Good day, and thank you for standing by. Welcome to the Össur conference call and webcast covering the acquisition of FIOR & GENTZ. At this time, all participants are in listen-only mode. After the speaker's presentation, there'll be question and answer session. To ask a question during the session, please press star one and one on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star one and one again. Alternatively, you may also submit your questions via the webcast at any time by typing them in the question box and click Submit. Please note that today's conference is being recorded. I would now like to turn the conference over to speaker, Mr. Sveinn Sölvason, President and CEO. Please go ahead, sir.
Thank you very much. Good day, everyone. I would like to welcome you all to this conference call, where we will cover the strategic rationale and financial aspects of the acquisition of FIOR & GENTZ that we announced earlier this morning. My name is Sveinn Sölvason, and I'm the President and CEO, and also on the call is Arna Sveinsdóttir, our CFO. Go to the next slide, please. I'll start by going through the big picture rationale and how this acquisition fits with our Growth' 27 strategy that we announced at our Capital Markets Day last year. I'll then introduce the new product business segment and give a brief introduction to the company and the market growth drivers. We will then end with the financial impact and transaction highlights, followed by Q&A. If you go to the next slide, please.
First of all, I am very pleased that we are here today announcing the acquisition of FIOR & GENTZ, which is a big milestone for our company and in line with our strategic direction that we presented last year at our Capital Markets Day. The main points that we'll cover in more details today are, again, the rationale, big picture rationale. Neuro Orthotics is a new product segment for Össur and highly synergistic and complementary to our business. FIOR & GENTZ is also a company that is a strong cultural fit and founded very much on the same principles as Össur, which is to improve people's mobility. We are entering a market that is already has strong growth and very favorable structural growth drivers. And finally, acquisition is accretive to our organic growth and earnings profile.
If you go to the next slide, please. At our Capital Markets Day in March last year, we presented a vision for a company maturing from being a product company to a more patient-focused company that is addressing the whole value chain and focused on serving individuals with a chronic mobility challenge. That is the business we are building, referring to the picture you see here on the left-hand side of the slide. The O&P market serves individuals that live with impaired mobility, which is largely due to either limb loss or neurological conditions. The acquisition of FIOR & GENTZ, therefore, positions us to be a more complete supplier of products and solutions by adding a portfolio of neuro-orthotic products that address challenges faced by people with gait impairment due to neurological conditions.
As of today, we therefore have a wider offering and can reach a larger portion of the patient population already served by orthotics and Prosthetics clinics, which is our core business. FIOR & GENTZ has principally been focused on the German market. However, with Össur's global reach and relationships with O&P clinics across the world, there are strong commercial synergies in leveraging our infrastructure and patient care network to offer FIOR & GENTZ solutions to even more patients. The market for neuro orthotic products is driven by strong structural growth drivers, and we estimate the market growth to be in the range of 10%-12%.
FIOR & GENTZ has outgrown the market in recent years, with sales growth of 16% in 2023 and an average annual growth of 14% since 2020, while also generating a strong EBITDA margin of around 30%. This acquisition is therefore financially accretive and will increase both our average organic sales growth and operating profit margins. Furthermore, we expect the transaction to have a minimal impact on earnings per share in 2024 and be earnings per share accretive from 2025 onwards. Össur has a strong M&A track record with acquisitions such as Touch Bionics, medi Prosthetics, Naked Prosthetics, and also College Park, where we are acquiring strong products or solutions and can leverage our global market presence and make these solutions available to more patients. That is exactly what we are doing here.
