Good morning. This is Gray Oslo reporting in. Welcome to Medistim's Q1 2023 presentation. My name is Kari Krogstad. Together with CFO Thomas Jacobsen, we will take you through the quarterly results. We will follow the same agenda that we are used to going through, starting with the highlights. We're starting with the quarterly sales of NOK 129.3 million in revenues this quarter. This is the second-best quarter we have delivered, only beaten by the Q4 last year. But as we see here, the majority of the contribution to growth comes from currency. If we look at the growth in Norwegian currency, we see 15% growth in sales of our own products.
We can also see that all the product categories and marketing segment categories are contributing to this growth. When it comes to the third party, those are down this quarter by 4.5%. If we look at the currency neutral growth, we see that this is a very modest 1.2% in total. When it comes to our currency neutral growth for our own products, that is also a modest 2.5%. As I said, we need to see this in relation to a very strong finish of 2022, very strong Q4 there. This was influenced by some inventory build-up and also driven by a warrant price increase from January 2023.
We can see that Americas and Europe and Middle East is down, and that Asia Pacific has a very strong quarter this Q1. This is related to the changes in business that we have set up in China, where we have now decided to go direct, and we see the effect of the last sales that we are doing to our former distributor for China. It's actually a NOK 9 million extra revenue compared to last year. These are really the most important news for the quarter, that they're going direct both in Canada and also in China, and I will comment more on that later in the presentation.
When it comes to the EBIT, it is more or less the same as last year, a little bit lower on the margin side. This is related both to high activity, we've had a lot of traveling to China, so one of the things. Also some timing issues with regard to some QA audits. Inflation currency also contributes to the high expense level. Thomas will go through a little bit more detail on this. The last point here on the highlights is that yesterday, the General Assembly decided to pay out a dividend of NOK 4.50 per share. By that, I will leave the floor to Thomas.
Thank you, Kari. Good morning, everyone. I will, as usual, go through the P&L in a little bit more detail. When it comes to sales and split of sales per geography and per product, Kari will go through this in more detail later on in the presentation. I will not spend time on that here, but explain the expense lines in the P&L as I usually do. When it comes to cost of goods sold, we are at the same level as last year. That means 20% of sales is related to cost of goods sold. Same level as in the Q1 of 2022. Salary and social expenses are up NOK 3.8 million. Kari mentioned that we have currency help on the top line.
We also have currency when it comes to expenses. NOK 1.6 million of the salary and social expenses is related to exactly that currency. Another NOK 1.5 million is related to salary adjustments from last year. We had an adjustment on average 4% in April 2022, that affects obviously the Q1 this year. The remaining expenses is related to us increasing our resources in our organization. Other operating expenses is up NOK 7.2 million, that's quite a lot for this quarter, there are some reasons for it. One is the regulatory audit, there was an expense there of NOK 1.7 million.
These audits come a little bit different from year to year and the Q1 last year, we did not have a similar audit. Another NOK 900,000 is related to a one-time commission to a distributor. We had a letter credit agreement with an end customer, and then, based upon this agreement, there's a return commission to the distributor, and that is NOK 900,000, and it's a one-timer. We also had additional expenses related to our direct operations in China and Canada, and then thinking about recruitment, around NOK 600,000 is related to that. Another NOK 1.6 million in increased travel expenses is also added for this quarter.
This is much in connection with the establishment in China, but also in Canada. I would also like to mention our vascular initiatives and our activities related to that has also demanded travel activity. We then come to EBITDA, we end at the same level as the last year, at NOK 39.2 million, and also EBIT ends at the same level as last year, NOK 33.5 million. Net finance is positive. Weak Norwegian krone helps us, and we have a realized and unrealized gain on our positions with NOK 750,000 for this quarter. This results that we end up with a pre-tax profit of NOK 34.2 million, that's up 4% compared to last year, and profit after tax ends at NOK 25.7 million. That's up 8% compared to last year.
