Qiagen N.V. (QGEN) Earnings Call Transcript & Summary

Perfect. Well, welcome, everybody. My name is [indiscernible]. I am from the European Medtech team. And today, I have the pleasure of hosting Thierry Bernard from QIAGEN. So Thierry, thank you very much for being with us. Maybe as a quick introduction for everybody, could you briefly run through the key points of Q2 and the guide update?

So Q2 was a solid quarter for us. I mean, it sounds far away now. But first of all, we executed once again on the guidance, top line and EPS. Second, if you -- as you know, we have a very well balanced portfolio between life science, 50% of our activities and clinical diagnostic 50% as well. Life science was impacted by the context of slow capital sales in laboratory at the moment and we can come back to that. But still, we were above -- between flattish and 1% growth compared to competitors that were at negative growth, minus 5%, minus 6%. I think it's solid. It's driven by a better performance than expected on sample Tech. We were positive, QIAcuity digital PCR sales still doing extremely well. And clinical diagnostic was at 8%, which is top of [indiscernible] growth on the market, excluding NeuMoDx. So you know that we announced that we were divesting from that activity. And I think that's a tough decision but that's what the right decision to take. So solid quarter. The growth drivers are still up to our expectation. I spoke about QIAcuity but QIAstat was double-digit growth for the quarter. Once again, QuantiFERON was double digits. So we are delivering. We are delivering also on product launches. You have seen that gastrointestinal panel has been approved, which is a relief, I can come back to that as well -- in the U.S. So as a result, long story short, now the focus is, as we said, accelerating in H2. I believe that that's what we already assured at the closing of Q3, you will see that acceleration already. Second, we want to execute on the guidance for the full year, which is, as you remember, $1.985 billion where is that coming from? $15 million of what we exceeded from H1 but we had to subtract $30 million because we took the decision to stop NeuMoDx obviously. And for the year, the initial guidance for NeuMoDx was $55 million, we now expect because of the decision to stop, to close the year at $25 million. So it's H1 plus $15 million, minus $30 million gives you the new guidance. So -- and EPS also is [ seriously ] increased because we had an original guidance at $2.11 and we are now targeting $2.16, so.

And I know you also recently laid out this new midterm targets, including the 7% CAGR. So maybe could you highlight the key product line and business units that you see as the biggest drivers?

