Boston Scientific Corporation (BSX) Earnings Call Transcript & Summary

Good morning, everyone, and welcome to our next session here at the UBS global health care conference. I'm Matt Taylor, and I'm the U.S. medical supplies and devices analyst hosting sessions here in the medtech track and really excited to have with us management from Boston Scientific. So we've got a number of leaders here from the peripheral and oncology group, including Jeff Mirviss, EVP and Global President of Peripheral Interventions, President of Interventional Oncology; Cat Jennings, who's VP of Vascular Marketing, New Business Development, and GM for Varithena; and also have Susie Lisa, the VP of Investor Relations and [indiscernible] as well. So we're going to focus on peripheral and oncology, but we can ask Susie and Lauren some questions about broader BSC. Or they'll keep me in line if we're trying to get these folks off track and give us all the secrets, but I just want to start by saying thanks a lot for joining us today and really appreciate you taking the time, for the whole team. So it's going to be a 45-minute fireside chat. I have a lot of questions, but if you have ones that you want to submit through the webcast or e-mail, please do, and we'll try to weave them into the conversation.

And let me start with you, Jeff. I'll put you on the spot a little bit here and just ask you to give us an update on some of the recent trends in the business. Maybe remind us how COVID has been impacting things and how recovery has been looking in the last few periods here.

Yes. Well, good morning, Matt. And hey, everyone. Hope you're doing well. Excited to be here with you to talk about the peripheral interventions business and even more excited to be able to report that we've had a really good string of accretive growth to Boston Scientific all the way back to more than 5 quarters now. And frankly, when COVID first hit, we were sitting here in March, April of last year. I really thought the peripheral business was going to decline significantly, and we were thrilled with just how resilient the business actually was. A lot of the peripheral procedures, they might be able to be delayed a little bit, but they certainly can't be avoided. And we found that, the patients with some of these pretty severe diseases like end-stage PAD, cancer, blood clots, they need to get treated. And so our projections of a pretty steep decline were off base, thankfully. And we showed accretive growth quarter to Boston Scientific and then sequential improvement in growth throughout all of 2020 and into 2021. So we're feeling really strong about the pipeline and the portfolio and thrilled to be able to be accretive growth to BSX.

Okay, great. Fantastic. And there was a little bit of a background noise on the line there, so if you're not talking, it might be good to mute the line, but Jeff, good focus there, keeping yourself straight through that distraction. So heard a lot about the sequential growth, the accretive growth. That's great to hear. Maybe it's worth talking a little bit about [indiscernible] you can give on recent trends.

I'm sorry. You cut out there. I heard "recent trends," but that was about it. Can you repeat?

Sorry. Yes. I was asking if you had seen any differences in recovery by business or by geography that were worth calling out. And would love any color on recent trends.

Yes. In terms of the businesses, we define peripheral in 3 areas: interventional oncology; arterial, mostly peripheral arterial disease in the leg; and then venous. I'd say for venous there was actually a nice tailwind in that there was a lot of blood clots throughout COVID, whether that was either due to COVID or due to a more sedentary lifestyle of people, but we saw some continued good momentum in our venous portfolio. We announced last quarter that EKOS in particular grew double digits. That's a device that we acquired through BTG that's used for pulmonary embolism and other blood clots. So I'd say that was a nice, strong contributor to growth throughout COVID. The interventional oncology business was another one where patients can get in and out of the hospital same day or next day. So what we saw was a nice movement from things like external radiation or even perhaps chemotherapy to more minimally invasive approaches like what we have, whether it's ablation or Y-90 or drug-eluting beads, so that actually was also a nice growth driver for the business. And then of course, we launched new drug-eluting therapies in the middle of COVID, whether it was Ranger in the U.S., Eluvia in China, Ranger DCB in Japan. And so that market is recovering nicely. And our drug-eluting portfolio, being the only company that has both a state-of-the-art DES and DCB, that was another strong growth driver for us. And then geographically speaking, it sort of depends on where you are in the world. China recovered a lot faster and has been a strong, accretive growth driver for peripheral. Europe has been sort of lumpy, bumpy depending on lockdowns and what's going on in Europe. The U.S. was tough at first but then really accelerated nicely through the end of 2020. And then of course, there's places like India, which is really a tough humanitarian crisis. And obviously the business is tough in places like that, but the bottom line is there's some momentum in the peripheral space for us right now and we're optimistic about where we're at and where we're going.