If you go to the next slide, please. As was communicated in our company announcement this morning, we are renaming our Prosthetics sales segment to and Neuro Orthotics, and we will include the FIOR & GENTZ sales in this new segment. Our Prosthetic solutions, both bionic and mechanical, are used by O&P clinics to serve patients with limb loss and limb difference. These patients live with chronic mobility challenges and, require Prosthetics or custom Prosthetic solutions for the long term. Similarly, the solutions offered by FIOR & GENTZ also address chronic mobility impairment. the FIOR & GENTZ products are used by the same O&P clinics to make custom orthotics for people living with the consequence of conditions such as stroke, MS, cerebral palsy, and other neurological indications. These solutions are most often, required also over a long period of time.
the FIOR & GENTZ orthotic solutions are also both bionic and mechanical. Hence, in both cases, both on the Prosthetics and Neuro Orthotic side, we are offering innovative solutions that improve the mobility of a user with a chronic indication, and as I said earlier, are typically used for the remainder of the patient's life. Fitting takes place in O&P clinics. Both require custom fabrication to ensure the best possible outcomes. In Prosthetics, it's the custom socket, and on the Neuro Orthotic side, it's the shells. In essence, to maybe simplify, the Prosthetics and Neuro Orthotic solutions are as such similar in nature. On the Prosthetic side, the limb is not there, while Neuro Orthotics, the limb is there, but it's lost its function.
Hence, we are restoring some of the same motion, same biomechanical function, and ultimately, the end user or patient will need to have the solution maintained, upgraded, and renewed regularly. In most developed healthcare markets, neuro orthoses are reimbursed, as is the case with Prosthetics. The products we offer in bracing and support differ as they are designed for people with acute injuries or fractures, which are generally not a chronic indication, and with users typically requiring a bracing solution for a limited time, with some exceptions, obviously, such as the osteoarthritis solutions. I should note that there are instances where the terms bracing and orthotics are used interchangeably. To make a clear distinction between the two, we therefore refer to the segment Neuro Orthotics, which refers to devices designed to address mobility impairment of individuals with neurological conditions.
Finally, we have our Patient Care segment, which, includes our O&P clinics, who serve patients in need of orthotic and Prosthetic solutions. If you go to the next slide, please. FIOR & GENTZ was founded in Germany in 1997 and is a leading provider of functional lower limb Neuro Orthotic solutions. The company develops and manufactures a functional ankle and knee joints, which are utilized in custom-made Neuro Orthotic devices, especially designed for people with, yeah, neurological conditions. In the Neuro Orthotic segment, same as in Prosthetics, the ambition remains to serve more patients with, with functionally more advanced solutions and further the, well, thereby further enhancing mobility levels. FIOR & GENTZ has recently launched their first bionic knee joint, which supports a more natural gait and improves the safety of the users.
FIOR & GENTZ has a strong track record in R&D, and customer support, has patented innovation, and has direct sales operations in Germany, France, Benelux, and Switzerland, in addition to distributing to other international markets. FIOR & GENTZ generated about EUR 21 million in sales in 2023 and has around 80 employees. Just as we observe in our Prosthetics business, majority of the customers are repeat customers, and the customer channel is, as previously mentioned, orthotic and prosthetic clinics, thereby further underlining the similarities, let's say that, and the potential for commercial synergies across the two segments, Prosthetics and Neuro Orthotics. also, as previously mentioned, FIOR & GENTZ have a solid track record when it comes to organic growth and profit generation.
We expect growth to continue to exceed estimated market growth in the near term, and we expect to continue to generate a strong EBITDA margin around or above 30%. If you go to the next slide, please. Here we have an illustration of the market growth drivers. The growth drivers for the solutions offered by FIOR & GENTZ are sound and align well with dynamics we see for our Prosthetics and patient care business. Market growth is driven by both volume and value. Main growth drivers remain, firstly, in terms of newly diagnosed patients with chronic neurological conditions that would be assessed for eligibility to receive custom functional orthotics.
Secondly, is increased fitting rates with increased awareness and knowledge about, let's say, the functional benefit Neuro Orthotics, and the patient population here is currently very much underserved with relatively low penetration rates. Then there's reimbursement, which is there in most developed healthcare systems, and there remains a further opportunity to increase access to Neuro Orthotic solutions or increasing reimbursement. Then we have the product renewals and the upgrade cycle, and as with Prosthetics, functional trade-up is considered to be a key growth driver with increased use of higher value, more advanced orthotic solutions. And finally, we expect year-over-year average sales price increases.
