ResMed Inc. · NYSE:RMD
ResMed — Investor Day (2015)
106 slides from ResMed's investor day presentation, Oct 23, 2015
Slide 1: ResMed 2015 Investor Day
ResMed 2015 Investor Day Welcome & Opening Remarks
Slide 2: Safe Harbor Statement
Safe Harbor Statement Statements contained in this presentation that are not historical facts are “forward- looking” statements as contemplated by the Private Securities Litigation Reform Act of 1995. These forward-looking statements — including statements regarding ResMed's projections of future re
Slide 3: 2015 Investor Day Agenda
2015 Investor Day Agenda Presentation Presenter Welcome Agnes Lee, Sr. Director, Investor Relations Creating value with ResMed’s strategy Mick Farrell, Chief Executive Officer Focusing on innovation and continuous Rob Douglas, President & Chief Operating Officer improvement Financial review Brett Sa
Slide 4: Creating Value with ResMed's 2020 Strategy
Creating Value with ResMed’s 2020 Strategy Mick Farrell Chief Executive Officer
Slide 5: Why ResMed?
Why ResMed? 25+ years Disciplined of successful innovation, financial management market development and financial management Leader Proven in innovation for sleep capital deployment history, disordered breathing, respiratory committed to returning excess care and chronic diseases cash to shareholder
Slide 6: ResMed's Three Horizons Growth Strategy
ResMed’s Three Horizons Growth Strategy Changing lives with every breath 20 million lives changed by 2020 Improve patient quality of life Prevent chronic disease progression Horizon 3 Accelerate and Expand Reduce healthcare system costs Patient Growth into New Markets • Respiratory monitoring Horizo
Slide 7: Horizon 1: Sleep apnea is a huge, underpenetrated market
Horizon 1: Sleep apnea is a huge, underpenetrated market Sleep Heart Health Study: 26% of adults have sleep apnea Eastern Europe China India Brazil <10–15% penetration <5% penetration <1% penetration © 2015 ResMed I 7
Slide 8: Horizon 1: We changed the basis of competition in our market
Horizon 1: We changed the basis of competition in our market Air Solutions: Smaller, Quieter, More Comfortable… and More Connected DIAGNOSIS THERAPY MONITORING & MGMT. PATIENT ENGAGEMENT BILLING © 2015 ResMed I 8
Slide 9: Horizon 1: Growing importance of sleep and sleep apnea
Horizon 1: Growing importance of sleep and sleep apnea Sleep-concerned Consumers Better Sleep for Women © 2015 ResMed I 9
Slide 10: ResMed's Three Horizons Growth Strategy
ResMed’s Three Horizons Growth Strategy Changing lives with every breath 20 million lives changed by 2020 Improve patient quality of life Prevent chronic disease progression Horizon 3 Accelerate and Expand Reduce healthcare system costs Patient Growth into New Markets • Respiratory monitoring Horizo
Slide 11: Horizon 2: Huge potential to improve outcomes in COPD
Horizon 2: Huge potential to improve outcomes in COPD • Mortality risk reduced by over 60% on a relative basis when using long-term non- Control Group 0.40 invasive ventilation (NIV) treatment in Intervention Group chronic obstructive pulmonary disease p=0.0004 (COPD) Cumulative Mortality 0.30 • One
Slide 12: Horizon 2: Full spectrum of ventilation products
Horizon 2: Full spectrum of ventilation products Life Support Ventilation Non-invasive Ventilation (NIV) Product Features Astral™ Bilevel Lumis™ Stellar™ AirCurve 10 Patient Requirements © 2015 ResMed I 12
Slide 13: Horizon 2: Growing Businesses in key Emerging Markets
Horizon 2: Growing Businesses in key Emerging Markets China India Expand local presence Expand market through through infrastructure market access activity and expertise and clinical partnerships Brazil Poland Make additional investments to Czech accelerate growth Republic © 2015 ResMed I 13
Slide 14: ResMed's Three Horizons Growth Strategy
ResMed’s Three Horizons Growth Strategy Changing lives with every breath 20 million lives changed by 2020 Improve patient quality of life Prevent chronic disease progression Horizon 3 Accelerate and Expand Reduce healthcare system costs Patient Growth into New Markets • Respiratory monitoring Horizo
Slide 15: Sleep Apnea: Highly prevalent in key chronic diseases
Sleep Apnea: Highly prevalent in key chronic diseases Stroke 63% Depression 45% Drug-Resistant Hypertension 83% Heart Failure 76% Coronary Artery Disease Morbid Obesity 57% 77% Atrial Fibrillation Type 2 Diabetes 49% 72% References: Logan et al. J. Hypertension; O’Keefe and Patterson, Obes Surgery;
Slide 16: Horizon 3: Heart Failure reduced ejection fraction (HFrEF)
