Welcome to Nexstim's webinar for investors, analysts, and media. Nexstim's CEO, Mikko Karvinen, and CFO, Joonas Juokslahti, will be giving a presentation that will take about half an hour, and after that, they are available for answering any questions you might have. You can send questions through the Q&A chat at any time, but they will only be replied to after the presentation. As you send us a question, it will be first visible for us organizers only. The webinar will be recorded, and the recording can be accessed on this page after the event ends. You will also be able to access the recording through the Events page of the Nexstim website. We have booked an hour for the webinar, and now, let's move on to the webinar. First presenting is Nexstim's CEO, Mikko Karvinen. Go ahead, Mikko
Thank you, Essi, and welcome everyone to this H1 2024 Nexstim presentation of the results. My name is Mikko Karvinen, I'm the CEO of Nexstim, and I'm joined in this webinar by our CFO, Joonas Juokslahti. I'll be now switching into sharing my presentation. Seems like there's a technical issue. Let's see if you can see the slides. I'm presenting my screen. Okay, so let's go ahead. So, we will be presenting our H1 2024 numbers, but also before I start with the H1 content, I will be briefly presenting a bit about Nexstim in general, then moving on to talking a bit about the mega trends that support our growth, and then moving on into our business and our products and our approvals.
And then after that, we will go into the, of course, the most interesting content today, which is the H1 2024 numbers and our progress, and it will be also joined by our CFO, Joonas Juokslahti, who will be going more detailed into the numbers. And then in the end of this presentation, I will be going through the main strategic objectives that we have and how we're progressing in 2024. So first, into the Nexstim story in a bit more general manner. Nexstim is a Finnish, globally operating, growth-oriented medical technology company, and we have a very important mission to accomplish. We enable personalized and effective therapies and diagnostics for challenging brain diseases and disorders.
These challenging brain diseases and disorders, they include patients that are going to be undergoing into a tumor surgery. They could include patients that are mapped for radiotherapy or epilepsy-related surgeries. What we can do with our Nexstim Diagnostics System is to map the brain's motor and speech areas in the motor and speech area of the brain, and with these results, the patients can undergo a more safer and effective surgery. Our innovations create a possibility for a better life. This can also be seen by the patients that get helped by a Nexstim system that have Major Depressive Disorder or Chronic Neuropathic Pain.
Our vision is that with our technological know-how and superior services, we ensure the best treatments for our patients, deliver the greatest value for our customer hospitals, clinics, and business partners, and also, of course, long-term growth in shareholder value for our investors. We have succeeded in operating with our long-term values. This Nexstim started off from a technical university background being a spinoff. We value highly science and clinical evidence. Even to date, we have more than a hundred scientific papers that have Nexstim technology as part of their science. There's clinical evidence, of course, that backs our regulatory approvals to multiple markets, including U.S. FDA approvals and also European CE marking.
So that continues to be an important value for us. Financial success is more and more important for us. Also during this H1 2024, we saw progress, nice progress in both revenue growth, gross margin growth, and the result was our operating results was better than compared to last year's H1. And then we also had positive cash flow from our operations. So financial success is more and more defining our future also as we select our strategic paths. Passion and commitment can be seen from Nexstim team members. We have a team of experts here that also value Nexstim as an employer.
We have long-term relations and people committing their time into what they do best. This is something that I can be grateful for, and I'm grateful for our team's work in achieving also this half year that we will be reporting. Ethics and responsibility, finally, as a company based in Finland, we do all our R&D work also here in Finland. We manufacture our systems through our subcontractors that are located in Finland. We have high visibility into what gets done, both in the development of the system and the actual manufacturing. We take ethics and responsibility in multiple areas very seriously.