So first of all, that -- had been some time that we didn't have a [indiscernible] CMD, Capital Market Day. So New York, June 16, was important for us. We try to make it as simple as possible. So in a nutshell, what does it mean? We believe that we have the portfolio, the people, the past performance to achieve in the 7% CAGR for the coming years, delivering 31% of EBIT margin which would mean a 250 basis point of equivalent compared to what we target for this year. And we have triggered for this also a plan that I call QIA efficiency across different activities, consolidation of sites, cleaning of our portfolio, NeuMoDx is a decision, increased investments into digital activities. And the last number, which is important also is to say, absent of doable and financially sound M&A, the commitment to return $1 billion to our investors over the period of time. So now if you want to go into the details of the 7%, first of all, the balance between molecular and clinical diagnostic -- clinical diagnostic and molecular life science will remain. It's important for us and the focus also. This is one of the things that I tried to driving this company when I was asked to become the CEO, is that focus. We are a midcap, we need to focus where we can take between #1 and #3 position in the market. That focus continues. Two focuses on 2 #1 positions, sample tech and QuantiFERON. Three focuses on very growing dynamic markets where we have a differentiated solution, digital PCR, syndromic and bioinformatics. Sample tech. We believe that the market will remain very mature, slow growth, low single digit but we are launching 2 instruments. One at the end of 2025, which is the upgrade of our current flagship QIAsymphony and a new instrument to go into the very high throughput, sample tech where we are not at the one. So we are opening a new segment. And that justify where we believe that we could target between 3% to 4% CAGR for the coming years in sample tech. It remains a key activity for us. Never forget that everything in biology starts with that, starts with sample tech. Second, QuantiFERON. QuantiFERON, we believe we can close the year around $450 million. We propose a 3-years perspective at $600 million. Why? Because there is still a significant markets in skin test to convert. I know that some people are intensely talking about some coming competition over the last month but skin test is the competition and has been for years. It's not the first time, by the way, that we would be faced with competition, PerkinElmer when they acquired Oxford Immunotec became a competitor. It didn't change the paradigm of our growth rate and our market shares. But anyway, $600 million that gives us a CAGR of 7%, which proves that we have factored already in our forecast the potential arrival of new entrants and we are prepared. And then moving to the, let's say, newer products in our portfolio, QIAstat delivers, the GI approval in the U.S. is unlocking new potential obviously. We are currently submitting 3 new assays for QIAstat in the U.S., meningitis, obviously, and 2 new mini panels or mini respiratory, or mini GI. So for me, it's very clear, by early 2025, the configuration of QIAstat in the U.S. is completely different. Suddenly, we went from 1 panel to 4, at least. So that's completely a change of potential. That's justified together with the growth in Europe and in other countries, why we believe that in the coming 4 years, we can really double the number of QIAstat and be at $200 million. And it's -- what we always have said, we will be a solid #2 on that market. I never said #2, because that would have been aspirational but #2, solid, clearly. QIAcuity digital PCR, first of all, leveraging of what is probably the most impressive growth of installed base, not just for QIAGEN but in that business. Think about that. We launched our digital PCR solution roughly 3 years ago. In less than 3 years and it was at the beginning of COVID and this is one -- it was not relevant for COVID, so despite that, we are at more than 2,000 system installed in less than 3 years. This is remarkable. It's the best tribute to the product and the quality of the solution. We have specialized people. We have an increased menu on life science, not only purely research and academia, biopharma, cell and gene therapy. You have seen that we launched a press release, adding even new assays. We are now bringing the solution to the clinical world. At the end of September, QIAcuity will be FDA approved. Next year, we will have the first oncology assay approved, BCR-ABL. I see no reason unless the management is not able to execute and then you need to take decision or actions. I see no reason why we shouldn't triple the numbers for QIAcuity and target $250 million by end of 2027. So just purely a question execution. Then QDI bioinformatics, we are the leader on this market. And like the rest of the market, we are a profitable leader. I remind you that bioinformatics is accretive to our gross margin, accretive to our EBIT margin, accretive to our EPS. You remember that in Q4 of last year, we presented an investment plan. So we are putting more feet on the ground, more investments into R&D, being -- or remaining the leader and having a double-digit growth is perfectly achievable. And seeing QDI activity for us, we address basically NGS in oncology. So huge potential market, $200 million by the end of 2027. Once again, it's ambitious but it's very realistic. We are already at 100 million.

Okay. And if you look at the -- in your midterm target, you're assuming that the market grows 4% to 6%, maybe what do you think is the market growing at right now? And has it evolved throughout this year, 2024?

So I'm inviting everybody to take, first of all, a longer-term view. I always said for the last 2 years, or QIAGEN has always said, the fundamentals of the markets are very good, both for life science, or for clinical. The real fundamentals, the ones that are really impacting the trend. Population is still aging all over the world, aging populations need more test, more and more diseases, including cancers are becoming chronic diseases, more test. Think about that, it's a business where there is constant pushes from innovation. Who was talking about liquid biopsy 10 years ago? It's becoming now a clear reality and a clear driver, who was talking about microbiome and microbiome impact 8 to 9 years ago? Who was talking about minimal residual diseases 2 years ago? So every 2 years, there is something which is pushing for more test and more, let's say, understanding of the disease mechanism. So the fundamental, this will never change. But this year, there is a bit of more overhang of capital sales in many labs, post-COVID, that, let's not forget that it's probably one of the few years in history where most -- more than half of the world population is going or has gone through election in 2024. Elections is never good for life science because it's a lot of labs depending on grants, public funding. So there is a kind of wait-and-see attitude. Is it going to last forever? Do you really imagine that, for example, the NIH budget will remain at 0% growth for years? We forecasted 0%, normally, QIAGEN always say NIH margin should go with the inflation, 3%. This year, we said 0 because it's election year. We have never seen an example where the NIH were for many years at a 0% budget. So this is going to obviously come back, the speed of coming back, I don't know. I don't want to take a commitment. It depends on many things. We see that there is a better understanding what would -- could be the inflation, or the economic situation in the coming weeks and months as well. So people will get more visibility, I believe. So betting on the 4% to 5% growth in the coming years, accelerating again in 2005 -- '25, I am sorry, it seems realistic. Seems realistic.

Fair enough. And if we look into 1 segment, in particular, we've noted some continued cautious a little bit in life science capital spending. So how do current dynamics in life science instrumentation compared to what you've assumed for the midterm CAGR targets?