The combination of these growth drivers results in what we believe to be a strong growth in FIOR & GENTZ key markets, which we estimate to be in the range of 10%-12%.... And if we then go to the final slide, please, here we have an overview of some of the key transactional items. Purchase price is EUR 100 million, which is paid in cash in several installments and a share issuance to the sellers of FIOR & GENTZ, with a lock-up period of two years. In addition, there is a potential earn-out, which is currently estimated at around EUR 10 million. We will expense transaction costs as special items of around $1 million in quarter one 2024.
Since part of the acquisition was financed with additional credit facilities, our leverage ratio will temporarily go slightly above our target range of two to three times EBITDA. The effective date for the financials to be included as part of our consolidation is first of January, even though the transaction is signed and closed today. The financial guidance for 2024, which will be published as part of our 2023 annual report, will include the effect of FIOR & GENTZ. So in summary, this is a, or FIOR & GENTZ is a strong fit to us, to the company that we are building. Very compelling commercial synergies, strong organic sales growth outlook, and solid operating margin, which we believe will support long-term value creation for our shareholders.
That was it, let's now go to the Q&A session, please.
Thank you, sir. As a reminder, to ask a question on the telephone, you need to press star one and one on your phone and wait for your name to be announced. To withdraw your question, please press star one and one again. Once again, please press star one and one on your telephone and wait for your name to be announced, and to withdraw your question, please press star one and one again. If you wish to ask a question via the webcast, please type them in the question box and click submit. Thank you. We are now going to proceed with our first questions on the phone line. The questions come from the line of Christian Ryom from Danske Bank. Please ask your question. Your line is open.
Yes, good morning, and thank you for taking my questions. I have three, please. So the first one is a fairly open one, and the question is essentially why now? And why is now the right time for you to move into Neuro Orthotics domain? Given it's a new adjacency that's been there for a while, can you maybe give us some insights into why you chose to make this move at this point in time? And then I'll come back with the two additional questions.
Hi, Christian. Thanks for the question. I'll go back to the big picture, as how we've developed as a business. Össur is transitioning from being, let's say, a focused product business to addressing the whole value chain that is serving individuals with a chronic mobility challenge. We have been monitoring the right time to enter this part of the market for some time now, and, given where we are, both with respect to our core customer access and also with regards to our own patient care network, this is simply a very strong strategic fit.
And opens up a new growth track for our business as individuals with neurological conditions that have a mobility impairment as a result of neurological conditions is a large and underserved patient population. So we believe, given where we are as a company, and our overall strategic context, that this is the right time to take this step and the readiness within our organization to take it on.
Okay, great. That's clear. Thank you. And then second question is whether you can share some, or whether you can share your view on how mature markets are outside of Germany, because. The reason for me asking is, of course, this relatively concentrated presence that FIOR & GENTZ have in Germany. Is that just a matter of their say historical origination, or to what extent do you also see this as a reflection of the maturity of other markets?
We believe that the neuro-orthotics market is, let's say, a few years behind the prosthetics market in terms of maturity, let's say. And if we look at our main, let's say, the biggest healthcare markets globally, where there is a well-developed reimbursement system that serves these patient populations, let's say these products are reimbursed, although reimbursement levels differ. Again, as with Prosthetics, the health economic rationale or the logic to get or to provide access to these types of solutions is very, very strong in terms of just overall health economic outcomes and with looking at lowering the cost burden for healthcare systems. So the logic is very, very strong to also continue to fight for more access.
But these are products that are generally already reimbursed in all of our, let's say, major markets today. But it is in terms of maturity, it's still somewhat behind Prosthetics. That is something that we and other industry participants need to work on furthering that maturity.
... Okay, thank you. And then final question from my side is on, on synergies and more specifically, potential synergies, on, R&D, and possibly also on manufacturing, whether you can talk to that?