When we now look at our balance sheet, intangible assets are increasing, and that is a natural consequence of increased activity in our R&D department developing products. No major investments under fixed assets, and therefore it's been reduced. All in all, intangible and fixed assets slightly down compared to how it was when we entered the year. Inventory is by our intention up, the supply chain situation that we were really feeling in the early 2022 has improved, and it is much more normalized. It's on purpose that we have secured critical components and end-of-life components and therefore increased inventory. We also have an increased customer receivables.
This is explained by the sales profile for the quarter with a hockey stick sales profile, relatively slow sales in January, February, and much of the orders have then been entered into March. These two things increases our working capital, and it is also the explanation for our cash position being about at the same level as it was when we entered the year. Equity and liabilities. We have no traditional interest-bearing debt. That means loan from the bank. Our equity is or balance sheet is in general strong. Our equity is about 80%. What is recorded here as long-term debt is related to lease obligations.
In total, Medistim has NOK 15.3 million in lease obligations, where NOK 8 million is recorded as long-term debt, and the remaining NOK 2.2 million is related to our service contracts, and it's therefore deferred revenue. Well, yes, as Kari mentioned, the general meeting decided to pay out a dividend yesterday, 4.5 NOK per share, and this will be paid out to our shareholders by the 5th of May. By that, I transfer the word to Kari again.
Okay. Let's take a look at the business segments update, starting with the imaging probes and systems and units. From what we will see here, we are seeing a very flat quarter when it comes to our sales of imaging systems and also of imaging probes. Again, a little bit affected by a strong finish last year, at least for the system side. One quarter doesn't mean that much. I had to remind about the finish last year. We grew 44% in our imaging sales portfolio. Also 40% of the systems we sold last year was on the imaging platform. Definitely there is continued very strong interest for our imaging technology, and we are expecting this to continue to pick up in the following quarters.
When it comes to the flow probes and also systems and units, we see good development this quarter. Number of flow systems sold as capital is up 33% from the Q1 last year. This is to a high degree influenced by this change in China. We have had a large sort of last time buy to our former distributor for China, which is driving the growth in Asia Pacific. We are adding up sales of systems, both flow systems and the combined flow and imaging systems, then we see a growth of 11 units this quarter, so 19%, which is also very encouraging for us to see. We can see the Q4 here, really strong.
We are seeing then this quarter, lower sales of our flow probes going down 5% from the same quarter last year, influenced by inventory build-up due to this price increase that we went into in the 1st of January this year. If we look at the revenue performance now by region. We can see the region split here. When we're comparing the developments in number of units and trying to make sense of that in sort of the Norwegian currency, just want to stress that there are several factors that are influencing these numbers, so that it can create some discrepancies, both in the positive and in the negative direction.
Of course, number of units, it will be influenced by currency, to what extent we will see the same level of growth in Norwegian currency. It also depends on which sales channel these products are going through. Of course, direct sales channels will provide higher revenues compared to the distributor sales channel. Also, our business models in the U.S., we have our pay-per-procedure business model, also our lease models, compared to the capital sales that we are doing all over the world. This will also influence. Lastly, the system configurations. Sometimes we are selling really high spec systems, products. We have an ultimate version of our p-technology, which is at a higher price compared to lower spec versions. This is just a reminder.
We then take a look at the various regions here in Americas, we saw that the revenues increased with 10% in NOK, declined 4.5% currency neutral. We look at the USA, which is the majority of Americas, in Americas now we are counting also Canada and Latin America. USA constitutes the majority of this region, in the USA, the currency neutral decline was 8%. Moving to Asia Pacific, as already highlighted, we had a great increase in sales this quarter, 79% in NOK, 64% currency neutral related to the transition of our China business from a distributors to our own sales organization. In Europe and Middle East, revenues were down both in NOK and also currency neutral by 12.4%.
