Hello, and welcome to today's webcast presentation, where we have Integrum presenting. With us, we have the CEO, Rickard Brånemark, CFO, Jörgen Svanström, and Jeffrey Zanni, President, U.S. If you have any questions, please feel free to use the form that is located to the right, and we'll take that up during the Q&A after the presentation. With that said, please go ahead with the presentation.
Thank you. Thank you, and good morning from Miami, and it's a bit hot, so I might need to take a sip. It's 8:00 A.M., and it's about 26 degrees Celsius outside, but it's a bit cooler inside with air conditioner. So, I'm Rickard Brånemark, and I'm the founder and CEO of the company, and together with me here, I have, if we take this from left to right, our president in the US. Hello, Jeff. Would you like to introduce yourself?
Good morning, everyone. Jeff Zanni. Pleasure to be here. Thank you.
And then, the guy with the money, our CFO, Jörgen, say something nice about the weather in Gothenburg.
Yeah, Jörgen Svanström, CFO. Well, I can say that it's better for running today than it was on Göteborgsvarvet, so...
Okay, so most welcome, everyone, and let's go ahead and start this call. Jörgen, you're the master of ceremonies. So, first, we're going to do a brief recap on about the company. If you don't know it, we're working in the field of extremity reconstructions. When you lost a limb, have an amputation, what can you do? And we use a innovative solution called bone-anchored prosthetics. And we also work with some scientific stuff that here is called neuromuscular integrated prosthetics, but it's typically known as the e-OPRA system. So our OPRA system, that is this bone-anchored solution, is still today the only FDA-approved prosthesis for above-knee amputees, and it's approved through the highest level, which is called pre-market approval process in the US, which creates a unique position for us in our top priority market.
We have been growing with about +30%, and we feel that there is a room for continued growth. I'm pretty sure we're going to come back to that. We have also expanding our pipeline of new products and indications. In Europe, we have transhumeral above elbow, and we have digits also cleared. We are working with transhumeral in the U.S., and we're also working with this e-OPRA system that is this science fiction thing. We are working in a fairly interesting niche, and that is advanced prosthetics. And it's so that the global market is estimated to be around $8 billion. So we have plenty of room for growth. And I think we have, as the leader in this field, a proven track record of clinical excellence.
We have scientific innovations. We work with MIT, et cetera. And I think we started to have a commercial success now when we are continuously growing, we are reaching profitability. And all of this is based on a foundation of more than 20 years. It's actually more than 30 years since we started this kind of treatment in Gothenburg in 1990, and we have treated more than 700 patients globally. Next slide, please. So I've already, to some extent, touched upon this, but just quickly, the company that was founded in 1998. And then we have added a product that I haven't really talked about. In 2011, we added a special safety device that is called the Axor. And I guess, Jeff, we're going to talk about that because that's important for your ecosystem structure.
We have published several scientific studies, and in 2015 already, we got the first FDA approval, but this was not in PMA. This was a humanitarian device exempt that actually gave us the opportunity to do a little bit of cut into the U.S. market, and that was also the reason why I moved from Sweden to San Francisco in 2015. We started fairly early in the U.S. to work with Department of Defense. And Department of Defense has been very interested in this technology and invested over SEK 60 million to really explore the possibilities. And they've been doing studies supporting our system from a scientific and actually also from a commercial perspective.
And then finally, in 2020, in December, we got this pre-market approval, which is now paving the way for an expansion on, on a true market scale in the US. And this call is also about, you know, the, the last milestone when we surpassed SEK 100 million in, in, annual revenue. Next slide, please. So if we look at a couple of years back, you see we have continuously been growing, and it's even picking up more this, this fiscal year. Average 34%, and, Jörgen will comment on the, the details for, for the growth this year. Next slide, please. So, so US is our top priority market, where we have a fantastic situation with the only cleared, FDA cleared device. We have, our Integrum Inc., that is run by Jeff. We have our internal sales force.
