Nexstim Plc (NXTMH) Earnings Call Transcript & Summary

Welcome to Nexstim's webinar for investors, analysts and media. Nexstim's CEO, Mikko Karvinen; and CFO, Joonas Juokslahti, will be giving a presentation that will take about half an hour. And after that, they are available for answering any questions you might have. You can send questions through the Q&A chat at any time, but they will be replied to only after the presentation. When you write a question, please state your name and optionally your organization. As you send a question, it will first be visible for us organizers only. The webinar will be recorded and we will inform you later on where you can find the recording. We have booked an hour for the webinar; in case we do not have time to answer all questions, we will e-mail you later, given that you have given us your full name with any questions. And now let's move on to the webinar, first presenting as Nexstim's CEO, Mikko Karvinen. Go ahead, Mikko.

Thank you, Essi. And Welcome, everyone, to this webinar. My name is Mikko Karvinen, I'm the CEO of Nexstim. I'm joined in this webinar by our CFO, Joonas Juokslahti. We will be going through the second half 2023 and full year '23 results. And I'll now switch to the slide show for my presentation. Okay. So first of all, if there are some new attendants for Nexstim, Nexstim focuses on personalized brain diagnostics and therapy. And you can see in the background of this cover slide are some pictures from our newest NBS 6 system. Me and Joonas will be running through the second half '23 and full year financial results in this webinar. I want to start a bit about the Nexstim story in general with a couple of slides before we go to the actual results. We are -- I mean, Nexstim is a Finnish, globally operating growth-oriented medical technology company, and I want to share our mission, vision and values with you. So we have a very important mission at Nexstim, as we enable personalized and effective therapies and diagnostics for challenging brain diseases and disorders. So patients who benefit from the systems and services that Nexstim provides are, for example, tumor patients. So we help on the diagnostics side of our systems and our business. We help map the brain's motor and speech areas prior to surgery. We can also help patients who suffer from major depressive disorder or chronic neuropathic pain with our therapy device and related services. Our innovations create a possibility for a better life for these patients that suffer from -- quite severely -- these diseases such as brain tumors, depression or chronic pain. We vision a world where our technological know-how and superior services combined ensure the best treatments for our patients, that deliver the greatest value for our customer, hospitals, clinics, and business partners around the world and also long-term growth in shareholder value for our investors. Everything we do at Nexstim is solidly grounded to our values, of which the first one is science and clinical evidence. So of course our system, as we are a medical technology company, everything we have technologically available in our system is based on science and proven also through clinical evidence in order to get regulatory approvals for sales and marketing in relevant areas in the world. We also take research and pushing our system forward through scientific research and development, a very important thing, and we are -- we are known in the area of TMS research in organizations and hospitals and clinics around the world. Financial success is more and more important to us as we are a First North NASDAQ-listed company here in Helsinki, and we have posted a number of better results as also the second half of '23 and the full year '23 have shown, with comparative sales, net sales growth and then results improving. There's passion and commitment wherever you see Nexstim team members, whether they are here at the office here headquartered in Helsinki, or our team members in Germany, in the U.S., and at our customers, there is a huge passion and commitment into running our business and taking our mission and vision forward. Ethics and responsibility are also really important thing for us. Fortunately, we have -- we design our systems here in Finland and we also manufacture them through our subcontractor here in Finland. So we have good visibility in how ethically and responsibly our systems and services are manufactured and delivered. And we also take pride in things like we have consumable head tracker that is part of how our navigation system works, onetime use head tracker at the moment. But these trackers that are onetime use disposables are also manufactured in a carbon-neutral factory already today. So we take ethics and responsibility issues also very seriously at Nexstim. Moving on then to some mega trends that support our growth. But before that, I want to -- the picture that you see on the right-hand side in the presentation is a picture of our unique proprietary neuro-navigated TMS technology, and this system can be utilized for both diagnostic and therapy applications. The platform is similar to both of these diagnostic and therapy applications -- I mean physical platform -- and the integrated TMS system, everything you see in this picture, is delivered by Nexstim, and it gives us unique competitive advantage also towards the competitors, the way how we navigate the TMS actual electric field that gets induced into the brain very accurately and repeatedly also with the correct dosing, so that this integration of the TMS and the neuronavigation gives us a unique competitive advantage over our competition. Now looking at the megatrends. First one that I want to highlight is aging population, specifically in the Western countries, where population aging and significant decline in the working age are issues, and brain diseases increase in general with aging. There is -- in this sense, there is a growing need for, for example, brain surgeries, tumor surgeries. There's also depression and chronic neuropathic