Yes. I mean, let's say when it comes to synergies, the short to medium term, it's about leveraging our commercial infrastructure and relationships with O&P clinics in a global context to provide access for FIOR & GENTZ solutions to more patients. However, there are synergies that, I mean, when it comes to technology application, because in its most simple form, on the Prosthetic side, we are restoring motion as a result of a lost limb. On the Neuro Orthotic side, we are. The limb is still there, but we are in essence solving some of the same biomechanical functions. So, there is still, there are definitely synergies when it comes to our technological platform and intellectual property.
We have lots of intellectual property know-how about movement, and as we go into more bionic bracing and steering and so forth, we will definitely be able to take advantage of both the know-how in FIOR & GENTZ and also to further advance the innovation levels.
Great. I'm looking forward to that. Thank you very much, Sveinn.
Thank you, Christian.
Thank you. We are now going to proceed with our next question. The question's come from the line of Martin Brenøe from Nordea. Please ask your question. Your line is open.
Hi, thank you very much, and, congratulations with, this, interesting acquisition. So I just have, two questions, if I may. One of them is, building on top of, Christian's question, regarding synergies, I think. Can you maybe just highlight whether, it sounds a little bit, like it's-- you're leaning more towards, revenue synergies. Have you identified, any cost synergies, and can you maybe help quantify just a little bit, how much you, you, you see that could, turn into? And then on the revenue side, how fast will you actually be able to harvest synergies, i.e., using the distribution setup that you have globally to, to push these, products forward?
That's the first question, and then I'll just say the second one, that's basically to understand the earn out model. Can you help us understand a little bit how that has been set up? What are the criterias for a successful transaction, and whether you'll have a earn out in the low end or in the high end? That would be very helpful. Thank you so much.
Yes. Hi, Martin. Thanks for the questions. This is principally an acquisition where we are focusing on growing this business. This company, FIOR & GENTZ has achieved success in mainly one market by being focused on one market without having prioritized building commercial infrastructure in other countries. So that is principally our focus. Cost synergies is not a big part of our investment case here, and we don't expect any meaningful cost synergy. Of course, we'll aim to utilize our infrastructure, our backbone, but in the medium term, we don't expect to do any significant changes in that regard.
When it comes to timing and how fast we're able to advance, we already use FIOR & GENTZ product in our patient care network in most of our countries and in Europe to some extent, and there remains an opportunity to further increase access to these products, and of course, also simply to leverage our relationships that we have with O&P clinics, both principally in on the Europe side, but also in U.S. to further, let's say, to further grow this business. That is the core of the investment case here.
And we have—we also communicated that we expect to grow above market here in the near term, and our infrastructure and our commercial synergies will contribute to that. And, finally, on the earn out, let's say if this business grows above market in the next couple of years, that will get us to about middle of the range when it comes to the earn out. And we estimate that the earn out payment will be about EUR 10 million, which means that we'll continue to grow the company at, or slightly above market growth rate.
Okay. That's very clear. Thank you so much, Sveinn. Maybe just a quick follow-up, which is maybe the near-term market where you can really start exploiting your commercial network? Is that mainly in Europe, or are we also speaking U.S. here?
I would focus on the main markets—or we will focus on all the main healthcare markets here in Europe, but we also see potential in the U.S.
Okay. Thank you very much.
... Thank you.
Thank you. We are now going to proceed with our next question. The question has come from the line of Niels Granholm-Leth from Carnegie. Please ask your question. Your line is open.
Good morning, and thank you for taking my questions. Could you talk about your Össur market share in Germany? And which would be the key competitors to your Össur? Those would be my two first questions. Thank you.
Hi, Nils. Yes, we estimate our market share in Germany to be somewhere between 15% and 20% for Neuro Orthotics solutions, let's say, in their addressable market. The competition is similar as on the Prosthetic side. Ottobock is established Neuro Orthotics, and Ottobock in the U.S., Proteor and a few of our key competitors on the Prosthetic side are also established in this part of the market.
Great. Thank you. Could you talk about what proportion of the patient population or the addressable patient population in Germany have adopted these technologies? And would there be any extraordinary beneficial reimbursement setups in Germany that would suggest that Germany has a kind of a larger potential compared to other countries because of their reimbursement setup?