We have also different kind of, we can call it strategic partnership or, or distribution partners, and I think, Jeff can expand on that. In the U.S., with the present product portfolio, we have a total addressable market of more than $5 billion. If we go to the rest of the world, and that's primarily Europe, with some additional countries, we have had a CE marking for long, but we have all the time been focusing on bringing this technology to the U.S. We have our internal sales force, and we have headquarters in, in Mölndal, just south of Gothenburg, in the new GoCo Health Innovation Center, which is a great place for us to be able to expand the business.
We are working with distribution partners in most of the new countries we enter, and we can come back to that. And as of now we have an addressable market of about $2 million. And it's not only so that we have this implant solution. The implant solution is so good, and with the additional scientific things I will talk about, the science fiction things, we are now collaborating with MIT, Johns Hopkins, and the Mayo Clinic, so we're really in the top segment in the world here. Next slide, please. So I've already talked about this, and this is a breakdown how we reach that. So we talk about, you know, how many are living with limb loss in the U.S. and in the targeted European markets, and that's about 3 million.
And then we look into those that has an amputation due to trauma, that's like road accident or something like that, or cancer. We're not targeting the fairly sick people that will have amputation due to poor circulation or what you call dysvascular amputation. And of those we have selected based on the indications we have for our implant system, the OPRA population, that is about 260,000 individuals. And it's also so that this is now based on the above-knee indication, and we have made a press release that would really start in a clinical study working with transfemoral below-knee amputations.
When that is done, which might take, you know, 5 years or so, that will have, and here we say, unlock a significant additional market share, and it will actually be the same 100% growth or maybe even more. Because if you look at the average between below knee and above knee, it is about 40% above knee and 60% below knee. Next slide, please. So what is it that we are really doing? Well, so if you have an amputation, you get a stump. And how do you attach a prosthesis to a stump? Well, the standard prosthesis, that is called a socket prosthesis, is sitting on the outside of the stump. So it really connects to the skeleton indirectly via skin, subcutaneous tissues and muscles.
That's not sitting still; it's chafing, it creates irritation, sores, could be infections. It's also so that the volume of the stump is fluctuating, I would say, all the time. Now, in the morning, it's one size, and in the evening it might be slightly bigger. And what you typically say, you know, in Sweden over Christmas, you might gain some weight, and then you might need a new socket. But I think the really triggering thing here for improvement is that it's not a direct connection to the skeleton. You lose that precision and that physiological way of loading an extremity. So we are bypassing the socket completely, and we put an implant directly into the skeleton, using a technology called osseointegration that was really developed by Brånemark for dental implants.
So that's a long track of over 60 years now. And by attaching the implant directly to the skeleton, we get increased range of motion and limb strength, because the sockets is not there to restrict, like, for instance, the flexion of the hip. And all of the socket-related problems I was talking about related to, you know, bad fit, the skin chafing, you know, in Miami, maybe you go out, you sweat, and then the socket will not sit there, will just slide off. And it's also so that with our direct connection to the skeleton, you get something that we call osseoperception or maybe enhanced proprioception. And what is that? Well, we get more accurate information into the human body again. So the brain will have easier to understand where the leg is and how it is positioned and can feel-...
The different qualities of vibrations when you walk on grass or when you walk on concrete. And that is creating another layer of what we call embodiment. That is that you feel like the prosthesis is a part of you. And another feature that is easy to forget is that it can be very cumbersome to put on, the socket. It should sit very tight, and it can take maybe 20 minutes. If you take a shower and there's humidity, it's very difficult to slide it on. But with an implant system, it's just a quick mechanical connection, takes, like, 10 seconds. So that's the balance here. What might be the drawbacks? Okay, this is surgery, and there could be problems related to the surgery, infections, et cetera. So next slide, please.
