Next, Nexstim CEO Mikko Karvinen and CFO Joonas Juokslahti will be giving a presentation that will take a little over half an hour. 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 a question, it will first be visible for us organizers only. The webinar will be recorded, and the recording can be accessed on this page after the event. You will also be able to access the recording through the events page of the Nexstim website. Now let's move on to the webinar, first presenting as Nexstim CEO. Mikko Karvinen, go ahead, Mikko.
Thank you, Essi, and welcome. My name is Mikko Karvinen. I'm the CEO of Nexstim, and I will be presenting today our last year 2024 financials, both second half of 2024 and full year 2024. I'm also going to be assisted by our Chief Financial Officer, Joonas Juokslahti, who will be going through some numbers, mainly the full year 2024 figures. I'll start off with a few slides. First, we've been doing some updating of our strategy during last year 2024, and our new strategy period has begun this year 2025 and will be ongoing until year 2028. Here's a picture as a result of our strategy work that shows the main elements of our strategy, and I will briefly go through some of these to assist your understanding of our future.
On the top of this picture, we can see the megatrends that affect most companies in our industry, which are aging population, technological development in healthcare, and also healthcare cost pressures. Nexstim operates globally to a certain extent, and we need to be, of course, knowledgeable about these trends. As examples, we have some pinpoints I want to mention. For example, our partnership plans with Sinaptica Therapeutics, a U.S.-based company in relationship to Alzheimer's disease treatment and developing that treatment together is something that, of course, benefits from the aging population and the vast number of Alzheimer's patients that suffer and need new treatment forms.
As a result of technological development in healthcare and healthcare cost pressures, there are more and more needs to technologies such as Nexstim's to assist in having more efficient treatments for the patients and also to assist the staff requirements, which are higher in most healthcare systems. Of course, as we know, there's a need for more nurses and doctors, and there isn't necessarily such a supply. Technologies such as Nexstim's technology, which helps treat patients more efficiently, helps also with these types of trends. If we look at the lower end of this picture, we can see that as a basis for anything we do, we have our mission, which is a very important mission, that we enable personalized and effective treatments and therapies for challenging brain diseases and disorders. This has been unchanged for the new strategy period and is very valid.
Our vision is that we ensure the best treatments for our patients. We deliver the greatest value for our customer, hospital, clinics, and business partners, and long-term growth and shareholder value for our investors. Our vision is also unchanged in the wording, but of course, we take different measures to fulfill this vision during these upcoming years. If we look at the main elements in the center of the picture, which we describe our businesses. First of all, we will be having diagnostic business and therapy business also during this strategy period. We have research and neuroscience customers that we want to especially focus on, and then also the clinic partnerships that we evolved during the last strategy period. I'll give a few examples of important notes for each and every of these areas that are strategic importance for us.
Beginning from the Diagnostics business, we recently told about the partnership with Brainlab, a German-based company that works in the area of neurosurgery, supplying both software and hardware solutions for neurosurgical hospitals around the world. We see that the Brainlab Nexstim partnership, which I will tell more details in the later slides, is a key element for system and service sales volume increase during the strategy period. As our key partner, both as a distributor and as a future technology developer together with us, we see that there is a lot that we can do in the area of system and services volume growth. I'll just give a few examples. Brainlab, as a company, is much larger than Nexstim and has a larger presence in different markets. They have over 6,700 customers in the neurosurgical field.
They also have a representation of their own in almost 30 countries or 30 locations in the world. Their staff, or full personnel, is 2,400 people. There is a lot of potential in bringing the Nexstim offering and the Nexstim technological solutions to the front of more and more neurosurgeons and their personnel and staffing around the world. We look forward very much into this partnership and the first full year of partnership beginning now in 2025. If we look at the therapy business, this is an area where we have grown a lot during 2024 and also during the strategy period before that. We have this as an independent area also in the future for Nexstim.
