Welcome to Nexstim's webinar for investors, analysts, and media. In this webinar, Nexstim CEO Mikko Karvinen and CFO Joonas Juokslahti will be giving a presentation that will take about half an hour, followed by a Q&A session. The webinar will be recorded, and we will inform you later on where you can find the recording. For the Q&A session after the presentations, we ask you to send any questions through the webinar's Q&A chat. Questions can be sent at any time during the webinar, but they will be replied to only during the Q&A session. When you write a question, please state your name and possible organization you are representing. As you send us a question, it will first be visible for us organizers only. Now, let's move on to the webinar. First presenting is Nexstim CEO, Mikko Karvinen. Go ahead, Mikko.
Thank you, Essi, welcome everyone. My name is Mikko Karvinen, I'm the CEO of Nexstim. I'm joined in this first half 2021 half yearly report webinar with our CFO, Joonas Juokslahti. I'm very glad to go through our results soon. I'll start with putting the presentation mode on. Now the slides should be visible. At Nexstim, we're all about personalized brain diagnostics and therapy. Our share is listed in the Nasdaq First North Growth Market, both in Finland, Helsinki, also in Sweden in the Nasdaq Stockholm. Before investing into a Nexstim share, please take a look at some of these important information regarding the company. To begin with, I would like to start with an overview of Nexstim as a company and tell a little bit about our business.
Maybe there's some of you joining who haven't heard about Nexstim earlier, just a couple of minutes overview. On the right side, you can see this is our fully integrated neuronavigation TMS system, a Nexstim system. Whether it's a diagnostic or a therapeutic system, it looks about the same. This technology of ours is unique and proprietary. We're a Finnish medical technology company operating in the international markets. Our neuronavigation TMS technology platform, transcranial magnetic stimulation, TMS, enables individual treatment and diagnostics of patients with severe brain diseases and disorders. Talking about both our diagnostic and therapy applications, first of all, our NBS systems is what we call a Navigated Brain Stimulation system, is what we use for our diagnostic applications.
It's a non-invasive brain stimulation method of which we can map the brain's speech and motor cortices prior to a brain surgery, very usually a tumor surgery. This way we can show that in which places of the brain are the motor and speech functions located. This provides the neurosurgeon very useful information. Then on the therapy side, we have a system called the NBT, Navigated Brain Therapy system, and we are approved in the U.S. markets for major depressive disorder treatment. Then also in addition to that, in the European markets, we're approved also for chronic neuropathic pain treatment. The diagnostic system is both U.S. FDA approved and in the Europe CE marked for pre-surgical mapping of the brain's motor and speech areas. We have quite a large installed base already, so some of the world-leading centers already rely on a Nexstim device.
There's a total of over 220 Nexstim NBS and NBT systems that have been sold to research centers, hospitals and clinics worldwide. Just to mention a few, in the close home markets, all university hospitals in Finland have a Nexstim device. We have a good presence also in the Nordic and German markets as an example from Europe. In the U.S., we have our own direct sales team and have tens of systems already installed for both NBS and NBT, so diagnostic and therapy purposes. Finally, about our position for the future development, we're very well positioned for treatments that are called the accelerated theta-burst treatment protocols. We have piloted this new form of TMS treatment where, just to give a bit of background, a normal FDA-approved TMS depression treatment is one TMS treatment per day for as long as six weeks.
In this accelerated iTBS treatment protocols. We've piloted methods where there are multiple treatments a day, as many as 10 treatments a day for five days in a row. With these accelerated treatment protocols, we've shown very encouraging results, and we continue to pilot these. This is an interesting area of study with global interest. We have done pilots in Kuopio University Hospital in Finland for severe depression patients. We're running a pilot right now in Helsinki University Hospital for chronic neuropathic pain treatment with these accelerated treatment protocols. I'll talk a bit more later on this presentation about also these pilots and their statuses. Moving on now to today's main part, which is of course the H1 2021 report.
We published the half-year numbers for the first half of this year earlier this morning at 9:00 A.M., Finnish time. I'm very happy to tell that this was Nexstim's historically best first half measured by net sales, operating result, and result for the review period. We can see that our business has adapted very well to the changes in the operating environment caused by the COVID-19 pandemic. Even though our business did, of course, suffer a bit from this pandemic, we saw that, first of all, with our diagnostic business, we were able to sell seven new NBS systems and deliver them during the review period. This helped us a lot in the system sales side. The system sales grew faster than the full revenue. System sales for this first half was very strong.
