Earnings Call: H2 2020

Mar 31, 2021

Thank you. Thank you very much, and welcome everybody to this Full Year 2020 Financial Results discussion. I'm together with Corrado Foresetta today, our CFO and Jan, our investor leader. I think we can quickly move through the slides. And at the end, we're going to have some Q and A as always. I still see the first slide. You can proceed. It's online. Yes, I don't see it. It is refresh? Let me try to do that. Yes, here it is. Thank you very much. So we did discuss and went Through the revenues, Medacta managed to have a good recovery in H2 last year. We finished 2% behind 2019 with especially a good second half. We could have done better. We have been hit by the 2nd wave in the last few months of 2020, and we finished at EUR 3 0 €2,000,000 in revenues. Today, we will focus more on the profitability, cost and financials of 20 2020, good results in terms of EBITDA margin above 29%, which is very close to what we did last year, 29.5 percent, a solid EBIT margin at around 17%, a good profit for the year. Very good Cash flow, we knew in 2020 protection of the cash flow was one of the key aspects for us almost €32,000,000 And this did come together with a big effort in terms of investment for our growth. Here we picked the number of employees that continue to grow in 2020 together with other important investments for our future. We will see it later in terms of CapEx and overall marketing and sales efforts. If we go to the next slide. In terms of key achievements, we did discuss the revenues, the EBITDA, the cash flow. We in terms of strategic investment for the future, our sales force expansion was quite aggressive given the external circumstances, especially in the second half of last year. We did discuss and went through a significant amount of new product launches that helped us refresh some areas of our products in terms of primary hips, enlarge our product offering and enter into additional niches area or specialty products in knees, shoulder, spine together with some key technologies like the augmented reality solution. We did invest a significant amount of cash into new surgical instruments that are required to serve new customers and this is a very good indicator of new number of customers that we were able to generate in 2020 even in those difficult circumstances. We did increase our balance sheet by reducing our leverage, which is now below 1 point ratio to EBITDA. And we are going to propose to the AGM no distribution of dividend for 2020 in light of the global uncertainty caused by COVID. We want to have as much cash as needed to address future uncertainty and if the uncertainty is not there to reinvest in our future growth plan. If we go to the next slide. We did discuss during the year about our obligation, we were forced to redesign our marketing and medical education offering. We Launched a lot of web based initiatives, including the Medacta TV, the More in Touch program. But as well, we did increase and change completely the way we organize the physical meeting, Utilizing mobile trucks, for example, in the U. S. More than large events, we prefer to focus on smaller events at national and regional level in Europe, in Australia and Japan, in the U. S, more frequent with less Surgeon, we did try and succeed in bringing those events to the surgeon rather than asking them to travel given the external limitations. Thanks to that, we have been satisfied about both the quantity of surgeons that have been exposed to our medical education, quality and especially which was the most important, the conversion rate of those events. If we go to the next slide. I'm sorry, I have a long delay. Strong R and D focus, we mentioned this 2020 has been one of the most rich year in the history of Medactin in terms of new product launch. This was a strategic effort in line with meeting the changes associated in Europe with the MDD to the MDR regulation. So we wanted to have as many product cleared with the older regulation. That's So one of the reason behind this increase of new products cleared, you will see something similar in the second half of this year because as you know due to COVID they postponed this deadline. So we had another shot for another year of clearance. In terms of key products, we mentioned on the hip side that the full renewal of our primary implant offering. We did expand into the revision product range, which was one of the few gaps Medacta had in total joints. We did launch new solution in the area of preoperative planning of the HIP intraoperative verification with MyHIP verifier, which again can deliver in a very effective way personalized approach on the hip side. On the knee, we got our augmented reality platform Nexstar cleared and We did start with total knee replacement. We launched Sensitive Coating, which is a solution that allows to address metal ion sensitivity, especially in certain markets. This is becoming a growing fast growing niche and is important for us to be able to compete in this space. There are very few company is able to offer those solutions. We did further expand both spine and shoulder in terms of new implants to expand and complete