So we have over the years developed a very efficient and standardized treatment protocol. And I will not talk about the details of the surgery, but we have also developed this Axor II release system that is a safety device that is decreasing the risk for fracture if you have a fall, for instance. And we have also developed, since we started in 1998, a BioHelix surface that is improving the integration, speeding it up, making it stronger, and it's based on a combination of a macro, micro, and nano structure that we create with a laser. So it's a very clean process and very precise. And now we have more than 700 users globally. Next slide, please. So coming back to success rate. So we have prospective five-year follow-up studies.
This is in 151 patients, and the clinical success rate is slightly above 92%, where we can see that it's not so that it's just sitting there. You can actually use it, and you get this osseoperception. We see increased step count per day, which means that you use your prosthesis more, you can walk longer. And we have also in this result showing that we increase the mental wellness, and we increase quality of life. Next slide, please. So this is just a panorama. I talked about the digits and the upper arm and the above knee that are all approved in Europe, and then the above knee that is approved in the U.S., and that we are working on the below knee. I haven't talked about the lower arm. That's something for the future.
Next slide, please. So now to the science fiction, and it is not science fiction because it's already here today. So the e-OPRA Brain Implant System is the world's first mind-controlled prosthesis. And, what is that? Well, we're trying to have sort of direct brain control, and maybe you know about the guy called Elon Musk. He's trying to do that by implanting stuff inside the brain. That's, that's a very, very challenging thing. I think we are doing a less risky and, at least short-term, more powerful, and we use electrodes that we plant, not in the brain, but on muscles and peripheral nerves, where the brain language is already decoded. Almost decoded, I would say, because we also need to use artificial intelligence to create pattern recognition algorithms to get precise movements.
And by working with implanted electrodes, you get about 10 times the resolution when you're gonna control the precision of your grip. Where am I here? Okay. So this kind of movement will have 10 times the resolution. And what we can also do, because we can put electrodes around nerves, we can create artificial sensory feedback, so you can feel with your prosthesis. And of course, all of those signals coming to the brain, the brain will perceive as the limb is almost there again. It's creating another layer what I talk about embodiment, that you feel that now the artificial component is a part of your body. Next slide, please. So this is the world-leading technology, and then when I sometimes joke, I say part of our R&D department is located close to Jeff in Boston, and it's called MIT.
To some extent, exactly, it's because we do a lot of fascinating things, primarily together with MIT, but also with other world-leading institutions that I mentioned previously in the U.S. Next slide, please. Oh, so I-- that was an introduction to you, Jeff.
It's a wonderful-
Take it away.
It was a wonderful bridge. Thank you, Rickard. Good morning, good afternoon, everyone. I'm gonna provide a U.S. market update. We can go to the next slide. So last quarter, we've taken our ecosystem model, and we drove it to more of a focused ecosystem model. So think about the resources going extremely sniper-like versus shotgun, and I'm gonna share some findings that we've realized just in the last couple of months. We've also started to expand our indirect representation of our portfolio within these specific ecosystems, and now we're starting to do field-based as well as virtual training for CPOs and hospital staff.
So it's not just about focusing on the ecosystem, it's about completely involving and educating the entire surgical staff, as well as other hospitals within the ecosystem, and I'll share that on another slide. We've also realized that surgeon-to-surgeon education may be relevant in other orthopedic businesses. However, patient-to-patient education is critical here, amputee to amputee. So we've expanded our ambassador team, which has been proven successful and is working really nicely to create more patient production. And then lastly, we're happy with where we are right now, but we know we have an incredible opportunity for continued growth, and some of these opportunities will come with scaling our staff as well as our resources. Next slide. So we have ecosystems all across the U.S.
The smaller dots represent hospitals that are using our implants. However, last quarter, what we did was we said we were gonna focus in on high-production, high-opportunity environments that are targeted ecosystems, and we deployed our internal resources deeply into these focused selling opportunities. The market has responded well, and I'm gonna share with you some of the things that we found throughout the ecosystem, but this continues to be fine-tuned, and we continue to penetrate and get deeper into these ecosystems so that patient production is first and foremost. Next slide. So I'm not gonna spend a lot of time on this, but if we think about our ecosystem and the model that we have here, it's very simple. The surgeons is in the center, and all the things that generate patient production are around that.