On the NBT on the therapy business side, we had five new NBT systems sold to clinics in North America and Europe across multiple sites for the treatment of Major Depressive Disorder. Despite the COVID-19 pandemic affecting the depression therapy business in particular a bit more due to the restrictions for mobility for patients, we managed to sell five new NBT systems, and this was also partially ended up as a result of a strong system sales for the first half of 2021. System sales were EUR 1.6 million. There was an increase of 186.6% in comparison to last year's first half. The recurring revenue accounted for EUR 1.4 million. There was also an increase of 29.3% in comparison to the first half of 2020.
About the recurring revenue, I'd like to mention that this was affected slightly, of course, by the mobility restrictions in certain markets, like in the U.S. and Europe, that affected the patients' possibilities to travel for treatment or their likelihood of reaching out for help during this pandemic. The first half was the company's best reported half to date, with net sales being EUR 3 million. That was an increase of 83.3% in comparison to last year's first half. Our operating result was a EUR -0.9 million, and that resulted in an over 50% decrease in the losses that we saw a year before at this time. Very happy progress in both growth and profitability. To talk a bit about the different sides of our business, the diagnostic net sales grew by 96%, and first half revenues were EUR 1.8 million.
The therapy side net sales grew also with a healthy 67.3% during the first half of 2021, amounting to EUR 1.2 million. Both businesses growing, but due to the sizable amount of NBS systems we sold in the diagnostic side during the first half, diagnostic net sales grew even faster than our therapy sales for the first half. During the springtime, we had a successful rights issue, it was happily oversubscribed, we raised a total of EUR 6.6 million of new equity. New capital was raised, I thank all the subscribers of Nexstim shares for this very good result. Finally, we had some time during the spring and summer time to review our strategy for 2021 to 2024, the main take from that process right now is that we will focus on profitable growth in both the diagnostics and therapy businesses.
As we can see, this first half of 2021 is also already producing results that are very favorable with our selected strategic focus. At this point, I would like to ask Joonas Juokslahti, our CFO, to go through a bit more detail for our first half 2021 numbers.
Thank you, Mikko, and good afternoon, everyone. The review period was the strongest first half in the history of the company, and that is by almost any metric. Despite the continuing pandemic, we were able to reach a record growth pace of revenue, and our total net sales grew by 83% to EUR 3 million. Now, the diagnostic NBS business almost doubled in sales to EUR 1.8 million. At the same time, our NBT therapy net sales increased by 67% to EUR 1.2 million. Now, if we break down the total net sales to system sales and recurring revenue, we can see that the most significant growth driver this period was the sale of new systems. The system sales grew by 187% to EUR 1.6 million year-on-year.
At the same time, the recurring revenue, which is really important for us strategically, continued to grow at a good, steady pace of 29% to EUR 1.4 million. What I would like to highlight is that we were able to generate this kind of growth while at the same time increasing our gross margin level profitability. The personnel expenses for the period was EUR 2 million, showing growth of 27%. At the same time, the other operating expenses grew by 14% to EUR 1.6 million. The growth in operating expenses was mainly due to the cost-saving measures taken in the comparative period in 2020, in the second quarter. On the operating result level, we saw the best first-half operating result of minus EUR 0.9 million, we can see that the operating loss decreased by 51% year-on-year.
I wanted to have one graph in this webinar, which is shown under the financials table. The graph is showing our H1 net sales and operating results development through recent years. In the orange columns, we can see the net sales growth. It has been at a very good pace, and the growth pace has been accelerating strongly. In blue, we can see the operating losses decreasing, and we could roughly say that for two years now, we have cut our losses in half back-to-back. At the end of June, our cash balance was EUR 6.7 million, and we estimate that the working capital is sufficient at least until the end of 2022. That is next year. The increased cash balance was mainly due to the successful oversubscribed rights issue executed earlier in the spring.
Also, as a result of that, our group equity increased and our equity ratio grew to 39%, so significantly. After the first half, our future outlook remains the same, and that is that the company expects its revenue to continue to grow during the year 2021, and the loss for the period is expected for the financial year. If there are any questions regarding the financials, I would be happy to answer those later in this webinar. For now, back to you, Mikko.
Thank you. Thank you, Joonas. I at this point also I thank our customers, I thank the full Nexstim team and our partners and also our shareholders for these exceptional results we have seen during this first half of 2021. Towards the end of this presentation, I'd like to take a look at our key strategic objectives for the year 2021. Number-wise, we've seen what has happened during the first half, but also when we look at the second half of 2021 and our full- year strategically, what should we look for? First of all, the key strategic objective number one is to continue focusing on achieving profitable revenue growth and strict management of operating expenses. What we saw during the first half, the very strong increase both in revenue and profitability, we want to pursue this also for the full- year 2021.