So we operate according to our values, and I'll move on into talking about the megatrends that support our growth. But before going into these three megatrends that I want to highlight, there's a picture of our integrated navigated TMS system there. It's unique, it's proprietary technology, and the system visible is similar. It looks similar if used for diagnostic or therapy applications, but of course, the differences are more in the software that gets used. Aging population is one megatrend that I want to highlight. As population ages in general in the Western countries, and more and more, of course, globally, even in larger Asian countries, there is a decline in the working age population, and at the same time, brain diseases increase with aging in general.
For example, brain tumors are more common with aging population. We've also seen on the therapy area, a recent development that we've had when signing a letter of intent with a US-based early-stage company called Synaptica Therapeutics. They're working on a new way of treating Alzheimer's with a navigated TMS system combined with EEG mapping and also cloud-based personalization for the targeting of the treatment. This is very interesting, and even though we haven't signed definitive agreements yet, this is a big opportunity for Nexstim in the beginning to develop our system towards Alzheimer's treatments, first in a trial system phase, but then also hopefully in the future for a commercial partnership together with Synaptica.
But there's more news along the way when this year moves forward, and we're working hard to get a definitive agreement signed in no time. Technological development in healthcare is something that has always been part of why we are here. And as there are more than 200 systems that have been delivered to customers worldwide, the majority of the customers or a great part use it also for research. So by using these Nexstim systems in the leading hospitals and clinics in the world, doing more research, they validate what we've already found in trials, but also at the same time, they provide possible new applications or new data that for treatment of challenging brain disease and disorders of the future.
So it's not only mapping the motor and speech areas or treating depression and chronic pain patients. I believe that in the future, there's a lot more that can be done with the Nexstim system. As it is the most accurate and the repeatable. We provide accurate, repeatable stimulation of the brain cortex and also with the right dosing. So these are very important factors that we see for future research and applications. And finally, but importantly, healthcare cost pressures. There is a need, clear need for more effective and faster rehabilitation. Whether it's the public healthcare system that we operate here in Finland or largely in Europe also, or the more private based healthcare system in, for example, in the United States, where we operate.
There is a need for more effective and faster rehabilitation, and I'll use as an example, either a major depressive disorder patient or a chronic neuropathic pain patient. They typically, if they are of severe condition, this condition can take you away from normal life, whether it's work or study life, and these patients need effective and fast rehabilitation so that they can get back to the society and be effective and productive members of the society, and by this way, both the costs are lower, but also the benefits of a more wider society being healthier are seen. So this is a very important point. Okay, a little bit about the business and products in general.
We have two businesses that we operate in Nexstim. There's a diagnostics business and a therapy business, and as you saw in the previous picture, the system itself doesn't look from a common quick view of the system. It doesn't look from the outside a lot different than whether it's used for diagnostics or therapy. But of course, for regulatory reasons and for marketing reasons, we do have to differentiate these systems. If we sell a system for the diagnostic use, we currently, the latest version is NBS 5, fifth generation system that we use that can be used for mapping the brain's motor and speech areas. This business is where we started off with, so the diagnostic business has been around for a longer time.
We have over two hundred and thirty systems sold, and the application is pre-surgical mapping of the brain's motor and speech areas prior to complex surgeries such as a tumor surgery. We are both a CE Mark in Europe and FDA approved for the U.S. markets. We're the only navigated TMS system used for pre-surgical mapping in the world that has both of these approvals, CE marking in Europe and FDA approval in the United States. So it's a truly unique application for our system. On the therapy side, we have both NBS 6 systems, which is the latest generation for therapy, and we have some NBT systems, of course, that have been installed during the years.
There's over ninety systems that include the therapy software, and we're shifting now towards selling the NBS 6 system, which is the newest generation, in markets like in Europe and the United States, where it's been approved already for depression treatment. So the major application is depression and chronic pain. Depression is CE mark and also U.S. FDA approved for treating major depressive disorder. And in the United States, there's also existing reimbursement coverage, which is very wide, and among the larger insurance groups. It's a very effective treatment for depression patients. So for treatment-resistant patients that suffer from depression, this means that they've gone through already, usually a few medications, so pharma drugs that haven't helped.