pain patients that are growing in scale also through aging population. We can also see technological development in health care. And we are very fortunate that Nexstim systems have already been installed widely into leading university hospitals around the world. We have science and research that is done with our system, has been done and is done, and this enables to find wider and new applications in the treatment of challenging brain disease and disorders, and together with possibly finding TMS treatments also for better supporting the aging population needs and diseases that are -- brain diseases that are unique for the aging population. And finally, health care cost pressures. So there is a need for more effective and faster rehabilitation. We know that in case of, for example, depression, major depressive disorder or chronic neuropathic pain, typically the first approach is through drugs and trying to get the treatment through an efficacy through that. But if these drugs don't work for certain reasons or they are not effective enough, then there is a need for more effective treatment such as these Nexstim TMS treatments, and then they are beneficial in the society because even though you invest quite a bit of capital into providing these services and then -- but if the effect is to get these patients rehabilitated back to the society as working members or studying or whatever their role is in the society, the benefits are there to try to get faster and more effective rehabilitation and these members back to the society. So whether the system is public or private health care, the need is the same: to try to get the people back into their normal life as contributing members of the society as fast as possible. Before going into the H2 results, I want to share one more thing. So a bit about general, about our business and products. We have two businesses at Nexstim, we record also our numbers both for the Diagnostic Business and Therapy Business to some key numbers for both businesses. The system platform is similar for both systems, but we do have, based on the regulatory approvals and also marketing purposes, we have -- we call the diagnostic systems, typically an NBS navigated brain stimulation system. This is the older part of our business, this is where Nexstim has had its first commercial products. Then we have the NBT, Navigated Brain Therapy, this is the marketing name -- and also the newest NBS 6 system has been launched for therapy applications to begin with. But most of the systems are labeled NBT, and that is for Navigated Brain Therapy, and it serves the Therapy Business. We started off with the Diagnostic Business, and we have over 230 systems sold as of end of last year '23. The application is presurgical mapping of the brain's motor and speech functions prior to a surgery, such as a tumor surgery, which is a typical use case. We are FDA approved and CE marked to sell market and sell the systems both in the United States and in Europe. And we are the only TMS manufacturer that has both FDA approval and CE marking for presurgical mapping of the brain's motor and speech areas at the moment. That is a very unique thing for us. The surgeons can benefit -- the surgeons and patients can benefit from the usage of our system so that they can have more gross total resection of the tumor in tumor cases, and also have the surgery performed in the safest manner for the patient. In the Therapy Business, we have over 80 systems that include the therapy software at end of last year, '23. The applications are depression and chronic pain, which are both CE marked, so we can sell and market these NBT and NBS 6 systems for depression treatment and chronic pain treatment in Europe. We are also FDA approved in the United States for major depressive disorder treatments, with existing wide insurance reimbursement also from private insurance groups. And this reimbursement really helps TMS companies such as Nexstim to have their systems commercially adopted to private clinics, where they can then of course get -- the patients can get reimbursement for the treatments, and in this way it has a better commercial success, both from the purchasing side and then from the patients' capability to get the use of these type of services. The chronic pain is not yet approved in the U.S. We are looking for additional clinical trials, and we are -- we have a few prominent research centers in the Europe and U.S. located, and we are having discussions about what kind of trials to start and to plan in order to also maybe in the future, get access for chronic pain treatments in the United States. But currently the depression shows efficacy that we have a patient registry of over 400 patients, where we see close to 50% remission rates and over 70% response rates. And this is really, really, really good rates for treatment-resistant depression patients. So these are patients that have typically failed multiple medicines or drug treatments prior to going into TMS treatment with the Nexstim system. In the chronic pain side, we have systems installed in Europe, such as Helsinki University Hospital, that actively use our Nexstim system for chronic pain treatments. And we can see that about 40% to 50% of the patients get a clinically meaningful pain relief when treated with the Nexstim system in a chronic pain treatment protocol. So this is also very promising and providing actual true clinical benefits for patients today. So that's a quick overview of our business and products. Before now going into maybe the most interesting part of this webinar, which is, of course, the number parts as we are going through the H2 and full year '23 numbers. I am going to go through the second half of '23 in two slides and bullets, and then Joonas, our CFO, will focus more on the full year '23. So this is how we've selected to present the numbers. So to start with, the end of '23 was a record-breaking for Nexstim in terms of net sales and operating result. So we had a record-breaking end of the year. We did a new net sales