Of course, we haven't guided in detail what kind of growth levels we're expecting or profitability-wise, but we expect that, of course, the full- year to grow and we'll manage all the sales and operational activities in a manner that we will have a successful year also for the full year of 2021. There are certain things we look forward to. We've had some recent new market openings and new partners that have been ordering also systems. We have the Canadian partnership where we delivered three NBT systems, new NBT systems during the first half. Our new Australian partner and the regulatory approvals we got for the Australian market during the summer. Those are things that we also look forward to for the future years and, of course, 2021 to supply us with gross.
Not to, of course, forget our markets both in EU and in the U.S. where we have teams and we do more regular business. On the digital side, if we think about the operating expenses, we've learned during the COVID-19 pandemic that we've adjusted our ways of doing sales and demonstrating the systems, and utilizing virtual tools for this. We've seen also that we can be operationally efficient in the future using these tools now during the COVID-19 pandemic, but also very likely once someday this pandemic hopefully will be over, and more normalized business environment. A second very important strategic objective for us is the accelerated therapy treatment protocols and the pilots that we're running. The Kuopio University Hospital pilot, which focused on treating severe depression with these accelerated protocols. We provided results already in springtime, in March of this year.
We are looking forward to continuing pilots with Kuopio with some increased patient amounts. We are quite not ready yet to release more information about this pilot. This is something we look forward to informing more during the second half, so continuation of the Kuopio pilot studies. In Helsinki, we are looking forward to hopefully getting the chronic neuropathic pain treatment pilot study finalized with the treatments during Q3 of this year by the end of Q3, reporting the early results from that pilot study once they are available soon after the treatments have all been made. This will provide us with more information on how we will then make decisions on progressing to possible even further trials. The pilots and continuation of those pilots is a big focus for us strategically during the second half of 2021.
A third important objective and a focus is developing and executing deeper profitable partnership business models in key therapy markets together with valued partners. Here, as I mentioned, we had a success with the Canadian partnership, a distribution partnership, and selling three systems during the summertime. We're also talking to some of our clinic partners, both in key markets in the U.S. and in Europe, about the future ways of how we could do business in an even more deeper manner. This is also a way to look at the TMS therapy market in a more broader manner, and think about how could we do these treatments in a more sustainable manner financially. I mean, looking from a device company or from a system provider's point of view.
In order to be sustainable in the long- term and in providing TMS therapy treatment, the business model needs to be arranged in a manner that it is also financially profitable for the device company. This is the only things I can tell at this point about this. Partnerships in the key market is an important development area for us. We slowed down a bit due to COVID because meeting people, meeting new business partners, and trying to innovate business models is somewhat easier, of course, when having face-to-face meetings. It's been taking a bit more time than we expected and anticipated earlier on.
This process is moving on, and we have good discussions and good partnerships that have already been established, and some are on the working, and we'll be presenting hopefully more news flow on this topic during the second half of this year. It's important for our strategy to progress with this objective. The fourth strategic objective for this year, 2021, it was about our patient registry. The patient registry of over 200 completed treatment sessions of depression patients, that's our objective for the full- year 2021. In June of this year, we published the first 187 patients treated in the United States at clinics for Major Depressive Disorder. Out of those results, we can see over 50%, so 50.3% remission rates, and then also 77% rates of clinical response. Very good numbers, and the numbers are in comparison to other patient registry data out there.
It is better. If we look at the same ratings of patient-gathered data, so PHQ-9 or BDI, we can look at competitive patient registries where our numbers are better than in the comparative, and also better to the clinical trial data out there. We feel confident about our neuronavigated TMS therapy system providing better or at least as good results than the competition at the moment. A patient registry growing is the way that we selected to provide this data also in the future. This is also an important objective for us for this year. You might notice our fifth objective that we had when we started off this year was about our funding and the funding to progress with our strategy.
As we have completed our fundraise, the stock exchange, the issues that we had, the rights issue earlier this year in springtime, we no longer have needs for fundraising right now. As Joonas mentioned, we have a cash runway at least until end of 2022. At the moment, this is our estimate. There's no financial objective on that side right now. To end my presentation and to remind us in a nutshell about Nexstim. Nexstim, we have a unique proprietary neuronavigated TMS technology. We deliver the best-in-class mapping and treatment for patients with brain diseases and disorders. We're very well-positioned to a disruptive shift that we see in depression therapy. With our improving economics driven by record revenue gross and increasing operational efficiencies, Nexstim is now a unique investment opportunity. I thank you for your attention until now.