We will sell therapy systems and solutions mainly in the EU and U.S. as we're approved there in both markets for major depression, but also then for chronic pain in Europe. These two indications mentioned are going to be the ground that we start building our therapy business also in this new strategy period. We will be looking into expansion of new possible indications and market opportunities within this area. I won't go into the specifics of which indications, but besides major depressive disorder and chronic neuropathic pain, there are a lot of possibilities that we will be exploring and possibly pursuing. We will be doing this in both supporting our values so that the indications that we select are science and clinical evidence-based, but also that they can provide financial success and growth in a profitable manner for the company.
As a third focus area, we've noted our research and neuroscience customers. You can see a picture there on the right of a TMS-EEG patient being treated with a TMS-EEG combination. As an example, TMS-EEG technology is something that we've shown as a company that we're capable of providing huge value for our customers, and Nexstim's offering is unique in this area. As a recent example of this, we signed a letter of intent during the summer of 2024 with an early-stage company called Sinaptica Therapeutics that had shown excellent results in the area of Alzheimer's treatments, slowing down the disease by as much as 80% in comparison to the Sham group in a six-month follow-up period. These types of partnerships are possible because of our presence in the research and neuroscience area and our offering to that.
We are looking forward to the negotiations finalizing in a definitive agreement, hopefully during this year with Sinaptica Therapeutics, but also exploring other parts of other possibilities of doing research and neuroscience system sales and possible partnerships for the future. This is a hugely exciting area. I do want to emphasize the role of TMS-EEG and Nexstim's unique knowledge and expertise in this area as future growth potentials. As a final element, but a very important one, during the last strategy period ending 2024, we established management services organizations with three clinics in the U.S. Now we have three partnership clinics that work, one in California, in Oakland. We have a clinic in New Jersey, and then we have a clinic in North Carolina.
These three are now in the focus area for us for further expansion and also providing and showing operational excellency through these partnerships. We will be actively monitoring new effective treatment methods while we also refine the business models. These expert clinics in these areas will be helping us better understand both the business and the evolution of the possible new treatments for the future. We look forward to expanding Nexstim's presence in the clinic partnerships and in the area of therapy, especially in the United States. That as a summary and a quick cap of our future look into the 2025-2028 strategy. One slide, this is not so much content, but very important to logos here. Brainlab Nexstim, this is a slide from the Brainlab marketing material showing that we've joined forces recently.
This is, of course, because of a collaboration that we started by signing a development and distribution distributorship cooperation agreement. As we have the world-leading non-invasive brain mapping technology based on navigated transcranial magnetic stimulation, and Brainlab, as I mentioned, in the neurosurgery field has a huge basis of existing customers and also future potential and has a very broad footprint in this area. This gives us access to the market, but it also gives us a possibility to develop the new solutions and improve the workflows together with Brainlab. I just wanted to emphasize the meaning of this partnership for the year 2025, but also for the future years of Nexstim, especially in this strategy period. Here's a quick view into what area of actual operations this Brainlab partnership affects when we look at Nexstim technology.
This is an example of the steps for a non-invasive brain motor mapping in 20 minutes. When we do a brain mapping with our Nexstim system, it begins with step number one, which is preparing. We upload the patient's own MRI image into our system. After that, we do the registering. We register the physical head of the patient into their own MRI that is in our system. The physical world and the 3D model of the brain meet in this way. We stimulate. We have the navigated transcranial magnetic stimulation that is done with the coil. You can follow the real-time electric field navigated in the 3D model, and you can do the mapping based on that. Evaluation of the results. We review the areas of the eliciting responses to avoid during surgery.
Of course, the information that we get by mapping motor functions of the brain cortex is valuable for the surgeons because they can do decisions. They can do decisions related to, is this patient operable? Can they operate? If they do operate, what areas should they avoid? Where to take the less risks? In this way, while they are resecting as much tumor as possible from the brain, they're doing it in the safest possible manner for the patient. Finally, exporting. Bringing data into the surgical planning and navigation tools, which in the Brainlab partnership, of course, means that we develop the methods of exporting the data, particularly into the Brainlab system. We are also compatible with other surgical planning and navigation tools.