We can see that from our patient registry, which is several hundred patients. We can see 50% remission rates and over 70% response rate. It is very effective treatment with the Nexstim system for treating depression. For chronic pain, we are CE mark, so we can and have sold NBT systems for using in chronic pain area. This is also effective, so we can see between 40 and 50% of the patients getting a clinically meaningful pain relief after receiving TMS treatment with the Nexstim system. In practice, it is effective, but we would need more clinical trials, trial work for getting an approval in the United States, very likely.
So we're working on evaluating this, and this has been an area of focus for quite some time. But we do see that we want to, besides treating patients in Europe, we would also want to see treating them in the United States in the future. And we have active steps in this area with international key opinion leaders in pain from France, from Finland, and the U.S. that will be and also in Denmark, that are helping us to further with these necessary steps. But of course, it's an investment. It's an investment of time and money, so we have to balance it with our operational profitability needs and such. But it is definitely something worth looking at in for the United States in the future.
So these are our existing business and products, and I'll tell a bit more about the future opportunities as part of the following slides. So now one of the key things, of course, that we want to present today is the Nexstim business and financial summary for the first half of 2024. I'll start with a few bullet points, and then our CFO, Joonas Juokslahti, will continue with a bit more detail into the numbers. So most importantly, we continued to grow, and we improved our profitability. That's very important for us, and that's been our main strategic objective. We've been focusing on profitable net sales growth. And as a happy thing to also report is that the sales forecast looks promising also for the full-year of 2024.
We'll look at the future outlook a bit later in this presentation. We have seen very good support from our distribution partners, so we sell directly currently in Finland, in Germany, and in U.S. We have team members in those three countries that support our direct sales. Everywhere else, we rely on expert distributor partner network. This in particular benefited us for the first half of the year in European system sales that we saw. So we've had an distribution relationship with a German company called Inomed, and we have a distributorship for them in some European countries.
But we also signed a collaboration, strategic collaboration agreement, including the U.S. market, for a long-term strategic helping each other with marketing and sales efforts. Of course, that will show results, hopefully in the long term, but in the short term, we're already seeing a lot of traction with the help they're providing us in the European markets. We also made effective use of our global teams, new global team structure to ensure positive development and profitable growth. We structured our teams to global teams last year, 2023, and I think we're now seeing the full benefits of those changes. We're sharing the knowledge in a different manner.
We're also able to scale operations better because we can help each other, whether it's in Finland or U.S., or in Germany. We've added some new team members effectively. As an example of this, our gross margin grew 30%, more than 30% during H1, but our fixed cost went up, operating cost went up only 3%. So I see this as a signal of the effective use of our global team structure. All the diagnostic systems we delivered during H1 had both diagnostic and therapeutic applications. This is according to what we've also planned for our future system.
So, a lot of our customers in the area of diagnostic mapping of the brain also want to have the therapy possibility to provide depression or pain treatments, or do research in the area of therapy. On the other side, a lot of our therapy sites here in Europe in particular want to also have a possibility of having the brain mapping, either in use from the beginning or as an option for the future. We see that the combination platform is a clear competitive advantage, and as our new NBS 6 will get launched by the end of this year, later this year, we will have both the therapy and the diagnostic applications in one system in the newest platform.
Currently, we sell the NBS 5, so-called NBS 5 Plus, which also has diagnostic and therapy applications in the same system, but it's based on our older software platform so we look forward very much to getting our latest product generation soft launched by the end of this year, and then providing our customers an insight when they can also get their systems delivered. We have done some technology licensing in the past, and one particular licensing deal that we did in 2022 was with a U.S.-based company called Magnus Medical, that work in the area of treating depression with their same protocol.