I apologize for the slight technical problem with the internet connection, and I welcome any questions to myself or Joonas through the Q&A chat. Thank you. There's a question from Fredrik [Cooper] from Redeye about the prototype NBS system for research purposes we announced. Is it going to be delivered in H2? Are they still on track? Yes, that's a good question, we are still on track. For the second half of this year, we are looking forward to delivering these prototype systems, the value of the order was EUR 0.9 million. Upon a successful delivery of the systems, we would look also to recognize that revenue during the second half. That's still on the working, it means that we haven't delivered it yet, we are looking forward to that, everything should be aligned with that.
Okay, there's another one I'm reading now also from Fredrik. Thank you. From Redeye. You reported higher revenue per system in H1 compared to full- year 2020. Is it mostly explained by a decreased pandemic effect? Can we expect further increases as the treatments normalize this year? Joonas, do you want to comment on that? I do know that of course, on the therapy side, the pandemic effect last year's H1 was more dramatic. There is definitely partially us having a better revenue this year is explainable by last year we suffered more from the pandemic. Anything else you would want to, Joonas?
No, that is true, and we were estimating some sort of a dip to utilization in Q1 this year with the news about the second and third wave, but we haven't actually seen that in our actual H1 figures. The utilization of our systems has been higher than expected.
If we look about the increase, well, at some point of time, I think we were also discussing and thinking about whether we start publishing more estimates on how this per system revenue is going to be developing. I think that you can see from the pattern that how it has recently developed, and my only kind of estimate and a guidance at this point is that there are differences between markets because of reimbursement, because of issues related to how TMS has already been in Europe and in the U.S., we already have differences. Once we start progressing to new markets such as possibly Australia, then Asia, I think it's still difficult to have a very accurate estimate about the average revenue. We definitely have some numbers that we model to our own strategy, and we're expecting some levels in order to be successful in our strategy.
At this point, it's too early to give too much of a guidance on that. We're happy to see that if we compare our per system revenue to some of our competitors that publish data also in that area or what you can calculate based on their public data, we're happy to see that even though our volumes of systems that we sell or that we deploy are slightly lower in comparison to what some of our therapy competitors are doing, we can see that our model and the way we do business is more valuable for both our customers and ourselves. We can see that the revenue levels are in a very good level per system. This is a happy note in comparison to some of the competitive numbers. Let's see. There's a few new. Any update of Stanford patient studies? Is an anonymous question.
We do have a system at Stanford, also a Nexstim system. At this point, it would be too early to give any notes on the studies that they've done with our systems, and for us commenting on Stanford studies, I wouldn't want to do that right now. I do know that, as a general note, in California, the COVID-19 pandemic has restricted quite a bit of both research and, especially on the research side, it's restricted quite a bit of things and treatments that have been done. I think it has had quite a bit of an effect to also the accelerated therapy treatment protocol studies that Stanford was running at some point. I don't want to go into detailed commenting on that on behalf of Stanford. A coverage of competitive landscape.
I'd like to, first of all, if we compare ourselves in a general manner to the competition, most of the TMS companies that operate, and some of them are public, but most of the TMS companies, public or not, operate in the area of therapy treatment, and mainly in depression therapy. We do compete with most of the TMS companies with our therapy applications, and especially in depression therapy, less in chronic neuropathic pain. With that said, our uniqueness, the way we have our neuronavigation technology helping us with the accuracy, and how we can, based on the patient's own MRI as the data we need for our system to begin with, we can have a 3D model of the brain created to our system, and then accurately stimulate wherever in the brain's cortex. That helps us with a few things.
First of all, we have a diagnostic application of our system. The pre-surgical mapping of the brain, as a TMS company, we're the only FDA approved CE marked company for the pre-surgical mapping of the motor and speech areas of the brain. Competitive-wise, this is definitely an advantage for us. As you can see, growth-wise, this also helps us currently, and we look forward to it helping us also for the future growth. A definite competitive advantage is through the neuronavigation, providing us with the possibility of having this diagnostic application, pre-surgical mapping of the brain. On the other side, as we can see, there is more fierce competition in the depression therapy area.