Got it, yes. I want to get into some of those product launches later, but is it right to think about you having almost like 2 years of product launches because a lot of those things really didn't get off the ground last year and you've got a nice bag to work with as we resume normalization?

Yes. I think someone coined it embarrassment of riches, and the number of product launches we have right now is really unprecedented for us in peripheral. And we're doing our best to get them all launched during COVID, where in some places there's less access and things are taking a little bit longer than perhaps it normally would have, but all told, through 2020 and 2021, we'll probably launch 8 to 12 new products, depending on where you are in the world. And so that's across all 3 of our franchises and so the momentum is definitely real.

Great, great. So at a high level, I wanted to ask you one about how to think about the growth rate for the entire business post normalization. And then it might make sense to step through some of the growth drivers for each and bring [indiscernible] to the conversation. So maybe just at a high level talk about how we should think about growth going forward and start to get into some of the key growth drivers for each segment.

Yes. So we think about peripheral as sort of that mid- to upper single-digit fundamental market growth. The fundamentals in this market are very strong. There are still tons of room to innovate, to bring new technologies to bear to not only advance the health of patients but to also take costs out of the health care system because many of these devices are cost effective. And we can talk about some of that later, if you want. And the disease states in general are underdiagnosed and underpenetrated, whether that's peripheral arterial disease or blockages in the SFA or below the knee; whether that's venous interventions from superficial vein like varicose veins or deep veins like deep vein thrombosis, blood clot in the thigh area or pulmonary embolism where the device utilization for patients with a PE is like low single digits penetration. So our goal is to not only bring meaningful innovations to help patients [ that go to us ] but to also expand the market and grow the size of the pie and move some of the patients from pharmaceutical therapy or surgical therapy into a minimally invasive approach. And we think we're like at the center of the bull's-eye in terms of the disease states and market spaces to be able to do exactly that.

Great. Why don't we focus in on each of the segments now? And let's talk a little bit about arterial, venous and interventional; and what some of the key product launches and growth drivers are for each of those. Do you want to start with any particular one?

Yes. I think it would be a great time to maybe bring in Peter. And we can start with oncology because there's been several announcements recently that we've had some good momentum. And I think this is an area that is maybe sometimes less well understood, so I think it'd be great to sort of go through a little bit on oncology and then we can switch to drug elution and venous. So let me introduce Peter Pattison. He's the president of the interventional oncology division at Boston Scientific.

Matt, can you hear me okay?

Yes. We can hear you perfectly.

Great.

So Peter, why don't you talk about some of these recent announcements and help us understand what you think some of the key growth drivers are for the oncology business? And maybe help investors understand what's underappreciated about this area.

Sure. Well, I'll start off by saying oncology is traditionally a pharmaceutical space. It's not typically a device space. And if you do have a device in oncology, they tend to be more 510(k)s, if I think about maybe the most familiar ablation. So we use a hot or a cold needle or a probe to ablate, and those are -- tend to be around kind of soft tissue. And those tend to be 510(k) cleared, as opposed to kind of full PMA approved. So it's always been -- and oncology is also very much a data -- very data-driven specialty. So what we were able to do. In March, we were able to get our lead product, our flagship product, in oncology called TheraSphere a PMA for primary liver cancer or, in other words, hepatocellular carcinoma or HCC. TheraSphere, these are tiny microscopic glass particles are injected via a catheter. And they flow through the bloodstream, find -- hit the tumors, lodge in the tumor and deliver a very high-concentrated dose of radiation continually over about 2 to 3 weeks. And that's important because TheraSphere has been on what's called a Humanitarian Device Exemption or an HDE, which is essentially you could think of it sort of like almost like an orphan drug status in the pharmaceutical world, for about 20 years. And it's big momentous occasion. We're actually able to convince the FDA and worked with the FDA to get TheraSphere off of an HDE and into a full PMA for -- again, for treating hepatocellular carcinoma. And it's one of the -- it's really the first Yttrium-90 or radioactive microsphere to get PMA and one of the few medical device to actually get granted a PMA for [ treating in ] oncology.