Since there's, of course, been a lot happening since spring of 2022, but to keep the story short for this particular reason, we ended having a disagreement about royalties in that our agreement, our long-term agreement includes, and based on the information we've received from Magnus during the spring and summer time, we don't currently expect to receive royalty income from Magnus Medical during 2024, and I'll leave the details of the dispute or the disagreement out from this presentation, of course, as this is something that we don't want to publicly comment.
But I want to say that Nexstim is working towards, of course, getting both parties into the same agreement again, and to have also the royalty portion of the agreement being paid as agreed in 2022. And we're working very hard together with our advisors to get this done. So of course, we will be getting back into this topic once there is something that either expense or income-wise is something that is necessary to be reported. So news flow to follow. We've also continued discussions with new strategic partnerships to further scale the use of our technology in care.
As an example, I used already earlier in this presentation about Synaptica Therapeutics, the company that is bringing a totally new Alzheimer treatment form into a phase III trial phase. We're excited about this, and the letter of intent is good progress, and we look forward into getting into this EUR 6 million agreement. So it's EUR 6 million for the two first years of the agreement, where we would, as Nexstim, we would get, first of all, a signing fee type of a fee. We would get a development project to develop the Nexstim TMS integration with a third-party EEG and the Synaptica's cloud-based personalization engine.
To get this together, there's a development project, which is income also for Nexstim, and then we would have also the delivery of the 20-plus trial, phase three trial systems. The trial is expected, based on Synaptica estimates, to begin in 2025, so next year. And we're working hard, of course, both parties, that we would get a definitive agreement agreed soon so that we can move on with the mentioned milestones. So very exciting and one example of the strategic partnership discussion. As a smaller partnership, but an important strategic path for us is also our clinic partnerships. So operating clinics together with leading key opinion leaders in TMS therapy. And we have management services organization that we've established in the United States with
Dr. Kuluva and Dr. Nadkarni. So both are Dr. Kuluva in Piedmont, California, and then Dr. Nadkarni in New Jersey. So there's two investments into management services organizations to date, and we're having discussions for further investments, of course, in a manner that we carefully select the doctors that we do partnerships with, but we're looking to some nice possibilities for the future. And hopefully we can also get some more news flow soon on that topic. A couple of bullet points before I let Joonas go deeper into the numbers. System sales during the first half was EUR 1.2 million. There was a nice increase of 11.4% in that area. Recurring net sales grew faster.
It was EUR 1.9 million, and there was a 39% increase in our recurring net sales. Our recurring net sales includes typically our service and maintenance agreements for systems. We also have disposables and spare parts that we sell, and then we also have monthly leasing fees that consist. So we had a lot of positive development in all of these areas that I mentioned, and that's why the increase was such a high number for H1 in the recurring net sales. Net sales in total was EUR 3.2 million, and there was a nice increase of almost 27%. Comparable net sales, similar amounts, so no incomparable elements between H1 2024 and H1 2023. EBITDA was EUR 0.5 million n egative .
That's a nice progress from EUR 1.1 million negative H1 2023, and operating result was also progressing nicely to -EUR 0.9 million from -EUR 1.4 million last year H1. Profit for the period was exactly the same with these EUR 0.9 million, and coming up from EUR 1.4 million last year H1. If we look at the diagnostic business versus and the therapy business, diagnostic business net sales was EUR 1.6 million. There's a nice increase of 16% in comparison to H1 2023, and the therapy business was EUR 1.6 million, larger increase of 39% from H1 2023. So the split between diagnostic and therapy business was about 50/50 during our first half.
And that, that's a nice thing that the diagnostic and therapy businesses support each other in this revenue manner very nicely and balancing our business. So with that, I let Joonas go into more detail about some of the key financials before I also wrap up the presentation with our strategic objectives for this year. Joonas, go ahead.
Sure. Thank you, Mikko, and good afternoon, everyone. So this morning we published our first half results, and the report was generally very, very positive and very much in line with our full-year future outlook. The total net sales were 3.2 million EUR, with an increase of 27% in comparison to 2023. Now, if we break down the net sales to business level, the diagnostic and therapy business, we see that it's pretty much an even split, both of them being 1.6 million EUR in revenue. The diagnostic business showed 16% growth and the therapy 39%. Now, looking even more into the details, in both businesses, the system sales as well as recurring revenue showed growth.