Of course, in the area of this Brainlab partnership, we will be developing this part in close collaboration with Brainlab to make the export also as seamless and efficient as possible. Okay. If we look at moving on from this brain mapping to the business and products, everything that I described about the Brainlab partnership and related to motor mapping relate to the diagnostic business. The Diagnostic business and the Therapy businesses are the two businesses we run at Nexstim or ran also during year 2024. We started off with the diagnostic business. We've sold over 240 systems in this area. The application is presurgical mapping, motor, and speech mapping. We are the only navigated TMS system in the world that is both CE marked in Europe and FDA approved in the United States for navigated TMS mapping of the motor and speech area.
That is a very unique indication for us and something that we have managed to grow during the past. We look forward to growing this together with the Brainlab team for the future. In the therapy business, we have a more independent role also in the future as we have done to date. We have two products that I want to mention. The first one is navigated brain therapy, NBT. Then we have the NBS 6. The most recent version of our system, NBS 6, is approved for the area of therapy, especially in the area of depression, where we are approved for both US FDA and CE marked in Europe for major depressive disorder. There are over 100 systems that include the therapy software. This installed base has grown also nicely and is roughly half of the business we currently run. Chronic neuropathic pain is something that is already CE marked.
We have systems out there. For example, in the university hospital in Helsinki, we have a system that treats pain patients, mainly pain patients. The results are impressive. We get between 40%-50% of the patients get a clinically meaningful pain relief after they're treated with the Nexstim system for the treatment period. We're looking at additional clinical trials to see if there would be possibilities to expand into this area during the new strategy period. We will be reviewing both the scientific data needed and then, of course, also the return on the investment that this would return. If we look at the depression, which is already approved in both markets, it also has a high efficacy.
We can see based on the patient registry that we've gathered over 400 patients and published on our website that there's a roughly 50% remission rate and then more than 70% response rate for treatment-resistant depression patients, so suffering from major depressive disorder. This is also a very high efficacy rate for patients that suffer from depression and have not got relief from that with medication or other treatment forms. A very resistant patient group. That is to summarize business and products. Moving now finally, but also welcoming the review of the numbers that we actually published this morning at 9:00 A.M. local Finland, Helsinki time. If we look at the second half business and financial summary, one of the main takeouts is that Nexstim continued profitable growth and signed significant partnerships.
In line with our main strategic objective for 2024, we continue to focus on profitable growth, and our sales forecast for 2025 also looks very promising. I also want to notify that because of the increase in net sales and our gross margin growing, we achieved first-time a positive EBITDA for the full year when we exclude non-recurring license income. This is a positive signal of our operational business receiving EBITDA positive results without any one-off income elements. This is great news, I think, for the financial stability also and profitability of the company. If we look at the partnerships that are mentioned also in this header, we did enter into the collaboration agreement about the development and distribution of our diagnostic field systems together with Brainlab. We also agreed on an equity investment.
Brainlab invested a little over EUR 1 million into shares, new shares of Nexstim. They also have warrants open for an extra EUR 4 million worth of Nexstim shares for the future. This is important for business, but also in aligning our future incentives by Brainlab being a very welcomed large investor into Nexstim now and with their future warrants also as an optionality. Finally, something to note is that we're continuing the negotiations with our partner Sinaptica, so Sinaptica Therapeutics, for a definitive agreement with the aim of enabling them to further explore Alzheimer's treatment in studies and trials that would start off further in this year, 2025.
As a concrete example of a step forward, we released also a note in mid-January that we've started to build the first integrated test system, which includes Nexstim's navigated TMS technology, Bittium's EEG system, and then also Sinaptica's cloud-based engine to show the exact treatment spots. This combination, Nexstim, Bittium, Sinaptica, is producing the first system that hopefully will be used in future trials done by Sinaptica starting later this year or during this year, 2025. We look forward to finalizing the work together with the three parties mentioned. The team is working hard to get this done and the system shipped still within the upcoming months. That is an exciting area. Let's look at some of the numbers for the second half. System sales were EUR 3.6 million, increased nicely, more than 19%.