our product portfolio in spine on the cervical portion of the business standalone and minimal invasive solution on the shoulder mainly on the revision and fracture, which is an important area of the total shoulder replacement market. Finally, the sports medicine, which is very rapidly expanding its product for you. We did start with some initial market introduction and it's going pretty well in certain very competitive markets like the Australian market where we have done this initial market introduction, for example. Our augmented reality surgical platform did receive a warm welcome by the community. We have seen some strong attention from the general news as well. We have See in Wall Street Journal picking up on the very first augmented reality knee case is done in the U. S. At the Hospital For Special Surgery. In the meantime, we have been introduced the system as well in other centers, both in the U. S. And in Australia. And we expect clearance for the knee application in Europe in the next quarter. We are working as we announced to span the indication for this surgical platform to the hip, to the shoulder, to the spine in the months years to come. And this is a particularly suitable for the ASC market in the U. S. Given its very, very low impact in terms of financial capital requirement, cost per case and overall space that is occupied by the system, very portable, very easy to use more than one platform in a given location. And we start to see a lot of demand from the market. So good positive early feedback. If we go to the next slide, please. I think we can go over the details of of the P and L and balance sheet, and I will let Corrado Foreseta move forward on that aspect. Thank you, Francesco. I have as well a delay in the slide projection. So please tell me if there is such which is not working well. If we go to the slide, the revenue bridge, I would like just to recap What has happened in terms of growth for business lines, we say the core business was affected by the COVID pandemic with the negative results. The new business lines did perform very well with the growth both extremities and in the spine segment. If we move The next line where we see the performance for the our geographies in Europe was the market most affected, North America in line with last year results and the Pacific with a positive performance and the growth of 9%. If we go to the profit and loss slide, I think that you all are in this page. We see that the gross profit margin in 2020 declined from 72% to 70.8 0.3%. And this reduction, let's say, is primarily attributable to 2 main factors. The first one is COVID, of course, and the second one is pricing and FX effect. With regard to the COVID effect, which I explained about 50% of the GP reduction, this is a negative impact, which is mainly due to the depreciation and amortization of new instruments with insulator. That increased at a higher pace than revenue. As we said, the increased customer base in 2020 did not express its potential in terms of revenue, but the quota of investment and of depreciation is now at profit and loss already. And the second point is the direct manpower increased its weight as a result of The temporarily lower level of credit. In addition to the COVID effect, we also had pricing, which are, as expected, going down and even if by offset by the positive geographical mix evolution affected in a negative way of a profit and loss, sorry. And We experienced also a negative effect from the currency evolution with the, The strong devaluation of the U. S. Dollar against the euro. This had a negative translation effect, which combined with the Pricing, the negative trade prices of about 50% of the gross profit margin decline. If we look at the to the cost, the cost of the company, In 2020, we see that there is a reduction. The OpEx reduced And this is mainly due to the limitation, let's say, to the traditional sales and marketing activities imposed by the cost restrictions. And you see in the sales and marketing line this effect. In that line, it is also reflected the increased wage and salaries that We have seen due to the sales force expansion in all our geographies, the folks in the U. S. In the Japanese market. Another positive effect on the OpEx side derived from the Cost containment measures that we implemented and by the Board decided by the Board in terms of salary cuts and postponement To 2021 of the long term incentive plan, for example. The final positive Effect on the OpEx side is the government, the $2,700,000 government subsidies will be recorded In 2020. I would say the rest is in line with last year, but those are the key aspect that helps the company to keep its profitability. Thanks to this evolution of the OpEx, the EBITDA adjusted from the U. S. Legal expenses was equal to 29.1%, which is slightly below the adjusted EBITDA of last year. If we look now to the financial result line, you see EUR 9,500,000 of financial cost. And this is almost, let's say, the increase compared to last year is almost entirely attributable to the exchange rate net loss due to the already mentioned devaluation of U. S. Dollar, But this time against the Swiss