That's, let's say, I mean, first and foremost, the patient population that would benefit from these solutions is very much underserved, and that also goes for the Prosthetics population as well, to some degree. Now, the German market is perhaps the most mature market when it comes to access and where the biggest advancement has been made in terms of education and awareness around what these types of solutions can do for individuals that have suffered a mobility impairment as a result of some of these neurological conditions. So there's still a big job to do to increase awareness and to increase the penetration, but it is still very, very low.
I don't wanna put a number on that, but it is, it's low. But let's say the growth rates, as we've seen for FIOR & GENTZ in the last couple of years, is just very, very solid, and that reflects that the awareness levels are up and a lot of progress has been made. Now, the German reimbursement system is favorable, but again, these solutions are also paid for in other healthcare markets, and we have seen new reimbursement come into this area as well in recent years. So, but again, there remains some work to be done there.
But we still expect to be able to promote these products and grow these products in all of our key markets in Europe.
Great. Thank you.
Thanks, Nils.
Thank you. We have no further questions on the phone at the moment. Please, go ahead with your webcast questions.
Yeah. So hello, this is David in Investor Relations. I'm just gonna read the questions your way, and then, maybe you can take them one by one. So the question is, I mean, whether there are any, are any plans to use the, strong Össur brand image for FIOR & GENTZ? Or, yeah, I suppose whether we're keeping the, the brand of FIOR & GENTZ intact or not.
We will continue to operate this business under the brand of FIOR & GENTZ. However, Össur has relationships in a global context with orthopedic and Prosthetic clinics, and we will, of course, utilize that access and open doors and promote the FIOR & GENTZ brand. But our assumption is to continue to operate under the FIOR & GENTZ name and brand.
Okay, thank you. And then we have one more here, which comes from Felix at SFO. So he's asking about the background of the new orthotics market. I mean, and we know that the Prosthetics market is now quite a bit consolidated with, you know, two to three large players. How does the structure of the new orthotics market look like? And whether it's still much more fragmented or whether we can expect more consolidation going forward in this market.
It is a somewhat fragmented market, and as I mentioned earlier, this market has not reached the same maturity stage as Prosthetics. When we look at Prosthetics, that market has matured in terms of, let's say, reimbursement, is at least paying for similar solutions in most developed healthcare markets. Neuro Orthotics is a little bit behind, and it's our belief that there is again a big opportunity to continue to mature this market, because always going back to the value that this creates for both patients and healthcare systems, to raise mobility levels, and lower the cost burden for systems, that is ultimately what it's all about.
So we believe the market is somewhat behind the Prosthetics market, and as we move forward, we'll continue to, let's say, become a bigger part of the overall O&P market.
Great. I have one more, one more here from Morton, our analyst. He's, he's actually traveling in London, he says, so he sent me a question over email. Maybe you can take it on the call here. So he's asking about, I mean, how unique the German products are versus, you know, that the competition has globally, and, and whether there's a lot of tweaks needed to get them ready for regional markets, or whether this is sort of a more plug-and-play?
No tweaks needed. This is, FIOR & GENTZ has done exceptionally well in creating exceptional products. They have been super focused on this segment for over 20 years. And there's a lot of passion in this business to get more people acceptable solutions that are, and very often just lost in the system after having suffered some of these indications that we've talked about, don't get any acceptable solution. So that is the passion that has driven this business to create exceptional products. And it's our intention to take these products and provide access to more patients. That's gonna be our job, and we will be committed to doing that.
Yeah, I think this concludes the questions that I have here on my end.
Thank you. We have no further questions on the phone line either.
Thank you everyone for dialing in, and thank you for your participation and questions. Please reach out to our investor relations team if anything, if you have any follow-up questions. Thank you very much and enjoy the rest of your day.
Ladies and gentlemen, this concludes today's conference call. Thank you for participating. You may now all disconnect your lines. Thank you and have a good day.