. While we're a relatively new player in this segment, we are very encouraged by the momentum we've seen especially in the fiscal year that we just closed yesterday, really substantiating that this launch is gathering encouraging momentum. There's lots to be excited about about aScope 5 Uretero. Of course, the innovation doesn't stop there, right? It's a broad space. We have to continue to innovate for customer value and acceleration of our urology growth. There are three major tracks along which we do that.
We want to innovate for the next generation of our core solution families. This is the next generation of cystoscopes, it's the next generation of ureteroscopes. That matters because we can continue to differentiate our solutions. It matters because I've said a couple of times that clinical breadth and portfolio breadth matters in this space. Secondly, I've talked to that Endo Intelligence is a great opportunity for us in urology. There are many different directions we can go in. For instance, imagine if we were able to provide live guidance to clinicians during procedures. Lastly, this is an area where it's very natural for us to explore and evaluate adjacencies to extend our leadership position. When we sum up for our urology business, I've said a few times that we're excited about it, and that's because we are excited about it.
We're excited about the growth it can drive today with our current solutions, and we're excited about the growth it drives in the future through our innovation agenda. That specifically means that in urology, we're advancing our innovation and our commercial execution to again grow that leadership and drive that single-use adoption, because that is a major opportunity in urology. We're accelerating ureteroscopy by building both on the position we already have in cystoscopy, but it's also a space where I mentioned we have those clear benefits in terms of cost and no downtime. We can lead intelligent care in this space to create even further differentiation and truly customer-connected solutions in urology. That also means that we're confident in being the company that extends our leadership position in urology and in the process really placing us as that clear number one player.
It also means that we're confident in a future where single-use really becomes the leading technology in both cystoscopy and ureteroscopy. I think it's even better to hear from someone who lives it every single day in a clinical environment. To finish up our session on urology, I'm very pleased to welcome Dr. Tareq Aro to the stage to talk about his experiences with single-use endoscopy and the Ambu solutions, as well as the evolving landscape in urological care. He's a distinguished urologist based in New York, where he serves as Director of Endourology and Stone Disease at the Smith Institute for Urology as part of Northwell Health. He also holds an appointment as an Assistant Professor at the Zucker School of Medicine. Welcome to the stage, Dr. Aro.
Thank you. Morning everyone. My name is Tareq Aro. Thanks for the introduction. My urologists specialize in endourology. There you go, I work in Northwell Health. Northwell Health is the second largest employer actually in New York, just after the government. I am the Director of Endourology and Kidney Stone Disease in the Eastern region. My training after urology had one year of robotic research here in Hopkins in Baltimore, which was an amazing year. Just to introduce me to the idea of how to transform an idea into a product, which is something we don't really get exposed to in the medical school training. After that, I did my clinical years in the Northwell system for the combined two years of endourology and robotic surgery. Joined the practice after.
I'm honored to be invited today to talk a little bit about my journey with endoscopy, how the past transformed into today and what we expect to happen in the future and what we see is happening in front of us. I put together a little bit of a timeline here and excuse me if the dates or the years are not precise. It depends on the literature and who you ask. It's fascinating when you look at it, that when you look at the milestones in flexible at least cystoscopy and ureteroscopy in urology, roughly every decade there is really a leap and something that sort of changes the field and makes us think of how to do things differently. It really started with the fiber optics in the 1950s, did not really do much at the time.
The flexible cystoscope is really the one thing that at the time changed completely how we do office-based urology for different purposes. We did have the flexible ureteroscope somewhere in the 1980s. That did not gain a lot of popularity. Actually, if you talk to a lot of people in the 1980s and 1990s, you would hear stories about different hospitals having only a specific fellowship-trained urologist who is allowed to use the flexible ureteroscope and no one else is really allowed to use it. It was not really something that is very well common. The digital chip-on-tip in the 2000s is probably what really made the difference. Really only in the last couple of decades we started seeing ureteroscopy as the major player in at least kidney stone in particular. I'll get to that in a little bit.
Honestly, in recent years, the major topic that everyone is talking about is really the single-use ureteroscopes. I'll touch on that in a little bit. A lot of people talked here and I was listening to Bassel and Britt. I'm shocked that we all came to the same conclusions. I assure you we only met today. There are a lot of challenges in the healthcare system. Yes, we can talk about the access cost and the pressures that exist on the system. We can all talk about the workforce and basically the shortage of the workforce. It doesn't matter what specialty you come from. We need more providers, we need more doctors. There are more patients. It takes too long to train them as well. Typically speaking, it doesn't matter which country you come from, going through pre-med or whatever it's called, med school, residency, no fellowship.
It's probably going to take somewhere between 12 - 14 years until you can actually finish that journey and have another attending, which at that point also needs another two, three years until he or she feels confident to do what they need to do. There is a problem. We always talk about patient safety and quality. This has always been basically the cornerstone, the most important thing in anything that's medicine. It's really amazing that it's only in the last probably decade or less that the technology and sustainability became an issue. That was not really a talk or a topic that anyone used to talk about.
Part of it is because we have so much technology recently, but a big portion of it is that the pace of the technological advancements recently are making it actually a little bit difficult sometimes for the healthcare system to adopt them and to train new physicians on them. It's kind of a double-edged sword. We want that, but we want to make it in a way that it's also a little bit easier for the systems to actually implement now. You heard that we talk in urology mainly about cystoscopes and ureteroscopes now. I'm going to touch on the cystoscopes later, but I really want to focus on the ureteroscopes now. Why is that important? Ureteroscopes are mainly used for kidney stone treatment at this point. There are other applications, but that's the main one. I tried to look up the data on this.
It's not the kidney stone prevalence, it's the kidney stone procedures performed in the U.S. only for Medicare insurance, so it's not even all of them. This is really the most available data. It's amazing that you can see that there's exponential growth. We're practically doubling the numbers every decade or so. You can attribute that to a lot of things: aging population, dietary changes, global warming, morbid obesity, metabolic syndrome, you name it. The fact is the numbers are going up and we're doing more and more procedures literally every year. There was one dip in 2020, we all know when that was. It's amazing when you look at 2021, it actually caught up and continued with the exact same trajectory that we had even before. Now, when we treat kidney stones, we have three major ways to treat kidney stones. Doesn't matter where you are.
If you look at the chart on the right, PCNL, that curve at the bottom is the procedure that is usually reserved for the most complex stones, generally performed by specialized fellowship-trained endourologists. Honestly, it's not the bread and butter of what kidney stone treatment is. The two procedures that are really performed by almost everyone are the ureteroscopy and the shockwave lithotripsy. It doesn't need you to be a genius to realize that shockwave lithotripsy, that blue line, is practically disappearing, whether it's because of the outcomes or because ureteroscopy is becoming so much better. Practically speaking, and this is only to 2018, this doesn't even continue until today. Within a few years, ureteroscopy is really going to be the bread and butter, the king of what kidney stone treatment is across the world with some specialized cases for other scenarios.
Now, when you look at the ureteroscopy innovation, and this is very similar to what we talked about before, again, dates change. Based on the literature you look at, the miniaturization of the device made a major leap simply because smaller instruments are safer. We can actually go into the ureters, which is where we're talking about tubes and lumens inside the body that are only a few millimeters in diameter. The smaller, the better the chips. The digital chip-on-tip scope, again, really what made a huge difference. Our lasers became better, they became more efficient, they became stronger, dangerous in a way. We learned how to use them and again, we always come back to the single-use. Ureteroscope entered the market and that's really when everyone started talking about the use of ureteroscopy.
Now, when the debate goes to the reusable versus disposable ureteroscopes, we can talk about a lot of things and you heard a lot about different factors. The reusables are fragile, the reprocessing is way more labor intensive than people think it is, with a lot of variability between systems. It depends on how efficient they are, contamination risk. I wanted to break them down a little bit. I know we have a lot of, you know, everyone has something to say, but I wanted to support it by a little bit of data and I went and researched this a little bit. The first thing I actually looked at, and this is something that's not reported a lot simply because I think it's very difficult to capture.
If you look at OR time and OR waste, if to call it that way, OR time waste, I looked up what's the average OR time cost if I wanted to actually quantify it in academic centers in the U.S. It depends on the practice. There's a lot of variability. It depends on the type of cases you do, depends on the payer mix you have. If I want to be very conservative, we're talking about DKK 40 a minute at minimum. Some go all the way to DKK 150. Basically, I'm trying to say here if for whatever mundane reason I wasted 10 minutes during the case because there was a problem with the equipment, which is something no one cares about, no one's going to care about 10 minutes, no one is going to report 10 minutes and no one is actually going to file any complaint about that.
That's about DKK 400 for the case. Now DKK 400 is not a lot, especially for large systems. If you think about that, if that happens 2x, 3x a day across 20 rooms, we're talking more than DKK 20,000 a day. Take that for a month. That's more than half a million dollars for the system simply because of a 10 minute delay because there was a problem with the equipment when they opened it. Going forward, I believe personally that this is going to become a quantifiable factor that we will need to start. We will start basically demanding from both the surgeons and the companies and the hospitals to actually report and go by it.
When you look at the durability and repair, and I think, I don't remember, someone talked about it, there is this conception that the reusable ureter scopes are better or potentially better because you purchase the device, you have the one single time cost. After that you use it for as many times that you can use it without any cost after. It's not exactly accurate. One of the largest systematic reviews that looked at it found that on average, you need to repair or maintain those devices with ureteroscopes roughly every 15 uses. The cost of those repairs on average is about DKK 440 a case. Practically speaking, you're actually paying about DKK 440 every time you're opening that device. That's on top of the initial cost that you paid originally.
Yes, there are systems that have some kind of an umbrella insurance policy, but that's the same concept, you're still paying to actually use the device per case. Now, the sterilization, honestly, I think this is the easiest one. This battle has been completely lost at this point. Every single study that came out recently has shown that the reusable devices, especially with ureteroscope, simply because the channels are so small and they're so difficult to sterilize, are simply not sterilizable, at least not enough. Almost every study has shown that there is growth of microbial material in more than 10% of those devices after sterilization. There are 100% protein residues in those devices. A lot of the studies that have looked at the infection, actual infection rate, not just how much microbial growth there was, have shown that the reusable devices have more infection. That battle is lost.
One of the big factors that everyone has been talking about in recent years is really the environmental impact and the carbon footprint. There was always this conception again that disposable equipment is not good for the environment, which is, yes, I understand where that comes from. When we started actually analyzing the data in larger studies, we came to the conclusion that it's actually almost the same. This is before the recycling programs that we're hearing about now, and Ambu is actually leading one of them. The reason, just if anyone is wondering, is because of the sterilization process. The sterilization process, and specifically the fluids they use in the sterilization process, is actually worse sometimes than the carbon footprint that we have from the disposable scopes that we use.
With the exception of very large volume systems that have an extremely efficient sterilization process, that was the only place that they showed that there is, yes, an edge to the reusable ureteroscopes usage in terms of the carbon footprint. No one else showed that there is a difference. There was no statistical difference between the two. That one also went down the line. Now I wanted to look a little bit. Okay, what did we learn from the past? Because when you start looking at this data, we had the exact same discussion probably about five years ago when we talked about cystoscopes, disposable versus reusable. Regardless of the exact data in any of those studies, at the end of the day, when you look today at the utilization index in the United States.
of disposable cystoscopes, and a lot of this is actually Ambu data, the utilization index is not absolute numbers. The utilization index is skyrocketing year by year. It's just exponentially going up in the last five years. If this trend continues, those graphs are going to converge in a couple of years and we're going to start seeing that the disposable cystoscopes are going up further, more and more. Now, I wanted to talk about the single-use experience for me personally, and there's a lot I can say, especially with the cystoscopes in the office. How it transformed the office. It's simpler, more efficient, we have more staff availability because one is not tied up to do whatever we need to do for the sterilization process. The new HD scope has completely changed a lot of how we do office-based cystoscopy.
At the end, instead of saying that, I said a picture is worth more than a thousand words. Basically, this is what happened. Instead of having a bulky tower on the left with a person sitting in the lab always sterilizing the equipment, all of a sudden you have a PLA pack that has a scope in it and a single tablet-size screen that you can take anywhere with you, anywhere, which makes it completely one, convenient and two, innovative in how you do cystoscopies in any office. I think this is what's, other than everything that I said in terms of cost and sustainability, really driving all the providers and all the systems to really switch to the disposable equipment. Now, again, reusable versus disposable.
I personally think, and I had this discussion with a couple of colleagues, although this is the topic of discussion now, I honestly don't think this is the battle that's happening right now. I think we're just on the cusp of what happened with cystoscopy. Five years, the battle has been won. We just need to wait a little bit longer so we can see the exact same graph with disposable ureteroscopy happening just like disposable cystoscopy for the exact same reasons I showed you. Every single study that has come out in the last three, four years is showing the same thing. When we talk about surgeons and systems, we have different needs, we have different requests. Obviously, with surgeons, we always care about patient care and quality of care, reliability and complications. That's the most important thing.
Systems, you start hearing things around how much is the company reliable, how much support are we getting, what are the P&Ls we're having, what's the cost effectiveness. At the end of the day, the disposable ureteroscopes are going to be used. I personally think the question is, what's the next step? I put this here, if you remember, the first graph that I put. With every decade we had a leap. Surprisingly, almost all of them, with the exception of the chip on tip, are hardware leaps. We've done tremendous efforts and we really advanced the field in the last 20, 30 years in terms of hardware almost to the limit. There's surprisingly very minimal software innovations in the last several years.
Just to put this in perspective, and I'm not an engineer, those small boxes that you see in the operating rooms that actually analyze all the data and actually show us a picture on the screen, the computational capacity of those boxes is roughly 100x more than what we're actually using them for. There's a tremendous amount of data that is being analyzed second by second. Currently, nothing or very little is happening with it. We're all so happy to hear that, really. We're going to the next level of how can we integrate, not necessarily AI, that's potentially a HIPAA problem, but machine learning, advice, training, skill assessment, all into the devices that we already have.
The second question that needs to be asked, and I didn't have the exact answer, I admit I went to ChatGPT and I asked, give me an estimate of how many companies worldwide are producing a disposable ureteroscope right now. The answer I got is we don't know exactly, but a conservative assessment is around 20. I think that's probably true. I know at least 10 major companies that are producing them. There are probably another 10 minor companies that are doing them. That's not going to. That's not sustainable. The reality is, within a few years, there are going to be a couple of major players and they're going to lead the market with everything that is disposable, at least ureteroscopes, probably across the field of disposable endoscopy. The question is who does it first and who does it better?
I think those are the questions that we need to be asking ourselves. Thank you and thank you very much.