francs. The reason is that we have a big amount of receivables between Medata U. S. Medata International and the change in the closing value of the U. S. Dollar change exchange rate against Swiss franc determined this increase, which means that the biggest part of this increase is Unrealized loss. So depending on the evolution on 31 December this year, you will see another number there. The interest costs this year were lower, mainly due to the reduction of the interest late applied on the debt in U. S. Dollar. And we have debt in U. S. Dollar to partially cover The risks just described in terms of U. S. Dollar against CHF 6. Overall, the average cost for our financial debt is around 1 point Finally, if we move now to the income tax line, we see here the positive effect of the already mentioned in the past Swiss tax reform. As a result of this reform, the average tax rate of the group reduced by 7% from 20% last year to 13% In 2021 in 2020, sorry. Let's say that this 13% can be considered the tax rate acquired also for the future before extraordinary effects. But if you see What you see, let's say, in the profit and loss is the effective tax rate, which is even lower, the 13%, And this is due to the one off positive effect in this line from adjustment of the first tax liabilities Coming from the revision of the tax rate. So the effective tax rate that you will see this Here is 7.1% compared to 13% of last year. As a result of the above, the Profit after tax increased to €37,100,000 equal to 12.3% on revenue. If we now move to the investment, Swanayde, Here, we can see the split of 2020 investments. The blue slice of the cake represents the new instruments we put into the market in 2020 for EUR 80,000,000 and that is what affected the GP margin, as we said before. Other investments are composed by research and development for EUR 8,000,000 The Green Slice, which is in line with the past. And other tangible investment for EUR 5,600,000, which include also Extraordinary investment for the, let's say, the expansion, the creation of new offices The building of Renkata, the new building. The rest is in line with the past. Overall, we are talking about EUR 34,000,000 If we now move to the cash flow slide. Okay. Here we see the increased cash flow generated From EUR 22,000,000 to EUR 32,000,000, the adjusted free cash flow. The cash flow from adjusted cash flow from operation, of course, reduced because of the lower EBITDA generated in 2020 and The increased level of inventory, this increase in inventory was decided to face potential disruptions in the supply chain, potentially generated by the COVID pandemic or other risks in Supply Chain and Industrial side. The investments you will see you see here from EUR 41,000,000 to EUR before already discussed lower than last year, allow the company to reach a Strong cash flow generation, which adjusted for normalcy is even more is higher than last year. If we now move to the final slide, The evolution of the net financial debt. We see here that The net debt of the company reduced from EUR 105,000,000 of last year to EUR 83,000,000 this year. This is the result, of course, of the cash generated and the investment in CapEx. The leverage is now equal to 0.95 times the adjusted EBITDA, so below 1 time EBITDA. I think we touched almost all the important points of our 2020 financials. And I would like now Francesco to close the presentation with the outlook on 2021. Thank you. Thank you, Corrado. I believe the outlook is a very important aspect given the current uncertainty on the pandemic and how this pandemic would impact our ability to restart growing. So I would say that we remain highly committed and focused, 1st of all, on our future growth. This has been the case already in 2020. That is the reason why we did continue to hire, we did continue to invest. And there's no reason now that we hopefully start to see some light at the end of the tunnel at least in certain areas of the world not to continue or actually to accelerate further in order to recover some of the growth we missed in 2020. We believe we can and we will deliver some good growth in 2021 and in the following years. We have further expanded our presence in terms of geographies. We have been able to increase and reinforce our product mix together with some very relevant innovation. We did continue to hire in even in the Q1 of 2021. What is at the moment, I would say, calling for a certain level of be cautious, let's say, is clearly what happens in Europe. We have been we would have expected by now to be almost out of the pandemic. We still see countries which are in rough and tough lockdown. Italy is clearly 1. Last week, they did close down Paris again. Until few days ago, we were expecting a tough lockdown in Germany and then they changed their mind. So there is still a good level of uncertainty, especially in Europe. I was surprised to read as well yesterday Head of the CDC in the U. S. To say that she is scared because of the surge of cases of COVID. And so if she is scared, I should be cautious as well. This is the reason why we have been cautious in releasing our top line guidance, which remains significant