Good morning, everybody. It's a little bit after 10:00 AM this morning. We're very sorry that we're a few seconds late. Of course, the computer decided to do a close down exactly at 10:00 AM. We had to do some technical stuff in the room. I hope that you can hear us now. Most welcome to this meeting where we will present the September quarterly results for AddLife. This morning we released our report. It's a report that we are very proud of. I think we all know that the last year has been a very strong year for AddLife. Of course, the comparisons for all our business is very tough. Nevertheless, we are very proud of what we achieved in this third quarter. Looking into some highlights, we could say it's a strong quarter.
We had continuously strong COVID sales within our Labtech business, but more or less just SEK 10 million of sales of COVID-related products in our Medtech business. Overall, the growth in this quarter is driven, of course, by the larger acquisitions in the second quarter. As many of you know, the third quarter is seasonally the weakest quarter for us and has been so for many years. July and August are normally very weak months, low activity within healthcare. I would say this summer is no exception at all. We see that many hospitals actually have given all their employees vacation, which I think they have really needed after this tough period with the COVID treatments. We also saw that it was a strong recovery in most markets in September.
What happened generally is that we have also in this quarter, starting in September, been able to visit our customers. Most hospitals and also research clinics have opened up for customer visits and of course, that is very positive because then we can start selling products for the future. Summarizing this quarter positive, as I said, we did also an acquisition in the quarter of Bio-Connect Group, adding another sales of SEK 140 million for the coming 12 months. 49% up in sales. EBITDA increased to SEK 286 million, and the EBITDA margin ended on 15.5%. We cannot discuss AddLife and what is happening with us without discussing the COVID, because COVID, of course, affects our business a lot. We all know that the communities have reopened, restrictions are lifted, vaccination rates are increasing in most Western European markets.
We have also seen, which is also obvious now after the quarter, that in the more Eastern European countries, the vaccination rates are still very low. Therefore, we also see now that there is another wave coming up. It looks like that now in October, and the spread of the infection has restarted in many countries through the new mutation. It's very difficult timing to say what will happen in the future for us all, I would say, and also for our business. What we saw in the quarter was, as I said, in September, a lot of business started again. We saw, though, that the resumption of elective surgery takes longer time than we anticipated. There are still huge backlogs in many countries. We see just in Sweden, I think we have 650,000 people in the queues. In Ireland, I think it's 870,000.
In U.K., actually 5.7 million people waiting for elective surgery. This will, of course, take time. It has been obvious for us and for, I would say, many companies that the global supply chain is somewhat weaker still after the pandemic, which of course affects our businesses and our companies. We have also seen that the freight cost has grown tremendously, especially when you are trying to do sea freight from Asia. That is a negative impact in the margins in this quarter. In this picture, we have now put in a chart where you can see the COVID-related sales from quarter starting in Q1 2020, where we had only two weeks of COVID in our books. Then you see the growth quarter by quarter.
It's obvious now when you compare Q3 2021 with Q3 2020 that we have a decrease in the COVID-related sales. You can also see that we are actually lacking the sales in the Medtech business. We had strong Medtech sales from COVID products in PPE last year, but this year, very little actually, especially in this quarter. A few words about the future. Of course, as I said, it's very difficult to foresee what will happen in the pandemic, and the development for us will be depending on how this evolves in the market. We also see that we have good business underlying, but we also perhaps have possibilities to continue somewhat longer than we foresaw with the COVID-related business. Looking into the net sales in the quarter, sales up 49% to SEK 1.9 billion. The acquired growth was 54%, SEK 672 million.
Of course, we have a negative organic underlying growth, 5%. Taking away, again, the COVID-related sales, the organic growth was actually up 9%, which we are very pleased with. For year- to- date, we have the same figures, SEK 5.9 billion in net sales. That is up 65%. We see the organic growth was 22%, including COVID, but excluding COVID, we have a rate of 6%. That is actually more or less on par with the organic growth we have had since 2004. Of course, we are very pleased now to see that the underlying business have actually restarted during 2021. A few words about our EBITDA. It was an increase of 44% to SEK 286 million. We are very pleased with the result we got in this quarter, even though we had problems with the disruption in global supply.
I think you hear that from all companies. There is raw material problems, I would say, in the world. For us, it is mostly plastics that we are waiting for. Takes us some difficulties, especially in the Medtech segment, to get these plastics. In the Labtech business, we see that there are the problems in the world with the semiconductors. Gives us some problems when we want to install new instruments that we, of course, have to, with software, put together with the customer's system. Therefore, there is late deliveries in the semiconductors, and that hurts us as well. Mostly, the increased freight cost is, of course, tough for our companies as well as it is for most companies right now in the world. Therefore, we are very pleased with the margin of 15.5%.