Got it. No, it's really exciting. Could you help us understand, I guess, maybe the sales base under HDE and how you view the opportunity now that you have PMA? Is there any way that you can frame that?

Sure. So if you think about an HDE from the commercial perspective, there's 2 barriers normally, right? There's safety and efficacy. Under an HDE, you can -- you have to show safety and -- but only probable benefit. So there's enough of a signal to look at potential efficacy down the road, but you're only able to talk about probable benefit. You can't come down with the gold standard of efficacy. So that handcuffs you a little bit in terms of what you can say on the commercial side. On the physician or hospital side, they have to treat it like an investigation or a clinical product. In other words, they have to go through the hospital ethics committee, IRB committee. And it has to be used under that IRB like you would a clinical trial. So both sides had their hands tied a little bit when you think about an HDE. The other thing about -- and as a result, only larger hospital systems that actually have an IRB, that actually do clinical trial work, they're more able to have TheraSphere in their shop, in their hospital because they have the resources to kind of run an IRB-type research product. So what this does now, it lifts that bar. We can now talk about efficacy pretty freely. And on the hospital side, they can treat it like any other product and they don't have to treat it like a clinical research protocol and all the paperwork and checks and balances that, that requires. So it really opens it up now beyond just the -- your top, like, tertiary centers. It now really levels the playing field for patients across the country that can all equally receive TheraSphere. So what it also does, it -- in the eyes of -- we can now -- this has been relegated pretty much to the interventional radiologists doing the procedure. Again, in a very data-driven specialty like oncology you really need that full PMA, that full approval and that kind of data to convince medical oncology and other specialties to refer patients or to collaborate with interventional radiologists. So what this does is -- besides something [ let's talk about it and free at the ] hospital system, it now gets into that mainstream oncology world where we can now talk to pharmaceutical companies about partnerships and collaborations, collaborative studies. And it also lets the medical oncology community view us in a different light.

Understood. And maybe one more on that. So you've got the liver indication, which is a big one. Could you talk about other places that the platform could go in the future, whether it's other specific diseases or ways that it can be utilized to treat other things?

Sure. So it's a great question. So I think the first thing is, if you understand TheraSphere as the most effective and efficient way to deliver a high dose of radiation into a very, very small volume, there's no reason it needs to be -- stay in the liver or in primary liver cancer. So we think about these as different markets. Wherever you can put a catheter essentially and wherever external beam radiation works, you should be able to apply TheraSphere down the road. So we're starting off with HCC and our PMA that I mentioned. Our next step is we have -- we're finishing the end of randomized controlled Phase III trial looking at TheraSphere plus chemo for colorectal cancer that's metastasized, essentially stage 4, probably the worst prognosis, after they failed first-line chemotherapy. So we'll know that sometime this year, how it performs in colorectal cancer. And then the next 2 blocks for us would be looking at glioma. So the worst kind of brain cancer, glioblastoma. And just last month, we received breakthrough device designation from FDA based on our canine work. They thought it was worthy of that. And we'll be starting first in human for brain cancer in -- towards the end of this year. And we also received innovation of the year award from the radiology society on prostate. So we'll also be kicking off first-in-human studies for TheraSphere in prostate later this year, maybe drifting into early '22 as well. So we do see these as different indications that can open up, as long as we do the clinical data. So we've got 1 under our belt. We have another reporting out this year and we'll be starting 3 and 4 later this year.

Okay, great. A lot of exciting potentials there for tough-to-treat cancers, so that's a really great outlook for that product. Why don't we stick with interventional oncology for 1 more minute? Is there any other products that you would highlight for folks? I think this is the area of the portfolio that investors are less familiar with. What other products should we be following in the IO segment?