It was factored in our growth plan. If you remember, when we gave the guidance for '24, we said slower in H1, accelerating in H2 and this is what we are going to deliver. There is no doubt that it's difficult to sell instruments in life science currently. We never said the contrary. I'm just convinced that it's not going to last forever. What is important for us is that we don't see project cancels. We see projects can postpone, sometimes it's postponed a lot. Okay, it's a bit frustrating. But as long as the pipeline, as long as the teams on the field continue to basically show the value of the solution, we will close those deals. So I don't expect a significant change for the coming 6 months. As I said, I believe that '25 will show an improvement. Something that you need to always remember, when it's difficult to sell instruments in clinical, you can always place the instrument or lease it. Basically, what you do is that you amortize the value of the instruments on the price of the reagent. And why is it very possible to do that in clinically because you can, together with the customers define volume for the years, the consumption for the years to come and you can, therefore, do the financial proposal. This is much more difficult in life science. Why? Because life science, again, academia, research, they don't know exactly the kind of volumes they will have next year or 2 years down the road because it depends on grants, it depends on research project. So it's much more dangerous to lease or place instruments in life science. Why? Because never forget that when we do that, the instruments stays on our balance sheet. And obviously, I mean, for me, I consider our installed base as our main asset and is the bread and butter of future consumption of consumables. So that's why I'm very, very reluctant to place or lease in life science and we still have to weather that period of time. It's going to come back. We have good instruments. We are going to bring new solution on sample tech. QIAcuity, as I said before, is a very good solution. It will come back.

Okay. And what do you think is going to be the driver of this inflection? Is it innovation, like you were mentioning, the replacement cycle?

More visibility, more visibility. I mean, once those elections, I mean, we will have a new budget for NIH. We will have a new budget for CDC, more visibility also in the economic environment. Obviously, I'm speaking, absent of a major international crisis, or, of course but people have more visibility, trust is back. And in our business, there is no rule but there is a rule of thumb is that on average, laboratories are upgrading their automated system every 5 years. When they have more money, it goes quicker. But every 5 years, they upgrade their solutions. You really need to be tested for flu or COVID. You need to go to QIAGEN for this.

That's true. And several others have also called out a little bit of slowing in the large pharma customers. How have your conversation evolved with them?

We have seen pharma going to, or through significant movement of restructuration. I think we are still in the tail moment of that. What I find interesting is that projects in companion diagnostics are back, clearly. You have seen -- I mean that's probably one of the main highlight of the last 2 months for us, is that QIAstat now goes into the pharma and the companion diagnostic world. It's the only syndromic platform in the market that has been chosen by pharma company and not small name -- names. I mean, AstraZeneca, Eli Lily to choose QIAstat as their partners for some companion diagnostics. So that's very encouraging. Projects are back. The pipeline of companion diagnostic based on digital PCR is very interesting. We are probably the only company at the moment offering companion diagnostic solution for pharma companies on PCR, digital PCR, syndromic and NGS. So that's good. At the same time, we also sell directly instrument to pharma company, QIAcuity, especially the high throughput format, the 8 plates, we sell it to pharma companies and we see them investing. Is it basically super active? No but it's coming back.

Okay. And maybe at a high level, big picture, could you compare a little bit the current trends in your clinical, biopharma, academic, government customers? How does that differ between [indiscernible]?

I said it before, clinical is still active. I mean 8% growth in the first H1, in the first semester, it shows pharma, it's a bit slower. I mean we were at -- between flattish to 1% growth but again, much better than many competitors and big ones. So that's the situation. It's really impacted by this low capital sale in life science. But once again, I have never seen many years in a row of lack of government funding for life science. So it's going to come back.

And I know it's a small part of your mix but maybe could you give us a bit of an update on China and what's happening there?