Thank you, Dr. Tareq. That concludes the stories and the sections really about our two main Endoscopy Solutions, respiratory and urology. We have another two to talk about, ENT and GI. I'll start with ENT. When we delve into this area, it's a focused business in terms of geographies and in terms of technological solutions, but it has a history of driving strong growth for Ambu and it has a future of driving strong growth for Ambu. Now we're a leading single-use player in this space, but as you also would have seen earlier, we still have a lot of room for single-use adoption in ENT. It's a relatively focused market in ENT. It's an attractive space though. The underlying driver is really visualization of the sinus and the throat, typically taking place in the ICU and the outpatient setting.
The reason I say it's a focused market is that a lot of it is really from a single-use perspective, placed in the U.S. and in the U.K. That quite simply has to do with clinical guidelines in these two geographies. What's interesting, I think, is that that alone, that focused market still yields a single-use market opportunity of DKK 20 billion. Again, with a majority of procedures that can be addressed with our solutions. Whilst we have created traction in single-use adoption, you can also see up on screen that there's lots to still go for. One of the reasons for that is that single-use just provides a really compelling case in ENT. It gives you simpler and more efficient ways of working if you're a clinician. To address the ENT market, we have made substantial inroads into the ICU with aScope 4 RhinoLaryngo as our solution.
We do also have our next-generation solution in the pipeline. That solution is very much about addressing the outpatient business. I think that's an important distinction. That means that our current and future solutions will play very clear roles in our portfolio, one for ICU, one for the outpatient, and like in all of our endoscopy business areas, they are powered by the Ambu endoscopy systems. With that in mind, our path to unlocking the next wave of growth for ENT is also clear because that means that we're extending our leading single-use position in our traditional base of business in ICU and venturing into creating a new stronghold in the outpatient sector segment. There is an opportunity to pioneer intelligent care delivery also in ENT, and that's really very much about creating efficiencies in the ways of working in the healthcare setting.
When we try to sort of bundle all that together for ENT, Ambu really is poised for further growth in this space as well. We have that strong base to build from, but also an innovation pipeline that is targeted at opening new segments. We can lead in the ICU, we can build on that base to create growth and unlock expansion into the outpatient setting. We can drive those customer efficiency gains in ENT in general with our intelligent care solutions. As a result, we do predict a future also for ENT, we'll be the number one single-use endoscopy company. That single-use is the leading technology in both ICU and in the outpatient setting for those focus markets where we play the most. That's ENT. Let's then finish up with GI.
You would have seen earlier that this is, when we look at market potential, the largest opportunity Ambu works in. It's larger than all of the other endoscopy business areas combined. When we do the math and how we approach unlocking that opportunity really is with a stepwise and long-term strategy. Let's start again with what drives the market. This substantial market opportunity in GI, where does it come from? It comes from macro trends in healthcare. When you have cancer types like colorectal cancer, gastric cancer, and also gastrointestinal bleeds, these are life-threatening conditions and they're conditions where it's crucial that there's early detection of the underlying conditions. That's just what yields this very large endoscopy opportunity for Ambu to play in. Let's dive into that market opportunity. I started out by saying it's massive.
As Bassel said, if you do the math and you do it at 100% full single-use penetration across gastroscopy, colonoscopy, and duodenoscopy combined, then what you get is that DKK 120 billion. We can also see it's early days for single-use adoption. There are three distinctly different segments in this market. Gastroscopy, those are high-volume diagnostic and therapeutic procedures, and they take place in several different places, several different sites of care. Colonoscopy is very much about screening. The volume numbers are large, but it's very much about screening. Then lastly, you have duodenoscopy. That's where we see the most complex of procedure types, and they typically take place in the suite environment. Even though single-use is at its early beginnings, there is a case for it in GI. There is a case for it, because what do you get with single-use?
You get access to endoscopy in any site of care environment that you're in. As we begin to see procedure types migrate between different sites of care, that matters. Still, building a market does take time. It does take time. Now, when we look at this market opportunity, we see a clear reason for why we should do it. If we refer back to our urology section, you may recall that we looked at that 10% global single-use adoption rate in that market. If we were to reach that same level in GI, it would represent a DKK 12 billion market opportunity. That's about twice as much as what Ambu sells today. Why should we believe that can be done? It's because the market trends over time really play into our hands. It's because we see clearer and clearer cases for single-use penetration.
It's because we're a company that is well positioned to really lead that single-use transformation, leveraging the platform synergies we have and building it just like we've done in other therapy areas. I'll delve into those in a little bit. I think it's also fair to look inwards a little bit and say, when we looked at our first foray into GI, it was not as successful as we had hoped at the time. I think the encouraging news is we understand why that didn't work out. Those reasons are clear because despite the FDA policies at the time about infection risk, concerns associated with reusable options, our starting point was still to tackle the most challenging part of GI, namely ERCP procedures with duodenoscopes. Those are procedures that are inherently associated with risks that are beyond the risks of infection, and they require extremely high, extremely accurate product performance.
At the time, at least the technology only partly allowed us to meet that. It wasn't time wasted because we did learn a lot as a company. We learned that efficiency and clinical performance are really key drivers of adoption, also over infection risk. We learned a lot about the suite environment and the capital cycles in that space, and also what it takes in terms of sales cycles and time to drive penetration there. Lastly, and most importantly, we learned a lot about our customers and we learned a lot about the areas that they do their work in. That means that we understand that much better now, including how we execute in that environment. We did also take those learnings and we've been able to launch the significantly improved, improved duodenoscope, which performs substantially better than Generation 1, including on image quality.
We did that because when we updated our GI strategy about three years ago, we still see a need in this segment. If you see a need in the segment, you should make the product. This is a product that has received positive customer feedback with really strong satisfaction ratings after we've begun putting it to market. It is also still a market segment with a sales process that's complex. It requires a high touch model. You have to be there and you have to be there a lot. That also means that our approach to commercialization is targeted and it is a bit more limited and really centered around the procedures and settings where single-use makes the most sense.
If we zoom out from Duo for a minute and just broadly look at how we approach GI, we have really sharpened our strategy to make sure that we are focusing strongly on the niches where we can see clear unsolved customer needs. The primary step in doing that has been the launch of our aScope Gastro and aScope Gastro Large solutions to really penetrate and redefine endoscopy in the gastroscopy segment. These solutions are associated with clear benefits because with them you get flexibility, you get constant availability. Insomuch that as a clinician you are not dependent on somebody or somewhere else in the hospital to be able to perform endoscopy where you are right now, if that's what you need to do. They give us suction capability, strong suction capability. For instance, with Gastro Large, that product has the largest working channel. That's just great for suction capability.
What that means is, for instance, that these solutions are great for managing bleeds. Those benefits make Gastro and Gastro Large ideal for use in the OR and ICU settings already known now, already today. As such, that also means that Gastro and Gastro Large are really the first step in us building our single-use business. Further in GI, this is where we build that clear conviction of the value proposition. It is from there that we take a stepwise approach to continuously identifying the most attractive niches for us to target. You could really simplify it. Say, as Henrik sometimes says, we win small now so we can win big down the line. As we build that GI business and we build the single-use market in GI, I think it's important to also come back to those market trends that I mentioned play in our favor.
We can see that there are more and more procedures that need to take place in the ICU and the OR environment, and clinicians are just expecting that to increase. We can see that there's an emergence of procedure migration into entirely new sites of care. We've heard a few times today that the system is overloaded, and that's one of the major drivers of this. Lastly, technology is just moving fast in this space. Even versus a couple of years ago, we're at an entirely different place in terms of the technology we can access and use and what it costs for us to do so. That also means that as those market trends shift in our favor, then what has happened time and again is that new customer needs emerge and we can meet them as a result, as we've done in respiratory, in urology, and in ENT.
We know that a sizable portion of clinicians consider efficiency gains really a sizable advantage of single-use. Those benefits just become more pronounced when you take that procedure migration I spoke about into account. That means that Ambu is going to provide a way to rethink endoscopy and GI. We're the ones who can reduce the complexity for our customers. As you can see up on this slide, if you can reduce complexity, these are benefits that can really truly change the game for single-use in GI.
Because.
You will know as a customer, as a clinician, and if you work in supply chain in a hospital, that these solutions will always be available. You don't have to wait for them. You'll get the same performance every time. There is no declining quality over time. We free up time, free up budget, and there's cost transparency at what it's going to cost to perform the next procedure. These are all real benefits that can change the game in GI. Why can we do it in Ambu? That last point, why can we do it in Ambu? We're well positioned to really drive this shift, like I said, just as we've done in other areas. That's because we have a technology that advances image quality.
That's really what Finn and his team are doing every day in the lab, that advances that image quality and cost efficiency, really making single-use a compelling choice. It's also because we have experience in doing it. We know how to clearly identify customer needs and innovate towards them. It's because our scale, as Graziela also will talk about, enables us to achieve cost leadership. That means we can provide these solutions at a cost that is meaningful to the healthcare systems. We have a commercial footprint also that gives us direct access to our decision makers. We've just seen time and time again that that's key to driving adoption. I think it's also important to say for GI that when we say stepwise strategy, that also goes for that commercial footprint. We expand as the business expands.
Lastly, we've spoken a few times about the synergies across our business areas. We've spoken about the benefit of standardization in a healthcare system. That's really true when we look at driving uptake for single-use in GI. When we sum up for our GI business, we're the company that will lead the single-use transformation with a long-term stepwise strategy. We have already begun, we're already underway in building that foothold by educating our clinicians on the value of the single-use value proposition. We're expanding the traction we're already seeing in ICUs and OR with our gastro and gastrolarge solutions. As I spoke about, we're also the company that is advancing that stepwise strategy by making sure we are also innovating for the long-term expansion play into new settings. As a result, we do project a future in GI where single-use becomes the standard of care in ICU and in OR.
We're seeing a future where we're seeing strong adoption of single-use in the major market segments that we focus on as we ultimately move towards that long-term aspiration of leading the transformation towards single-use. That's all of our business areas in Endoscopy Solutions. The time is 11:54 A.M. If I'm not mistaken, I do believe it's also time for lunch that will be served in this room. I've been told that I have to make sure to ask all of you to please be back in this room at 12:30 P.M.
Thank you.
All right. Welcome. Oh my gosh. Welcome back everyone. I hope you enjoyed lunch. Before lunch, we shared, you know what an attractive market we see single-use endoscopy is. We shared that we are a clear world leader in the market and we have a very strong position to lead in the future with our solutions. I wanted to, you know, in terms of our solutions, one of the strengths we have is the full breadth of our endoscopy portfolio that we spoke about across Respiratory, Urology, ENT, and GI. We have two kind of like cross-cutting topics that go across our business areas. We have Endo Intelligence, which is our technology platform, and we have sustainability. I'm going to go through both of those now, starting with Endo Intelligence. There are three main things that I want to cover in this session.
The first one is that customers, health systems, have important needs which can be addressed through digital technology and endoscopy. Second is that we're already a leader in addressing those needs with our current platform. The third one is that with our Endo Intelligence platform, we're going to be in a very strong position to continue to lead. Endo Intelligence is our next generation technology platform, a platform that brings new capabilities, hardware, software, and AI-enabled applications to address customer needs. Let's start with the customer needs. As I shared, health systems have important needs in endoscopy that can be addressed through technology. This is true before, during, and after the procedure. Before the procedure, in areas like training and preparation. You heard from Dr. Tareq how long they spend on training and how much it takes to onboard into a new technology. Bronchoscopy is a great example.
It takes on average an early-in-career doctor about 80 bronchoscopies before they can do it proficiently. Anything we can do to shorten the learning curve is extremely valuable for customers. During a procedure, in areas like disease diagnostic and treatment guidance. Here, cystoscopy is a great example where for cancer detection, on average a typical cystoscopy could have a 20% miss rate in terms of cancerous lesions. That's obviously an area where things like AI could help, as it has in other areas in endoscopy and healthcare. Finally, after the procedure, in terms of automated documentation and reporting, doctors on average spend about two hours per day on these tasks. Anything that we can do to streamline their workflow and efficiency will be very appreciated. It's not just the time spent, it's also the way they're doing it.
Right now, health systems and doctors are still working off of printouts, USB sticks, using their phone to take a photo of a screen and then sending it via WhatsApp for many reasons. Patient care, streamlined operations, cybersecurity, there are many reasons why it's a top priority for health systems to address this. Across the procedure journey, important customer needs. The question is, how is Ambu playing in terms of addressing those needs? Something that we're proud of is that we're already helping customers today and we're already a leader on this topic in addressing unmet needs with our advanced technology platform. We've made important leaps to do this. If you look back 10 years ago, we called our aView a display unit, because that's basically what it did.
It would display the image from the end of the camera onto the screen and it would do that for a bronchoscope, that was its main functionality. Now, fast forward 10 years, we've developed it into an entire ecosystem. An ecosystem which is covering, of course, our full range of endoscopes, respiratory, urology, ENT, and GI, but is also bringing new advanced features like advanced image processing, customer integration into their electronic health records, cybersecurity. Still, with this platform, we've been asking ourselves, how do we close the gap to reusables with our platform? Now, with ZOOM AHEAD , we don't ask ourselves that question anymore. We're already the standard of care in many areas and instead we ask ourselves, what are the things that we can do through these digital technologies that don't exist today in single-use or reusable? That is what Endo Intelligence is all about.
It's about being the global leader in endoscopy and bringing AI-enabled diagnostic treatment support training into health systems. The exciting thing about Endo Intelligence is it's not just a future vision. The first wave of Endo Intelligence is already in the market today. Before I get to that, I want to start with our 2.0 endoscopy ecosystem. Now, today, our 2.0 solutions platform has been one of the most important ways that we've helped to develop the single-use endoscopy market. We have the largest installed base globally. It includes the two hardware options you see, aView 2 Advance and aBox 2. One more portable, one more powerful, one, the full range of compatibility with endoscopes, and importantly, one software platform, a unified software platform that operates across the entire range of endoscopes. On top of that, we started to introduce new features that make Ambu stand apart.
If you look on the right side, you see three key examples of that. One is advanced imaging. We have proprietary image enhancement tools, tools that don't exist in any other single-use endoscopy platform, things like advanced red contrast or ARC. It's something that helps doctors distinguish between different tissue types when they're doing a procedure. We also have customer integration where we set up our customers, a connection between our Ambu platform and their electronic health record. When we do that, we save time on data entry, on using USB sticks. We create very appreciative customers. It also helps to drive customer stickiness because once they get set up with digital integration, they see the workflow benefits and don't want to compromise that by switching to another provider. Finally, cybersecurity. Cybersecurity is a topic that we're seeing customers ask more and more about.