In the depression therapy area, the clinics and the partnerships that we are pursuing need to be, let's say, willing and wanting to acknowledge the fact that with more accurate stimulation of the brain, helped by our neuronavigation capabilities, you get better results. At this point, we have our patient registry data to back up that data, and for the clinics that work together with us, they can see this happen in real life, and they believe in Nexstim system also being superior with the results provided by our patient registry. In the therapy side, there's more competition, especially in some markets like the U.S., and we need to, of course, focus on the benefits that what the neuronavigation technology for Nexstim, the E-field navigation, the SmartFocus TMS provides.
On the diagnostic side, we have less competition, of course, there's also less knowledge about TMS helping with pre-surgical mapping. That's a short competitive kind of update. There's a question about updating our sales resources. Without going into too much detail, there was a bit of information also in our H1 report. The first thing is that we have direct sales organizations both in U.S. and in Germany. Large one in the U.S., and a small one in Germany. Those are the two markets where we sell directly Nexstim NBS and NBT systems. Both diagnostic and therapy. We've successfully added a few new people to our U.S. team, into the sales team during the first half of 2021, and we can see already results that have been provided by those additions. Systems that have been sold.
From the markets, we have markets covered in Germany, Switzerland, and Austria, also from the same, our German subsidiary. All other markets are more or less covered by distribution partnerships, networks of distributors with various hospitals and clinics around the world, but especially in Europe, but also in the Middle East and Asia. We are also in the lookout for new partners all the time, and we evaluate them very frequently. We have processes going on, and currently we're also looking at new partners for the vast Asian market. We'll come out with new information on that side once we have new partnerships. The expansion, especially outside from our current direct sales network, is very much aligned with our strategy to find new distribution partners for markets where we're not present yet. That includes, of course, largely the Asian market. Let's see.
I think we've gone through the questions that were posted at this point. We still have some time if someone wants to post a question. There is a very good question. Thank you. Thank you, by the way, for all of those. I'm glad that we could discuss those topics of my presentation. There's one more question about expanding a bit on how planning to accelerate NBT system sales post-COVID, what will be easier? Well, strategically when we talk about partnerships, and working on basically having some clinics or partners that work together with Nexstim and having more Nexstim-dedicated clinics in the future, instead of maybe just reaching out for totally new clinics out of the vast amount of psychiatric clinics, as an example, that could provide TMS.
Having a more deeper relationship with certain clinics and then expanding together with them in opening new clinics is one method. Post-COVID-19-wise, it's easier to, first of all, when we find these partners, and by the way, we of course have existing partners and discussions, but if we find partners that want to engage in these type of partnership discussions, it's easier to progress things when the teams can also meet together, plan together, and have a more of a normal type of finding a new type of a business type of a relationship. Certainly that will ease a bit. If we look at other things like the traditional methods of finding new opportunities, one big thing that has now been affected are all the events, all the industry events.
Not all of them, but a lot of the industry events have either decided to be virtual for quite some time, or then if there has been a physical possibility of participating, the participant amounts and the amount of people and partners that meet are quite a bit less than prior to COVID. In a sales/partnership opportunity-wise, it's gone a lot is digital. That is a good thing, of course, for some of the deals. You can have digital marketing and digital demos, even digital deal closings. To have a longer partnership and to establish a longer business relationship, it typically also takes time and face-to-face meeting time also to get that done. I think we've done very well despite these elements being affected by COVID.
I'm at least looking forward for these mentioned type of elements also to help us once the COVID pandemic hopefully eases up. Then as I'm mentioning also on the new team building and getting new people to get knowledgeable of Nexstim and the way we work and all this is also slightly affected, of course, because most of the people, even the new team members, have had to work quite a bit from remotely and virtually, and there's been less amount of getting together. I think, again, virtually training, getting to know each other and all that, we've done as good as you can in this virtual world.
Those are the things that I look forward to, also meeting more with people, and I know our teams want to get together more and develop the way we work and the way we understand the business and operate in it. That's the way we see NBT. Partnerships, building partnerships, building the business models, and then actually having more sales opportunities through more engagement with potential customers and partners in the future. Is there still some time if someone wants to post a question? Otherwise, I once again thank you for attending. Thank you for the very good questions, and I hope that you all stay safe wherever you live and operate in this COVID-19 world.
We hope to, of course, bring you news flow during the second half, and then, of course, ultimately, in late February of next year, we will be publishing our full- year 2021 results. Results-wise, that's when we're going to have the next webinars. Of course, we look forward to meeting with you, hopefully at some events, investor events, or otherwise if we'll have some updates on recent news flow. Thank you, everyone, and I wish you all a very good weekend. Bye-bye.