Once again, here, I think we have been very coherent. We said for the last 2 years systematically, we don't see China bouncing back before at least the second half of '25. And China post-COVID is quite different from China pre-COVID in terms of personal -- potential growth for foreign companies. What I mean by this is, nothing that is currently happening in China should be new to many people. This was written in China for many years. One, we want foreign companies to localize as much as they can into China, not only consumables but also instrument and not only are basically just made in China but developed in China. That's a clear policy. Second, any time we can, we will favor the growth of local champions. In next-generation sequencing, for example, BGI is the best example of that. Are they subsidized by the authorities? And of course, they are but that's the policy of building national champions. It's very fair. Third, we want to make sure that any time we have the ability to give a Chinese solution we will favor that Chinese solution against foreign solution, in local tenders or national tenders. This is exactly what is happening. VBP is just a tool to make this happen. So you have many solutions, either you say, okay, that's not my market. I don't want to go there. QIAGEN is thinking, absent of, again, major international crisis, is too big of a market to be ignored because there are still some equipment needs but at the same time, there are specific rules, the one that I mentioned. So what do we do? We localize. We have a specific site in Shenzhen, in the South of China to do local R&D and manufacturing but we cautiously localize because there are IP questions and we are sensitive to that. And where we are potentially different than other companies because many are localizing is, we have a second brand, a brand which is completely Chinese, owned by QIAGEN, completely consolidated in our results but operationally independent. Headquarter of -- in China for QIAGEN is Shanghai, their headquarter is Beijing, it's different management, different salespeople, different marketing, different product, different manufacturers. That helps. That being said, the market is depressed in price, in demand. But at a point, that should obviously come back because of the size of the market, obviously. Second, before COVID, I would never negotiate -- start the discussion with my team in China for budget at less than 10% growth. Now I said 4% to 5% potential growth coming from China because again, that preference for local players. And this is how I see it.

And do you expect to see any benefits from the government stimulus and...

No, no, I'm very clear. If there are opportunities, we will take them. But I think that stimulus, obviously, it's a pragmatic answer to a kind of depressed market. I think that, that stimulus will favor primarily local companies. But if there are opportunities, we will take them, obviously, we have a sales team ready. What I find interesting, that doesn't mean that I change my view that the market will not fully bounce back before the second half of last -- of next year, what I find interesting is that some tenders that were constantly either postponed or where we had no visibility, now we have [ dates ]. That doesn't mean that we will be selected, but we have [ dates ]. Now 2 things where I will conclude on China. First of all, I invite you to always take once again, a kind of longer-term view. What I mean by this is that in many discussion with many of you, 7, 8 years ago, a company would be stupid not to be in China. And now a company is equally stupid to be in China. So you need to basically pick a stance. It's a big market. So let's again look at trends. Second, it's also a politically motivated market. There is a political strategy by local authorities. I don't judge it. I -- it's a fact. And what is clear is that the tensions between the U.S. or Europe and China, also in health care are not going to decrease regardless of administration. The U.S. Security Act is an example of that. I mean, in this document, some companies are specifically listed and we need to also consider this. So it's not going to be easier in the coming months.

Okay. That makes sense. And maybe we can move to another subject about QIAcuity. How should we think about the impact of Bio-Rad upcoming digital PCR [ continuous ] system?

I think it's a good reaction. This company is very respectable. They have created the market of digital PCR. So kudos to them. And basically, their offer became a bit outdated. QIAGEN came, it triggered 2 interesting things. First of all, is that they suddenly started to communicate a lot about the potential of the digital PCR market, which obviously, I thank them that for doing that because it confirms that the market is important. And second, obviously, they tried to react and they by definition spend more time talking about it. So it just shows that the competition is becoming active. I think we have an edge because we don't have 1 integrated box. We have 3 integrated boxes, a small volume, mid-volume, high volume but it's a very healthy competition.

Fair enough. And could you look a little bit at your customer base here, how sticky do you think they are and what levels of pricing and topology maybe do you have to maintain and defend the gross target in the midterm?

You mean digital PCR or? First of all, life science customers are -- because at the moment, our digital PCR solution is still very much into life science. Life science customers are always more sticky than clinical customers. In other words, if you want to simplify the profile of our customers and I'll address specifically digital PCR. So a bit simplistic but that's a nice way to look at it. Life science customers are long-tail customers. When you are there, normally, you stay there unless you do something. This is more mature markets, lower growth because depending on funding, non-funding, grants, not grants but it's basically high-margin market as well. The clinical market is a bit more dynamic, more active but also more volatile. And customers are not necessarily so much long tail. They put you constantly under price pressure, competition. And as also a consequence the cost to being -- for doing business in clinical is higher because you need the clinical trials and the regulatory expenses. That's the way to look at it. For digital PCR, First of all, because of the differentiation of QIAcuity, let's not forget that compared to the competitor that you mentioned or other competitors, QIAGEN delivered -- delivers a result in 1/2 the time or sometime 1/3 of the result at a higher [ inflection ] point. As long as we maintain that edge, we should be able to retain those customers, you see. But obviously, we cannot be complacent or guarantee, it's a question of investment. This is why for the last 3 years, we keep every 6 months adding new solution for those customers. We were not in the biopharma testing 2 years ago. We are -- we were not in the cell and gene therapy testing in the last 6 months. We will be -- we were not in the QC control for pharma. We started to be there. QIAGEN basically drove the wastewater testing in digital PCR. This is QIAGEN. This is not in any other competitors. We convinced the CDC to say wastewater testing on PCR, it was on digital PCR it's even better. And now this is becoming the standard. So as long as we keep pushing, educating, spending and investing money, we should be able to retain that edge, I think. But we need to invest, obviously.