They're asking about suppliers, what are your cybersecurity credentials? This is also an area where we lead across all single-use endoscopy players. We have the leading credentials. Bringing that all together, let me share with you a video that shows the experience when one of the most prominent health systems in the U.S. adopts the Ambu platform.
Prior to implementation of the work list, every time we took images or.
We would have videos of patient procedures.
To physically print out the image.
We would take that and scan it in directly into the patient's channel.
Sometimes I took my phone and we would take pictures of the image on the monitor, and then I would.
Use my phone to upload the images that way. All those modalities are very time consuming and very inefficient. Obviously, this is a very insecure method for uploading patient media to an EHR system. Patient data can be misplaced, can be lost, or even stolen.
However, with implementation of work list on.
the aView 2 Advance we're able to instantaneously upload patient media, you know, images and.
Videos of interest directly onto patients' charts.
On the Epic system, having the Ambu system basically changed our workflow overnight.
It made everything streamlined, it made everything much easier. Ambu team was able to come in and integrate the hardware and the software into our network.
The aView 2 Advance system was able.
To integrate and connect to our EHR.
Seamlessly in a much more user-friendly way.
A much easier method did.
You heard from Dr. Zhao just how transformative the Ambu system was for NYU's workflow and efficiency. What's exciting for us is that this is just the tip of the iceberg because right now the vast majority of health systems are not taking full advantage of the functionality of integrating the Ambu platform into their electronic health records. Obviously, that means that there's significant room for us to further drive this adoption and increase customer satisfaction and stickiness. If we look to Endo Intelligence, we see even more opportunity to drive customer impact. For Endo Intelligence, we preserve our shining strength, which is our unified platform, hardware platform, and then end software platform. We build on that with next generation hardware, next generation software, and advanced AI-enabled applications. In terms of where we focus our innovation efforts, it's exactly the unmet needs that I spoke about earlier.
It's before the procedure for training solutions, during the procedure with diagnostic support, and then after the procedure to further streamline documentation. As I said, this is not just a conceptual kind of future vision on a slide. The first release of Endo Intelligence is already in action today. To show you Endo Intelligence in action, I want to share our first AI-based application, which is an application that's been deployed in many markets around the world and with growing evidence behind it. I mentioned earlier that in bronchoscopy one of the most important needs is to improve training of doctors in doing effective and complete bronchoscopies. It's an important need because if you do a better bronchoscopy covering the entire lungs, then you probably get to a better diagnosis.
If you do a better diagnosis, you can have a more tailored treatment, and a more tailored treatment and a precise treatment means more responsible use of things like antibiotics. It's a top priority, a top priority for the World Health Organization and the CDC, an overall high priority to drive this better treatment and antibiotic use. Overall, doing high quality bronchoscopies is an important need. Because of that, our team, the R&D team, worked to develop a tool that can help address that need, a tool that can help to train doctors better on doing high quality bronchoscopies. You're going to see a video now to show how this works. On the video you'll see that our AI-based system basically does two things.
Number one is as you're navigating the lungs, it's basically a GPS that shows you where you are now and what are the lobes ahead, what are the parts of the lungs ahead. The second one, which you can see on the bottom right of the screen, is it shows you where you've been, in this case in green, and importantly where you haven't been yet, to make sure that you're doing a complete bronchoscopy. With this foundation, we've built a training module, a testing module, a guided module, and then we deploy this application in an academic medical center. When we did that, what they found was that critical care doctors who were trained on this system did faster and more complete bronchoscopies than if they were trained using a human tutor. That's a result now that's been published in prominent journals like Critical Care Medicine and Chest.
On the back of that, the organic demand for this platform has been very high, very encouraging. As you can imagine, we also have our eye towards how do we then translate this into a clinical use case, not just a training case. This is just one example of Endo Intelligence in action applied to bronchoscopy. We have a full innovation roadmap of how do we apply this to all of our strategic focus areas. As we do that, it will enable us to have a strong path to leadership in endoscopy because we will continue to increase our installed base, which is already the largest in the world. We'll advance our platform infrastructure with next generation technologies and we'll pioneer breakthrough solutions just like the AI tool that you just saw. As we do that, we'll extend our leadership position.
We'll continue to be the number one player within digital solutions. More importantly, we're going to start to bring advanced technologies to elevate the standard of care in the areas we operate. When I started the session, I mentioned there's two different kind of focus topics that cut across our business areas: Endo Intelligence, sustainability. Now I want to switch gears and talk about sustainability. The first question is why is a Regional Sales President up here talking about sustainability? It's because for Ambu, sustainability is not just a corporate ESG topic. Sustainability is a growth driver because if we do sustainability right, we accelerate the transition from reusable to single-use endoscopes. We also strengthen our position within the competitive environment of single-use endoscopes. There are three important things when it comes to sustainability. The first one is this is an important and growing priority for our customers.
The second is that we're proud to be a first mover and a leader in this area. We're the first and only company to pioneer breakthrough things like bioplastics in our endoscopes and the recycling platform, which we'll talk more about. The third is that we're committed to continue to lead in sustainability and take even more bold steps to drive to advance this in the future. We believe that's going to drive differentiation and it's also going to drive business growth. Let's start with customers. I mentioned sustainability is a growing priority for our customers. Health systems recognize that they're a major contributor to CO2 emissions. They're asking themselves, how can they address that? They're asking us, how can we help? Where we see it most visibly is in tender criteria.
Typically, when a hospital issues a tender for single-use endoscopes, in the past, it might include topics like product quality, reliability, supply, service, cost. Now, over the past year we've seen that in our EU5 markets, about 10% of tenders issued have sustainability as a scoring criteria in some form or another. We expect that number to only grow. Customers also tell us directly, they tell us that what they need from us is two things: recyclability and more sustainable materials. The great thing is that, as ever, responsive to customer needs, that's exactly where we're leading the way. We do have an important task ahead, which is to demonstrate in words and actions how our products are compatible with their sustainability goals and values. It starts by showcasing that single-use endoscopes can be better for the environment.
The evidence here is growing and it's true in many real-world health settings, because as you heard also from the doctors, cleaning reusable endoscopes is resource intensive. It requires special disposable equipment, chemicals, electricity, water. There's so much disposable waste in cleaning a reusable endoscope that in many customer settings it ends up being better for the environment to just use an Ambu scope. It's 20% better in the case of cystoscopy, which is based on a recent publication. That is an unintuitive finding for many customers. It also means that we need a lot of independent evidence and communication to be able to convince customers of this. The encouraging thing is, and I think, you know, it's great that we heard from these doctors unprompted, how they see it.
They are starting to recognize it more and more, the true underlying resource intensity of reusable and the benefits of single use. That's also one of the reasons we see continued rapid uptake of single-use endoscopes, even as sustainability becomes a more important purchasing criteria. When they do adopt, they are asking us what are we doing to do better on the things that matter most to them, the recyclability and the sustainable materials. That is also where we shine because Ambu is the world leader in driving sustainability and endoscopy. I remember sitting here or standing here two and a half years ago when we as a company committed to do two very bold things. Number one was we committed that we would introduce bioplastics into our full range of endoscopes.
I remember holding a bioplastic handle which was fresh off the manufacturing line in Malaysia and then somehow we had to go from that to having the full endoscope portfolio being single use. The second thing was that we committed to do recycling, get recycling pilots up and running in our major markets. Today I'm proud to say that we're ahead of plan on both fronts. For bioplastics, we are the first and only single-use endoscopy company. We've gone to prototype to having every single endoscope that comes off our manufacturing lines being made with bioplastics. As a reminder, when you transition from normal fossil fuel based plastics to bioplastics, you drive a 10% reduction in CO2 emissions. We're also the first to launch a recycling program. We have 25 hospitals, 26 after Dr.
George adopts, and I want to share a video of the progress we've made today in terms of our recycling.
The healthcare industry is responsible for 4.4%.
Of global emissions, and medical devices account.
For 71% of that footprint.
For hospitals, recycling medical devices isn't simple.
Regulations are complex, logistics are demanding, and solutions are rare.
Enter the Ambu Recircle program, a pioneering endoscope recycling program.
Ambu and its partners give hospitals an.
Efficient way to collect, transport, and recycle.
Used Ambu endoscopes into new non-medical products.
More than 25 hospitals in the U.S.
U.K., France, and Germany have already partnered with Ambu, turning shared environmental ambition into impactful action.
This is how we move healthcare forward together. Ambu care beyond expectations.
You can see the progress that we've made as the world leader in sustainability. The final thing I want to say is that we're committed to continue to lead on this topic. Our ambitions are becoming even more bold for recycling. By 2030, we're going to collect more than 1 million devices for recycling. Our scopes will be made by at least 50% circular materials. We're going to become the strongest advocates for customers incorporating sustainability into their purchasing criteria. It's an area where we're going to continue to excel. Because it's an investor day, I'll also highlight that we're going to support this without diluting margins. We're about to shift topics to anesthesia and patient monitoring. I just want to close by saying that in terms of endoscopy, you've heard it now, we see endoscopy as a very large, attractive, and fast-growing market.
We're very well positioned, we've built ourselves as a clear world leader in that market with a proven ability to build and scale, and we're very well positioned to continue to lead in the future with our full range of endoscopes, with our Endo Intelligence platform, and with everything we're doing to lead in sustainability. With that, I'm going to hand it over to Henrik, who's going to share more on our ambitions for anesthesia and patient monitoring.
Thank you very much, Bassel. Good day everybody. My name is Henrik. I am the CFO with Ambu. I believe I've met, if not all, then most of you in the room at least. Now I have been with Ambu for almost two years now and really enjoyed the journey and I'm excited today in this session first to present anesthesia and patient monitoring. Celebrate the legacy of our company, the growth and the success and then wrap up this section on winning in attractive markets. If we look, we go to this one. If we look at our anesthesia and patient monitoring business, we have over the past two years been through an impressive commercial transformation where we have managed to improve the commercial setup, increase prices, and maintain strong customer loyalty based on high quality and high reliability of our products.
With all of that combined, we've managed to increase the compound annual growth for anesthesia to 8.4% and for patient monitoring to 8%. That is quite a unique transformation considering where we were two years ago. Even though I think I share my colleagues' excitement for industrial solutions, which will be a very big part of our future, I'm also very excited about this journey moving forward. For anesthesia and patient monitoring, we will continue to drive the positive momentum we have now through a combination of, one, maintaining the strengthened pricing governance we put in place now, two, continuing to optimize the commercial organization, something Scott will also come back to later, and last, continue to invest in our supply chain both for efficiency in manufacturing, for resilience, and for continued high quality.
These initiatives are all designed to ensure that we can continue to drive further value out of our anesthesia and patient monitoring business. Let me now present the two businesses separate because they are indeed very separate. Let me start with anesthesia, but before I start with the details of the business, I also want to take this chance to look back and celebrate the legacy and the strength of our products. 2025 marks the 70 years anniversary for the launch of our first resuscitator product, also known as the Ambu bag. I think if many of you have ever come across Ambu in a clinical world, this would be the first product most would think about. It would be the first product that a nurse would know. They would not necessarily know the word resuscitator, but they would know the word Ambu bag in an upgraded version.
This product continues to be a solution for the market today. More than 6 million patients are every year ventilated with the resuscitator with the Ambu bag worldwide. A good reminder of the value we've driven into this market, of the legacy we carry, and the quality brand we have in the market. Let's have a closer look at the relevant anesthesia market. For us, we have a strong position with high quality products in a large and scalable market that today represents around DKK 4.5 billion. Within our categories of products, we see annual growth of 3%- 4%, driven by a combination of demographics and continued higher procedure levels. Our portfolio includes products such as the circuits, the resuscitators, the Ambu bag I talked about before, the Ringo masks, and face masks. A wide portfolio presence in most anesthesia departments around the world.
Our strengths include that we've managed to drive profitable growth for this segment, that we have a leading portfolio within our fields. We have a strong brand and very high customer loyalty. Let me just deep dive on customer loyalty for a second. For a customer or clinician in this area, high quality products and high reliability in your supply chain are crucial. These are potential products that can save lives and death. You need a quality product at the right time, at the right place, and that is exactly what we can deliver. Even though you haven't seen a lot of new innovation, these brands carry a lot of value in the market. Last but not least, connecting anesthesia to Endoscopy Solutions, there's also an overlap in where we sell our anesthesia products. Between this and the respiratory products, particularly the bronchoscopy solutions we sell in the market.
With all of this in mind, our strategic focus going forward for this important business is to maintain our position as a reliable premium brand and continue to drive further profitable growth for the future. With that, let me turn to patient monitoring. Another business, completely different.
Different.
Even though reported together with anesthesia under the Anesthesia and Patient Monitoring business umbrella, similar to our Ambu bag, 2025 actually marks the 50 years anniversary. For the first time, we launched a patient monitoring solution into the market within cardiology. Since then, we've launched several new versions of these solutions both within cardiology and more recently also within neurological quality. That means that each year more than 50 million patients around the world are treated with either our cardiology or neurology products. Looking more closely at the market, the relevant market size for us in patient monitoring is around DKK 3.5 billion. Globally, it's a market with intrinsically slightly higher growth than anesthesia with a 4%- 5% growth rate, particularly within neurology, which is more like a high single-digit growth subsegment.
Our portfolio includes cardiology products, the Blue Sensors and the White Sensors, as well as neurology products, EMG, EG, electrodes, and needles, all of which contribute to our strong and leading market position within this field. Our strengths within patient monitoring are in many ways similar to those of anesthesia. We have developed a platform with solid profitable growth, we have a strong market-leading single-use portfolio, and we have a strong brand and strong customer loyalty where, again, quality and supply chain reliability really matter. In terms of our strategic focus going forward, we will therefore continue to work on maintaining and developing our premium position and continue to drive profitable growth also within patient monitoring.
With that, I want to wrap up our session that started earlier today with introduction of the intrinsics of the Endoscopy Solutions market, the presentation of the business areas, the presentation of the two external speakers, Endo Intelligence and Sustainability, and now Anesthesia and Patient Monitoring, and sum up in really what is six key messages. In summary, we see very strong organic growth ahead of us as part of ZOOM AHEAD towards 2029/2030. These are first and foremost driven by a very attractive single-use endoscopy market with more than 20% annual growth, growing to the magnitude of over DKK 15 billion by 2029/2030. The clear and most important value driver of this is the conversion from reusable to single-use, where we presented all the logical customer propositions of why we believe in more and more settings single-use is going to be the future.