If you compare that with last year, there is some product mix change, you could say. Last year, we had sales in the Labtech business, a lot of instruments. This year, we did not have so much instruments. We actually had more reagents, meaning that the Labtech margins are higher this year. In the Medtech business, we did have a lot of PPE sales last year which gave us a big margin in the Medtech business, but this year we didn't have it. Therefore, we have lower margins, you could say, in our Medtech business. Below, you see the year-to-date figures that really sums up what I have said before. We have continuously a very strong development in our results.
Looking into the Labtech business, we, as I said, have high volumes, what we have done also is actually to compare the Labtech figures with what we had in Q3 2019, we see that. Last year, of course, it was very weak organic, excluding COVID sales. Comparing to Q3 2019, we have, in this quarter, a small positive organic growth ex-COVID, comparing two years behind. Which, of course, gives us good faith that we are now see the opening of other parts of the business again. Very positive is, of course, that we also in this quarter made a smaller acquisition, I will come back to that. You see that we had extremely good margins in the quarter, close to 22%.
Of course, that comes from what I said before, that we have a bigger portion of reagent sales in this quarter compared to last year's third quarter. Next slide, more details. I think I discussed some of it. I think the positive side on the diagnostics is actually that the, what I said, customer starts to engage in other activities, meaning that we see now they are really taking on other tests. We are able to meet and discuss future projects. We have sold much more tests within oncology, genetics, meaning that the installed instrument base that we have had during the COVID period, we now can start to run other tests on those instruments. That is very positive.
Our diagnostics company has, for the last three, four months, actually had one big focus, and that is really to make sure that we can shift existing COVID customers to customers running other tests on the same instruments. They have been so far very successful in this change in the business. Looking into the research and laboratory side, virus research continues to be very strong. We have that strength most in Denmark, where we've seen a big part of investments in these areas. What is very positive is that we have had, during the pandemic, we discussed a lot with research customers. They postponed a lot of acquisition of investments in instruments, but that has actually opened up again. We have now much more opportunities to restart that sales in the quarter and for the coming period.
If you look at Labtech, it's a very strong quarter, and the organic growth excluding COVID sales is actually up 14% in this quarter. We are very pleased with the business that we have in the Labtech businesses. Medtech in the third quarter, we had a sales growth of 131%, and the organic side is negative with 28%. Of course, the acquisitions is really the driver in the Medtech business. Vision Ophthalmology Group and Healthcare 21 are of course, doing the major part of this added sales, and they have developed according to our expectations during the quarter. We see in the quarter that it's very limited sales of COVID products. As I said, the resumption of elective surgery is taking a long time.
I would say right now we are probably running -20% compared to normal when it comes to surgeries in most countries. It's also very different compared to what different types of surgeries to be conducted. For example, we see that the cardio side in our central eastern countries are more negative, but they are more positive on the orthopedic side on the surgeries. A bit different, but on overall, some -20% still. The reason for that is mainly because the customers have, or the hospitals, has lacked personnel during this time. They also have a lack of beds because still, a lot of COVID patients are in the hospitals, even though they are not in the ICU so much, but they are still in the hospitals. Therefore, it's not enough resources, you could say.
I already discussed a bit about the health services at Healthcare 21 and Vision Ophthalmology are delivering according expectations. We see also for their businesses, of course, that it is lower activity during the summer period, as we always expect it to be. What is very positive in Medtech is the home care part. We had big closedown, I would say, during the pandemic for the home care businesses. It was extremely difficult to do tryouts and meet the customers and install products. This quarter it really opened up again. We have a good underlying organic growth, and we see also very positive growth there compared to what we had in 2019. Also positive is that we see that fairs are opening up. We had a few fairs in Norway in the quarter.
Actually now after the quarter, we see that there are fairs also in Sweden and Denmark coming up, so we can now start to showcase our products. Organic in the quarter, excluding COVID, we have 0% growth. Still good if you could know what is happening in the elective surgery. Year-to-date, -1%. As I said, acquisitions, and you all know that acquisitions is one of the most interesting things that we are doing outside just running our companies, but also adding new acquisitions to our group. We did last quarter, Vision Ophthalmology and Healthcare 21. This quarter, we did a smaller acquisition with Bio-Connect. Bio-Connect is a distributor in the Benelux countries. Benelux is a market where we have only had Medtech business before. We have it in our business, Mediplast, and we have been in Benelux for many years.
Our Medtech Benelux business has developed very well over the last five years. What interested us is to also be in the more Labtech side in Benelux because we know that Benelux is a leading pharma biotech research area in Europe. We have now been able to buy Bio-Connect. It's a smaller company with 31 employees, but a good sales of SEK 140 million. It's a really niche provider. They are working both in life science and diagnostics, where they sell leading brands from more research-oriented suppliers. What we think is very interesting is that they are also a full-service provider in very niched life science research where they have a strong competence, especially within proteomics, which is an interesting research area.