Here Europe constitutes the majority of these regions, showing 1.9% growth in NOK, declining 8.3% currency neutral. Third party, as mentioned, was down 4.5% this quarter. If we look at the same numbers now divided by product category, we will see that the procedure sales in the United States, the number of procedures increased by 9.8%. It is both the favorable currency, or the favorable currency actually, in entirety that is explaining the high growth that we're seeing in NOK.
When it comes to the flow probes, the number of units sold was 4.9% lower than last year, again, related to this inventory buildup and increase in Norwegian currency. The NOK is driven by the currency and also the price increase that I mentioned. Flow systems, number of units sold was up 33%. The high level sales through distributor channel is resulting in lower increase in Norwegian currency. When it comes to the imaging systems and also the imaging probe, number of units sold was the same level as last year. Sales in NOK shows low growth for system and decline for probes. It's the favorable currency effect was here outweighed by higher sales through the distributor channel. A little bit complex to understand the different parameters that is impacting on the overall development.
Okay, let me continue with some comments on activities this quarter to implement the strategy. Our strategy on a high level is, as we have explained several times to continue to convert routine flow market to a flow and imaging market in the markets where we already have a very strong position with the flow technology. To continue to develop those markets where we do not have as strong position in the CABG, such as the U.S. and U.K. and France, as examples. Continuing into the emerging more price sensitive markets with our entry level solution, concentrating on building also the vascular surgery and also expand our direct market coverage. This is high level our growth strategy.
As we have pointed out several times, the USA remains to be a very high target and important market for Medistim. As mentioned, this quarter, we see currency neutral sales declining by 8%. When it comes to the total number of procedure, this is actually quite positive, 5.7% up in Q1. Flow procedures up 4.3% and imaging procedures up 11.8%. Capital system sales is a bit lower than the same quarter last year and of course, impacting on the overall results. 12 units sold this quarter compared to 15 units last year. We are continuing to keep winning new customers. Six new customers this quarter compared to the 13 last year.
I think it's pertinent that we are also starting to comment a little bit more on our progress in vascular surgery since we have stated very clearly that we are aiming to build and strengthen our position there. Just a little reminder here to say that our MiraQ system is a tool which is just as relevant for the vascular surgical procedures that we have targeted just as in CABG. It is peripheral bypass, it's carotid endarterectomy, and it's AV access, which are the targeted application areas that we are focusing on. When we're looking at the market size, we see a market based on the size of or the number of procedures performed in key markets, more than 900,000.
It's actually a larger market in terms of procedures compared to the cardiac market for us. Little bit lower in terms of market opportunity in NOK, which is related to a little bit more price-sensitive market compared to the cardiac. Still very interesting. How are we doing when it comes to growing this vascular segment? Well, we can see over the years that we have had a steady progress, and last year we were growing 27%. This Q1, we're growing 21.5%. Currency neutral, this is a bit lower, 8.8%, but still continuing in a positive fashion. Yeah, as pointed out, it's a larger market than the CABG market, and it is driven by the same underlying factors that we're also seeing in CABG.
Increased diabetes, which is also associated with increased risk for diseased blood vessels. We are applying and bringing with us all the experience that we have from the cardiac market when we are now getting to the vascular segment as well. We are very much busy with relationship building, with key opinion leaders, performing clinical collaborations, product development, also together with key opinion leaders. We are increasingly participating in vascular conferences and congresses, exhibitions all around the world. This quarter we participated both in the European Vascular Course and also in the Society for Clinical Vascular Surgery in the United States. Endovascular treatment alternatives are also dominating in the vascular space, just as the situation is in CABG.
There are also new information that may drive some change to this fact. There was a very interesting new study presented at the end of 2022, the so-called BEST-CLI study, where they wanted to look at what is the best surgical therapy in patients with critical limb-threatening ischemia. It was a large study, more than 1,400 patient. It was a prospective randomized study involving 150 sites, so a very important work. The conclusion from this clinical study was that bypass surgery should be offered as a first-line treatment option for suitable candidates with CLTI.