We have decisively within ZOOM AHEAD focused our strategy across our segments with deliberate strategic choices, focusing more on respiratory and urology where our target is to accelerate and win while still growing ENT where we see a unique value proposition, particularly in the U.S. and U.K., and last but not least also unlocking GI as Jesper presented earlier, a clear differentiating factor once you've convinced yourselves of the potential in the market. Our ambition to win for us in Ambu is the Endo Intelligence platform, an integrated Ambu-only platform enabled by the two monitors and our one unified software. We have a very unique value proposition that we believe will matter even more going forward. Bassel presented some of the further enhancements we're working on and Finn will also come back and talk a bit more about the innovation ahead. We believe fundamentally sustainability will be a differentiator.
It already is in some instances, but it will become an even bigger one for the future. We are leading innovation within sustainability, both on materials and now with the launch of the Recircle program, and we think that will continue to matter and only matter more in the future. Last but not least, as I presented, we have a strong position in our anesthesia and patient monitoring business with solid established market positions, solid underlying growth. Therefore, today we are also increasing the growth ambitions for anesthesia and patient monitoring, which I will come back to later. All of this has been about organic growth and organic growth will continue to be the main driver of our growth story going forward and as part of the strategy of ZOOM AHEAD .
Last but not least, I also want to cover M&A because we do believe that with a stronger financial foundation, we have the financial muscle, we have the ambition and we have the capability to also look at how we can drive inorganic growth above and beyond our organic growth ambitions. Let's have a closer look at what could M&A mean for Ambu. As I mentioned first time last year, we have been looking at M&A for now about a year. It takes time to define the right areas and focus areas, particularly when you, like Ambu, like us, have this many different growth opportunities.
That.
Doesn't mean that we don't have high ambitions, but it means that it needs to be very closely linked to our strategy. The focus areas of M&A are therefore all under the premise that M&A should support and accelerate the Endoscopy Solutions growth. That is, whatever we do in M&A needs to enable us to sell more Endoscopy Solutions. What will we then focus on? We will focus on around four overall themes. First, technology. Technology that could help enhance the solution space of what our industrial solutions can deliver, capabilities, internal or external, that could accelerate our innovation or our ability to commercialize software that could integrate or strengthen the Endo Intelligence platform and again accelerate our ability to solve even more customer problems and become even more differentiated versus the rest of the market.
Last but not least, also other adjacencies, tools, other solutions that could help enhance the value proposition of what we offer today as well as expand our presence into new sales tenants. Reminding you all, all of this will be under the premise that it needs to be linked to our strategy, that it needs to enable us to sell more industrial solutions and expand our ambitions above and beyond the organic growth ambitions we already presented. Of course, it also needs to have a solid financial return profile while supporting our growth ambitions. Last but not least, we will therefore be very disciplined and strategic about how we look at M&A. We are not in a hurry, but we are sharply focused and very ambitious about what M&A could and will also do to Ambu's growth theory going forward.
With that, this concludes our section on winning in attractive markets and I would therefore like to invite Britt and Jesper and Bassel to the stage for the first round of Q&A focused on this part of the day. We will also have a Q&A later on before we conclude the session today after I've presented the financial outlook and therefore also please focus the questions relevant for these sections in this Q&A session. Please join me on stage.
And.
For practicalities, perhaps in the room. I believe Anas and Frederik will help with the microphone if you have any questions.
Yes, hello everyone.
You talked a lot about product launches and software and AI and how this can help drive. Do you have any critical upcoming product launches other than the one you mentioned in ENT over the strategy period? How much do you envision that these contribute to the 11 %- 13% sales CAGR over the period? How do you envision this balance between accelerating growth of the Endo Intelligence platform but also hardware platforms and these?
Launches to impact growth over the period?
Because we also heard Dr. Aro talk about that libs historically have been hardware, but now he envisions that in the.
Modern era, it'll be more be software. That was like two questions or three questions in one. Let's start there.
Yeah.
Bassel, do you want to start on this?
Sure, maybe I'll start. Overall, when we talked about how we look at the market, and this also applies to us, we see that part of what's going to drive our overall growth in endoscopy is the underlying endoscopy procedure growth, and then another part is the transition to single-use endoscopes. As I think we all share, there's ample headroom to continue to grow in that area. Within the single-use penetration, the main driver is still the existing solutions that already exist on the market, which from the positive side significantly de-risks the overall number because they're proven. We have very high visibility into their traction in the market. There's also some component that will relate to new solutions that we plan to launch. We don't get more specific than that in terms of sharing our new solutions.
Part of that is because it is a competitive market, and I hope you all understand that. I think it's actually in the best interest of Ambu that we don't be too transparent about our pipeline. What you can count on is that, and you'll hear it also more from Finn later, we continue to be an innovation-driven medtech company. We invest a significant amount of our revenue back into innovation, and it's going towards a mix of advancing the hardware platforms and the software solutions.
Yeah. I think maybe just one addition we can make to that is that the task still also when we specifically look at the hardware that you asked about, is the task for us still in the pipeline under the guise as Bassel said, there's a limit to what we can disclose. I think it's reasonable to say that the task for us is not filling the opportunity pipeline. The task is to prioritize in the opportunity pipeline.
Maybe I should also say that Scott will in his presentation talk a little bit more in detail around what are some of the drivers of our growth when it comes to what is it we're addressing with the customer. We may come back to your question and elaborate. In the end if you are still curious, I will say something that we have shared also earlier that when we, I mean the ramp up that we have on our solutions as you've seen before, means that that is slightly slower than you see in some other medtech segments.
This means that we have quite a number of years of runway when it comes to driving growth from existing solutions like the aScope 4, Cysto, Broncho, and ENT are very good examples of where we many years after the launch have continued to see a strong growth as we are building those markets. I think that is also how to think about it. As Bassel well said around thinking solutions, I think it's important that it's at the end of the day, whether it's hardware or software that is really the key to solve the problems for the customers.
It's Yiwei from Handelsbanken. Thank you for taking my questions.
I have two, both on the long-term targets. Firstly, you have talked about.
The 15 %- 20% organic growth for the Endoscopy Solutions. In total, you have provided some sort of soft guidance for respiratory, previous Pulmonology, and then out Endoscopy.
I was wondering if you have any update on the sort of divisional outlook. I'll do next question later.
I can perhaps take that. We will come back to financial long-term guidance later. I think really what I hope is clear here for everyone in the room and online is that we feel very confident today about the organic growth potential within Endoscopy Solutions overall, and therefore for us to expand the 15% - 20% growth ambition within endoscopy for a longer period feels very natural with the potential we've seen today. I will not comment on the two specific business areas individually, but say two things. I hope also again today with the external speakers that it's clear that it is two different businesses as such in terms of maturity, that there's still a lot of potential in Respiratory, and that also in Urology there will be a lot of leeway ahead of us.
Therefore, in terms of the specific guidance between the two, we will come back to that also when we start looking at next financial year. That's for later.
Thank you. The next question is on the.
On the capital structure, I remember last time you did have.
A soft guidance, and this time we hear nothing for now.
You talk about a strong cash position, but you also talk about M&A.
I just want to get a feeling what would be sort of maximum.
Net debt to EBITDA?
I will come back to this later, but I think the short of a long is we stick to the guidance we gave last year of the max gearing level, and we stick to the overall principles. Let me come back to that later in the presentation.
Thank you.
Jump back to the Q.
Hi everyone, it's Tyra from UBS, and thank you all this morning for some great presentations. I just have two, so you've flagged adjacencies as one of the drivers within.
Respiratory, neurology going forwards?
I know there's only so much you can say, but could you give us a taste for what those pockets of opportunity are within those. Is that internal development of associated tools, acquisitions of emerging technologies within via M&A, or even partnerships with other companies and kind of how you.
See these ranking in priority.
I can maybe start on this one and you can add. I would say, in general, and this is very much for competitive reasons, that we don't provide unfortunately a lot of insights into this, and we of course have our internal prioritization and ranking. In general, what I will say is that we are of course looking at what is it that we are providing for our customers with our endoscopes and with Endo Intelligence, and then what is it that surrounds that, which will be different in respiratory relative to urology, but what is it that surrounds that where we can also make an impact for our customers? We are looking at both avenues, one being acquisitions, the other one being developing ourselves. You can say also somewhere in between where we could partly insource some components. I think we are looking fairly broad.
It's again back to, as Henrik talked about with our M&A strategy, it's the same we are looking at here. What is it that fits into the areas that we focus on now and eventually what we are solving for our customers around those. We are not looking too far outside that. That's all again also for competitive reasons that we'll talk about. I would say SureSight that we launched is a very good example that it's not an endoscope, but it fits perfect into our offering in respiratory.
Perhaps building on that last point, I think whatever we will be looking at, also organic or inorganic, needs to complete the solution portfolio. We are not attempting to become a one stop shop of all of the accessories you have around. We are continuing to be a solution provider that solves the specific integrated procedures that we serve, and that is the key threshold for what we will be doing.
You can really say maybe adding one comment. It has to meet clinical relevance, and it has to be an accelerator.
Right.
We can maybe be a little more method agnostic in terms of how we get there.
Good afternoon. Dephanie with Bernstein. Two questions if I may. Because obviously you open up the door through the M&A and your guidance does not include any M&A. Most of the company do actually, and especially on the long term. How and if you project yourself back to in 2030, how much do you think or what might be the bracket of the M&A contribution into your organic targeted top line revenue? First question. Second question on the R&D, you have an amount which obviously technically will increase dollar wise or Danish krone wise over the time. Can we get more granularity in between the breakup of this investment in between tools, innovation, development, software in the future, and also possibly the cycle of that? Meaning do we have to expect a continuation of a strong investment in R&D short term versus back in Ludin? Thank you.
Great questions. Thank you. I guess I will get a go at it. If we start with M&A, I think we are very deliberate. I recognize your view that other companies are explicit about their growth impact ambitions from M&A. We are very deliberate in not putting it out for two reasons. One, we are an organic growth company overall and I think for us to substantiate the organic growth uptake we have in itself carries a lot of value. Two, depending on the characteristic of the M&A, it might accelerate other organic growth or it might provide standalone revenue. Right now we've not defined one versus the other and actually in the end it matters less, you could say, because it's all about out. Whatever we would do in M&A would come on top and above and beyond the organic growth level.
I will come back to how we are then still guided by our financial policy in terms of maximum leverage, but beyond that we are not going to give more specific guidance on M&A. On R&D, I don't want to take away all the exciting things that my colleague Finn will be presenting later today, but I think the two things I will remind you all, some I've had this conversation with many times in the room, is one, we invest a substantial part of our cash flow in R&D and de facto more or less all of that obviously goes into Endoscopy Solutions. How that then breaks into hardware, software tools, we're not going to go in detail with here, but I think Jesper said it well earlier the day. Where we run out of good ideas in what we could develop in R&D is far away.
For us it's actually more of a prioritization question of how do you enhance and strengthen your customer value proposition in the market, which might be hardware in some business area, might be software in others, might be a combination in others again, and that's really how we look in innovation, constantly prioritizing the many, many good ideas we have.
and maybe.
A quick add on to the M&A and the guidance. It's very deliberate also that we have decided to guide on organic revenue growth because it's very binary whether you find something to acquire or not. I hope it's super clear from also Jesper and Bassel 's presentations that we actually believe that there's a lot of growth just with the portfolio and continuing to innovate around the portfolio that we have now. That's also why we want to be very explicit around that this is actually where we believe that growth 15% - 20% can come from.
Yeah.
All right.
Thank you very much for taking my questions. I have two. First one is to you, Jesper. Very happy to hear that Henrik is doing his job as CFO, telling you to win small now, win big later with the budgets that you have. I guess that the question would also be, do you have the commercial setup and the team that you need to actually deliver in GI?
Or.
What do you actually see is needed to accelerate GI from here? That's the first question. The second question is about the monitors and the software, the 3.0. How important is this and how much of sales do you expect to come from this next step in the software? What does it mean to pricing? Are you able to actually lift prices as a consequence of better software, better money?
Thank you.
Should I start on the pricing, then? You can comment on the first question and on the 3.0. I think what's important to highlight here is that we sell solutions and we don't price individual components. That's also why we cannot comment on that. Of course, we are very focused on continuing to evolve our business model and our pricing model in line with how we are adding value for the customers, as also our model is transitioning, as it has been so far, towards more software. Having said that, I think some of what Bassel shared, it's also very clear that we do have a lot of software features that are out there today that are not fully penetrated in the market, meaning there's still a lot of opportunity with what we already have developed.
I think that's an important takeaway from everyone here in that we are already on a journey where there's a lot of unexplored territory as we continue to evolve. We are not specific around the pricing. We are more specific around how we bring our solutions and that full pricing to the market. Do you want to comment on GI?
Yes. I think it's a great question, and you may recall from the presentation that I spoke a little bit about this sort of stepwise strategy, which is really about making sure that we keep on demonstrating the clear value proposition in the targeted niches that we're currently focusing on. That journey has really started with GI and GI large in ICU.
Or.
That's in place already now. We have the setup to be able to do that now, right? There's lots of commercial execution involved in that test, but we have that set up in place. You could say when we then think about the future in GI, right, that's when it really begins to come into place, this stepwise notion, right, that we expand as the business expands, right? For that first step in ICU and or for Gastro Large, yes, we have the setup we want.
Yeah. Maybe I can comment a bit on the more long term and what we are talking about in terms of what is it that is going to, you can say, break the curve and create that full transformation into GI. I mean, I think that basically two things are driving that. One, it's innovation, and that's what we are fully focused on, where we also heard earlier today around some of the technology evolving. It's actually possible to make more cost-effective solutions at a different quality than it was just a few years ago. Innovation will be one. The second one is around commercialization of execution. To your point, what we can assure you is that we are not going to go down the same path as we did a couple of years ago under a completely different scenario with the duodenoscope. We will look at it gradually.
It's of course clear that this is a massive market, and in order to also get out to all customers, we will not necessarily look at doing that alone fully. I think what Jesper is talking about now, we are really learning a lot from being much more focused and targeted. We also do that because we have a lot of other opportunities in respiratory, urology, and ENT. If, when the market really starts to take off, we could explore commercial partnerships. We are not there yet, but that could be a way to scale so we don't go the same path of hiring overnight too many salespeople because we have good experience from our ramp up. As I mentioned before, this is taking time and we need to balance that. We invest ahead of the curve, but not too much ahead of the curve.
In all transparency, that's the mindset that we have right now, but where it's super important for us to continue to be close to the signals we get from customers so we can see when does that start to take off and very much also how Jesper and Finn, in strong partnership, are driving the innovation in this field.