growth, especially compared to the market. We are talking about 15% of growth with an EBITDA largely in line with 2020. So this is clearly feasible if the external condition will allow us to do better. And that's basically what we are betting on. The more the external condition will let us work. The higher will be our ability to continue to expand and especially realize most of the work of expansion we have already done in 2020. I think this was Our last slide and we have hopefully good time for good Q and A. Thank you. Ladies and gentlemen, then we will now begin the question and answer session. And we've received the first question. It is from Alex Gibson of Morgan Stanley. Your line is now open. Please go ahead. Great. Thank you. Good afternoon. Thanks for taking the questions. I have 3 right now. The first one is just on the Guidance. And thank you for the explicit guidance. That's helpful. But to help us put that in perspective, what has been the trend in the Q1 of this year. And maybe you could add some regional color as well in terms of growth. And the expectations for growth in margins in the first half of the year as well, just to help put that in perspective. And then second, what are you expecting in terms of pent up demand? Do you forecast a large bolus of procedures coming back in Q3 3% like last year? Or should we anticipate a more normal Q3? Do you not see as much pent up demand anymore? And then lastly, on the margin forecast for the full year, are you baking in incremental sales force hiring on top of what you already have in place and or a return to travel in that margin forecast? Or is it are you done for now in terms of the investment? Thank you. Thank you. Thank you, Alex. So, of course, your questions are all about the future and that's what is more interesting. The Q1 has been on a regional basis very, very different. Asia specific is the region of, so in particular, Australia and Japan. That's when what we're talking about when we talk about APAC Medacta. They have been able to work without COVID impact. So this with the exception of few regions in the North of Japan, particularly in COVID-three area when it comes to business. So we have seen a performance in Q1. We were not particularly affected in Q1 last year. So we are comparing numbers which are comparable. We are not yet done with the end of the month, but we have a very good visibility. Europe on the other side is exactly the opposite. We were comparing our January, February with a very strong month of filed last year. The performance has been, of course, behind January February last year. But on the other side, March was particularly hit in negatively hit in 2020, while in 2021, March is clearly stronger than last year. And overall, the quarter could be almost in line with the previous this year. And then finally, the U. S, it's similar, I would say, to the European performance, but March was significantly stronger. So overall, I think we're going to close Q1 with a positive growth, which is already a very, very good news for us. And it's all based especially in Europe and the U. S. On March performance. Because as I said January February outside of for APAC were clearly negatively impacted by the tail, if you and did not allow us to grow in the 1st 2 months of the year. The second question was around H1 margins. I think in general, we tend to have a significant amount of hiring in the beginning of the year because we want to try to maximize the development of sales of those new hires, I think this partially answers your 4th question about are we done with hiring? We are never done with hiring. Medacta is growing because we are constantly hiring new sales force in new areas where we are not present and they do come because they see potential, thanks to our products and to our services and marketing to grow faster in their territories. So we constantly hire sales force, either direct and you see it in the employees or through agents, especially in the U. S. Market, less on the joint side, more on the spine side. So H1 margin will probably be in line with our historical pre COVID margins, given that we're going to probably struggle a little bit on the European side sales wise. But we definitely still have benefits in terms of savings coming from travel congresses, which are basically not there. So it is helping us on the margin side. Last point, I think, was on the pent up demand, when it's going to come and when it's going to finish. I think it will be different in different areas. So we do see some pent up demand in Australia in Q1 in certain areas, in particular in Melbourne area. That's happening now partially. We will see, I believe, some pent up demand definitely in quarter 2 in the U. S. This will probably last longer than a quarter. And we will not see pent up demand until quarter 3 or quarter 4 in Europe. And given the affect certain countries have been in lockdown for a year. If I think about, for example, the UK, the pent up demand will probably be there or at least a strong recovery of waiting list probably still next year in 2022 in certain countries. So it's very different, very variable. But I would say the biggest