This is where we deploy our resources, to a specific ecosystem, focusing in on the surgeon, but then touching all these branches of rehabilitation, other surgeons and physicians within the practice, trade shows, et cetera, et cetera. What we've realized here as we fine-tune our ecosystem model is that the prosthetist is the connection to the patient. It is the main focus. So now what we're doing is we're seeing the ecosystems, and we're identifying all the prosthetist centers around these ecosystems and engaging in customer-generating opportunities, as well as deploying resources to these prosthetists to create more awareness and more patient production. Next slide. Once we capture that patient, we are now taking this... and this is kind of an overview of the patient journey. One is you need to identify the prosthetist, the center, and identify the patient.
Then we need to get to the patient and walk them through this journey, which is, are they a candidate? What is the system that they're going to? Completing the surgery, and then, of course, post-surgery rehabilitation and follow-up. The great thing about this opportunity is that because we're hand-holding these patients throughout this as a concierge service, we're finding the patient upfront, and then we're staying with them for a lifetime, and the Axor connector and the relationship with the prosthetist enables us to stay connected to the patient long-term. Next slide. So if we think about our immediate as well as our long-term growth drivers, it's really a four-pronged stool.
The first is continue to focus in on the US market, where we can get these ecosystems, these focused ecosystems, strategize and fine-tune the approach, so then we can expand to other ecosystems, each ecosystem to target 10-20 surgeries per hospital, per facility. Also, engaging with prosthetists and engaging with CPO centers. So through independent capture, through strategic partnerships, we will start to expand our reach into these prosthetist centers that can go into their patient base, engage with the patient, and drive them to the patient journey or the concierge journey process. Also, within these ecosystems, we're starting to partner now really closely with these hospitals and centers, and what's come out of this is more of a direct-to-consumer initiative that's been really beneficial in this ecosystem approach.
So by spending more time on these focused ecosystems, by fine-tuning our approach, we're now seeing hospitals investing in the technology that they have. We can go to the next slide. Here are some examples of what we've done with this focused ecosystem approach: identifying the marketing teams at these facilities, investing resources into these facilities, understanding or allowing these facilities to understand that they are a OPRA Center for Excellence. They are now standing behind us and helping use their resources to highlight the facility and the opportunity for patients, and these are just some examples of what we've done in a very short period of time. What's also come out of this exercise is that not only awareness that we're driving into the market, but also awareness that the facilities are driving into the market.
We're getting a tremendous amount of inbound requests for more information, requests for surgeons and facilities and centers that this technology can come from, come into. Next slide. We actually recently had gotten a request, which I believe is also indicative of what I would classify as a breakaway moment for OI, is that the producers of Grey's Anatomy reached out to us, and had heard a lot about our, our technology, and we were recently featured on Grey's Anatomy just last month. I believe it was season 20, episode 6, and this also is instigating more patient production, inquiries on our technology, and inflow, influx of patients. So, that's a quick U.S. update. I'd be happy to answer any questions as we go through this presentation.
Okay, Jörgen, it's time for you.
Yeah. I was starting, but I was muted, so-
... Anyway, looking at the quarter, we have a revenue or net sales of SEK 26.1 million, which is an increase of 43.7% from last comparable quarter last year, which was at SEK 18.1 million. If we look at the profit, the EBIT level, we have 2.6+, versus -7.2 year on year. That leaves an EBIT margin of 10% for the quarter, and obviously a -1% last year, so quite an improvement. Looking at the full year, I think it's a cause for celebration to recognize that we finally hit SEK 100 million, and three figures. I mean, of course, we're not satisfied, but it's a milestone, certainly.