Horizon 3: Heart Failure reduced ejection fraction (HFrEF) • SERVE-HF Headline Result: ‒ Neutral with no signal in the primary endpoint: • Key Points: all-cause mortality and HF hospitalization ‒ The use of positive airway pressure in other clinical indications is not associated with increased cardi
Slide 17: Horizon 3: Heart Failure preserved ejection fraction (HFpEF)
Horizon 3: Heart Failure preserved ejection fraction (HFpEF) Dose-response relationship between SDB and cardiovascular outcome Reference: Damy et al. Eur. J Heart Fail. 2012 • Goal: Incorporate ASV therapy • Status: Enrollment underway as into the ACC/AHA heart failure preparation for future clinica
Slide 18: Horizon 3: Atrial Fibrillation (AF)
Horizon 3: Atrial Fibrillation (AF) • Conclusion of study in JACC: ‒ CPAP use associated with reduced AF recurrence ‒ Reduced AF recurrence seen in two key groups • Patients who underwent catheter ablation • Patients who underwent non-ablation medical mgmt. ‒ Data included 7 studies with n=1,087 pat
Slide 19: Horizon 3: Coronary Artery Disease (CAD)
Horizon 3: Coronary Artery Disease (CAD) • Conclusion of data from ATS ‒ Results suggest CPAP reduces risk for adverse cardiovascular outcomes in revascularized patients with CAD and non-sleepy OSA ‒ CPAP usage of at least 4 hours per night is crucial to achieve this risk reduction © 2015 ResMed I 1
Slide 20: Why ResMed?
Why ResMed? 25+ years Disciplined of successful innovation, financial management market development and financial management Leader Proven in innovation for sleep capital deployment history, disordered breathing, respiratory committed to returning excess care and chronic diseases cash to shareholder
Slide 21: Thank you
Thank you © 2015 ResMed I 21
Slide 22: Focusing on Innovation and Continuous Improvement
Focusing on Innovation and Continuous Improvement Rob Douglas President & Chief Operating Officer
Slide 23: Importance of ResMed's culture
Importance of ResMed’s culture • Ethics and integrity • An apolitical team player • Initiative • A sense of urgency • Instinct and resourcefulness • Creativity • Proactive communication • Commitment to quality and continuous improvement • Self-esteem • Value-consciousness • Customer-focus • Concern
Slide 24: Leveraging global innovation in local markets
Leveraging global innovation in local markets Product and Solution Innovation and Expertise Global Infrastructure Market Focused • Strong R&D organization in Europe, • Innovation and quality driven global • HME sales force in the U.S. and Australia and North America supply chain major European marke
Slide 25: Innovation continues to drive our growth
Innovation continues to drive our growth • Creating game-changing products and an • Focus on smaller, quieter, comfortable and evolving pipeline of high quality products now, more connected products ‒ AirSolutions platform: full range of flow generators and • Our business unit leaders drive global a
Slide 26: Innovation is rewarded across the organization
Innovation is rewarded across the organization John Wickham Memorial Innovation in Quality Award Award for Invention Peter Farrell Remote troubleshooting for AirSense10 AirSense10 Performance Testing Innovation Awards Recognizing ResMed’s world-leading innovators Innovation Delivering a Significant
Slide 27: Innovation drives our supply chain
Innovation drives our supply chain Sydney Singapore Product Design Global Manufacturing Philosophy Maximize Use of Global From product inception ResMed designs • Best in class quality and GMP Supply Network for manufacturing efficiency and product • Lean manufacturing Leverage supplier IP and use lo
Slide 28: Our global manufacturing and supply chain footprint
Our global manufacturing and supply chain footprint • Sydney, Australia 155,000 ft2 • Singapore 95,000 ft2 • Johor, Malaysia 46,000 ft2 • Lyon and Paris, France 43,000 ft2 • Munich, Germany 43,000 ft2 • Strategically Designed • Chatsworth and Moreno Valley, ‒ Supplier Base California 30,000 ft2 & 71
Slide 29: State-of-the-art supplier management
State-of-the-art supplier management ResMed is committed to delivering innovation, quality and value to our customers. We will deliver this through building and strengthening our alliances with suppliers and providing best practice leadership. © 2015 ResMed I 29
Slide 30: State-of-the-art supplier management