This is an example, and we believe there will be more publications going forward that will stress the importance of the open surgical alternatives as sometimes a better choice than the endovascular, which is of course, very good news for Medistim. I already mentioned that the most important news this quarter was our going direct in more markets and starting with Canada. In Canada, we already have a strong position in the Coronary Artery Bypass Grafting market. In Canada, there's about 18,000 CABG procedures performed, and based on our probe sales so far, we can state that about 37% of these procedures are supported with our technology. 38 cardiac centers in Canada, 15 of them are already using our technology.
I also want to mention that we have a long standing advocate and friend, Teresa Kieser, working out of Calgary, which has been a tremendous supporter for Medistim's technology over a number of years. Medtronic has been our distributor in this market for a long time. We always enjoyed a very positive and strong collaboration with Medtronic, but now we have decided to continue this journey with our own sales reps. Yes. Medistim Canada was formally established actually back in 2022. Now we have recruited sales reps both in Ontario and Quebec in addition to also the West Coast. We also are dedicating resources from our Medistim USA Inc. office to support the Canadian team.
We see that we, based on this strong position already, we have a great starting point to continue the CABG growth, continue or accelerate the imaging adoption. This has not come very far in Canada, so there's a lot of growth opportunity there. Also when it comes to vascular targeting, which has, I would say, barely started. The second country, and the point I want to make is that we have gone direct also in China. China is obviously a very important market for us to to make a very strong presence. We've had a distributor there, working out of Hong Kong and overseeing China for us, using local distributors internally in China and for a number of years.
They have really been able to build also a very strong position for our technology in this market. Currently, more than 60,000 CABG procedures are performed per year. So far, about 70% of them are supported by Medistim technology. I think the most important thing about this market is that it's one of the highest growing markets when it comes to CABG procedures in the world, and expected to continue to grow high single digit going forward. We are present in all the top 10 cardiac centers, good relations to some of the key opinion leaders there, but of course we see opportunity to get closer to our customers, as we now are establishing ourselves with our own team. Now we are starting to build our own organization, and on the first recruitments.
We also have very strong local third-party support, we feel that we are already up and running and able to start up the business in China. The situation for further growth is expected to come from continued CABG growth. We will grow with the market, and also we will be, we believe better equipped to drive the imaging adoption. Is quite a low adoption rate at present. Lastly, vascular is also a new opportunity in this space. I would like to round off with just a few comments on the recent Capital Markets Day that we arranged.
On March 21st, and we were very happy to have two excellent speakers, both Professor John Puskas and Professor Pirkka Vikatmaa, gave their opinion about, well, the future of surgery and also Medistim's role in this future. I think both of them were able to really stress the severity and burden that cardiovascular diseases put on people and on society. It's still the number 1 cause of death globally. They explain how modern lifestyle with increasing population suffering from diabetes, obesity, which are really conditions that are risk factors for cardiovascular disease, how this is influencing also the need for treatments alternatives going forward. It also means that younger and younger people get these diseases.
Of course, it's very important that they get access to treatment alternatives that are really prolonging their lives. There are clinical studies, many big clinical studies proving that, for instance, CABG surgery has survival advantages compared to stenting. It's really pushing that argument. We also heard during these presentations, we got introduced a new term, peak stenting, it was really set expectations for future growth for open surgical alternatives. We felt it was a very interesting reflections from both of these surgeons, and I would really encourage everybody to listen into the recording, and you can find that on medistim.com. By that, I'm done, we might have some questions.
I'll read them. We have one question. It says, "How do you expect your EBIT margin to develop going forward?
Yes. As we have indicated before, we believe that we will be able to improve our EBIT margin over time. This is both due to an increase in growth of our own products. It is also due to sort of, well, the size of the business and how everything is developing. I mean, from quarter to quarter, we will continue to see variations, and it will be influenced also by the investments that we are just making. At the time this quarter, as you understand, much influenced by the new activities in the new regions, both China and Canada, and then also some one-off effects. From quarter to quarter, I cannot promise to have improved the EBIT margins, but over time, we certainly aim to deliver.