We all want a piece of the GI answer because we all believe this dream. If I want my little piece at the end before we have the last question in this Q & A session, I will also just say from the finance side, making a bet in GI investing in 50 or 100 salespeople is also just very, very different from where Ambu was two or three years ago in terms of size to where we will be two or three years down the road with a growth trajectory we are on. We can allow ourselves to think differently about these bets in terms of magnitude simply just because of the scale of company we are in innovation, manufacturing, and also financially. That's perhaps the lead way for the last question before we go for break.
Thank you very much, Morten from EBG. Two questions if there's time, one on a disconnect you got to help me with. You're guiding for a structural growth in the underscore market of plus 20%, but you're aiming for 15 to 20% growth. Obviously you're coming back into the GI, but are there certain channels, geographies you're choosing to not address today that you.
Maybe should be addressing? I implicitly are saying you're losing share. That's one second on M&A.
Just to come back on this, Henrik, in the past you've been pretty elaborate on the requirements for M&A around not being margin dilutive over time. These something.
That's something I haven't heard you address as forcefully today.
Are you loosening up on your requirements behind M&A?
I can take the first one quickly. Basically, we have been alone in this market because we have created the single-use market. That means in the past when the market grew 20%, we grew 20% because that was a full market. Now we are seeing in some segments competition coming in. That's also why we talk about the fact that we are not necessarily growing at the same rate as the single-use market is growing, but we see competition coming in, taking a share of that market.
I can just go ahead.
No, I just wanted to say, which is not necessarily bad. I mean, you could say if you are creating an attractive market, you do attract competition, and that is also helping expand and accelerate the market growth. This is of course where we try to also look into what is it we see in terms of competitive dynamics, and that we still believe that we are going to be very strong market leaders. Of course, we like to see the market being a bigger market. At the end of the day, it's about DKK. How much are we selling?
Do you want to go?
Did you want to say something, Bassel?
Maybe it's a bit redundant, but I think, you know, when you look at our business, by far the single most important driver is single-use penetration.
Correct.
I think in this market creation environment, as we talked about, it has so much headroom to further grow. The singular thing we focus on, the main thing we focus on, is how are we accelerating single-use penetration. As Britt said, mathematically, if other people come in, then they take some share. Our goal is that we take more than our fair share of the market.
This couldn't have been planned better. Building on what Bassel Rifai said on M&A and target requirements, as you allude to, I don't feel we have loosened them today. I think we've been more explicit about how exactly the M&A deal target would create value. Value matters less. It's not a standalone assessment of a separate tool. For back to one of the earlier questions, it's more a matter of what will it do to our growth journey within industrial solutions? If the value is that it sells more solutions, even though it's standalone, doesn't provide as attractive parameters, it's still attractive for us overall.
I think what we are being more specific on today is that it's all about looking at inorganic growth opportunities that can accelerate above and beyond the organic growth journey we're on and that can come from different avenues and that the criteria to do that will be within the boundaries of our finance policy and within the scheme of it needs to sell more industrial solutions overall. If that means slight margin erosion in some case on a short term, that is something, as we've communicated before, we could accept, but it needs to substantiate and support the growth journey.
Good. I think that concludes our Part 1 Q&A session. We will have a short coffee break now and then we will continue with the last session. We will have a 10 minute break, I'm told. Thank you, Anas. Please be back in 10 minutes. Will you please have a seat and we will continue. All right, we are on to our final stretch of today. You've now heard from my colleagues Bassel, Jesper, and Henrik talk about our strategic choices and the great opportunities we have. Now it's on to four of my other great colleagues, the ones that you've not seen yet, and then Henrik finishing up. Scott, Finn, Graziela, and Sennet will talk about how we will actually deliver on our strategy and on our aspiration to deliver global endoscopy leadership.
What I'll remind you is that the four topics that we are going to dive into now are our strategic themes around customer centricity, innovation, our business platform, and last but very importantly, our people. With that, it's a big pleasure to welcome our new kid on the block. Our newest comer on the team is Scott. On stage. Thank you, Scott.
When we were planning out the schedule, I said, hey, if you can put me about an hour after lunch when our glucose levels are dropping, put me right after Henrik teases up M&A, and just right before Finn talks about R&D and innovation. That's the sweet spot right there. I'll take that one. In all sincerity, honored to be with everybody here today. I'm, as Britt said, the NKOTB, the newest member of this leadership team here at Ambu. I've actually been in the medtech space for about 23 years now across a number of different companies, from some of the largest medtech companies, even some of the smaller ones. You learn a thing or two across all those therapeutic areas.
You kind of learn about how to size up different market opportunities, how to understand the growth potential, how to learn how to scale and grow up these organizations. Earlier this year, I was kind of doing what you all are doing here today. I was evaluating Ambu, only I was trying to evaluate it from the perspective of, you know, should I really stake my career on coming over to Ambu and what would that opportunity be like? They've had a great track record of success, but do I see that continuing into the future? I was kind of thinking about maybe some of the similar themes that you all are evaluating here today. With regards to the first one, I looked at market opportunity, and the answer is yes.
Right.
We've learned today this is a very attractive market opportunity. A lot of solid growth still ahead. The second question I had was, you know, does Ambu have the right to win? Sure, they've had the first mover advantage and they've done quite well with it, but do they still have the right to win moving forward? I think based on the portfolio, as you've heard today, based on strong clinical performance and perhaps, you know, even more importantly is just that value proposition, the kind of winning economic value proposition, improving operational workflows. You heard from a few of the physicians earlier today on just how important that is. Do we have the right to win? I believe yes, we do. Finally, it's about momentum, you know, does Ambu have momentum moving forward? Of course there's been a strong track record of double digit growth.
They are highly trusted amongst healthcare professionals. I do believe that there's still plenty of opportunity left with just the markets we serve today, with just the solutions that we offer today, there's still a lot of momentum. To answer the question, do I believe, you know, Ambu has the right to win here, do they have the momentum? Are they in the right market? I believe the answer is yes. We don't just want to win, right? Our aim here is not just to win, our aim is really to lead. Let's look specifically at why. Why has there been such strong momentum here? It's because we have the strongest customer intimacy. We have the largest direct presence, the largest direct sales force in the single-use endoscopy market. We've won in some of the key markets. We're direct in these key markets like North America and across Europe.
We have one that is focused purely on driving single-use endoscope adoption across all these major markets. It is a global growth story for sure. We're also winning in that key market of North America. As you can see here, we've really invested to win. I believe this is what has created the strongest customer relationships. Although I've been here a short time, I've already begun to witness this firsthand. These represent our key drivers moving forward. For me, this is actually what represents our right to win in this market. Again, we have the largest commercial footprint in presence in these 25 major markets, as you've heard, the largest single-use portfolio and we also have the largest single-use install base across the globe. Any one of these individually are really strong, but when you combine those three or four together, that is truly differentiating in the market today.
It's really setting us up a strong foundation so we can continue to scale the organization. Now, our ZOOM AHEAD strategic priorities. When we look at customer centricity, I believe this is going to set the standard for customer centricity in endoscopy. I'd like to share a brief story that I think really kind of captures this really well. Very recently I was with a critical care physician. This is a pulmonologist at one of the largest health systems in New York City. This gentleman is the clinical decision maker for all new products that enter that system. We were discussing how we could better partner together, how we could continue to integrate and drive adoption across the health system. We were on the topic of electronic medical records, EMRs.
For those of you who may not be quite as familiar with what EMRs are, think of it as like this giant filing cabinet, and this is what the doctor and the nurse use to capture all the patient information they need to make the best decision about how to treat that.
That patient.
We were talking about how to use this, and there was a physician who unfortunately joined us about 10 minutes late. This was a completely different specialty. This was an ENT, an ear, nose, and throat specialist. This woman walked into the conversation, and we said, you know, how are things going with the Ambu scopes? You know, are you happy? You know, give us the latest. She said, everything is going good-ish. I hope ish kind of translates over correctly, but means, you know, it's kind of okay.
And we.
We said, what does good ish mean? She said, look, the product's fantastic. She goes, we're all very happy with the product. It's working really, really well. She said, but we spend a lot of time after the procedure because we're snapping a lot of photos, and we've got to capture those images and upload them into our system. We were all sitting around a table kind of like you are, and the rest of us just looked at each other and smiled. We said, actually, that's exactly what we were just talking about. We've already done a demonstration of this in another unit in your hospital, and it went so well that now we're ready to roll out this integration across the entire health system. We said, maybe your unit could be next.
She was absolutely ecstatic about this because, again, speaking to operational workflow and how to improve that, how to save them time, this just hit it right on the mark there. I think that really kind of explains this power of partnership, and that is really how we accelerate adoption. To close off that story, afterwards I was speaking with that original pulmonologist, and we were having a good conversation. He kind of leaned in, looked me right in the eye, and said, Scott, this is the time to take advantage of this central platform that Ambu has. He said, nobody can do what Ambu can do right now, and hospitals are consolidating into bigger systems, and you need to keep taking this platform to the other decision makers across other health systems. You're at a unique pivot point.
That really resonated with me, and I thought that was such a great example to share with all of you today. We've got a lot of great examples. Here's another one on the screen behind me. You can see a further proof point of this partnership. As you can read, this may have been for different reasons, but here clearly the physicians are looking at that product coverage, the portfolio that only Ambu can bring today. Their focus is more on quality of those products. You can see how we tap into a lot of different stakeholders across the health system for various groups' reasons. How are we driving customer intimacy? It really starts with that clinician, it starts with the physician, with the nurse and the tech. We win them over because we provide solutions in endoscopy that they need every day in how they treat their patients.
We improve that operational workflow, and that allows them to serve more patients. As we gain adoption across each of these departments, we start to generate some scale at the hospital level, and we start to attract different economic stakeholders. Those economic stakeholders are more interested in how we drive value across the entire system. Often, these hospitals are part of larger health systems, larger health networks, and that's where we come in with some of these integrations that allow this thing to scale really across an entire health system. This is where we really build that moat, we build that barrier to adoption for some of our competitors. This is how we are going to strengthen our growth journey moving forward over the next years.
Few years.
Our broad portfolio drives these long term contracting opportunities. Last Wednesday, in fact, it was exactly one week ago today, maybe a little bit later in the day on the East Coast, but I was with the Head of Purchasing for one of the largest health systems across North America, a gentleman, I'll just call him Robert. Robert summarized this up so well. I said, Robert, I said I'm.
Going to be meeting with our.
Group of investors next week at our capital market days in Denmark. I said do you mind if I quote you? He smiled. He said, yeah, of course. I just want you the quote of what he shared with me. Robert said, what Ambu provides is efficiency and time management over reusables. He said we can now see more patients and we actually right now have a three month backlog of urology patients waiting to be seen. Ambu provides the best customer service. He said, when I first meet a rep from one of these organizations, I tell them, if you can't provide great patient care, I don't even want to talk to you. He said, do you know when I get a response from the Ambu rep, whenever I call? He said, if they happen to not answer within five minutes, they call me back.
He said, I'm actually still waiting on a response from some of the other competitors that you guys work with. I checked with Robert this morning. He's in fact still waiting for a response from one of our competitors. I think that just briefly speaks to how important service is in this kind of market creation environment where it's important to be right there and supporting your customers.
Customers.
Now, you'll find it interesting to note that Robert recently converted all cystoscopies across his health system to Ambu and they're about to do the same thing for ureteroscopies. In the coming months, they will also be integrating to the electronic medical record system with Ambu. While these real world testimonials are great, it does take a lot of work to drive adoption. It really depends on how we drive standardization. It depends upon the specialty, it depends upon the procedure. We've learned, as you can see on the right side of the screen, that in cystoscopy we can drive adoption relatively quickly, whereas in ureteroscopy sometimes it does take a little bit longer. We just want to set proper expectations as we move forward that each of these markets is a little bit different and we're learning about them, but sometimes there's different adoption curves in each one.
As we start to culminate here, these are really our key growth drivers moving forward. It may come as no surprise that first and foremost is we want to continue to focus on driving increased penetration with our current solutions, with our current customers. Today, there's still plenty of opportunity for us to do that really well. That's where commercial execution is going to be absolutely key. Number two, we can still focus on winning new customers still with our current solutions and focusing on driving great clinical outcomes and improving operating efficiency. Third, we're building that moat that I talked about and we're creating stickiness with some of these customers by offering our digital solutions and integrating into their electronic medical records system. Finally, there are still new markets that are not yet participating in.
We will continue to invest in our commercial infrastructure and we will look at investing resources into distributor relationships, especially in APAC. In closing, when you have the physician saying, I want that Ambuscope and you've got the hospital staff saying, hey, this actually makes our lives easier. It's improving our operational workflow. Finally, when you've got the hospital administrators, now the purchasers saying, this is a great economic value proposition for our system. I may be from the U.S. but usually when you score three goals like that in a game, that's called a, it's called a hat trick, right? Whether it's hockey, soccer, football, whatever you want to call it, it's a hat trick. That is pretty unique. Up next, I'm going to introduce Mr. Hat Trick himself. We're going to invite Finn Möhring, our Chief Technology Officer, to the stage.
Thanks, guys.
Thank you.
Great.
Good afternoon everyone. Great to be on the stage. Basically, we will look into innovation. My name is Finn Möhring, I'm the CTO of Ambu and I'm here to talk about customer-centric innovation and how that can deliver integrated and high-impact solutions to enable growth in our ZOOM AHEAD strategy. I must admit, I've been sitting like a loaded spring because there's been made so many references to innovation during the day and so many questions. I hope I can give you some answers and also some perspectives on what innovation in Ambu is. I joined Ambu in 2023 and prior to that I have a background leading R&D organizations for more than 20 years within MedTech and mobile communications and defense.
It is, I would say, really a great privilege to stand here and talk about innovation in Ambu, especially when you look at our legacy, because we stand on the shoulders of some great things that have happened in the past, as Henrik was also alluding to early on. Ambu is and has always been about innovation. From 70 years ago when we actually defined a completely new product category with the resuscitator for emergency events, ventilation and, you know, enter any emergency room and I bet you it'll be hanging on the wall ready to save another patient. Over to that, we became the gold standard in patient monitoring with our Blue Sensor electrodes for cardiology. Further on to redefining a whole market of endoscopy with the introduction of the single-use endoscope in 2009. It's this legacy that drives our continued commitment to innovate even today.