record for the H2 of -- in Nexstim's history, and we also did the first positive operating result for the second half of any report to date. During the second half we continued our focus on projects that are important to the company's strategic competitive advantage, such as enabling the company's future growth and improving cost efficiency through our new global team structures. So we introduced the new global team structures in early '23. We continued to execute our business through these new team structures, and we could see the improved cost efficiency. We saw that in both in record-breaking growth in the second half of the year, but also with the cost efficiencies. So on the cost side, we had a year where we did some cost savings, and Joonas is going to tell more about the full year cost saving benefits that we achieved. We were also very happy that we received the first system orders and deliveries for our new NBS 6, the therapy system that was launched in H1. In the second half we got the first orders and deliveries in the U.S. markets. And this demonstrates the strong competitiveness of our system in the world's largest market. So we had 6 NBS 6 systems that were ordered in the last -- the second half of '23, and 4 out of those 6 were actually from the U.S. And it's in particular, of course, important for us as U.S. markets represent a large portion of our sales, but also to highlight the fact that most TMS companies in the world operate in the U.S. market, and that's the most toughest market also to compete in any area. So we're very happy that our first launch was successful, especially to begin with in the U.S. markets. And we were finally very pleased to announce a second strategic partnership with Dr. Nadkarni's clinic located in New Jersey, U.S. We had done one investment into a management services organization earlier, located in Piedmont, California, Dr. Kuluva's clinic that is the Piedmont Neuroscience Center, operating in Oakland, California. And now we have a second management services organization that we've invested into, that is in partnership with Dr. Nadkarni's clinic in New Jersey. So one strategic partnership clinic in the West Coast and now a new one in the East Coast. And we're happy to continue discussions on new strategic partnership to further scale the use of our technology in care. So of course, we have further discussions of strategic partnership nature in the second half of '23. In addition to the clinic that mentioned from Dr. Nadkarni, we also had strategic discussions in the area of possible distribution relationships, new distribution, wider distribution relationships, and then also looking at some indications for the future that Nexstim is not directly investing right now, but maybe that could utilize our technology in the future. And I'll tell a little bit more about this at the end of my presentation today when we go also to the '24 strategic objectives. But now if we look purely on the numbers of the second half, we happily can report system sales that were EUR 3 million with an increase of over 127%. So -- and this was mainly due to the huge growth in the area of diagnostic system sales in the second half. We also experienced an increase of 20 -- almost 24% in sales in the recurring net sales that were EUR 1.8 million. If we look at the total net sales for second half, it was EUR 4.7 million and a happy increase of -- over 73%. The comparable net sales -- we report also comparable net sales due to one-off revenue items or net sales items in the past -- but the comparable net sales for second half of '23 was exactly the same as the net sales, so EUR 4.7 million. So we did not have any one-off items, net sales items in the comparative year or now on the second half of -- or the comparative second half or this second half of '23, so the sales were exactly the same, net sales and comparable net sales, EUR 4.7 million. The EBITDA was EUR 0.6 million positive compared to the last year's negative of EUR 1.2 million. So a huge leap up upwards there. And the operating result, as I mentioned, first time ever positive second half operating results, EUR 0.2 million positive compared to a negative EUR 1.5 million minus prior year's second half. And then when we look at the profit of the period, it's EUR 0.1 million positive, the net result, and that is in comparison to second half of '22, actually, minus EUR 1.9 million. So these numbers are nice to report in comparison to last year. And if we look at the reasons, the main reason for the success, it was in from through the Diagnostics Business, where the NBS net sales were EUR 3.9 million in net sales. And there, we could see a huge increase of 122% in comparison to previous year second half and the Therapeutics Business, NBS 6 and NBT net sales were EUR 1.8 million, which an increase of 27%. So as -- in a nutshell, we can say that the Diagnostics Business, especially system sales, were very, very large numbers of system sales for the second half, and this was the main reason for the increase. But also in the Therapy Business, we could see that there was a healthy increase of 27% compared to last year's second half. And after these numbers, I want to stop for a moment to a slide where we go through the -- some comparable net sales and comparable gross margin figures. And I just wanted to highlight this fact that how historically good the second half of '23 actually was. And if we look at these numbers, we can see that the huge leap that we made the second half of '23 in comparison to the previous year, but also in comparison to the good trend that we've done in the second half during this strategic period beginning from 2020, and now the latest report second half of '23. So comparable net sales and comparable gross margins growing, but especially well now between '22 and '23. So I pause here for a while to look at this very, very nicely progressing graph, and I also over -- next -- the speech for our CFO, Joonas Juokslahti, to present especially how we did during the full year of '23. Joonas?