The product portfolio that they have and the service provider solutions that they can have in their market is very interesting for our other businesses within the AddLife Group. We have already opened up cooperation between Bio-Connect and the BioNordika companies and EuroClone, and other Biomedica businesses within our group. Let's see how we can cooperate more in the future. This is a very positive growth for our Labtech business, and it's a very positive opportunity to have more life science and diagnostics into AddLife. Martin, please.
Thank you. Talk about our long-term financial goals. We continue to be above our goals here. The EBITA growth was, for the rolling 12-month period, 114%. If we look at the long-term trend since we were listed in 2016, we have been able to have an average profit growth of 50%, and the goal is 15%. We have been well above the goal. Looking at the other financial goal, the profit through working cap, we have had 105% here over the last 12 months, also very well above our goal. This of course is important for us because this is how we calculate and see if we have a good cash flow for the business.
Looking at the income statement, as K ristina said, when we look at the gross margin here, you see that we have been able to increase it with one percentage unit to 35.7% in the quarter. You see that there is the same trend in the year-to-date figures. This is of course one factor here is the product mix, the change that we have had in Labtech from instrument sales to reagent sales. What we also see in the income statement is that the intangible depreciation related to intangible assets are now increasing due to the acquisition of Healthcare 21 and VOG, and also the financial income and cost interest expenses for the loans.
Looking at the balance sheet, there are small changes compared to last quarter, but of course there, if we compare to 31st of December, there are quite substantial changes in the balance sheet, and this is of course from the acquisitions that we have done. We continue to have a strong balance sheet. We have an equity ratio of 40%, and the net debt or financial net liabilities ended up on SEK 4 billion. Here we have included SEK 408 million that are pension related and also liabilities related to leasing. The net debt equity ratio multiple is 1.0. We continue to have a strong balance sheet for the future. Looking at our cash flow in the third quarter, we had a quite stable cash flow in the quarter, ended up on SEK 233 million in the operative activities. A little bit stronger than the last quarter.
What we see here, when we look at the rolling 12-month and accumulated figure, we continue to have a good cash flow, which for the rolling 12-month period ended up at almost close to SEK 1.2 billion. Otherwise, nothing to comment here. Some key financial indicators, we have talked about most of them. The only one I want to comment is the number of employees. We are now almost 1,800 employees in the group after the last acquisitions we have done. Let's open up for questions. If you want to ask a question, you unmute yourself and now just
Hi there. Daniel from SEB here.
Hi, Daniel.
Hi. I have three questions for you today. If we start off with the first one. I know it's getting rather tiresome to talk about COVID-19 testing, but given the current situation, do you feel that the Q3 number of SEK 300 million in sales is a good proxy for Q4 as well? With that said, is it possible to quantify how much of those volumes and sales are being related to, say, routine tests at hospitals versus non-routine tests such as travelers certificates, et cetera, to get a greater understanding of the recurring-ness of this?
If we talk about the COVID test, I would say the absolutely majority is coming from routine tests in the hospitals. The side where we more travel certificate testing or also where we see, especially where we in Norway have testing for employees on the oil fields, et cetera, that of course is a very small part of the SEK 300 million. To say if SEK 300 million is sustainable for the coming quarter, it is very dependent on how the COVID pandemic develops.
I don't think it will decrease even more because, as we've heard, both in, for example, Sweden and Finland, the governments have said that if you are now double vaccinated and you will be sick, you are not supposed to take a test because they actually want you just to stay at home. Therefore, it could mean that the COVID for the coming quarter would probably decrease. It's difficult, but I would assume it will decrease in the coming quarter. That's the best answer I have.
Okay, understood. Thank you. The second question relates to elective surgery seeing pretty low volumes in August and July, but stronger in September. Has this strength continued in October? There are some talks about lack of surgery gloves if you listen to Mölnlycke. We'd like to know where the status is today.
I would say what we saw in September has, for us, continued in October as well.
A last one then from me. On the margin side for Medtech, believe the margin look a bit shy at 9.9% if we are looking at Vision Ophthalmology Group and Healthcare 21. Wondering if there are any seasonality effects or cost or mix effects in this quarter.
They have the same seasonality effect as we had in the rest of the hospital side, meaning that they had also very low volumes in July and August. That is what we expected as well, because that is normally how this type of business works. For them, July and August were also very weak months. The same for our rest of the Medtech business. Therefore, we have a lower margin. That's how we expect this business to be. Have seen it in other big companies before.
Okay. saying more long term, rolling 12 months, a margin profile above current sort of Q3 level?
It's absolutely expected, yes.
Okay. Yeah. Thank you. That was all for me.
Thank you. Do we have any more question? If not, we welcome you to either call us or send us an email and we will try to answer the questions you have. Thank you so much for listening in to the presentation today, and we continue to work within AddLife the rest of the day. Have a good Friday, all of you. Bye-bye.