If you fast forward until today, then you could say what really makes a great product in the single-use endoscopy market today, it is having really a great product with the right time to market at very, very competitive costs. We have four key areas that we think set us apart in the market today compared to competition. It always starts with the people and the engineering approach and process that we have. We have a great talent base of more than 400 engineers, truly gifted and very experienced. I can tell you I've met them all myself, located at multiple R&D sites around the globe. When we combine the brains of these engineers with our agile development processes, we are capable of really bringing superior solutions to market fast and efficiently. Again, what is a great product? A great product is all about solving a customer problem.
In our organization, we are obsessed about solving customer problems even to a level where it's not only reflected in the ways that we work, but actually in our organizational structure. We actually co-develop with our customers whenever we create new products. We also engage in regular feedback sessions to understand the use of how our products are working so that we can upgrade and introduce new areas in incoming introduction productions. The third area is about our scale, and there was a question about how much we spent on innovation. We use 10% of our endoscopy revenue and invest that back into innovation. That gives us a great opportunity to leverage our investments across the portfolio for a significant cost advantage when we actually share components and designs across our portfolio.
Think about it here as an example we show here is a shared mechanical structure that we have in all our endoscopes, in our handles, a little bit the same way as the Volkswagen Group reuse, you could say, elements and parts across their models and brands. If you walk through the parking lot out here, when you exit, then look at the Skodas, Cupras, Audi, whatever there is out there. Look at the side view mirrors. You realize it's practically the same no matter what the brand. We are utilizing some of the same thoughts. The final area is by being a market creator and a pioneer. To me, this is actually our secret sauce.
This is our ability to think outside the box, explore and create breakthrough solutions where we lead not only in endoscopes, but also within systems and software where today we have a truly market-leading position with a very intuitive user interface. A third area where we are pioneering is within our sustainability and sustainable solutions where we are the only supplier today that have bioplastics, as we already heard, in all our endoscopes. Let's now take a look at ZOOM AHEAD and the strategic priorities for innovation. The whole thing is about delivering integrated and high-impact solutions, and we have three priorities here that were also introduced earlier on by Britt. The first one is about breakthrough customer-centric solutions. This is really about how we continue the customer problem-solving journey but with an increased focus for patient outcomes and hospital efficiencies.
The next one is about transforming transformative technology, and this is how our skilled engineers will do radical innovation within areas such as image enhancement and AI-supported detection, training, and documentation as covered by Bassel. When you spoke about Endo Intelligence. The third one is about using partnerships across the value chain. This is basically about how we supplement our own competences and deliveries with support for best-in-class partners. Now let's dig into each of the three priorities. If you know, as I said, solving customer problems is really key to us. Let me help you a little bit on navigation on the slide here. I start to the right about our experience. What I spoke about is doing customer feedback and co-creation, working closely with clinicians.
When we do our new developments, when we combine that with our multi-generation product learnings, and we have actually introduced many product generations as you saw before. Again, on top of that, use the, you could say, the skills of our engineering teams. That is really when we can hit the bullseye in solving true customer needs. We have three examples on the slide here. Let me actually take a look at the one in the middle, the ease of use. As was already said, we actually offer two systems today, the aView 2 and the a Box 2, and both of them run exactly the same software platform and the same intuitive UI. This creates an immediate familiarity for the clinician whenever they meet one of our systems. When I talk about intuitive UI, let me give you an example.
Today it is so that you, if you are getting ready for the procedure, you unpack the endoscope, you plug it into the system, and you are basically ready to go. You don't need to press a single button, it will work right out of the box. In the same way, as was also mentioned before, I think by you, Bassel, is that we are the only supplier that actually has EMR integration into our systems today. Looking at those two areas, this is really two areas that help, you could say, hospital and physio, but also gives confidence from the clinicians. Talking about clinicians, they are really selective about their image quality and really try to figure out what is the best for each of their procedures, and here in order to help them with their patient outcomes.
We are actually looking not only at camera technologies, but also beyond the camera. We actually enter what was being spoken about before. We actually look into how we can improve the clinical outcomes with software and how we actually use AI to do enhanced imaging quality and also help with detection and training and documentation. That brings us to the next slide, which is about the transformative technologies. This is probably, if you're an engineer like me, the most interesting slide. It's always interesting when you talk about transformative technologies if you're an engineer. We have three categories on the slide. This is the way it's sort of constructed. Think about it as short term, midterm, and longer term, you could say, impact and introduction horizons.
If we start on the shorter term with our next generation upgrades, there was some mentioning in the previous presentation about next level bronchoscope, next level cystoscope, and so on. What is it that we do here? We basically innovate using new materials, miniaturization, cameras, and light to improve the endoscopy hardware. We do that in order to be able to, of course, improve clinical outcomes, but also to address more procedures. In the same way, we will update our systems with extreme processing power and software capabilities driven by new algorithms and AI to provide a new frame for our Endo Intelligence platform, which will result in improved image quality and also provide the opportunity for the areas I mentioned before: diagnostic support, training, and documentation. In essence, what does this mean?
Basically, it means that the value proposition will switch from being mainly hardware driven today to become more and more software driven as we move forward. A couple of examples here. When we look at breakthrough technologies, we have two examples here, the idea of some AI-driven detection algorithms that can help clinicians with outcomes. The first one is applications for procedure navigation. Bassel showed our Bronco simulator, but it's clear next level is going with clinical data and actually get something that can work in real human beings. Also, we are looking at applications that can improve diagnostic confidence, like, for example, within lesion detection for cancer diagnostics in various parts of the human anatomy. The final area is about adjacent solutions, and there was some mentioning about adjacent solutions, and that was where I became the loaded spring as I mentioned before.
Within the adjacent solutions, we actually have a team of dedicated multi-skilled engineers looking at these adjacent areas to figure out what is the next game changer within endoscopy. With that team, we strategize, we create prototypes that we then evaluate and run through together with clinicians to gauge the market potential. Examples that we are looking at are shown here, could be hybrid solution tools, new clinical areas, and accessories. It's very clear when we look at this that the lion's share of at least the first two will be within respiratory and for urology, as these are key areas, you know, with some ENT thrown in for good measure. However, for the adjacent solutions, we are of course looking across all our different business areas to see if there's anything where we can discontinue the market and create the new game changer.
Let's move on to the final priority within innovation, and that's about accelerating innovation with new partnerships. It's clear to cover the broad variety of opportunities, approaches, and technologies that we have. If we have a keen eye for time to market, because that's important, then it's clear that we will continue to develop our proven partnership framework. Partnerships are nothing new to Ambu . We actually use partners for full system deliveries, over sub-assemblies, to standard capacity and competency backfill. However, going forward, we will really work on accelerating these three areas that are mentioned here, really focusing on getting partners on data and actually making sure we have great data for training our AI algorithms.
As you know, an AI algorithm is no better than the data it was trained with, and if you have trained it with the best data, then it's very, very difficult to copy for any competitors, and you know, you can only realize what makes a difference in the real procedure. The other thing is about integration and workflow partners, and basically here we look for enabling a superior integration of our system into hospital networks so that we can actually enable automatic documentation and integrated workflow management. Building further on what was mentioned before about updating and downloading work lists and pictures and images and so on. Finally, these are sort of two really new areas that we have that we are accelerating.
We of course continue to co-develop and key technology differentiation in the endoscope as we do today, such as camera and light, to make sure that we continue to lead within visualization. That rounds my presentation up. We focus our efforts to deliver integrated and high impact solutions in the ZOOM AHEAD strategy. These consist of superior endoscopy hardware, which we complement by a system platform with extreme processing power and software in the form of the Endo Intelligence platform, delivering an increasing part of the value proposition as I said before. Thereby, we actually also as a secondary thing, if you move the value proposition over to software, you are capable of improving cost in your hardware offering and make you even more competitive in that area.
Finally, on top of the systems and software, we will offer these advanced applications, for example for navigation or for detection and documentation, here exemplified with the Bronco simulator that we have in the market today. That ends my presentation. Thank you very much and I will now hand over to Graziela. Here you go.
Thank you very much. My name is Graziela Malucelli. I have been in Ambu for more than one year now in the CEO area. We have around 3,500 employees and I have more than 30 years' experience in the CEO area, in pharma, in biotech, and medtech, which is the best. I'm actually super happy to be here to talk about the business platform in the ZOOM AHEAD strategy, the largest producer and supplier of single-use endoscopes in the world. Let's look a little bit on the Z OOM IN strategy, which was quite a transformational journey from an EBIT expansion point of view. Twofold from 6% to almost 14%, which is really fantastic operating leverage.
There was a decouple of administrative costs from revenue growth and also incredibly commercial effectiveness from a gross margin point of view, really significant operational output increase, and also quite an important product mix optimization with high margins on Endoscopy Solutions that shows Ambu 's ability of doing cost management, cost efficiency, and also product mix optimization. If we go further, it is also about ZOOM AHEAD strategy. We have a very important footprint with the right scale and right resilience. This has been proudly built throughout the time and it constitutes a very strong foothold where we actually have delivered productivity improvements around almost 1% year- over- year, actually offsetting all the costs. This is just going to continue because that's the scale and the advantage we have on our footprint. Another very important element here is that we have four very important sites.
They are efficient, they are lean, they are consolidated, and they are really well located. We started in China, then we went to Malaysia, which is a very important hub. Then we are in the U.S., extremely well located site, and Mexico, the last one built end of 2022. These sites are somehow dedicated but also multi-flexible in nature. If demand picks up in one part of the world, we are able actually to leverage from all of them and deliver to the growth needed. One important element also of this footprint is our scale-up experience and ability. As Finn said, we have had around seven significant launches the past years and we will have many more to come. You can imagine that having that experience to scale up innovative solutions.
We are an innovative company with a large scale that gives us a really strong business backbone that others would dream of having. I would say I want to share a little bit of the case study of Mexico. This is our last hub built from greenfield construction, fully operational, showing actually Ambu's ability to invest and be successful. Right staffed, fully certified, high quality standards, technology, state of the art and very large space, really well located, part of USMCA agreement, mitigating tariffs. Also very close to obviously the North America market but also to serve the whole Americas market. Just that you know we have in the last year tripled already the output of that facility and we have already achieved more than 1 million endoscopes produced there.
It just shows also Ambu's ability to be ahead of the time in terms of investments and be ready for the future. I want to highlight a couple of other things. Largest producer of single-use, not only giving us an economy of scale but giving a very important high purchasing power because we are producing 60% of all single-use endoscopes in the world. This also gives us a very resilient and responsive supply chain. Very close to customers and patients. That has helped us to already achieve 50% of our investments on decarbonization of our value chain towards 2030 sustainability targets on SPTI in scope 1 and 2, CO2 emissions reduction and preparing for scope 3 on the whole value chain.
Another important element is not only what we have, which is really incredible, the capabilities we have in house, but we have doubled the amount of suppliers and engineering partners we have that brings their technologies and combined we have a very strong foothold because of our scale as well. The last one, the most important thing is quality and supply reliability. I can tell you quality management in Ambu is super strong. Quality assurance of our solutions is super strong. It is often why customers rank us as number one on quality and supply reliability among other players. That is super important because this is Ambu's reputation, right? Just sharing that. We have invested almost 200 days on the ZOOM AHEAD strategy period from audits, internally, externally, all 100% successful but also training of all our people in quality which is extremely important.
I'm thrilled to talk about the ZOOM AHEAD strategy on the business platform. It is about leveraging the scale and enabling the profitable growth ahead of us. Three pillars: resilient global footprint. Advancing our operating model to harvest on scale but also on cost competitiveness, then having future-proof infrastructure for accelerating that growth. I'm super happy actually to share the first pillar, which is about continuing to leverage our footprint and the scale and being ready for the growth with all the market responsiveness needed.
So.
It's super important to say that our manufacturing sites together with all our distribution centers cover the whole world and also mitigate any kind of risks. We have talked about tariffs, but any supply disruptions and all this is something we are well covered. You can see from the graph to the left, it's actually about volumes in the Endoscopy Solutions. You can see that in the past we have used a lot our Asian footprint to actually serve most of our Endoscopy Solutions market. You can see that throughout the ZOOM AHEAD head strategy until 2026 we will be already achieving close to 50% of the entire Americas market will be actually supplied by our Americas footprint. That is because of our U.S. site and our newly site just established.
We will be then going throughout the time until 2030 where we will have close to 100% of our supply to Americas market from our Americas footprint, which is already very strong, positioning us very close to customers and patients again and really with a strong supply responsiveness as well. To the right you can see a graph that also shows another very important consequence out of that, which is that we do have already super strong infrastructure and scale in Ambu.
This means that with the space we have and all what is already in place with these four hubs, we can actually supply not only the growth throughout the ZOOM AHEAD strategy and beyond, which is super important because the message is that we will not need a very significant CapEx investment to actually deliver to the growth ahead of us, which just shows again Ambu's ability to be ahead of time. Also thinking about long-term growth capabilities, the last one which is very, very important as well. Here we talk about scale and cost competitiveness. Advancing operating model is going to be key to expand margins. I want to give you some examples about how we are going to expand both gross margin and OpEx.
As I've mentioned to you, productivity, our ability to do productivity because of our scale will be doubled throughout the ZOOM AHEAD strategy from close to 1% to almost 2% points of improvements year over year, offsetting other expenses, which is going to help us to expand margins. I'm going to give some examples. Procurement, for instance, we are obviously inviting all our key suppliers of key materials to join us on this growth journey, and then together we are actually going to deliver a reduced stacking case on pricing, which is going to be fundamental for margin expansion. I also want to say that majority of our key materials and key services will be towards 2030 with dual location or dual sourcing, expanding margins but also ensuring that we don't have any downtimes and we are not disrupted at all from a supply perspective.
We will be also working with our supply chain, reviewing and maximizing our logistics, reviewing our distribution points and where all connects to our customers and patients. This is also going to expand margins, but it's going to be giving us even more sustainable supply going forward. We will continue to invest very much in quality with a multisite and multi-location enhancement of quality as we grow the company. We will be also investing on AI, digital machine learning, robotics, and all these tools to decouple costs from revenue volume growth. With IT, we are also close to start an ERP cloud version upgrade, which is going to be fundamental for us to actually standardize our workflows and enhance digital workflows together with our shared service centers in Malaysia, for instance, to avoid where we duplicate teams throughout the world.
These are some examples and levers that will ensure we will actually meet our margin expansion, our margin target through ZOOM AHEAD strategy that Henrik will be talking about later. I am truly excited to implement, to be forward looking, implementing the ZOOM AHEAD strategy and also impacting further positively the impressive impact and purpose we already have with our customers and patients. Very much looking forward, and with that I think I'm going to pass on to Sene, who is going to be talking about people and culture.