State-of-the-art supplier management ResMed’s Global Supplier Alliance consists of four complementary functions Protect the designed to foster mutual Business partnership with suppliers: Supplier Strategy Management Grow the Run the Business Business Supplier Innovation Supplier Category Management
Slide 31: Global logistics network
Global logistics network To have the right product always available… Formal feedback 18 month Sales process to ensure forecast accuracy 12 month forecast Regional fulfillment to our Suppliers, for Global ERP centers for fast capacity planning Customer response Platform and purchase price negotiation
Slide 32: Continuous Improvement
Continuous Improvement Approach Small team of experts working with department champions to determine areas for removing waste and improving efficiency Success ~ Achieved tangible cost improvements with each new product launch Philosophy Full Participation Implement LEAN principles > Hundreds of acro
Slide 33: Continuous improvement — our culture
Continuous improvement — our culture © 2015 ResMed I 33
Slide 34: Presence in over 100 countries with multiple market models
Presence in over 100 countries with multiple market models Multiple market models - DME/HME Sales Force - Distributor Networks - ResMed Home Care Provider - Government Sales - Unreimbursed Markets © 2015 ResMed I 34
Slide 35: Leveraging global innovation in local markets
Leveraging global innovation in local markets Product and Solution Innovation and Expertise Global Infrastructure Market Focused • Strong R&D organization in Europe, • Innovation and quality driven global • HME sales force in the U.S. and Australia and North America supply chain major European marke
Slide 36: Thank you
Thank you © 2015 ResMed I 36
Slide 37: Financial Review
Financial Review Brett Sandercock Chief Financial Officer
Slide 38: ResMed Finance Philosophy
ResMed Finance Philosophy • Strong history of financial discipline and controls • Investing for growth • Managing operations • Cash generation • Active capital management program © 2015 ResMed I 38
Slide 39: Global Finance Organization
Global Finance Organization • Strong finance leadership team located in our main offices in Australia, California and Germany • A deep bench ‒ International experience ‒ Strong commercial and technical experience • Team has strong functional relationships; business partnering to manage for long-term
Slide 40: Revenue Growth
Revenue Growth 11% $1,514 $1,555 CAGR $1,369 $1,243 $1,092 $921 $M 2009 2010 2011 2012 2013 2014 © 2015 ResMed I 40
Slide 41: EPS Growth
EPS Growth 21% CAGR $2.42 $2.22 $1.71 $1.44 $1.23 $0.95 2009 2010 2011 2012 2013* 2014* *EPS excludes 2014 restructure charges and 2013 Sydney University settlement. © 2015 ResMed I 41
Slide 42: Diversified revenue sources by region and product
Diversified revenue sources by region and product Europe Masks and 31% Accessories 41% Flow Americas Generators 59% 59% Asia-Pacific 10% © 2015 ResMed I 42
Slide 43: Drivers of Gross Margin
Drivers of Gross Margin Average Selling Prices Geographic Mix Product Mix Expected to be modest Outperformance Outperformance decline of Americas of flow generators Foreign Exchange Rates Manufacturing / Logistics / COGS ? Low AUD & high EUR ideal scenario; Continued focus Weak Euro has been a headw
Slide 44: Operating Expense Leverage
Operating Expense Leverage SG&A 31.5% 450 431 402 371 349 329 29.9% 290 30.1% 29.3% 29.0% 28.4% 28.5% FY’09 FY’10 FY’11 FY’12 FY’13 FY’14 YTD FY’15 SG&A expenses (US$M) SG&A expenses as % of revenue © 2015 ResMed I 44
Slide 45: Capital Deployment: Employing a Disciplined Approach
Capital Deployment: Employing a Disciplined Approach Capital Deployment Returning Cash to Shareholders Investing in Growth • Combined dividend and buy-back over rolling • Investment in total solutions and new markets 5 years = 98% of free cash flow • YTD 2015 dividend payout ratio of 44% of net inco
Slide 46: Strong Return on Equity
Strong Return on Equity ~20% 19% 20% 21% ROE 16% 15% 13% 15% 635 605 559 575 406 367 254 FY’09 FY’10 FY’11 FY’12 FY’13 FY’14 March FY’15 Net cash ROE © 2015 ResMed I 46
Slide 47: Key Takeaways
Key Takeaways • Strong track record of growth • Demonstrated financial discipline • Relentless focus on operational excellence • Committed to an active capital management program to enhance shareholder returns © 2015 ResMed I 47
Slide 48: Thank you
Thank you © 2015 ResMed I 48
Slide 49: Healthcare Informatics Progress and Vision
Healthcare Informatics Progress and Vision Raj Sodhi President, Healthcare Informatics Global Business Unit
Slide 50: Why does Healthcare Informatics (HI) matter?