pent up demand we will in quarter 2, quarter 3, probably quarter 4 in the U. S. And the second half of this year potentially with leaking into 2022 in Europe. That's all very clear and very helpful. Thank you. Thank you, Alex. Thank you. The next question is from Fritz Growe of Credit Suisse. Your line is now open. Please go ahead. Thank you, operator. Good afternoon, Francesco, Corrado. My first question is just on your guidance as well. Does this kind of the margin guidance, is this geared towards the lower end of your sales guidance? Or in other words, kind of if you're kind of doing more towards the upwind on the sales line? And now there should be upside? Or is it basically kind of geared, let's say, to the midpoint? So Kevin, it will also be more Kevin off at the lower end Kevin off in terms of welding if the top line is at the lower end? Yes. So I think, as you can imagine, we have to have relatively high variability in terms of top line range given the external circumstances. We were hoping to be done with COVID at the end of Q1. That's why I was more comfortable when we were suitable when we were discussing previous consensus. Now with Europe in this situation, definitely impacted in Q2, we have been revisiting and be a little bit more cautious on top line. The consequences in Europe are probably linked somehow to marketing expenses 3rd party events, which have been canceled that were planned in quarter 2. I'm talking about 3rd party events that were planned in May, June, European Congresses, etcetera. It is probably helping us to offset some of the lower sales contribution that we would have had if we are on the lower end. So basically, I think we will be able to remain close to our last year EBITDA even within certain changes in top line because this will have as a consequence some cost saving as well. So quarter 2 will come weaker, but it will probably bring some cost savings as well. So I don't expect a huge variability in our EBITDA given the top line variability. We have seen it this year that we are able to adjust cost relatively well and relatively fast, especially those expensive third party events that carry a lot of cost on marketing and sales side together with some hiring postponement based on the ability or not to be active. So if we don't see the ability to serve our customer in quarter 2, we might postpone some hiring in certain region by a quarter. So this is what we have been doing in 2020 and probably what we will have to do until the end of H1 in Europe, it's not the case in the U. S. Where we hope not to have additional surprises and be able to further accelerate. So in general, I would say we did target cost and hiring to be aggressive on the top line. This is the reason why you don't see any margin expansion because the faster we grow, the less is the chance that we can expand our margins. Okay. And then just basically kind of in terms of understanding, I mean considering your comments, is there to assume that kind of the second half is fairly your assumption implied in the guidance is a fairly undisturbed kind of market where you can grow kind of in the range of historic growth rates, kind of low teens or something? Is that kind of or is there still kind of more conservatism baked into the second half as well kind of? No. If you wanted, the hypothesis we made is that basically we can restart working on a normal pace in Asia Pacific and U. S. From quarter 2 onward. And Europe should be resolved by end of quarter 2. So starting from with the second half, we should be hopefully able to work on a normal basis. That's where we hope to be at the end of quarter 2. Okay. And then my last question is maybe just on kind of last about CapEx and instrumentation investments in 2020. Could you maybe make a comment on that? What kind of plans you have? So the substantial step up again or kind of more in line with In the turn of 2020? I think it will be probably in line with 2019 more than 2020 because if we are able to stay at the upper end of our guidance. And potentially, if the situation is not worsening as we all hope, but is actually finally opening up, we might we definitely never want to be short on the supply side, because we know that if we don't use those sets in a given quarter, we will just absorb it on the next one and then moving forward. So the last thing we want to do is to have customers and not to be able to serve them. And there is a potential upside in the second half of the year. We might need to prepare ourselves for this upside. We do have a significant amount of new products introduction And new products very often do bring a significant amount of CapEx without the immediate sales. So I would probably take 2019 more as an indicator of our potential CapEx to sales ratio. Okay. Very helpful. Thank you. Good afternoon. Thank you very much. Thank you. The next question is from Daniel Levascan of Mirabu. Your line is now open. Please go ahead. Hello, good afternoon as well. Good afternoon. The first question is on just on the NEXT R Total Knee. When you introduced it in Australia Not so long ago, what was the major feedback? You said it's good, but what is so special