Good afternoon everyone. Just stepping forward. My name is Sani Hjordrup, I'm the Chief People Officer here at Ambu . I joined Ambu A/S just before we launched ZOOM AHEAD . It's three years ago now. I bring 20 years of experience within my field across a number of industries and the last five years I spent in medtech. Here in Ambu I'm responsible for leading our global people and culture strategy and initiatives. Now we're actually getting to the most important part of the day and by that I mean what ties everything together and makes sure it happens and that's our people and culture. That's how you should think of this topic. I will share with you what we've built so far, which is a highly engaged and unified organization.
I'm also going to share with you how we're going to take it to the next level during ZOOM AHEAD .
We've been on.
An incredible growth journey and we have a model for growth now. The past decade we more than doubled our headcounts and we are truly a global organization. We have 93% of our employees based around the world outside our headquarters. During ZOOM IN , we invested real time and energy in building one strong shareholder culture. We did that to avoid some of the challenges you receive with fast growth, silos, inconsistencies. The investment has paid off. We're in a position of strength and we have a very solid foundation to build from when we look ahead towards 2030 and we have bold ambitions. Fueling that shared culture becomes even more critical as the whiskey. That's because our culture is our edge. That's actually what sets us apart because it allows us to create the results we set out for.
There's four main reasons for that and I'll take you briefly through them. First and foremost, we have a purpose-driven culture. We have strong engagement, our employees are engaged and they're aligned around a shared direction and it shows. If you look at the numbers up here, we're in the top quartile of engagement in the medtech industry. Second, we've proven now that we're an employer of choice, we attract and we retain high caliber talent. Our turnover and, well, maybe I should say we do that because we offer challenging and meaningful jobs in a dynamic and environment. Our turnover has significantly improved compared to three years ago and we are now at a healthy 9% which is aligned to market. Our culture also resonates pretty well in the external market. Now we see a 50% uptake in applicants to our open positions. Third, we have customer-centric capabilities.
We stay close to the customer, we understand their needs and we innovate to solve their challenges. As just shared with you in the previous slide, we have a responsive operating model that allows us to scale. We adapt, we're able to adapt quickly to the market conditions and support our growth. That also means the culture is what translates into an edge for us. That's also why we are quite excited and also confident that we can deliver on the ZOOM AHEAD . If we talk about ZOOM AHEAD , we have one priority and that's about fueling our culture of empowerment and growth. We have three focus areas here. Let me take you briefly through them. One, we want to leverage that special culture. Two, we want to advance our strategic capabilities. Three, we want to lean as one. I'll guide you through each of these.
Now, we use culture intentionally and we do that to drive execution. First, our three core values are very central to how we get things done. Two years ago, we went through a refresh process where we ended up here, as they stand today: take charge, team up, and be true. We train, we hire, and we operate by these values. We hold ourselves accountable for them. 85% of our employees say that these values truly resonate with them. For us, that tells us we have a strong culture. It also tells us we're scaling well. Second, alongside our values, we focus on streamlined ways of working because that drives accountability, but it also drives speed and decisions where it matters the most. It gives the teams clarity, it reduces internal friction, and it also boosts alignment about delivering value to our customers.
I think one example I can share here, Graziela just shared with you, in terms of how we moved our endoscopy manufacturing from Asia towards America. Together, our values and our ways of working are very central for the culture we create. Focused on execution, it becomes part of our operating rhythm to grow and reach the long-term ambitions. We need the right capabilities today, but also for tomorrow. That's where we focus on three areas. My colleagues have alluded to some of them early on, but in brief, it's about accelerating technology innovations with smarter data and connected technologies. It's about commercial execution, and then it's about scalable platforms so our processes, systems, and teams grow efficiently. Equally important is how we build these capabilities, because we know it's not about doing everything ourselves.
We know about making the smart choices that allow us to move fast, stay focused, but also build what we need to grow. That means the way we build it is we take a balanced approach. We develop core capabilities internally, and we invest externally in new tools, also skills and technologies. Then we partner when it makes sense. It makes sense when collaboration brings access to expertise or capacity in a faster way. One example here is, I think Finn already shared some of it with you, but that's in our innovation in AI. We partner in areas like data integration, system data acquisition, and system integration in the hospitals. We do that to ensure we have well-functioning algorithms and efficiency in the hospital systems. When we talk about building these capabilities, it's only part of the equation. Strong, aligned leadership is what drives the consistent results.
It's also what brings strategy alive through employees throughout the organization. We know today that the large majority of our employees actually feel connected to our strategy and vision. That's a strength. As Ambu A/S grows, aligned leadership becomes even more critical, both so we can deliver what we set out to, but also so we scale in the right way. Over the past years, we've seen some real shift. We know that approximately one fourth of our top layers of leaders are hired externally. They bring in new capabilities and they bring in fresh perspectives. At the same time, we've seen a shift towards more global, functional reporting lines instead of local teams. In this setup, it becomes critical that we lead as one. We're doing that by focusing on three things. We focus on being aligned, and we do that through a shared framework.
We call it our leadership compass, and it's rooted in our values. That sets expectations clear. Second, we're investing in leadership at all levels and we're doing that to increase skills and mindsets so we can lead the increased complexity and support growth effectively. Last but not least, we hold leaders accountable not only for the results that they deliver, but also how they lead. Our strategic theme of people and culture is centered around a strong culture, capabilities to drive progress, and then aligned leadership to make sure we drive execution forward. I trust with this it's clear how proud I am of what we achieved so far, but also how excited I am for what we're capable of when we look ahead, and all the great things we.
Have ahead of us.
For the financials, no waiting floor.
Thank you. Thank you very much, Sanne. Sanne already took the first thunder away. I was supposed to say now for the most important section, but now for the second most important section on finance, given that people are the most important, of course, for success. I'm here to wrap up today with a section on our increased financial ambition, reiterating the messaging that we sent out yesterday evening. Before I do that, it's good to just come back to where Britt started today. Today marks a new chapter for Ambu , a new era where we can, with good satisfaction, and I would say even pride, close the prior chapter of turning around the business and start really looking ahead for the future. A few facts around those.
We've managed to drive more than 18% compounded annual growth within endoscopy for the strategy period of ZOOM IN , a total combined revenue growth of around 14%, more than 7 percentage points improvement in EBIT margin, and almost DKK 1 billion in free cash flow. Impressive results considering where we were just two and a half years ago, driven by growth and margin expansion and a number of key people initiatives. With such a solid foundation, it's also worthwhile to look ahead with some level of pride and perhaps an even higher level of ambition. That is really what we're presenting today. Today we are therefore setting new targets for the ZOOM AHEAD period that runs until 2029/30 and still also maintaining our ambition on a number of levels in what we presented within ZOOM IN originally, that is confirming a number of target achievements by 2027/28.
Today we are basically, one, maintaining and extending our very ambitious growth within Endoscopy Solutions of growing 15% - 20% compounded annual growth with a strong market opportunity, with high single-use, continued single-use conversion, and our differentiated leadership position. Secondly, we are increasing and also extending our growth ambitions for anesthesia and patient monitoring from previously a compounded annual growth of 2% - 4% per year to now 3% - 5% per year, again driven by a strong market position, a proven commercial track record, and continued growth in the segments that are relevant for us. That means combined for Ambu we're now lifting the growth ambition, increasing it from previously + 10% to now 11% to 13%, again compounded annual growth for the next five years.
In addition, with the strong financial performance, with our ability to scale and thereby also leverage our business, we are also confirming and lifting our EBIT margin ambitions. One, confirming that we still believe we can reach around 20% EBIT margin by 2027/2028 subject to potential trade-offs of growth investments, and deliver + 20% EBIT margin by 2029/2030. Last but not least, with strong growth, with a proven model and success within scaling our business, we are today also introducing the concept of cash conversion for the period, confirming that we believe we can continue a strong cash conversion, delivering + 40% cash conversion across the period of the ZOOM AHEAD strategy. Let me take a closer look at first revenue, then EBIT margin expansion, and then cash flow.
Looking at revenue, I think I've iterated a couple of times myself today, so have my colleagues with Bassel starting, seconded by Jesper, that our growth story is very much a growth story of single-use endoscopy. Therefore, I'm also reiterating the messages that Bassel brought this morning of a total growth within single-use endoscopy. We believe in the market of + 20% of which a very, very substantial part of that growth opportunity lies within respiratory, urology, and ENT, while a very big untapped potential also lies in GI. The single most important number on this page, to reiterate again and again, is the 15% growth level coming from single-use endoscopy, which means competition matters. Yes, but if we can continue to drive single-use conversion, that is the single biggest growth contributor for us and for the industry.
If we then reflect on the journey we are on and look at the composition of the business today, we are around 60% single-use endoscopy and 40% anesthesia and patient monitoring. With these growth targets, this conversation will change, change simply just because Endoscopy Solutions are growing faster. That means that by 2029/2030, we'll be more a 70% Endoscopy Solutions and 30% anesthesia and patient monitoring company. Therefore, with the extended ambition for Endoscopy Solutions, that is also the single biggest driver of our increased long-term growth ambition from + 10% to 11% to 13%. Within Endoscopy Solutions, the main growth contributors will be respiratory, urology, and ENT.
We feel very confident about the market potential and we believe, I think confirmed today with our two external speakers, that we have a proven model for how we can deliver on that growth that makes us perhaps even more confident about how we can deliver on the 11 %- 13%. That said, we still believe in the potential of GI. We have a more diversified business today and therefore we don't rely on unlocking GI within the strategy period, but in the longer run, even beyond the strategy period, GI represents a significant potential, one that we will eventually unlock and one that we, as I said in the Q & A, believe we will be better and better positioned to unlock with our broader portfolio, with our bigger scale, with our innovation, and with the market adapting more and more to the concept of single-use also in GI.
With that, let me turn to EBIT margin. When we look at EBIT margin, we've been on an impressive journey already and we are today confirming again, as I said before, that we believe we can deliver on the approximate 20% EBIT margin by 2027/2028. There are currently external factors that are driving headwinds for our margin. I've talked about FX until some of you were asking me why all the talk about FX a couple of quarters ago. I think last quarter proved why when FX moves it also impacts our business. It is temporary and long term. We have a good natural hedge. It does mean that with years of fluctuations there might be impact from the other thing that we have not talked a lot about today, beyond the fact that Graziela illustrated our strong and global resilient supply chain, is tariffs.
We fundamentally believe we can mitigate the negative impacts of tariffs in the mid to long term, but it could mean shorter term negative effects. Fundamentally, we remain focused on serving our customers and managing the continued single-use conversion and with our strong supply chain mitigating a very, very significant impact from tariffs. That also means that you flip around the question. We actually feel very well positioned, relatively speaking, on tariffs and see more the opportunity for driving relative strengths with what the tariffs mean for our competitors than a downside for us. It might mean in the short term certain sacrifices on prices or EBIT margin.
If we look at the long term of EBIT and our target of above +20% EBIT margin by 2029/2030, it also means that in absolute terms our EBIT from where we land this year until the EBIT absolute terms delivered by 2030 will be a above 20% CAGR every year. The magic number on this page is 20%. The even more magic number is above 20%, which is the EBIT margin we'll be delivering in 2030 and the compounded annual growth of absolute EBIT over the period. How are we going to continue to drive this EBIT margin expansion? A lot of these factors were factors that Graziela talked about earlier, and they basically split as we illustrated about a year ago.
In terms of our longer term journey from where we are today, we continue to believe around one-third of the further uplift in EBIT margin will be coming from gross margin and about two-thirds will be coming from OpEx leverage. Looking first at gross margin, as Graziela explained, a big part of this is better utilization, higher output from our production sites, of which Mexico represents one of the areas where we have significant capacity space available, still better product mix. Our single-use endoscopy business has a higher gross margin than our anesthesia and patient monitoring business, even though that has been improving. That means that a higher growth in Endoscopy Solutions will drive higher gross margin overall. We will not give up on pricing confidence. It's here to stay and it will continue.
We will continue to drive also price increases, even in industrial solutions, with better renovation in the market. In terms of OpEx leverage, we will continue to scale our business, obviously bigger scale within administration and distribution, where we'll be able to drive scale with better standardization, better automation, better digital tools, and more standardized processes. We will also scale in sales and marketing. We'll continue to invest where we see opportunities, but also drive more efficiency in our model and really also enable us to sell more to departments and systems, which provides a different scalability in the sales model than what we've had in the past. We will also scale R&D with the balancing caveat and no freebie for Finn that we will continue to invest ahead of the curve in R&D.
We are fundamentally an innovation company and we will continue to be that, closely tied with our high organic growth ambitions. Again, on this page I am also iterating that there can be short-term external factors that can give some headwind, but the rest of these are structural factors that will help us significantly both in a two-year and in a five-year period. With that, let me also turn to cash flow. Funnily enough, with a strong cash flow and a very, very strong balance sheet as ours, I get very few questions on cash flow from this group these days. For us, it remains a key priority to drive the proven model of strong cash flow conversion in Ambu . It is our right to continue to invest in the business organically and eventually also our right to continue or even accelerate the investments inorganically.
We are targeting a plus 40% cash conversion across the period based on three main assumptions. One, our ability to drive up the margin, which will drive further EBITDA. Two, that we will continue to invest in CapEx, both in R&D, in production equipment, and across the business where needed to strengthen the platform. Secondly, we will manage our net working capital around the 20% target. Currently, we are a bit ahead of that or above that, mainly because we are deliberately investing in inventories to manage the global geopolitical situation. We fundamentally believe there's still scale to be found in net working capital and therefore we maintain the ambition of managing net working capital against 12 months rolling sales of around 20%, and that even with some headroom leaves us still with a target of + 40% cash conversion across the period.
What are we going to do with all of that cash? We're going to invest. First of all, we're going to invest in organic growth, in commercial innovation, and operational scaling. We're going to continue to invest in pushing the boundaries of where we can see single-use endoscopy, pushing the single-use conversion, and driving that big, big market opportunity. We will also do inorganic investments. They will be done to drive this organic growth. They will be done to ensure we can sell more industrial solutions. There will not be sacrifices but be opportunities in what we see in inorganic growth, and it will be above and beyond our organic growth targets. All of that said, we're still with a very, very strong balance sheet, and therefore capital distribution in alignment with our updated dividend policy from last year remains also a cornerstone of our longer-term capital allocation.
We communicated last year that we will pay out up to 30% of net profit in a mix of dividend and eventually also share buyback, and today we confirm that policy. We confirm that we will gradually increase dividend, and when we see excess cash, cash outside what we see needed for our long-term balance sheet opportunities, we will also actively look at share buyback. All of this will still be done within the premise of the finance policy and the leverage we communicated last year. With that, I'm back to our overall growth and value creation story that Britt also presented earlier today.