Great. Well, our other main driver in terms of our therapy is cryoablation. So cryoablation reminds me of the Yttrium-90 microsphere that we just talked about in TheraSphere, but there's only a couple of products in that field. And the same with cryoablation. This is where you take extremely cold -- extreme cold. So through a needle, you can, under ultrasound or maybe CAT scan [ guidance ], put this needle through the skin and into the tumor. And by turning on these compressed gases, you create an ice ball and you literally freeze the tumor. You create an ice ball, turn the tumor into an ice ball, crack it, kill it and pull the needle out. So in the same way, Jeff mentioned at the beginning the economic benefits of some of these peripheral interventions. If you think about interventional oncology, TheraSphere is an outpatient procedure; the same with cryotherapy, local. Sometimes they're more of a general anesthetic where you can put a needle into the tumor, freeze it, pull it out, put a band-aid on it and then send those patients home usually that same day. And the nice thing about cryotherapy, again, it can apply, like TheraSphere, to wherever you can see this, the tumor; and can access it with the needle. So our -- even under the AUA or the urology guidelines for the United States recommend cryotherapy for kidney cancer. That's where -- the bulk of kidney cancer in the interventional space is done with cryotherapy. We also have data, clinical trials for lung cancer, for dealing -- and also there's cryoanalgesia; pain, whether it's bone pain or whether it's just nerve pain. Pain is a big problem in our country. It's going to get worse and worse, and cryotherapy is a great way to deal with that pain as well. So those are 2 main therapeutic platforms. And then as well, we just have great category leadership across the access and delivery tools to access TheraSphere and cryoablation, whether it be catheters, wires, coils. Our latest catheter, TruSelect, is a small 2-French microcatheter that works great with TheraSphere. So what we're finding is we're able to take these 2 therapeutic platforms that we can move into all different kinds of cancer and create more and more data to support their use just from an efficacy but also from an economic standpoint and use our access and delivery tools to maximize them.

All right. This is fantastic. That was a good overview. So Jeff, why don't we come back to you and maybe talk a little bit about arterial next and some of the key drivers in that segment?

Yes. So for arterial, we're focused primarily on blockages for PAD in the leg, both above the knee and below the knee. And I think you're aware that our strategy as a company and also peripheral as sort of a microcosm of BSX is category leadership. And so our goal is to have all the tools in the toolbox and to be the only company that can stand next to the physician and provide them and their administrators with whatever they feel is best for the patient. Many companies have like one solution or just a few solutions. And they try and perhaps convince people that they're indeed the best solution, whereas we can be sort of agnostic to the disease state and really stand next to the physician and say, whatever you believe is best, we can support you with that tool. And that goes all the way from a bare balloon to a bare stent, to atherectomy, to drug-coated balloons and then the Eluvia drug-eluting stent. And that's sort of from the simplest of lesions to the most complex. And what we're finding is that that's a unique, differentiated strategy that is working, that's supported by unparalleled clinical evidence. And we have invested a lot in bringing contemporary data to the field to elevate the field so that physicians can practice more and more evidence-based medicine. And I think, many, many years ago, peripheral was, frankly, fairly characterized as the Wild Wild West where docs were just sort of doing what they thought was best. And we've been able to change that and really deliver better, more level 1 contemporary evidence, the only company that's invested in head-to-head trials with Eluvia and with drug-coated balloon. And that strategy has been well received and the data are great, and so that's helping us on a variety of fronts. And we think that the drug-eluting space is best for patients. It's best for the health care system because it's lower overall cost over the longer term. And at the end of the day, we believe that this market is still going to continue to grow and ultimately get sort of back to what the original vision was before the questions around paclitaxel.

Right. You said the P word. Paclitaxel was almost a bad word there for a couple years, but it seems like now, more and more data sets coming out, that doctors are getting more comfortable with it again. And I guess, during COVID, there's an extra motivation to do a procedure where you'd get a longer-term outcome. You didn't have to bring a patient back in. Could you talk about how that's evolved and how people are starting to come back to paclitaxel?