Why does Healthcare Informatics (HI) matter? © 2015 ResMed I 50
Slide 51: Healthcare is shifting from the hospital to the home
Healthcare is shifting from the hospital to the home Across the globe, the future of healthcare delivery will center But data alone does around patient data coming not provide value. from the home. © 2015 ResMed I 51
Slide 52: Proven and evolving HI Solutions builds competitive advantage
Proven and evolving HI Solutions builds competitive advantage The ability to predict outcomes, communicate insights and act on data effectively and efficiently keeps ResMed in a leadership position. © 2015 ResMed I 52
Slide 53: HI can revolutionize the patient provider relationship
HI can revolutionize the patient provider relationship Care givers are looking for tools that allow fewer people to manage more patients. Patients are looking for simple ways to track their health outcomes. © 2015 ResMed I 53
Slide 54: ResMed is leading the way
ResMed is leading the way Because meaningful solutions did not exist, we have forged our way and set the bar for others. © 2015 ResMed I 54
Slide 55: ResMed's core capabilities are positioned for success
ResMed’s core capabilities are positioned for success Fast and Innovative Meaningful Secure and stable Global localized flexible integration efficiency-focused action-oriented IT systems market readiness capabilities solutions data insights Best-in-class Global HI platforms © 2015 ResMed I 55
Slide 56: Air Solutions — a proven success
Air Solutions — a proven success © 2015 ResMed I 56
Slide 57: ResMed delivers a compelling customer value proposition
ResMed delivers a compelling customer value proposition They are a suite of ResMed Air Solutions innovative solutions to are not just products… help make your business more successful. © 2015 ResMed I 57
Slide 58: ResMed is simplifying complex HME business processes
ResMed is simplifying complex HME business processes Submit claim for payment Order product from ResMed Get paid Enter invoiced products into inventory system Payors Setup patient with product Push Therapy Outcomes to Hospital Hospital EMR EMR Follow-up patient calls to manage compliance HME Mail Ch
Slide 59: ResMed is simplifying complex HME business processes
ResMed is simplifying complex HME business processes Submit claim for payment Order product from ResMed Get paid Enter invoiced products into inventory system Payors Setup patient with product Push Therapy Outcomes to Hospital Hospital EMR EMR Follow-up patient calls to manage compliance HME Mail Ch
Slide 60: The optimized delivery model with Air Solutions
The optimized delivery model with Air Solutions Payors Hospital EMR HME RDM Resupply OSA Referring Sleep Lab or Patient Physician Home Sleep Test Diagnosis © 2015 ResMed I 60 Therapy Monitoring & Management Patient Engagement Billing
Slide 61: Case Study: U.S. HME
Case Study: U.S. HME Proven ability to maintain positive patient outcomes with significant reductions in labor. Results SOC Group** U-Sleep Group* Residual AHI 2.8 ± 3.8 3.0 ± 4.1 Medicare Adherence 73% 83% Mean Hours of CPAP Usage 4.7 ± 2.1 5.1 ± 1.9 Mean Minutes of Coaching 58.3 ± 25 23.9 ± 26 59%
Slide 62: Case Study: Wrightington, Wigan and Leigh NHS Foundation Trust
Case Study: Wrightington, Wigan and Leigh NHS Foundation Trust • Background • Solution ‒ CPAP patient management wait times ‒ Implemented AirView, part of ResMed Air exploded due to awareness of OSA and Solutions to increase efficiency in patient related co-morbidities pathway with automation, repor
Slide 63: Case Study: Wrightington, Wigan and Leigh NHS Foundation Trust