Recurring net sales, where we include service contracts, then also spare parts and consumables such as disposable head trackers. They also increased to EUR 2 million. That's up 13% from H2 2023. Net sales for the company on the second half was EUR 5.6 million. That's an increase of more than 17%. EBITDA was positive, EUR 0.8 million, up from positive EUR 0.6 million in H2 of 2023. Operating result positive, EUR 0.3 million, up also from last year's comparative period. The profit for the period was EUR 0.1 million, positive and with an almost similar result than last year's second half, 2023. As a very positive note, the cash flow from operating activities was positive, EUR 1.2 million in comparison to last year's second half being negative, EUR 0.9 million. I think this is also an important signal for the financial health and the stability.
This is a result of the profitable growth that we've operated here in Nexstim for the recent years. Diagnostic business sales was EUR 3 million, a slight increase from second half of 2023. In the therapy area, we saw most of the increase for the second half, where net sales was EUR 2.6 million and a huge increase of more than 43% in this business area. In the second half, we could say that the therapy business growing was the main reason why we saw such nice growth. Of course, this is as a result of the new therapy system, NBS 6, being launched late in 2023 and then having a full year 2024 to do sales and deliveries. Quite a few deliveries were second half based. This is a huge reason for explaining the extreme increase in net sales for second half of 2024.
That is positive note. Positive note and positive development. That is the summary. One final slide before I give the opportunity for Joonas, our CFO, to go through some of the, especially the full year numbers. I wanted to show this graph, which nicely shows the development, all the second halves of our previous strategy period that just ended. If we begin in from second half of 2020, the highest bar being the comparable net sales, then the second highest is comparable gross margin. On the lower part, where there is negative to start with in second half 2020, we have EBITDA there. I think the other one is, let us see, there is a mistake in the slide.
I think that if we look at the progress of the comparable net sales, comparable gross margin, and the EBITDA, we can see that there's a positive progress that continues starting from lower numbers in the second half of 2020 with negative EBITDAs moving forward to the positive numbers in EBITDA and, of course, higher comparable net sales and comparable gross margin. The trend is clearly visible. This is a trend we want to, of course, move ahead during the new upcoming strategy period. I apologize for the error in this slide. We'll correct it for the one that we publish on our website. With these, and that relates to the EBITDA being shown twice, but actually, of course, only one of those is the real EBITDA. Thank you.
I will now move on to Joonas and Joonas having the possibility to present you with some in-depth figures for the full year. Please, Joonas.
Thank you, Mikko, and good afternoon, everyone. My name is Joonas Juokslahti. I am Nexstim's CFO. Mikko just presented some of the key figures for the second half of the year. Let us take a look at the financial highlights of the full year. The total net sales continued to grow by 21% to EUR 8.7 million. There were no out-of-the-ordinary one-off items in the review period or the comparative one. The total net sales in both periods are the same as comparable net sales. If we take a look at the breakdown of the net sales, system sales were EUR 4.8 million, up 17%. That is 55% of the total turnover.
The recurring revenue increased by 25% to EUR 3.9 million, representing 45% of the total net sales. This has become a significant item over the years, the recurring revenue. By business function, the split in 2024 was almost even between diagnostic and therapy. Diagnostic business was EUR 4.5 million with a 6% growth. The therapy business, EUR 4.2 million with a 42% growth. We can see that the therapy business was the single largest growth driver in 2024. Gross margin in 2024 amounted to EUR 6.9 million with an increase of slightly more than 22%. It grew faster than net sales. That means that the profitability on gross margin level improved. The gross margin ratio improved by more than 1 percentage point to 79% in 2024.