We are super excited to be here today, and I hope you all sense that we're excited about the attractive industrial market, 20% annual market growth, of which a vast majority of that being driven by the single-use conversion, but also general trends towards endoscopy and non-invasive procedures. Overall, we are clear leader in the market with the broadest portfolio, the strongest technology platform, the strongest digital capabilities, and with the largest direct commercial footprint and most resilient supply chain. We are customer-centric in how we solve problems for our customers in close collaboration with key clinical KOLs with unmatched solutions and believe we can provide better solutions and better outcomes for clinicians and patients around the world. Our platform is scalable. We can do even more. We have already in the ZOOM AHEAD period delivered very strong growth but can do much more ahead of us.
We have the space and capacity, and we have the capability and proven record. With all of this, it drives a very clear path for even more growth and even higher value creation than what we see in the past. In summary, we feel we are quite a unique place, and we have a very unique journey of both growth and value creation ahead of us. For us as a company and for you as investors, I remain super excited about what lies ahead towards Ambu achieving true global leadership in endoscopy. That concludes the Finance section, and with that I would like to invite all of my management colleagues on stage for the final Q&A, after which Britt will have a few final closing remarks. Please, please come up, then we will find space for everybody.
Are we lagging one?
What an amazing team we have here. I'll be standing, and I think Anna San Frederick is around with the microphone, so we are happy to take questions. David is.
Thank you.
Hi David from JPMorgan.
Maybe just to focus on the financials.
There, just in the near term, I.
Think it's going to be the inevitable.
Question is as we think about plotting the path to those 20%+ margins, particularly in the near term, could you.
Just sort of set out the quantum.
Of the headwinds you'll face from tariffs.
From foreign exchange for next year?
Thank you.
Thank you. We will not comment on the guidance specifically for next year. Today we have our annual accounts coming out in about a month, and as part of that we will also comment on the guidance more specifically for next year. What I will say is that in the next 12 months- 14 months or 12 months- 24 months, there can be some headwinds. As we also presented today, we think we have significant levers to mitigate the vast majority of those.
It's my turn.
Thanks for my question.
One question.
You talked about your ambition to be a partner to the hospitals, especially in the U.S. as Scott mentioned.
Where are you today in terms of the like bundled sales and the contracting big contract, and what is your target?
In five years' time?
Do you better start than the Scott supplement?
Just to kind of reiterate what I mentioned earlier, you know, and you also see it that customers are looking to standardize when it comes to single-use endoscopy. When they look at the things that matter most to them, they do tend to standardize more with Ambu because we're the company that's offering the full range of endoscopes and we have the Endo Intelligence platform integrating to their health records. You hear that's becoming more and more important to customers, and then kind of like geography specific, and Scott, feel free to jump in here too. We have different mechanisms where we drive that standardization in markets like the U.S. and Germany. With GPOs, we can have setups where we really collaborate end to end on single-use endoscopy, and we have categories that help to drive that in the market. In some other markets, it can be more tender-driven.
Many tender-driven markets have some specific reasons why they might want to just focus on urology or pulmonology and run their tenders that way. Sometimes that's even part of European legislation. I think what we're seeing is that regardless of the purchasing environment, in the end hospitals and health systems are looking to consolidate, and in that environment we do find ourselves very well positioned to take advantage of that.
Yeah, I agree. I think this is a strength of ours and an area that we can continue to strengthen because as you mentioned, specifically in the U.S. market we're starting to see a lot of that consolidation. For us, we kind of view those relationships with the GPOs and the IDNs as kind of our license to hunt. I think there's a great opportunity for us to even strengthen. I spoke earlier about kind of building that barrier, that moat. A lot of it does come through those long-term contracting opportunities where you can secure a multi-year agreement, which allows us to continue to drive adoption, as I mentioned, driving increased penetration within those systems.
Maybe the last thing I'll say is just that. I mean you heard from Dr. Tareq, he had kind of a closing comment talking about about 20 urology players and there's not going to be 20 urology players in the future. There's going to be a few. We'd hoped he said it would be Ambu afterwards but you know, of course we don't shape what they say. I think we also see that there's a proliferation because everyone sees it to be an attractive market. There's going to be a consolidation. We already see that there's not room for so many companies to have meaningful revenues and any sort of sustainable business model.
As we look at it today we just can't see an angle where it'll be anyone but Ambu leading in endoscopy and of course for the next five years we're very committed to make sure that remains the case.
Talking about this advantage of having this portfolio.
Does it need a microphone to hear?
Maybe a microphone.
with more
online.
Online.
I want to follow up on this topic. I mean you talked about advantage of having this ecosystem, and when looking.
At you one of your key competitor.
Boston Scientific, I mean they are a strong player and have been in the market for decades and they have, I.
Mean a lot more products than.
You do, and they also try to.
Bound out, I mean your Retroscope less.
View with other products, but over the last four five six years, they still lose a lot of market share.
To the Chinese competition, in your view, what is the learnings for you?
Should I take that or
you're going to go for it?
Everyone wants to. I think that's a great question. I think one thing that we, when we look at the single-use, you know, endoscopy market and our position within that market, we believe that our path to success is in the scale and cost advantage that we have overall in the market. Graziela talked about it earlier, it gives us the position to lead. It doesn't mean we're a price leader when it comes to endoscopy, but we clearly see when some of the larger companies are trying to come into this market, they do struggle to meet the competitive requirement or the pricing requirements that customers have.
We've established a strong foothold in pulmonology and then we saw some competitors try to come in and it was obvious they just didn't have the scale, they didn't have the production cost that could make them relevant in this market. Actually, when we created this market, we were very focused on, you know, as we continue to talk about single-use penetration, that's by far the + 20%. The main thing is how are we driving volume growth. We've also found that at the price points that we offer, we can be very attractive in terms of earning a profit for ourselves. The health economics are really driving the transition to single-use. We feel like we found the perfect sweet spot of really, like, you know, delivering the value in our solutions at a price point that drives the market creation.
We think that other companies on different sides of that are not quite as, you know, as advanced as we are.
I would say I think I see two prime learnings for us. What you're asking is specifically in ureteroscopy. I think one is, I mean, they have a solution that is eight, nine years old now, and I think that's the learning of innovation, that you need to continue to focus on innovation and improving your solution. The second one is around differentiation, that you really need to make sure that you differentiate yourself in the market and thereby create strong customer loyalty. I think those are two learnings that I believe are super critical, that we are very focused on.
We're all jumping into this question. I think just one final, final thing I would add, very much agreeing with my colleagues, is I think also it's a matter of commercial philosophy where the likes of at least how Boston did it in the past was also one of hardware product bundling, wheel setting solutions, which is a fundamentally different value proposition. The whole point is, and this is a discussion I've had with many of you, we are not in the single-use market to drive commodity utilization of hardware. We're here to sell solutions. That's a very different value proposition.
I think is Jesper next?
Yeah, Jesper, coming back to the.
Market outlook, I believe at your Capital Market Day.
Markets day in 2023, you mentioned you.
Saw the market in five years, time being DKK 15 billion -DKK 20 billion. Now you talk DKK 15, I know that's with a plus, but it's still, it's five years out and back. I mean we're already two years into.
When you gave that first target.
You say the market is +DKK 6 billion. Back then it was DKK 5 billion, which would suggest closer to 10% underlying sort of market growth.
Have you really seen the market?
Growth that you sort of like envisioned back then?
I'm happy to go. I think, and maybe I'll start by just saying that, you know, I mentioned earlier that one thing we try to do as a company is to continue to refresh our market intel to reflect our latest learning. Of course, if we went back now and said what was the actual market size a couple of years back, that number could also be different. I think, you know, I understand the question, which is you're trying to link from what we said two and a half years ago to what we said today. One thing we've done when we've refreshed our market intel is refresh our current understanding and see how we see the current growth strategy trajectory, and that, based on our latest intel, is more than DKK 6 billion market today growing at more than 20% CAGR.
I think the other thing that gives us confidence on the 20% CAGR is that compared to two and a half years ago when we said this market is going to grow to be the numbers that we gave back then, it had a mix of then pulmonology, urology, ENT, and also GI. GI has turned out, as my colleagues have shown, to be a more gradual ramp up, although we still believe in its long-term potential. Fast forward to today, we see the market has expanded. We also see that headroom for growth. The single-use penetration in many segments is lower than we thought it was. Uro is a great example of that, and we see the growth coming more from the respiratory, uro, and ENT, which are very well established now.
We can really start to track how these markets are evolving, and then next to that could come GI. I'd say if anything, we are more confident and de-risked on a 20% CAGR today compared to what we saw a couple of years ago.
Martin Weiner from Nordea. Two questions. I'll dissect the targets later with you, Henrik. I’ll ask Finn and Graziela instead about maybe, first of all, a little bit to the financials. CapEx 6% - 10% of revenue is relatively high. We have at the same time maybe just started to realize that we have the biggest market of Ambu is the U.S., and we have a leader there who is very focused on local production. You have production very close to the U.S., but do you see a need potentially to invest in more production facilities in the U.S. to mitigate that situation?
As I said, I think the way we constructed our Americas footprint is super strong, and we don't see a need of having more than our U.S. site and our Mexican site. That is very much backed up because of the whole planning we did and the space that I've mentioned that we already have available for the future, even beyond 2030. We are definitely going to leverage that, right, because the infrastructure is there, the scale is there. We are just going to take advantage of all this. There's not a need to have another hub in that region.
I think having said that, it's fair to say that we have a number of mitigating scenarios and actions that we are actually looking into right now around the tariffs because it's not as simple as it looks from the outside. We are super happy about our manufacturing plant with ample capacity in Mexico, which is right now at least under USMCA, so no tariffs. We do have a hub in Noblesville in the U.S., which is also strategically that makes sense. Of course, all the complexity of being in the U.S. with components in our industry coming from outside the U.S., which is a very similar situation as everybody else, including the U.S. MedTech company. That is where we believe that our situation and our footprint is significantly better than many of the others. That doesn't mean that we don't have to plan for different scenarios.
As Graziela said, we have potential to one way or the other best optimize our Americas operations and manufacturing footprint.
Makes sense. Just quickly to Finn, if I can just follow up with one. You said you jumped a little bit when you heard adjacent technologies. Just wondering what made you jump and what adjacent technologies are you looking at? Is it the EUS or is it more into the euro opportunities to have technologies adjacent to that? Can you put a few words on where you see an opportu nity?
Sure, I try to do that in the presentation. Basically, as I said, the team we have basically looks at what could be the next game changer. Of course, we will not reveal what the next game changer could be here. When we look into adjacent technologies, it's not just outside the core of, you could say, endoscopy and procedures and things that are happening in that vicinity, but which could also help support our endoscopy business.
These are the areas that we are looking at and then basically seeing what is the market potential. We have some great guys that can do these prototypes and then we can evaluate those with clinicians and maybe a clinician says, wow, why don't we have that? Then we can go further with these kinds of things and that's what we are doing right now. As I also said, the lion's share typically of all our investments go into respiratory and urology because these are the core areas. Particularly with these adjacent areas, you never know what comes up when you actually come up with great ideas. There we stay more open for what it could be.
Yeah, I think it's just key to say when I just build out. What Finn is saying is of course we do have some criteria around this, right. They have to be clinically relevant, they have to accelerate endoscopy growth, and in most scenarios they have to be in the areas that Finn explained and solve.
A good customer problem and then we're onto it.
Yeah, it's Tara again from UBS, perhaps asking the same question in a different font. If you had to highlight one area of innovation that you guys are most excited about, what would it be? I'm thinking what are you going to potentially revisit two, three years down the line as a case study at the next CMD?
I think this is a super good question, but I think also for competitive reasons we are not. It's a nice trials here, but we are not going to reveal it. I think we are super excited about the pipeline we have and we are super excited also about the level of innovation that our people provide and also how they look outside the company as well for opportunities.
We feel quite encouraged about our level of innovation continuing to be very high in the years to come and then hopefully this is a good way to make you come next time and we should hopefully be able to say more.
Should be some cool things to show off, right?
Yeah, that's good. We have your commitment on that thing. I think we are getting to the end. I think we'll have one final question and then we will.
Thank you very much, Britt, for the elephant in the room. Scott, as a newcomer, specifically regarding your U.S. commercial strategy, can you be a bit more precise when it comes to targeting the hospital? What is your main action already taken? Can you develop that a bit? Also, regarding the people development and the sales motivation when it comes to the KPIs, what might be the real KPIs for their comp that we need to look at? Is it really on the revenue? Is it on a new customer? Where do you put the needle there now that the install base is where it is?
Yeah, love that question. So far today I've been the elephant in the room and the new kid on the block and I'm just gathering accolades, but no sincerely. I'm still kind of in a lot of assessment mode of what the U.S. organization, what's going to be the primary drivers moving forward. I think as I spoke about, there's still a lot of opportunity for increased penetration. One of the things we need to solve for is what is the best way to go about doing that. We've got a number of specialties, number of therapeutic areas that we are focused quite heavily on. All of them present really attractive growth opportunities. One of the things I'm really keyed in on is how do we do this in the most efficient way, productive manner. A lot of my background is really about like Salesforce effectiveness and productivity metrics.
Those are some of the KPIs that I will be looking into which I think is going to give us a better advantage in how we choose how to scale this thing. We don't have a shortage of opportunities, but we need to make sure that the investments we're making specifically in headcount and I would say specifically in kind of commercial management systems are the right ones to get the most out of that resource. There are a number of different models we're looking at. We talked a little bit earlier about how to take advantage of kind of GPO opportunities, getting that license to hunt and creating those barriers to allow our team to be most effective. They're not playing defense but they're actually going on the offense.
I'd be happy to come back to maybe provide some of those specific KPIs that we're going to be looking at. There's a lot of opportunities. For me it's about, again, prioritization as you said earlier. How do we prioritize what's going to have the most impact in the short term?
Yeah. Thank you, Scott. Got well aligned. I believe we have come to an end here of both this session in the room and the online session. For those present, all of us will be around for questions, and outside the room we will have product demonstrations by our colleagues in R&D and marketing so you can be able to see and try some of our great solutions. Other than that, I do want to first of all and foremost thank my fantastic colleagues. It's a great and very collaborative team for your work and to the people who have helped also in the company prepare for today, and of course thank all of you both online, but in particular also all of you in the room for coming today.
I hope you leave this meeting being clear around the path and that we do have a clear path towards achieving global endoscopy leadership and also that we are very well positioned to be the one leading the shift towards single-use. Thank you all of you and have a great rest of day and safe travels to those of you who came from far away.