Case Study: Wrightington, Wigan and Leigh NHS Foundation Trust • Outcomes ‒ Quickly identify those patients who were non-compliant or experiencing problems ‒ Maximize new patient set-ups whilst reducing unnecessary out-patient appointments ‒ Care team could remotely check device status ‒ Care team t
Slide 64: Case Study: Wiltshire and Dorset Sleep Service
Case Study: Wiltshire and Dorset Sleep Service • Background • Solution ‒ Different pathways in each of the two services ‒ Trial of telemonitoring and implementation ‒ Unprofitable clinic operation of AirView ‒ Challenges with staffing ‒ Complete ROI assessment of old vs. new pathway ‒ Unacceptable w
Slide 65: Case Study: Wiltshire and Dorset Sleep Service
Case Study: Wiltshire and Dorset Sleep Service • Outcomes ‒ Reduced waiting times ‒ Doubling of clinic capacity for assessments ‒ 60% increase in capacity for set up appointments ‒ 58% reduction in nurse time/cost • Total nurse time cost per patient in the old system £34.00 vs. £13.45 in the new sys
Slide 66: HI and Chronic Disease Management
HI and Chronic Disease Management © 2015 ResMed I 66
Slide 67: Chronic Disease Management (CDM) is a key focus for ResMed
Chronic Disease Management (CDM) is a key focus for ResMed Prevalence of Sleep Apnea 72% 77% Type II Diabetes Obesity Sleep apnea is at the center of nearly every 37% Sleep 57% Hypertension Coronary Artery costly chronic disease. Apnea Disease 70% 49% Stroke / TIA Atrial Fibrillation © 2015 ResMed I
Slide 68: Telemonitoring is critical for effective CDM
Telemonitoring is critical for effective CDM Chronic disease is increasingly managed in the home Changes in lifestyle and disease progression need to be monitored on a daily basis © 2015 ResMed I 68
Slide 69: ResMed's OSA capabilities translate to the CDM market
ResMed’s OSA capabilities translate to the CDM market ResMed has years of success delivering data driven outcomes for our customers and patients. © 2015 ResMed I 69
Slide 70: Chronic diseases are complex for stakeholders to manage
Chronic diseases are complex for stakeholders to manage • Multiple caring physicians • Outpatient therapy • HME Equipment • Home Health Nursing • Prescription management • Loved ones actively involved in treatment • Varying treatment protocols depending on the disease and its progression © 2015 ResM
Slide 71: HI solutions for CDM is a natural extension of our core capabilities
HI solutions for CDM is a natural extension of our core capabilities Existing Core Capabilities Healthcare Informatics Fast and Innovative Meaningful Global Secure and flexible integration efficiency-focused action-oriented localized market stable IT systems capabilities solutions data insights read
Slide 72: Healthcare informatics is catalyzing ResMed's growth
Healthcare informatics is catalyzing ResMed’s growth Changing lives with every breath 20 million lives changed by 2020 Improve patient quality of life Prevent chronic disease progression Horizon 3 Accelerate and Expand Reduce healthcare system costs Patient Growth into New Markets • Respiratory moni
Slide 73: Thank you
Thank you © 2015 ResMed I 73
Slide 74: ResMed's Clinical Strategy - 20 million lives by 2020
ResMed’s Clinical Strategy- 20 million lives by 2020 Glenn Richards MD Chief Medical Officer
Slide 75: ResMed's Clinical Strategy — Sleep Apnea and Beyond
ResMed’s Clinical Strategy — Sleep Apnea and Beyond • Clinical Perspective on SDB • Core market ‒ Obstructive Sleep Apnea • Adjacent Markets ‒ Respiratory Failure ‒ Central Sleep Apnea • Serve HF ‒ What do the results mean • Where to from here? © 2015 ResMed I 75
Slide 76: Sleep Disordered Breathing