We ended up the year with SEK 104.1, which is an increase of 40% on year-on-year from SEK 74.3 last year. Also, we managed a full year operating profit of SEK 6.5 million versus almost SEK 20 million loss last year, which gives us a positive EBIT margin of 6.3% for this year and a negative 1% last year. Moving along, I think if you look at the graph of the quarterly sales, it's obvious that we don't have a linear development quarter-on-quarter. And I guess this quarter is also evidence of that.
But I think also what's worth noting is that there's a clear positive development this year, the year we just finished in comparison to the other years. And the increase is quite remarkable, to be honest. Also, looking at the operating profit, I'd say that we're consistently or trying to consistently make a profit now every quarter, whereas it has been sketchy the last years previously. I guess one thing I think worth mentioning, I've been talking about it before, but I think that if you look at our other external costs and our employee costs, they are more or less the same this year in comparison to last year.
And I know that in this call a year ago, we talked about having laid the foundation or the building blocks, as we talked about. And I mean, if you look at our numbers, you can say that the building blocks was social media and some other stuff. But I guess you can say also that we've maintained our cost, but we have switched from other external costs to boots on the ground. And I suppose that you could also say that that has had an effect. And I think also it proves that we have the operational leverage already that we need to continue forward and grow.
If we look at the different markets, of course, the United States market ended up at SEK 73.3 million in Swedish kronor, of course, which is about 25% growth year-on-year. And some of the highlights, I'd say, is the reimbursement code that we got for the Axor. That's... I know you can expand on that later, maybe, Jeff, but that's an important thing. Also, you already talked about the ecosystem, and it continues to help us drive the solid performance, I guess. Also, in the U.S., it was published an article that really shows how it's cost-efficient to use our implant system. But not only is it cost-efficient, it also increases the quality of life for the patients.
I guess we are, well, a good choice for both. Looking at the rest of the world, we have almost doubled our revenue, from SEK 15.8 last year to SEK 30.8 this year. So quite an achievement. Some of the things we've done as well is to expand our markets into Israel and, the U.K., and also, of course, Ukraine is becoming very important for us, alongside, Turkey, where we also have a collaboration with a distributor.
... and, yeah, I think the UK is important as well because even though they, they left the EU, they decided to, to go with the MDR system. So I guess since we invested a lot, it really, it's really paying off, not only for the EU, but also for the UK. So that's gonna help us a lot when entering that market. I guess that's what I have. Rickard, maybe you want to comment on the picture there to the right to finish off the presentation. You're muted now, Rickard, so-
Yeah, yeah. Okay. Yeah, thank you, Jörgen. And just to emphasize a few things here, that what we're doing in certain regions of the world where there are catastrophes, like war or earthquakes, and so it is a bit challenging to say, but that is creating business opportunities for us. But we need to make this in a very sound way. So Oleksandr Zozuliak, which we call The Archer, he actually came to OTWorld. That is the biggest prosthetic conference outside the U.S., which were held in Leipzig in mid-May. And he lost his arm already in the war in 2014, if you remember, that Russia invaded Crimea. And then he's been using an ordinary prosthesis, but that didn't really work. He has a fairly short stump.
I'm not sure you can see that. And he just slipped off all the time. Now he's competing against able bodies, and in his first competition, he came number two. That's the precision you get when you have bone anchor devices. And on top of that, he's, he's a, he's a great guy, and, you know, anything anyone can do to support Ukraine, do that, because Ukraine is defending the rest of the world from Russia. Okay. So, yeah, I'm a bit emotional. I've been there a couple of times, and I'm crying all the time. All these young people with lost arms and legs, and we are maybe the only one that can really help them, so we need to work harder, guys. Come on, step up a bit. Get it done, Jeff and Jörgen. Okay, so, yeah, sorry about that. I got carried away.
Let's open up for questions. Magnus, are you there?