On the operating expenses side, both personnel expenses and other operating expenses increased by approximately 8% compared to the comparison period. That was when we had taken some strict cost-saving measures in 2023. When we take a look at the expenses by main functions, we spent EUR 2.2 million on R&D, which is the same as the previous year. Sales and marketing expenses were 11% higher than in 2023, with total sales and marketing expenses of EUR 3.6 million. Admin expenses were EUR 2.3 million with an increase of 13%. The increase in admin expenses is mainly due to these non-recurring costs related to these partnership negotiations, which amounted to around EUR 240,000. The result levels in 2024, the company's EBITDA was positive for the first time in the comparable business. That was at EUR 0.3 million.
Our operating loss decreased by 56% to minus EUR 0.5 million. The result for the period improved by just under 33% to minus EUR 0.9 million. There was a significant improvement in the cash flow from operating activities compared to the previous year when in 2024, the cash flow from operating activities was EUR 1.9 million, EUR 1.9 million positive. In 2023, it was minus EUR 2.3 million. With that, the cash balance at the end of the financial year amounted to EUR 3.9 million with an increase of 166%. In addition to the cash balance, we had a pretty high accounts receivables balance of EUR 3.9 million. That was due to this strong emphasis time-wise of the system sales in December. Those invoices are due in the early year of 2025. There was a 39% increase in accounts receivables.
The group equity improved by some 30% to EUR 3.7 million. The equity ratio remained relatively unchanged at around 31%. Now, looking at the current year, 2025, our future outlook for 2025 goes as follows. The company estimates its net sales to grow and operating result to improve. On the next slide, we have a graph, this one here. It shows the development of comparable net sales and gross margin for the previous strategy period ended in 2024. The compound annual growth rate for the comparable net sales was 21%. That actually matches the 2024 sales growth rate also. The gross margin has developed slightly faster in relative terms. That is supporting our strategic objective of profitable growth. As I said earlier, our operating expenses increased by 8%.
It's a good growth rate for net sales and gross margin in comparison to the operating expenses. With that, I would now like to hand the floor back to Mikko for a bit before the Q&A. Thank you.
Thank you, Jonas. Yeah, there's a couple of things I still want to note before we move on to the Q&A if there's any questions arising from the audience. The first one I want to go through is, are the Nexstim's key strategic objectives for this year, 2025, this being the first year of our new strategy period? One of the important or the most important strategic objective we have is related to profitable growth. As we presented, profitable growth has been a focus area for us during the recent years. We want to increase net sales and improve operating result for the financial year, also this year, 2025.
We do that while minimizing future capital requirements. The second strategic objective I want to raise awareness to is our strategic partnerships. The Nexstim Brainlab partnership is the main strategic partnership we focus on this year. Successfully supporting the long-term collaboration between us is important for us and expanding. Besides that, we want to also expand the network of other partners and clinics primarily in the United States. There are other partnerships that we want to progress with. I mentioned Sinaptica Therapeutics working in the area of Alzheimer's treatments. We also want to grow the clinics that we're partnered with in the area of therapy. The clinics we have a management services organization that we serve with. These are also areas of strategic partnerships. The Brainlab Nexstim partnership is the main focus that we start with.
The first full year of partnership together with Brainlab is important for our diagnostic business and the future in that area. The third one that I want to raise and the final one that we focus on as a strategic objective is the technology leadership. Launching the new NBS 6 diagnostic system in key markets, enabling ease of use and future add-on modules in the same system. We have successfully launched the NBS 6 for therapy already earlier at the end of 2023. We had the first full year of selling the NBS 6 therapy successfully in 2024. Now, following the soft launch of the NBS 6 diagnostic system in the Berlin Symposium in the final quarter of 2024, we are now in the progress of the regulatory approval processes for both the EU MDR and also the U.S. FDA path.
We want to, of course, fully launch in both of those markets during this year. That involves not only internal work from our R&D and also documentation and quality. They also involve regulatory authorities' approvals. Of course, we do not want to give the exact timing of this. During year 2025, we want to have the diagnostic system launched in the key markets. That is a very big, important objective for us. It is also an important part of a successful partnership with Brainlab moving forward with the strategy period. Finally, I want to just state clearly, as Jonas did also earlier, that our future outlook for the year 2025 is that the company estimates its net sales to grow and operating result to improve. Our management personnel and board are motivated to fulfill this, of course.