Sleep Disordered Breathing • 3 very different abnormal patterns of breathing during sleep ‒ Obstructive sleep apnea ‒ Central sleep apnea ‒ Respiratory failure • OSA is easily the most common — affecting approximately 26% of the general adult population • OSA accounts for over 80% of patients • CSA
Slide 77: OSA and Upper Airway Collapse
OSA and Upper Airway Collapse © 2015 ResMed I 77
Slide 78: OSA
“escge' ResMed Changing lives with every breath
Slide 79: Apnea Hypopnea Index
Apnea Hypopnea Index Flow Thorax Abdomen 100 SaO2 % 70 • Apnea Hypopneas Index is a measure of severity • AHI is the number of events divided by time asleep - AHI less than 5 is considered normal - AHI from 5 to 15 is mild sleep apnea - AHI from 15 to 30 is moderate sleep apnea - AHI above 30 is sev
Slide 80: Obstructive vs. Central Sleep Apnea
Obstructive vs. Central Sleep Apnea OSA Flow Thorax Abdomen 100 SaO2 % 70 CSR Flow Thorax Abdomen 100 SaO2 % 70 CSA Flow Thorax Abdomen 100 SaO2 % 70 © 2015 ResMed I 80
Slide 81: Symptoms
Symptoms • Men present with “typical” OSA symptoms ‒ Snoring ‒ Witnessed apneas ‒ Daytime sleepiness • Women often present with different symptoms, causing misdiagnosis ‒ Insomnia ‒ Restless legs ‒ Fatigue/depression ‒ Headaches and muscle pain OSA reduces quality of life — CPAP improves quality of
Slide 82: Cardiovascular Consequences of Sleep Apnea
Cardiovascular Consequences of Sleep Apnea Negative swings in intra-thoracic pressure Increase in blood pressure Surge in sympathetic nerve activity © 2015 ResMed I 82
Slide 83: Sleep Apnea: Highly prevalent in key chronic diseases
Sleep Apnea: Highly prevalent in key chronic diseases Stroke 63% Depression 45% Drug-Resistant Hypertension 83% Heart Failure 76% Coronary Artery Disease Morbid Obesity 57% 77% Atrial Fibrillation Type 2 Diabetes 49% 72% References: Logan et al. J. Hypertension; O’Keefe and Patterson, Obes Surgery;
Slide 84: Effect of CPAP on Upper Airway
Effect of CPAP on Upper Airway © 2015 ResMed I 84
Slide 85: PAP Patient Interfaces: smaller, quieter, more comfortable
PAP Patient Interfaces: smaller, quieter, more comfortable Over the past 25 years there have been large improvements in the equipment used for treatment © 2015 ResMed I 85
Slide 86: PAP Flow Generators: smaller, quieter, more comfortable
PAP Flow Generators: smaller, quieter, more comfortable © 2015 ResMed I 86
Slide 87: Positive Airway Pressure (PAP) Therapy
Positive Airway Pressure (PAP) Therapy CPAP Pressure 1) CPAP Time VPAP Pressure 2) Bi-level (VPAP) Time 15 3) ASV 9 5 0 © 2015 ResMed I 87
Slide 88: Automatic Positive Airway Pressure (APAP)
Automatic Positive Airway Pressure (APAP) • Used in long term therapy or titration • Monitor flow to predict events • Raises pressure to prevent events and ‒ Apnea ‒ Hypopnea lowers it if no events ‒ Snoring ‒ Flow limitation © 2015 ResMed I 88
Slide 89: Respiratory Failure and Ventilation
Respiratory Failure and Ventilation Ventilation Demand Supply Exercise Weak muscles Illness Distorted chest Sleep Diseased lungs © 2015 ResMed I 89
Slide 90: Respiratory Failure
Respiratory Failure 100 100 Oxygen Saturation 80 Transcutaneous Carbon Dioxide 50 50 20 2344 Time 0540 © 2015 ResMed I 90
Slide 91: Positive Airway Pressure (PAP) Therapy
Positive Airway Pressure (PAP) Therapy CPAP Pressure 1) CPAP Time VPAP Pressure 2) Bi-level (VPAP) Time 15 3) ASV 9 5 0 © 2015 ResMed I 91
Slide 92: Respiratory Failure Treated
Respiratory Failure Treated © 2015 ResMed I 92
Slide 93: Ventilation for Acute COPD Exacerbation
Ventilation for Acute COPD 8 Initial IMV Initial NIPPV Percentage of Admissions 7 for COPD Exacerbation 6 5 4 3 2 1 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year References: Chandra et al, AJRCCM online pub 20 October 2011 © 2015 ResMed I 93