from the surgeon point of view, the Ease of use or the reduced cost per case, if you can shed some more light on that, it's my first question. Yes, it's the combination, I would say, basically of 3 factors, which is the marketability of the system. You can sell it as to the patient as a very good innovative platform, which is very important in certain markets. But at the same time, it does not slow you down and it does not cost a lot of money either in terms of investment required in capital or which is even more important in terms of cost per case of disposables, etcetera. So those are the key aspects, the sustainability of the system, the ability to communicate to the patients about the innovative procedure, the fact that the procedure is again based on personalized planning. The personalization is one of the key areas where Medacta is pushing. So it's minimally invasive approach and personalized approach. And together today, the knee Nexstar is clearly supporting the personalization that Medacta is launching, if you want, across the different product lines. So it's those three factors together can become very competitive in the market. Okay. And how much is the cost per case Cheaper, roughly, big picture? The point is that the absolute value varies significantly from market to market always to be significantly lower than the cost per case of our competitors. So if for example, Stryker is charging $1,000 in Australia for a case and you have to account into that the service agreement, the disposable, the depreciation, etcetera, we can come in at maybe half of this cost or less. So roughly that's our positioning at the moment. But knowing that our cost structure is very, very competitive, we can be extremely competitive in our business model. That's I think I did answer. Then you have to change it according to the price points of the implants of which are very, very different from market to market. Okay. Very good. And the last question is, I mean, a bit more than a month ago when Zimmer Biomet announced this Bizarre spin off of spine and dental saying that they reduce complexity with that. It's I have a lot of question marks about this. I mean, actually, you are combining all this, Of course, much smaller in Spain than a Zimmer Biomet with $500,000,000 sales just in Spain. But Is that for you? How can you explain that? I mean, for your company, it still makes sense to have all this business combined? Or is that even maybe a chance for you to get some market share? Or can you get some reps? Or Are the reps there maybe now also positive because they are part of a new company maybe which is a bit more dynamic? I don't know. Just your view on that. Yes. What I think is that the dental segment of Zimmer is clearly a different market. Even outside of Orthopaedics is a different business. It would make sense for me. It's actually surprising that it is still there. I do not understand why they did a spin off for the spine business. But it is true that if you look at the history of the spine division of Zimmer has been always very, very marginal for them. So they might have and the last question I still have is why do you spin off those 2 businesses together when they have nothing to do in terms of synergies? So that's the 3rd question, but that's a question for them and not for me. If I come back to our situation. And the reason why we have, if you want, added business line in our portfolio is because we wanted to have the ability to play at the same table where most of our competitors are able to play when it comes to dealing with administration. And this was happening 10 years ago when hospital power was clearly growing, especially in the U. S. It's not anymore the case. But we see markets like Germany, the UK, certain other areas, for example, in Italy or in Spain, where it's useful to have the ability to sit with the administration and to offer products beyond the hip and knee or hip, knee and shoulder and discuss the spine and sit at the table and build more value for them. So there are some synergies as you can see from the Nexstar platform. It is going to be applied on Spine as well immediately or the MySpine technology, which is clearly part of our My solution. So there are a lot of synergies in terms of technologies, some synergies in terms of marketing and branding, but you clearly have to invest in a fully dedicated structure. And I am not sure that Zimmer did that and that's probably one of the reasons it did remain marginal for so many years. We want to run it as almost an independent business the synergies and that's something we are starting to see as a doable thing. Thanks very much. And the sales reps, Is that an opportunity to get some good reps? Or doesn't that influence the things? If you're talking specifically about to the spin off of the spine, I would say is one of the many opportunities we see. We were still benefiting actually from the acquisition of Zimbra of LDR. But there are always or K2M and Stryker. So whenever there are mergers and acquisition, there are probably more opportunities than spin off, because spin off, they will basically remain within the same company. When there is a