Okay. Thank you very much for that presentation. And like I said, now we'll open up for questions. And we'll start with the first one. Could you please elaborate on your view of the quarterly performance from an operational standpoint? Are you happy with it? Are there any disappointments or other notable points that deserves mention?
Yeah, I think it's a good question, and you know, when you're in this space, you should never be happy and sit down and relax. So, even though it can be good, we will never be happy with the result, where we have thousands of patients out there that we can help, and we can run a solid business around it. Then it's also so that we are gonna build a global company, and then a quarter up and down is not really important if we feel we're on the right track. I think this is a discussion we can expand a bit on. I want both Jörgen and Jeff to chime in here from a more operational, you know, and also from what's happening in the U.S.
Because U.S. is still our top priority market, and there we had somewhat slower growth than the average. We also said, you know, we have seasonal variation. And the TAM is, you know, many $ billions, and that the need is out there for many, many thousands of patients, and we need to do this the right way, and that is a scientific approach, not just go out there and try to sell things and bring your bag. We need to do that, and I think we have a fairly scientific approach to it. So, maybe, Jeff, first, if you can expand on what I call your scientific approach to your ecosystem.
Sometimes it takes a bit of time to understand how everything is working, but once you have it in place, then you really know that it's gonna work and how you can scale it. Jeff, please expand.
No, sure. I mean, you covered a lot of it. I think that, you know, this ecosystem strategy we have right now is working, and now we're fine-tuning it, to make the best impact and really put the ingredients together to have the perfect recipe so that we can expand it. To answer the question, we did okay, in my opinion, this year, considering that there was new leadership, seasonal variation, you know, a new ecosystem model that we just launched. We're still fine-tuning it, but, I'm never gonna be happy.
To echo Rickard's comments, I think that we have an obligation as an organization to get our technology out to as many amputees as we possibly can to provide a better way of life, and in my own opinion, we should be growing, you know, off the charts, month-over-month. So we're gonna fine-tune what we're doing right now, really get the recipe down perfectly, and then expand in both ecosystem strategy, staffing, resources, but we want to get it perfect right now. And I think that what we've done in a very short period of time, I'm happy with, and now we just need to fine-tune it.
... Okay, yeah. It's good. Yeah, somewhat happy. Yeah, you know, we're talking about that, yeah, all the time. So, when are we coming to your breakaway moment? Maybe we can come back to that too. But Jörgen, if you elaborate a bit, you know, how we're running operations and, I'm trying to use the right words now, yeah. So, by not really scaling up the operational costs, I think we have been cost efficient. So, maybe you can expand a bit on how we're working with that.
Yeah, for sure. I mean, look, I think if you compare to last year, we had an operating profit of SEK -19.7, and that was at the same cost base, more or less, that we have now. I mean, give and take. And right now, for this year, we are making a profit, and I mean, it only goes to show that we are working efficiently, and what we are doing is actually working, bringing in the revenue. So I mean, I think also that I guess we did the right. We did put the building blocks in place last year, but then it's a question of executing on that, with the boots on the ground that we have. And I think the revenue increase of 40% really shows that.
I mean, because-
Yeah, thanks
... we've really, we've really increased, you know, our efficiency, operational efficiency here, and the numbers show that clearly, so.
Yeah, and, you know, frankly, and just to emphasize this, we are growing 40%, we're reaching above SEK 100 million, and we are profitable. This is really, the turnaround moment for the company. But we see that there are more to come, and that's what we call Jeff's breakaway moment, where it really starting to fly. So back to you, Magnus.
What are the reasons behind the challenges in receiving payment for outstanding accounts receivable? Should investors be worried about the liquidity?
Well, first, some general comments. You know, we are a relatively small company working with fairly big players like Department of Defense. They have certain payment terms, and I don't think we can negotiate great terms from a Swedish perspective; that'd be 30 days. However, as we said several times, I think Department of Defense in the US, they have the money, so they can pay. So we shouldn't be worried about those receivables would take longer time. But of course, we can also work on efficiency, and this is, you know, of course, a question for Jörgen.