Yes. I mean durability is key. And I'll say a few words and then maybe I'll ask Cat Jennings to jump in as well, but patients and doctors and health care providers, administrators want durable procedures. And that's what drug-eluting therapies have proven. We know full well that in the coronary arteries the DES is the standard of care, and it's completely taken over for bare devices. And I see no reason why that can't happen in peripheral arteries as well. And I think there was a legit question raised with paclitaxel. I believe that question has been asked and answered. Regulatory authorities are starting to see that -- in Japan, they just announced -- the PMDA just announced that they moved on from this question and support drug-eluting therapies in that country. There have been a number of new trials that have come out both randomized as well as real-world evidence to show that there is no difference between drug-eluting therapies with paclitaxel and bare devices. Of course, Eluvia was not included in any of these analyses. So there has not been any trial so far that raised a question on Eluvia. And I think for the category as a whole we see a lot of momentum and physicians feeling more and more comfortable going back to drug-eluting therapies. And we're well positioned with both Ranger and Eluvia. So I don't know. Cat, do you want to maybe chime in and provide a little more context?

Sure, Jeff. Thanks so much. So I'd maybe add just one quick point. I think the FDA has done a terrific job of really helping drive some of this data. I think about the most recent data set at ACC, the SAFE-PAD study that looked at almost 170,000 patients, these Medicare patients that were followed for almost 3 years, that data that Eric Secemsky presented. And really, any way you cut that data, whether it was by age, race, region of the country, hospital bed size, there was no difference in mortality between drug-coated devices and nondrug-coated devices. And I think what's so important about that data set is that analysis was really constructed in partnership with the FDA. So they have really been helping drive some of the data here in this space. And when you see those types of data sets, 170,000 patients, it really helps solidify some of the points that Jeff just made.

Got it. Is it possible to understand when FDA might make a more formal statement about their stance on paclitaxel? It does seem like they're starting to come around too.

Yes. Well, my view...

I think that they can...

Yes. [ I was just saying ] my view is it's been a very collaborative effort with FDA and with all of industry. And I think, as the data continues to grow in -- both in numbers of patients as well as numbers of trials, we're certainly hopeful that FDA would make a statement. I think in the meantime what we're seeing is doctors feeling more comfortable going back to paclitaxel. And I wouldn't be surprised if at some point in the near future things get back to sort of where they were pre the paclitaxel [ meta-analysis ], but even then, there's still a lot of room for this market to grow because at its highest point we still had pretty low adoption for drug-eluting therapies. So we're optimistic about this space for many years to come.

Great. And let's discuss you received some favorable reimbursement decisions and support for a number of products in the portfolio. I'd specifically call out Eluvia with the add-on payment and the increase in the EKOS reimbursement. Can you talk about how those are helping to drive therapy adoption?

Cat, do you want to take that one?

Sure. Sure. Absolutely. So I think this is the benefit of the investment that Jeff talked about with respect to clinical data because we have this wealth of clinical data for both therapies that help drive some of these reimbursement decisions. One of the great things with Eluvia is we have this head-to-head comparative data set. And that's really helped CMS make that determination around giving us that NTAP not only for last year but -- and also looking to extend it for 1 more year, which is terrific. And I think, when you look across all drug-eluting devices in the U.S. market today, Eluvia is the only one with incremental reimbursement. And so as you think about some of those comments around how do we get more patients access to this therapy, a lot of it is working with hospital administrators and helping them see how this is a good thing for patients but also something that's not going to have a negative impact on their economics as well. And similarly, with EKOS we have a number of studies that have demonstrated the benefits of the EKOS therapy. And we had a long-thought-through strategy around how do we get EKOS reimbursement to the appropriate level. And that increase came through last year, as you noted, and up to 170% increase for some institutions, depending on the type of therapy -- the type of anatomy that they're putting the device in. So it really speaks to the benefits of that clinical strategy that we have.

Understood. Maybe I'll ask a follow-up on Ranger. Can you remind us how that has differentiated some of the clinical data behind it? And how has the uptake of Ranger been so far in the U.S.?