We very much look forward to keeping within this future outlook for this year, 2025. The final slide of this presentation, I want to remind us and also give a bit of a marketing talk on the NBS 6, the future of the Nexstim system. The commercialization is now for this strategy period when we look at it, 2025 to 2028. We're looking forward to launching the new NBS 6 diagnostics for the key markets this year, 2025. Of course, this product generation is an essential part of this strategy period's growth. It's a combined system. It combines both the diagnostic and the therapy with our unique technology. The modular design makes it possible to expand the system capabilities over time. Once we have the diagnostic and therapy in the same system, we can add on modules for the future. They might be research-oriented also.
They can be either diagnostic supporting the Brainlab partnership, or they could be in the area of therapy, for example, supporting new indications. The main thing is that this solution creates long-term value also for Nexstim's customers, both customers and investors. We want to note that this is responding to the customer demand. Most of our systems are sold with a combination already now with the NBS 5 system. Especially with the NBS 6 system, they come with a combined system to begin with and also with the best level of usability, ease of use system. Helps with personnel being able to be treated more fast. Also, if there are changes in the clinics or the hospitals, the ease of use is something that is always a factor when you have personnel or staffing changes.
Of course, then training new users and getting the treatments to be more and more efficient is reliant to the ease of use. This also responds to the customers who've asked for the need to have both therapy and diagnostic capabilities in the same system. We have quite a few customers that are awaiting, of course, this possibility to be there and to have the new combined systems as part of our offering. This is why we want to launch the combined system later on this year. That being an essential part of our whole strategy period, 2025 and 2028. With that note and a very positive note, I thank you already for being part of this webinar and the presentation part of it. I hope that there are some questions that we can address together with Joonas.
I'll see if there's any in the chat. We can wait for a moment. It seems that there are no questions at the moment. If there are any, you're, of course, okay, there's one question here. Do the stakeholders, CEO, CFO, and CCO have plans to invest their own money in Nexstim stock? If not, what are the reasons preventing them from doing so? A personal investment would signal strong confidence in the company's future and align their interest with the shareholders. That's a good question. I can only answer for my own part. I mean, I think that I am a shareholder in Nexstim and among one of the largest shareholders, or let's say in the top 20 or so. I plan, of course, to I plan to do investments into Nexstim when it's possible.
There are, of course, certain regulations due to insider information and management of that. Unfortunately, during the previous, I think, two years, I haven't been able to invest in new investments because of mainly insider projects that have been ongoing at the moment. I look forward, of course, to trying to invest more into Nexstim, especially through the option programs that we have. As the amounts I've usually invested are significant in nature, once such decisions are done, we need to publish the information. I cannot answer this right now other than that I've tried always to invest into Nexstim shares also whenever possible. I also hold, at the moment, more than 30,000 Nexstim shares. I hold options, also stock options to purchase Nexstim shares in the future. Those are visible publicly on the website.
For other people doing their own investment decisions, I have to rely on the other people giving their own opinion. I strongly emphasize that it's a good signal, but also a good way of committing into the company is investing into the company shares. I've been doing that since the very beginning of listing Nexstim into the stock exchange. The limiting factor is the money. If there would be more capital to invest also personally, then I could invest more. The limiting factor is the capital. Any other questions? That was a good question. Okay, seems like there's no other questions. The presentation has been clarifying for most audience. I thank you for your attendance. We will be publishing the Annual report with the full Financial statements on the 6th of March.
We look forward to publishing the first half 2025 numbers on August 15th. That is quite far away. I am sure we will have a lot of news flow before that. Stay tuned with our news flow and looking forward to an event-rich 2025 year and wishing you all a nice winter day and upcoming spring. Thank you.