So, can you please expand on, you know, why it sometimes takes a bit longer than the 30 days to get the receivables in, and also where we are in relation to cash, and we put in the report that we have extended our credit lines and so on. Thank you.
Yeah, yeah, sure. We just... a thunderstorm just started outside, so I'm just I'm not agreeing on it's better running weather anymore, I'd say so. And I'd rather go to Florida. Anyway, yeah, it's what you said, Rick, that we're a small player. And if you look at the big players in the industry, you know, from our side, sort of, I think you can see that. I think one of the players I looked at, they had an average DSO of 60 days. So and that is one of the leading players in the business. So I mean, so the nature of the business is like that.
And I think it's especially in the U.S., because, I mean, although we have hospitals to work with, and they are very secure payers, but they can also be a little bit. Well, let's say they don't have a lot of operational leverage all the time, at least not in their administered departments. So of course, that is what it is. That's we cannot change that as a small player. But, I mean, having said that, obviously, there are things that we can improve to make sure the cash comes in quicker. But while we are doing that, we've also increased our credit facility with one of the. Well, we are customers to one of the major banks in the Nordics, and we have increased our credit facility to SEK 10 million.
And also, we are close to finalizing a deal that would make SEK 20 million, an additional SEK 20 million, ready for us to finance our accounts receivable with. And if you look at the cash flow statement, I mean, you can see that our working capital is increasing, and that's only natural when you're a company that grows as fast as we do, and especially in a business like ours. But if you look at it, I think that doing the backwards count here or calculation here, SEK 30 million in total will cover the cash flow that we had this year. So, I'm very confident. I'm very confident.
... Okay. Yeah. Thank you. And, as soon as Jörgen slightly pointed out, even though we say there are reasons why we have a longer payment, not terms, but actually occurring, that doesn't mean that we're not actively working on reducing it, trying to come closer to that benchmark that Jörgen indicated. And I know both Jörgen and Jeff are working very hard with their organizations to improve those payment terms. So, Magnus, do you have any more questions?
Yes. Thank you for that answer. In the Q3 report, you mentioned that there were some seasonal fluctuations. How was the beginning of your Q1 started?
Yeah, okay. It's a good question, but we're a public company, and we don't disclose those figures. Sorry.
2 got a reimbursement code eight months ago. Is this reflected in the newly released report?
So I'm sorry, I defer that question to Jeff, but it's under... I think it's important to understand that it's a big healthcare system in the U.S., fairly complex. I've been here now for, what is it, eight years? I still don't understand the system. So it's a big elephant, and it takes some time for things to move. But if you can give us an update, Jeff, I would appreciate that.
Yeah, so it does. It takes some time to move. However, what it's really done nicely is it's given us the ability to go after these prosthetists within these ecosystems with a value message. Having a product that actually has a code reimbursement has been beneficial and certainly instigating new conversations and levels of engagement. And this is, this was, I believe, one of the problems, historically, that shifting a prosthetist, which is essentially driving the patient for us away from what they're used to doing, which is creating sockets and moving towards osseointegration with the Axor connector, there needed to be a value message. And now with the code, the message is clear, and being received well.
Thanks, Jeff. Back to you, Magnus.
Okay. 9 months ago, you started a strategic review. Can you tell us something about how the work is progressing?
No, not really, because that's not something we can disclose, but it is progressing. That's the only thing I can say, unfortunately.
What's the status of the rollout with Veterans Affairs?
Oh, yeah, that's the biggest elephant in the world. So, Jeff, you need to help me here, too. But I think we made a, was it a press release or social media thing, that they've done their first surgery at the VA in San Francisco. I think you had that on your slide, too. So it's starting to move. Our feeling is that it will move, and it will be important, but sometime in the future, and I don't think that you really have any major revenue in your plan for the coming quarters, maybe even year. Yeah. So what's your take on the VA? You've been working, trying to get the speed up there, but it's been, should I say, slow?