That makes sense. And maybe if we move to another product called QuantiFERON, you were mentioning and [ alluding ] rumors around competition. So just wondering, if anything, what change would you make to your go-to-market strategy, if you see new entrants coming into the market?

No, because the strategy that we are going through at the moment has been defined, expecting new entrants way before there were any rumors and I'll come back to that. So first of all, it seems to be surprising that it's no more [indiscernible], it's a complex business but that -- people suddenly are thinking, oh, there is competition. Competition has existed on QuantiFERON for many years, it's antiquated technology, not patient-friendly, [ coarse ] skin test. And most of you in the room had a skin test. We came with a solution which is blood-based, much easier to use, much more accurate but we were not the only one. For many years in the past, there was a company headquartered here in this country called Oxford Immunotec. They were highly investing into that business. It never changed the paradigm of the relation between the 2 companies. QIAGEN was twice the size of Oxford Immunotec but growing at 3x their speed. In Asia Pacific, in Korea, for example, for many years, we had 2 or 3 competitors. We still have more than 50% of the market in Korea. No arrogance, no complacency. Those are just numbers. In China, there are at least 6 or 7 competitors of QuantiFERON. So competition is there for some time. And then one day, PerkinElmer, not a small company, did acquire for Oxford Immunotec. It never changed basically growth rate of QuantiFERON. No arrogance or no complacency once again but it's just -- and when PerkinElmer did acquire this competitor, at the same time, Quest in the U.S. acquired the full lab business of Oxford Immunotec in the U.S. Quest is one of our major customers, always said, continue to say, I will never change the way I'm going to use QuantiFERON, I will still be a user of QuantiFERON and a big user. I joined QIAGEN in February 2015. The first thing I did when joining -- in March of 2015, I was at DiaSorin because in the history of biology, there has been many products who were #1 at a point and people become arrogant and complacent. When you are #1, obviously, people are attracted. They say, oh, it's a growing market. So we protected QuantiFERON with different activities. First of all, partnership with DiaSorin. It works. Second, on the front end of the test partnership with [indiscernible] and Hamilton. Second, increasing the product efficiency, moving from what we call the data in the third generation to the fourth generation. Third, adding menu on the technology. It's latent TB at the moment. We added Lyme. By the way, Lyme has been submitted to the FDA, something like 2 weeks ago. So we should have the Lyme, together with DiaSorin, in the U.S. for next year, interesting. So competitors might come, we know that bioMérieux has said that they would launch a test, they did and then they withdrew it, which shows that it's not a classical and easy immuno assay test to develop. It's a complex one. They might come back. And there is another one who has said a lot of things without giving any date, any criteria on quality, what would be basically the sensitivity, specificity, limit of detection of the test. We already showing that we are now factoring 7% CAGR shows that we took that into account. And I believe that competitors are not competitors, it's well embedded in basically the valuation of QIAGEN at the moment. I mean, in the current price of QIAGEN.

Makes a lot of sense. And if you look at conversion of skin test to your test, what levers do you have to put that and accelerate it?

It's knowing where they are because something that is difficult to understand is that a skin test, as you might remember, if you did it, it's not a lab test. It's not only a lab test. You can do it at a GP. You can do it in a pharmacy. You can do it in a retail testing. It's very difficult to exactly know where they are. We invested a significant amount of money in the U.S. because this is the market where the statistical tools are still the best, especially from a marketing standpoint. And now, we can tell you where the skin test are by ZIP code, by ZIP code in the U.S. From there, we can say, okay, what are the volumes? Because if it's very low volumes, they won't ever bother to change. And second, also, what's the patient population, if they are massively also addressing immunocompromised patients, such as diabetes, patient under dialysis, patients with HIV? This is a key target. And then this is where basically we drive our salespeople. And then there is a conversion because for many of them, first of all, it's not their main concern every day. And then the typical reaction, now I know this blood test is much better, look at the number of publications. But I need to train again my nurses and things like this, okay, come back to discuss that with me next month, the month after. It takes, on average, 6 to 7 visits to convert the skin test customer. But when he is converted or she is converted, it's good business.