Another question. You mentioned that there was some inventory destocking at clients or distributors after good volumes in Q4. How long are the inventory cycles typically? Do you expect Q2 to be hampered by the same issue?
When it comes to inventory build-up at the distributors, of course, we don't have full insights into that. From what we can understand and interpret, I would be surprised if that is going to be continuing to affect the sales going forward. I think most of that effect is seen now in the Q1. We don't have 100% insights into how that looks.
Yeah.
Here's another question. It's related to China. Establishing direct operation in China is very interesting. Are you considering setting up manufacturing in China? How do you see growth potential using your own sales force compared to using selling through a distributor?
Yes. A good question. We do not have any plans of setting up either R&D activity or manufacturing in China. This is purely a sales operation with our own sales team. To the second question, yes. We've seen in the markets that we have gone direct before the importance of really having your own expertise on the ground, which are able also to sell and push the more challenging parts of our portfolio. And that's meaning the imaging. In many places we see that with distributors, you are able to gain a good position with the flow technology. But we also see that selling in the imaging is a little bit more demanding. We have seen that it's better to have that local Medistim expertise on the ground.
Here's another question. I think you partly answered it, but, it says, "When do you expect the market growth to normalize after the destocking ahead of your price increases? Can you remind us how much you have raised prices by?
Yeah. The prices was roughly raised by 10% as of January. Of course, we have to give notice in time about the price increases like that. Both distributors and also some large customers then got the opportunity to build up some inventory in the Q4. That is what we are seeing an effect of now in the Q1. I think I commented that, you know, we don't have full visibility into the effects of that, at least, not when it comes to our distributors. We would be surprised if this should be continuing a big impact for the Q2 and beyond.
It continues here. In terms of traveling, how do you see the growth in this activity for the rest of 2023 versus 2022?
Yeah. For sure, we've had a very high activity level now in the 1st quarter since we have prepared for this going direct into major markets. China, of course, as maybe the more challenging. I don't think the activity level when it comes to traveling, et cetera, will be as high going forward for the rest of the year. The ambitions that we have in the vascular surgical field, it requires us to be engaged in more conferences and also to travel out there, meet more customers. We also want to make sure that not only sales reps are meeting our customers, but also representatives from our marketing and medical department. It's an investment that we are making in building this vascular market.
The last one here. As mentioned, inventory build-up impact cash flow in Q1. When do you expect cash generation to normalize? I guess I could probably answer that, Kari.
You can.
Well, we've seen much improvement of the supply situation. We've been able to secure more of our critical components and end-of-life components by the end of this quarter, and we are very happy to see that. We think that the inventory position will be more stable going into the Q2. That will of course improve the cash position. When it comes to receivables, it is, yes, expected that we will receive payments from customers throughout the Q2. Again, it's dependent upon how the sales profile develop in the Q2. This can vary sometime from quarter to quarter, so it's a little bit hard to be exact on that answer.
In general, I think that, in the Q2, we will see an improvement in cash from operations. However, we will be paying out a dividend of NOK 82.1 million. That will of course affect our cash position.
I think it's fair to say that this quarter we were extremely backloaded when it came to timing on some large orders that we had.
Yes
both in relation to China but also in the United States.
Yes. I could then add that, you know, about 50% of all the sales for the quarter was in March, so that obviously affected our receivables.
More question. Have sales rates normalized by now?
Have sales?
Have sales rates normalized by now? That's the only one.
If that's a question whether April has changed the picture, that's. I think it's early in the quarter, and it's very difficult to say.
One final question. How and where are your products produced today?
Yeah. We are assembling the products in our operations facilities in Horten in Norway.
Okay.
Very good.
Okay.
Yeah.
We have tried to answer all the questions, so thank you everyone for joining us today, and we will meet again. Thank you very much.