Slide 94: Home NIV for Chronic COPD
Home NIV for Chronic COPD © 2015 ResMed I 94
Slide 95: Our new respiratory care platform
Our new respiratory care platform • Designed to enrich life for patients Life Support Ventilation ‒ Greater freedom ‒ Versatile choices ‒ Saves time, so that clinicians and staff can focus on patients Astral™ © 2015 ResMed I 95
Slide 96: Central Sleep Apnea
Central Sleep Apnea • Abnormal breathing due to problems • ASV is used to treat all of these with respiratory control subgroups ‒ Complex SA accounts for most prescriptions 1. Complex Sleep Apnea/ Mixed Sleep ‒ Around 25% of scripts are for heart failure Apnea ‒Associated with OSA (5 to 10% of sleep
Slide 97: Obstructive vs. Central Sleep Apnea
Obstructive vs. Central Sleep Apnea OSA Flow Thorax Abdomen 100 SaO2 % 70 CSR Flow Thorax Abdomen 100 SaO2 % 70 CSA Flow Thorax Abdomen 100 SaO2 % 70 © 2015 ResMed I 97
Slide 98: Adaptive Servo Ventilation — mechanism of action
Adaptive Servo Ventilation Adaptive Servo Ventilation — mechanism of action Flow Effort Pressure support Flow Effort Pressure support © 2015 ResMed I 98
Slide 99: SERVE-HF study design
• Primary endpoint • Multi-center, outcome study ‒ Time to first event of all cause mortality or ‒ Comparing control (optimal medical unplanned hospitalization for worsening heart management) with active treatment (optimal failure medical treatment plus ASV) • Secondary endpoints ‒ Sample size:1325
Slide 100: Patient Selection
Patient Selection • Severe heart failure • Systolic heart failure = HFrEF ‒ Symptoms on maximal therapy ‒ Around 50% of HF, men, coronary disease • Moderate and Severe Central Sleep • Diastolic Heart Failure = HFpEF Apnea ‒ Around 50% of HF, women, elderly, ‒ AHI>15 hypertensive, obese ‒ Not studied
Slide 101: Field Safety Notice — issued 13 May 2015
Field Safety Notice — issued 13 May 2015 Numbers of events reached late April and analysis began • Preliminary primary end-point analysis • However, there was a 2.5% absolute showed no significant difference between increased annual risk of cardiovascular patients treated with ASV and those in the m
Slide 102: Field Safety Notice — issued 13 May 2015
Field Safety Notice — issued 13 May 2015 • The increased risk appears to be greater in those with more severe ventricular dysfunction • The majority of excess mortality is due to death occurring out of hospital (likely sudden cardiac death). • The risk does not diminish with time on therapy and is i
Slide 103: PAP Therapy is Safe outside SERVE-HF patient group
PAP Therapy is Safe outside SERVE-HF patient group Marin et al, Lancet 2005;365:1046-53 • SERVE-HF population very different to other PAP users • Untreated OSA is associated with increased CV mortality • No safety signals among several large trials and several demonstrate a lowering of mortality wit
Slide 104: Sleep Apnea: Many clinical targets for ResMed to focus on
Sleep Apnea: Many clinical targets for ResMed to focus on Stroke 63% Depression 45% Drug-Resistant Hypertension 83% Heart Failure 76% Coronary Artery Disease Morbid Obesity 57% 77% Atrial Fibrillation Type 2 Diabetes 49% 72% References: Logan et al. J. Hypertension; O’Keefe and Patterson, Obes Surge
Slide 105: Where are we going next in clinical research?
Where are we going next in clinical research? • Many opportunities exist to increase market size through demonstrating the influence of therapy on chronic diseases. • ResMed remains committed to advancing the field through scientific research. © 2015 ResMed I 105
Slide 106: Thank you
Thank you © 2015 ResMed I 106