Okay. And if you think about the midterm patterns of QuantiFERON menu additions in the U.S. and [indiscernible].

The only addition in menu for QuantiFERON of value is Lyme. We have also test on QuantiFERON. We have a CMV test. Those are small volumes, those -- it's not very significant. It's a -- and Lyme, let's be very clear. Lyme will be a success in the U.S. or will never be a success. So we take a bet. We have obviously significant data to prove that we are launching a very differentiated product why because there is a standard test at the moment for Lyme, which is based on the traditional immunoassay without going to the techniques, it's called an IgG, IgM test. Go to visit a clinician even here in the U.K. because Lyme is coming in the U.K., weather and climate change, by the way, in many countries in Europe, it's increasing. And in the U.S. go to the Northeast, for example, in summer, it's vertigo to a clinician, they will tell you, I don't test because I don't trust the result. The test is -- the result is coming too late. And so I prefer to start a massive basically antibiotherapy from the start. And if you read the newspaper 2 years -- or 2 days ago, I mean, 39 million people are said to be dying or to die of bacterial resistance in the coming years in the world. So the sensitivity to awareness around bacterial resistance. You cannot continue to prescribe large spectrum antibiotics like this. So the solution on QuantiFERON Lyme is a very nice algorithm between DiaSorin, IgG and IgM plus our interferon gamma rate, I don't want to be too technical but the result that we have been submitting to the FDA is, one, we detect Lyme much quicker and second, we detect the recurrence of Lyme much quicker as well because you know that many patients sometime despite the antibiotic treatment, they still basically have episodes of the disease and it's very debilitating. So a clinician can, with much more knowledge, decide when to start or if to start the antibiotics. This is why we expect -- this is what we expect to be the differentiation. As usual, let's be very clear. If we submitted 2 weeks ago, if everything goes well, we will be approved, let's say, Q1. Lyme is a summer issue. So by next summer, we are operational. In the meantime, we cannot promote it. When you are submitting to the regulatory agency, you cannot promote the product. Once you are approved, then you can start the promotion. It's going to be a lot of clinical education. But we are used to that. Just to give you an example, are you aware that back in 2015, 9 years ago, the WHO was not even thinking latent tuberculosis in their policy against tuberculosis. This came from QIAGEN because we educate, we spend money on obviously, medical education, proving the data, proving the case with our -- and we do the same with Lyme. It's going to take some time. So next summer, I don't expect meaningful revenues, the summer after a bit more. It's not a huge market but it's going to be a market where we can have high prices. And we can obviously find another relay of growth for QuantiFERON. That's the game. That's the game but it's going to be the U.S. or not. I am sorry, sir.

Yes. [indiscernible]

No, we have never disclosed. But clearly, I don't see sales above the double-digit number before 2027. So it's not even really in our plan that we proposed in New York. And I'm not afraid by that because I know it takes 2, 3, 4 years of clinical education. But when it starts and we know, for example, that some of the biggest private lab in the U.S., so you quickly understand who I'm talking about, are already interested to launch it as quickly as possible. So let's be cautious. We need to spend on it. We need to prove the case but it can -- if you think about it, it can really help the QuantiFERON franchise when supposedly some more competitors are supposed to be active on latent TB, you see. So it will be the right timing. And this is why we believe that a 7% CAGR for the whole franchise is perfectly doable.

[indiscernible]

Europe, we are already present in Europe. I don't expect anything as long as we get reimbursed in Germany. In Germany, it's a long -- you need to go through a lot of red tape, if I may say so, plus data. I don't expect any reimbursement before probably at best end of '25, '26. So I bet everything on the U.S. at the moment.

Thank you. Thank you very much. I think we have 1 minute left. So maybe I don't know if you have any final remarks that you want to share.

No, no, just thanking you for your time. I think -- it's not up to me to say that but I believe this company has become over the last 5 years, a more solid portfolio, is much more coherent, while at the same time, we are strengthening our P&L and our balance sheet. So obviously, we would like to put that balance sheet to play as well. And so beyond organic investments in R&D, beyond the return to shareholders, M&A is key for us but with some key conditions. We don't do M&A for the sake of M&A. It has to be very synergistic to where we focus at the moment. So no M&A to spread the company thin again. And M&A should allow us to take more share of wallet. That's the strategy of what we want to implement. Thank you so much.

Thank you very much.