Thank you, Mikko, and good afternoon, everyone. So as we could see in the graph on the previous slide, we achieved record growth in the second half of last year, and Mikko went through most of the key financials for the H2. So let's take a look at some of the key figures for the full year of 2023. Our net sales were EUR 7.2 million with a comparable growth of 21%. Now in the comparative year of 2022, we had a one-off licensing payment of EUR 3.5 million recognized as revenue in the first half. So comparing total net sales, there was some 24% of decrease in total sales. The main growth driver in the comparable net sales was the record high system sales volumes at the end of the year. And the system sales for the full year were EUR 4.1 million with a 33% growth, while the recurring revenue grew by 8% to EUR 3.2 million. The recurring revenue is very important for Nexstim as it provides us with stability and predictability for our future. We started the year of 2023 without any system order backlog, whereas in 2022 we had about EUR 1 million worth of order backlog of our system orders to start the year with. So this means that all of the sales we did in 2023 we got an order for and delivered during the same year. With the EUR 7.2 million of net sales, we generated a bit more than EUR 5.6 million of gross margin, which means that our comparable gross margin ratio has been pretty stable at the level of a bit shy of 80%, which is very good. And if we take a look at the operating expense side, we focused on cost efficiency in 2023 and we can see that the cost saving measures launched in early 2023 realized as planned. The personnel expenses were EUR 4.4 million with 8% decrease. Other operating expenses decreased by 9% and were EUR 3.1 million for the full year. And in total, we achieved EUR 0.7 million of savings in operating expenses in 2023 in comparison to '22. When dividing the operating expenses by function, we can see that the biggest effort is put into sales and marketing with EUR 3.2 million of operating expenses, representing more than 40% of our total expenses. The R&D and admin and general both had a bit more than EUR 2 million of expenses each, with the group total operating expenses being EUR 7.5 million with an 8% overall decrease in comparison to 2022. The operating result for the full year was minus EUR 1.2 million and the result for the period minus EUR 1.3 million. Now the company had estimated that in 2023 the comparable net sales would grow and the EBITDA would be positive. We achieved the first target of comparable growth, but unfortunately we were a bit shy of the EBITDA goal with EUR 0.5 million negative EBITDA in 2023. The EBITDA target came down to a few system sales that we were -- they were expected for the last days of the year but which eventually didn't make it to the 2023 books. The cash flow from operating activities was minus EUR 2.3 million and the growth of the accounts receivables had a negative impact of approximately EUR 1.5 million for this. This is due to the heavy emphasis of the system sales having been at the end of the year. The cash balance was EUR 1.5 million at the end of the year with some EUR 2.8 million of accounts receivables, consisting mainly of system sales, receivables from orders, deliveries in December. Now looking into this year, 2024, our future outlook goes as follows. Based on business forecasts, the company expects its comparable net sales to grow and the operating result to improve in 2024. Now talking about comparable growth. We have a graph for our full year comparable net sales over the strategy period, and we can see that, during the period, the comparable net sales have grown from about EUR 4 million in 2020 to EUR 7.2 million in 2024. This means a compound annual growth rate of 21% over the strategy period. And in 2023 the comparable growth actually matched the compound annual growth pace at 21%. With this graph, and at this point, I'd like to give the mic back to Mikko for a few more slides, and then we'll go into the Q&A session. Thank you.