So all the important net sales elements are increased in the first half. The total net sale-- total system sales for the first half was EUR 1.2 million, growing by 11%. The recurring revenue was EUR 1.9 million, with a 39% increase. Now, the recurring revenues are strategically very important for us as it provides us with stability and predictability for our business... and the EUR 1.9 million in the first half represents roughly 61% of the total net sales for that period. So it's a very, very important portion for us. Now, not only were we showing some healthy growth rates for the net sales elements, but we did that while improving our profitability on the gross margin level.
The gross margin for the period was 82%, whereas it was slightly less than 80% last year's first half. Looking at the operating expenses, while we didn't have a cost-cutting project or anything like that going on in the first half, we still continued our focus on cost efficiency and strict cost control in our business. That can be seen in the operating expenses. The personnel expenses were EUR 2.3 million, which is the same as it was last year. There is less than 1% change in personnel expenses. The other operating expenses increased by 5% to EUR 1.6 million, which means that the total OpEx increased by 3% to EUR 3.8 million.
Now, with the 3% growth in our operating expenses, we generated more than 30% growth on the gross margin line on the P&L. And due to this kind of profitable growth and strict cost control, we saw the operating loss decreasing by 38% to EUR 0.9 million. Also, the result for the review period was minus EUR 0.9 million, showing improvement of 34%. So the good development on the result levels also reflects to the operating cash flow, where we see a significant improvement from EUR -1.4 million last year to EUR 0.7 million this year.
At the end of the period, in June, we had three million EUR in the bank, which means a 34% increase from June last year. Now, as we announced in June, we raised some new debt funding, the most significant being the Finnvera digitalization and innovation loan of 1.5 million EUR. That was backed by a convertible bond of 0.7 million EUR from our existing shareholders.
Now, based on the business performance in the first half, we will not do any changes to our full-year future outlook, so it will remain the same as it was when published in the springtime as a part of the annual report, and it goes as follows: "Based on our business forecasts, the company expects its comparable net sales to grow and operating results to improve in 2024." Now, at the end of this presentation, we have a Q&A session, where I'd be happy to try and answer any of your questions related to the financial figures, but before that, for a few more slides, back to Mikko.
Thank you. Thank you, Joonas, and, as Joonas reminded, we- you can, you can post Q&A questions, and we will be answering them at the end. But, I think you can already post them if you want to. If you find something that you want to, ask from us already when you're listening to this presentation. Okay, I'd like to, to start ending up the presentation with a couple of more points, but very importantly, so we've been looking at the past, of course, when we've been looking at H1 of 2024 and the numbers, which look good. But I want to look at how, the 2024 is going to end up as a full-year, and, by presenting also our next and key strategic object- objectives for this full-year. First of all, profitable growth.
Profitable growth is and will be a very important area for our strategic objectives. And as stated already early this year, we want to increase comparable net sales and improve operating results for the financial year while minimizing future capital needs. So this is something that I think H1 demonstrated already very well. Increased net sales, improved operating results, and minimizing future capital needs. We got some debt financing, convertible loan also. So structuring our finance for helping our development and progress our business. So we're still aligned with this as a goal also for our full-year 2024, as Joonas also mentioned, based on our future outlook. The second important point is in the area of technology leadership.
So the Nexstim system is a very sophisticated neuro navigated TMS system, and we are making it even better with our NBS 6 new platform and new generation of systems. And launching the new NBS with diagnostic applications included is an important milestone for the end of this year. It will enable easy-to-use systems and future add-on modules in the same hardware. Again, we want to do a soft launch of the system by the end of this year, and then providing our customers with knowledge of when they can have NBS 6s ordered and delivered to them. We're in the final stages of testing and restarting the regulatory path towards approval.