Yes. So as you know, we launched Ranger in Q4 of last year. And I'll tell you we've been really pleased with physician interest in Ranger. So as you may know, Ranger is on an .018 platform, which is a lower-profile platform than many of the other devices on the market that are on an .035 platform which just means they have a larger crossing profile. And what we've seen from physicians is they're really excited about the deliverability of Ranger. So in their hands, it's easier to use. And we -- one of the things that we love talking about when we talk about Ranger is that it's actually built off of the Sterling platform, which is the #1 .018 balloon in the world. And so when physicians look to choose which drug-coated balloon they want to put into a patient based on deliverability, Ranger is really a first choice. And then it's backed up by this wealth of clinical data, not only an RCT looking at Ranger versus plain balloon angioplasty but also an RCT that we conducted in Europe with Ranger compared to Medtronic demonstrating that, when you go head-to-head Ranger versus the Medtronic IN.PACT balloon, there's no difference in patency rates and outcomes for those patients. And that's with a balloon like Ranger that has half the paclitaxel dose of a Medtronic balloon. And we have talked a lot about minimal effective dose with these next-generation balloons and that's really resonated with the marketplace. And I would say that's [indiscernible] in the United States but also in Japan where we've launched Ranger just in Q1 and had really good physician response there as well.

Understood. Maybe we'll stick with your focus area and talk a little bit about some of the drivers in the venous area. So I'd love to dig into Varithena and discuss that a little bit. Help us understand how you expect the growth to be for Varithena; maybe understand some of the key drivers there, the market size. Any color on that product would be really helpful.

Yes. Absolutely. I'll tell you I think Varithena is one of the less-appreciated devices on the venous side. We're really excited about the growth that we've seen really over the last 3 years, strong double-digit growth. And this is a space where this market is really shifting from more thermal-based devices that require tumescent anesthesia for patients, which really equates to more needle sticks, to nonthermal, non-tumescent therapies, of which Varithena is one. And what we're seeing is that market starting to switch over to these nonthermal, non-tumescent therapies. And Varithena is -- benefits from being a really unique device with its own CPT code really in its own category. And physicians that use this device report that patients are extremely happy with this therapy because of the fewer needle sticks. We really see great uptake not only in terms of increasing utilization with existing physicians but also new customers coming onboard. So this is an area that we see continued growth prospects for. And Varithena, I think, is a terrific part of our growth story in venous. And with EKOS: We also have reported double-digit growth in EKOS for the last 2 quarters, so we're continuing to see that part of the business expand as well.

Understood. Maybe we could touch on SAVAL or any other drivers in the venous portfolio that you think are worth calling out. We'd love to just get some more color on maybe some of the hidden gems that we're kind of unaware of.

Yes. One of the things that's terrific about SAVAL is we've taken all of our learnings on Eluvia and put them into our SAVAL product. So if you think about SAVAL being a drug-eluting stent for below-the-knee lesions, one of the things that we've done is really run a very collaborative process with the FDA. That's one of the benefits of the breakthrough designation that we have is that we have a lot of touch points with the FDA on SAVAL. And so we continue to get feedback from them as they've had their learnings from the Bard Lutonix BTK panel, et cetera; and are able to continue to learn from the FDA. What are their thoughts on how do we bring a product like SAVAL to market? We know that there is a huge unmet need for treating patients with lesions below the knee. And we are -- continue to look at SAVAL as being a really unique therapy in the space.

And then maybe I can ask just a question for the group. Jeff, you talked in the beginning about how the BSX portfolio strategy gives you a lot of options in the peripheral space kind of more than any of the competitors, and so I'm trying to understand 2 things. One is, are there some adjacencies that you see that you could get into either through internal development or M&A? And then with the current portfolio, I think we've covered a lot of the places that you could go in therapy. It sounds like you still have a lot of options in terms of where these current platforms can go in the future, so there's just a long runway of internal development to be able to expand your current capabilities with the products that you have.