Thank you, Joonas. Yes, towards the end of the presentation after we have reviewed last year's '23 numbers in quite some details and also the H2, I'd like to focus the end of this presentation, of course, into this current year '24 and also, in particular, our Nexstim key strategic objectives for this year. The #1 objective is our most important one, which is continuing the profitable growth, and especially to increase comparable net sales and improve operating results for the financial year. And we want to do this while minimizing future capital needs. Our second key strategic objective is to ensure our technology leadership continuing. So we want to launch our new NBS 6 diagnostic product. And this enables easy-to-use systems and future add-on modules in the same hardware. We were successful in launching the NBS 6 therapeutic product during last year '23, and now we aim to do the same to add the diagnostic modules into the NBS 6 platform during this year '24. And then the final one, the third strategic objective we have for this year, is expanding Nexstim's network of partners and clinics, primarily in the U.S. and Europe. And in here, when thinking about the partners and clinics, we think about all strategic partnerships in Nexstim. So not only clinics such as the clinics we opened -- the partnership clinics for Dr. Nadkarni or Dr. Kuluva that are added for our therapy, strategic investments, but also through possible strategic partnerships in distribution of our product or possible partnerships in new indications for treatment with the Nexstim system. So in a broader sense, strategic partnerships will be a key strategic objective for this year '24. And we hope, of course, to have more news flow in this area to follow during this year. And I finally want to go through once more, our future outlook in how it is worded in detail. Based on business forecasts, the company expects its comparable net sales to grow and operating results to improve in 2024. Now after the strategic objectives, I want to spend the last few minutes presenting the NBS 6 future of the Nexstim system. So developing and launching our new product generation has been an essential part of Nexstim's work during our strategy period, 2020-2024. And as we are coming towards the end of this strategy period, we're very happy that we are seeing that we soon will have the NBS 6 as a combined system that has been built on Nexstim's unique clinically established technology and meaning the combined system, new, where we have both the therapy and diagnostic indications in our new NBS 6 platform. This modular product design allows us for an expansion of system capabilities over time, meaning that we don't necessarily need to rewrite the whole software when we add new features or new modules, possible new indications, but we can rather license new modules to the users of the existing hardware NBS 6 in the future. The new solution creates long-term value for Nexstim's customers and investors. For the customers in a sense that they don't necessarily always have to invest into new hardware while getting new modules to use, and then for investors it means that this Nexstim technology through the modular design gets more scalability also for future applications. And finally, I want to highlight that this has been responding to customer demand. So when we've been developing the NBS 6 software, it's been developed in collaboration with Nexstim's -- some key customers. And we want to ensure the best possible level of usability. So usability is coming more and more into importance as staffing in hospitals and clinics is changing. There is less and less, I would say -- there's more staff changes and there are less staff to produce the treatments. So training of staff is important and easy use of the systems as the people using the systems might change rapidly. We have a promise with our new NBS 6 system that anyone -- the NBS 6 therapy system that was launched last year -- that anyone who's trained on the system can do patient treatments already on -- during the same day. And we've seen that type of approach successful also in the very first installations and trainings of the NBS 6 in the U.S. So we're very happy that ease of use is not only a promise, but it's also practically how we operate already. And the new combined system responds to the great customer demand for systems that allow delivery of both diagnostic and therapeutic applications in the same system. This is of real importance especially for the hospital users, as many hospitals, when they purchase these systems through tender processes such as in Europe in the public system, they want to have as many applications used in the same system and the diagnostic -- combining the diagnostic and therapeutic applications is something very unique for Nexstim. And this ensures that the customer, hospital or clinic gets a lot of value for their purchase because they have the possibility of using it for diagnostic and therapeutic applications in the future, both. So this is something that the customers have demanded and it's something that we already have at use in the NBS 5+ system sold today, and we want to ensure that the NBS 6 system of the future also have this combined therapy and diagnostic applications. That's the final happy note. I want to thank everyone for your attention and your attendance until now. And please follow us on our social media platforms such as the X, LinkedIn or Facebook mentioned here. And if you have any questions at this time, we're happy to try to answer them through the Q&A function. So again, thank you at this point and looking forward to maybe answering some questions in a moment.

Let's see if there's any questions posted. Seems like the bulletin that we published in the morning and the presentation has not raised any questions at this point. We will be reporting news flow, of course, during the year. The next financial report that we will publish is scheduled for first half '24 results that will be published on the 16th of August. And of course, between now and 16th of August, we'll have probably a lot of news flow to inform the public and investors. So I thank you at this point and look forward to engaging with you during the future events this year. Thank you. Bye.