Not that much of new development is done anymore, but as listeners might know, in the medical device area, the quality regulation is very strict, and the quality needs are very strict and to undergo a lot of testing and auditing and approvals are needed before they're out to the market. But this is an important milestone for us, and based on our team's knowledge, I feel very comfortable about also this objective reaching its goal by the end of 2024. A third one, an important one, strategic partnerships. You've already heard about strategic partnerships in my presentation, about Inomed, about Synaptica Therapeutics, about Magnus Medical, about our clinic partners with Dr. Kuluva, Dr. Nadkarni.
We will be working, of course, with the existing partners and also with the new ones. Want to expand the Nexstim partnership network, whether they are then doing partnership with Synaptica Therapeutics to get more trial work done in the area of Alzheimer's treatments, selling more systems through the Inomed sales channel, or opening new partner clinics and treating patients through our help from the management services organizations, together with Dr. Kuluva and Dr. Nadkarni. I see that the strategic partnerships is a great help for Nexstim to grow, and we've seen this already in actual results, but I think this is a very important area also to continue working with in 2024, but likely also for the long-term future.
Very important thing to take care of our strategic partnerships and negotiations, agreements, for the end of the year, and hopefully we can get as much news flow out from there as possible. I also end this 24-slide with the future outlook. Based on business forecast, the company expects its comparable net sales to grow and operating results to improve in 2024. We posted this already at the end of February, and our forecasts show that this is still very valid at the moment. Looking forward to, of course, posting our progress under this future outlook. Finally, I'll end this presentation with a bit of a marketing note about the NBS 6, the future of the Nexstim system.
No longer is it only future, of course. It's been future during the whole strategy period, which started in 2020 and is now ending in 2024. We're working a lot on the new strategy, the new strategy period, beginning in 2025. We'll be posting, of course, some updates while the strategy work moves forward. A lot of good ideas, a lot of good scenarios, but we need to. We have some exciting things also to still think about, some selections. But one thing that we are very happy about is that the new NBS 6 system, that will get the diagnostic part combined with the therapy, by the end of this year, is a new combined system and is built on our unique, clinically established technology.
Of course, as the sixth generation system, we already have a lot of things that we can take with us from the past, but at the same time, the new modular design that we have in the Nexstim NBS 6 system is going to help us expand the capabilities to the future. The last fifth generation platform has been in use for about 10 years, so these are long life cycle investments into these new platforms, but it will also create long-term value for Nexstim and our customers. Both customers and investors will profit from this new NBS 6 system of the future. Finally, but very importantly, we're responding to customer demand. The NBS 6 software has been developed in collaboration with our customers.
It's been tested also with some of our leading opinion leaders. And the combined system responds to great customer demand for systems that allow delivery of both diagnostic and therapeutic applications. And we see this both, whether it's in our home market here in Europe or our largest market in the U.S., or the future markets in Asia. There's the same need. Our customers want to deliver therapy, they want to map the brain. They possibly want to also do research, very many of them. So this is responding to that, and we look forward to providing more marketing knowledge and more marketing around the combined NBS 6 diagnostic and therapy once we're there a bit later this year.
So with that note, I thank you for following this presentation until now, and we can take a quick look at the Q&A after this part and see if there's any questions. Thank you. Let's see if there's any questions that have been posted. It seems like there's no questions yet posted. There's a bit of a lag in time, I have to tell, in real time. If you post a question, it'll take a bit of time before I can see it here. But of course, there's been a lot of information provided today, both the actual H1 report published this morning, Finnish time, and now this presentation. So I hope you've enjoyed what you've heard.
If there are no questions, we look forward to formally telling about the financial results next time on the 27th of February, 2025 , when we post... are estimating to post our both H2 and full- year 2024 numbers. And of course, hopefully we before that on how we progress. So thank you once again, and have a very good weekend.