Yes. So thanks for that question, Matt. I was joking with someone else that maybe we shouldn't call it peripheral because the business is not so peripheral. It's actually central. There's so much room in the body to bring these therapies to bear because there's just miles and miles of highways of arteries and veins from the head to the toes. We obviously don't focus on the heart, but pretty much everywhere else is sort of how we look at the world. So we certainly could go other places, to adjacencies outside of the 3 businesses we're focused on, but there -- like I said at the beginning, there is just so much room to innovate. There are so many patient needs and underdiagnosed and underpenetrated disease states that we don't feel we really need to, that we want to stay close to the customers that we know and love. We want to stay focused on where we have capabilities where we can bring unique differentiation to bear and really improve the adoption and utilization of technology in the disease states that we actively treat. And I think that will keep us busy for a really, really long time. And we look at everything both internally and externally. We're on a very rigorous process on our internal R&D portfolio to make sure we're focused on the spaces that have the best opportunity for patients and for growth. And then we're very focused externally on scouting the landscape for new technologies, new companies and new spaces. And so I think that's been the story for Boston Scientific, which is a great hybrid of homegrown innovation coupled with some smart M&A to give us broader reach and fill some portfolio gaps. And I predict that, over the next several years, you'll see the same thing happen in peripheral where we just continue to innovate and continue to focus on patients; hopefully, layer on top of it some smart tuck-in acquisitions; and continue on this category leadership journey that we've been on now for quite a while.

All right, fantastic. So we have a couple minutes left, and I wanted to bring Susie and Lauren into the conversation maybe with a higher-level Boston side question since they're on the line as well. I was just curious. You had a nice comeback kind of across the board in Q1 with recovery; and the business seems to be performing well, recovering well. Maybe you can just talk about some of the key questions that investors are asking or focused on in this period post Q1; and help us understand, I mean, how peripheral kind of fits into the mix there.

Sure. So I think a big question has been -- after the better-than-expected results, in Q1, at the top and the bottom line is what's the pace of the recovery. How does the referral channel look? What's backlog like, et cetera? And I think that there's so much variability, and Jeff can touch on it, by business, by geography even, that we're most comfortable discussing our outlook for the full year, all right, the 2% to 5% organic growth versus '19 as one that assumes a gradual recovery scenario. And then that gives us room for maybe some backlog capture at some points and maybe second waves in certain regions at other points with the pandemic, but we think that that's the most likely and most reasonable scenario. And any sort of rebound, if you will, would be upside to what we're thinking, but we're really encouraged by the breadth of the recovery both in terms of by business and by region. I think that, as you saw in Q1, some of the strongest growth is coming from our MedSurg businesses with really exciting time period there. We just got announced approval of our bronchoscope in Europe this morning. As well as peripheral, with all the launches that we talked about, I think, are some of the probably most accretive growth businesses to Boston Scientific in 2021 and beyond. And we're excited about the category leadership that those 3 businesses in particular really exhibit.

Great. Thanks for that, Susie. That's good context. So Jeff, is there anything you would add there, you want to kind of leave us with as we think about peripheral and the portfolio and the outlook for the business?

Yes. So I would just like to boil down a complex topic to the most simple, one-word thing, which is the word accretive. And so that's our goal in peripheral is you pick the metric for Boston Scientific and our goal is to drive accretion, whether that's top line growth, OI growth, gross margin, et cetera. And I think -- with the portfolio that we have, the clinical data that supports that portfolio, the underpenetrated disease states, I think the future is very bright for peripheral. And we're roughly $1.8 billion of Boston Scientific today and we have aspirations to be significantly larger in the future and drive that accretion, so we're obviously very excited and look forward to sharing more at Investor Day in September.

Okay, great. Well, I think that's a good place for us to end. We're about out of time. And so I just want to thank Jeff, Peter, Cat, Susie and Lauren for all joining us today. It's been a pleasure speaking with you and learning more about this great business within Boston Scientific. So hopefully, things continue to recover. And we look forward to tracking your progress, but thanks a lot.

Thank you, Matt.

Thanks, Matt.

Thanks. Take care.