merger, you know that some regions are covered by too many people and they will need to cut. And that's when you can again stakes people probably more than when spin offs are happening. Okay. Many thanks from Jessica. Thank you. Thank you. The next question is from David Adlington of JPMorgan. Your line is now open. Please go ahead. Hey guys, thanks for the questions. Most of them have been asked already, but maybe just on again on the guidance. If we think about The components with respect to your product lines, maybe you could just talk to where you're seeing the most opportunities for absolute growth, particularly within the hips and knees? Thanks. Yes. Thank you, David. I think what we are looking is the recovery of the hip and knee business probably higher than the historical rates we had, especially in the second half of the year, it would have been nice to have Sorry, we can't hear you at the moment. Are you still there? Yes, I am. Francesco, the line Francesco dropped. Okay. I can still see him. Maybe he has a problem with his lines. Yes. Yes, let me check. Okay. Sorry. So I don't know where you lost me. I will basically repeat what we have been What we expect to see is contribution from the hip, the knee, the spine and the shoulder in this ranking in terms of growth rate coming from the different business line. And this is to be expected given the past performance of those lines and probably in hip and knees we have a little bit higher pent up demand in the second half of the year. So on a yearly basis, it will be probably slightly higher than what we have seen in 2019, hopefully, if the external circumstances allow. Perfect. Thank you. Thank you. Thank you. We now have a follow-up question of Alex Gibson, Morgan Stanley. Your line is now open. Great, thanks. I actually have 3 hopefully quick ones. Just in the U. S, what are you seeing in terms of ASC volumes, outpatient volumes in the last few weeks? Are you beginning to see volumes move back to the hospital as Hospitalization rates full? Or is there still an outflow from hospitals? And then secondly, on your adoption of Single use products, how did they perform in the last year? I would have expected they would have done quite well, but I haven't seen much of a mention in your releases and things. So I'm just wondering if this is still an area of growth for you. And then lastly, just wanted to touch upon your comment earlier about EBITDA margins in the first half being in line with 2019, which is pretty close to your full year guidance. I'm just trying to understand If it's in line with your guidance in H1 or close to, why would the second half margin not be an improvement over that? Yes. Thank you. So maybe I can start quickly with the last question. In the second half of the year, we do expect to have hopefully restart of 3rd party events, marketing, travel, etcetera, which is not the case in H1. So that could increase our marketing costs, but together with an increase of sales and margins. That's why we don't make a difference between H1 and H2 in terms of EBITDA. But as you know, it is not easy to change it and up and downs in the top line in each one and a lot of moving parts to be precise around the EBITDA, but the 29 plus or minus something will be more or less our target throughout the year because of those two variables. AEC volumes, I have not received a specific update on that in the last couple of weeks. I was more focused on the pickup and acceleration of the overall volume. I know for a fact that many hospitals, even major groups like Geisinger were completely shut down in January, February, and this was not the case in March. Clearly, that means that on our sales, the ASC volume is expected to go down a little bit, but not because the ASC will go down, but because the overall hospital volume will pick up again. Last question was on the efficiency. Our efficiency did help a lot to gain market share in the ASC. In 2020, the percentage of NIS done with the efficiency did increase a lot, but it was on a number that was overall decreasing. So again, we were mainly missing hospital based cases, which are traditionally done with or let's say more often done with traditional metal instruments reusable. So it's clear that we have seen an increase of efficiency. It does remain very significant. We are talking about almost 1 third of our knees. And given the fact that the knees are growing or are expected to grow to maintain such a percentage means that you continuously have to sell this solution to new accounts, which is the case and the it's one of the key driver of our total knee in ASCs at the moment. Okay, great. Thank you. Thank you, Alex. Thank you. As there are no further questions, I would like to hand back to you. Thank you. If there are no further questions, I would like to thank you all for your attention and Mention again and hopefully for the last time, the great results in 2020 were coming, thanks to the effort of all our employees from manufacturing to the President of the Board. And we all did exceptional efforts and sacrifices to achieve those results, and I would like to thank them all once again. Look forward to the next call.