Yeah, it's a focus for us for sure. We're doing some marketing activities, and they did publish in the VA of San Francisco in the U.S. Department of Veterans Affairs. So there's some marketing exercises that are going out, driven by the VA. But it is just a slow-moving vehicle, of course, as the VA is known for. But there are some efforts that are staying focused in on the VA, and we'll certainly report that as we close opportunities.
Thanks. Okay, Magnus.
Okay, the next question is directed to Jeffrey. You've shown strong confidence in the American market. Could you elaborate on why you maintain this bullish stance, especially considering that this quarter's number were largely bolstered by Europe? What specific strategies or initiatives are required to further strengthen our market presence in the US?
Yeah, that's a great question. So what I can say is that, I'm very confident in our ability to continue to execute and grow, and fine-tuning the ecosystem is the major focus that we have right now, and expanding our reach to prosthetists through partnerships, both indirect, and direct, to establish patient production. We have an obligation to promote our technology to those that need it, and quite frankly, we're the only ones in the U.S. with an approved technology. So, our strategy will continue to double down on the ecosystem model, and as we grow in revenue, we'll grow in resources as well as staffing and expand upon the opportunity to capture as much of the TAM as we possibly can.
Yeah. Thank you, Jeff. I would like to say, you know, U.S. is our top priority market, and we see a fantastic opportunity there. Our plan is not to have the best quarter ever now, it's gonna be in the long term. So that's why we do this, what I call the scientific ecosystem approach, where we're carefully working through exactly how we're gonna execute with the boats in the market, or whatever you said, Jörgen. That's what Jeff is doing now, and that might take some time, but once we have Jeff's ecosystem in place and really understand the mechanics, and the key component here is the identification of the prosthetist as one of the more most important stakeholders, then we have a fully scalable system in the U.S. Thank you, Jeff. Back to you, Magnus.
Okay, we'll take one final question here. Regarding establishing the Center of Excellence in Kyiv and expanding into the Turkish market, how do you set the specific milestones and goals to measure the success and impact of these initiatives?
Yeah, it's a good question, and so, in principle, I actually have two goals. So, one is the business goal, that this is gonna be a good business opportunity. I think we've already shown that Ukraine is that. We had a big order end of Q3. So, and we know that the TAMS in these markets are substantial. End of 2024, it's expected to have 100,000 traumatic amputees in Ukraine, so that's for sure a big market. And in Turkey, they also had the big earthquake. It actually triggered that we went into that market. But it's also so that Turkey is a very important orthopedic market in Europe.
The other side of it is that we're a med tech company, and a med tech company will need to take some responsibility for what the technologies that we have that we can help other individuals. On a small scale, we have been doing some pro bono to show that this technology is valid in, for instance, Ukraine, where they might have been concerned that it was valid. So those are the two things that I'm looking into. But I think from a business perspective, we need to have the relevant milestones, and we have them, and I think we already surpassed that for Ukraine, for instance.
Okay, thank you.
Oh-
Sorry.
No, we're running out of questions?
Yes, that was the final questions.
Okay, so maybe then I just round off. Thank you, Magnus, and thank you everyone that has listened, and thanks to Jörgen and Jeff. I think we, you know, we're in a very interesting position now, where we really moved the company around. We have been cost-efficient. We're growing. We're surpassing SEK 100 million. We're profitable. We have extended credit lines to support continued growth and expansion of working capital, and we have a fantastic technology.
And I was in Kyiv at the center, and the Swedish ambassador in Kyiv came to the center as one of the minister from Sweden, and when we met up with all the patients, we were all crying because it's so fantastic to be in a sweet spot where you can give a new life back to your, you know, your friends, the friends you have in the world. So that is what we can do, and we can do that with a profitable business. Few will have that opportunity, and I'm very fortunate to be one of those few. And with that, I would like to close this. Thank you very much.