Elekta Ab Class B · OMXSTO:EKTA_B
Elekta Ab Class B — ASTRO Capital Markets Presentation 2015
95 slides from Elekta Ab Class B's conference presentation, Oct 19, 2015
Slide 1: Elekta ASTRO Capital Markets Presentation 2015
ELEKTA ASTRO CAPITAL MARKETS PRESENTATION 2015 October 19, San Antonio, USA 1
Slide 2: Important information
Important information This presentation includes forward-looking statements including, but not limited to, statements relating to operational and financial performance, market conditions, and other similar matters. These forward-looking statements are based on current expectations about future event
Slide 3: ASTRO Capital Markets Presentation, October 19, 2015
ASTRO Capital Markets Presentation, October 19, 2015 Marriott Riverwalk Hotel, Ballroom C 09.00 Elekta Johan Sedihn, Chief Operating Officer 09.15 Regional business update Ian Alexander, Chief Commercial Officer 09:30 Q&A Kevin Brown, Global Vice President Scientific Research 09:40 Atlantic Beth A.
Slide 4: Elekta – ASTRO Investor Presentation
Elekta – ASTRO Investor Presentation Johan Sedihn Chief Operating Officer (COO) 4
Slide 5: Elekta – leading the future of radiation therapy
Elekta – leading the future of radiation therapy • Overview of Elekta − Net sales of approx. USD 1.4 bn − Active in over 120 markets − 3,800 employees − 6,000 customers − Installed base of over 3,500 hardware systems • Leader in innovation since 1949 − Stereotaxy, IGRT, VMAT etc. − Leading linac pro
Slide 6: Cancer is growing and driving need for cost-efficient care
Cancer is growing and driving need for cost-efficient care Demographics, higher life expectancy, lifestyle and improved diagnosis People, million 30 25 24 Incidence 20 14 15 15 Mortality 10 8 5 33 million cancer patients 0 2012A 2015E 2020E 2025E 2030E 2035E worldwide (within 5 years of diagnosis) 6
Slide 7: Recent Lancet article: >50% of patients recommended radiation therapy
Recent Lancet article: >50% of patients recommended to be treated with radiation therapy Share of cancer patients treated with RT today (incl. re-treatment) United States of America Netherlands Switzerland Australia Denmark Canada Singapore Sweden United Kingdom France Germany Italy South Korea Japa
Slide 8: Radiation therapy is cost efficient and set to increase in importance
Radiation therapy is cost efficient and set to increase in importance 1. Cost efficient 2. Increasing support 3. New technology will modality in literature drive higher usage (Relative cost per treatment) • Imaging 5x • Improved precision • Software 3x 1x Example: Elekta Atlantic project; i) improve
Slide 9: Elekta has pioneered radiation therapy since 1949
Elekta has pioneered radiation therapy since 1949 2013 1985 Electronic First digital brachytherapy controlled for skin cancer linac 2006 1949 Esteya® 2014 Integrated Stereotaxy oncology Software Leksell software Information- Stereotactic 2003 guided cancer frame solutions care™ The future Image Guid
Slide 10: Elekta has a market leading portfolio of solutions
Elekta has a market leading portfolio of solutions Versa HD™ Esteya® MOSAIQ® Monaco® 10
Slide 11: Continued focus on R&D for future growth
Continued focus on R&D for future growth R&D expenses SEK M % of net sales 3 000 13% 14% 11% ~11% 12% 2 500 Indicative 10% 2 000 9% 9% 9% 8% ~10% ~8% 7% 8% 7% 1 500 6% 1 000 4% 500 2% • Gross R&D investments will return to historical levels 0 0% 11/12 12/13 13/14 14/15 15/16 16/17 17/18 15/19 • Net
Slide 12: Action program to drive efficiency
Action program to drive efficiency • Two-year plan for cost reduction • Several activities and actions launched − Support from external consultants • New organization in place TA R G E T TA R G E T TA R G E T 2-year cost reduction EBITA-margin Lowering net working program of improvement of capital b
Slide 13: Initiated efficiency programs on track
Initiated efficiency programs on track 1. Reduce costs and increase efficiency in administration 2. Increase efficiency and productivity in: • Marketing • Product development • Service operations 3. COGS - reduction of product costs 4. Reduce working capital 5. Consolidate sites and functions 13
Slide 14: 14
14
Slide 15: Regional update
Regional update Ian Alexander Chief Commercial Officer (CCO) 15
Slide 16: Favorable market for radiation therapy
Favorable market for radiation therapy • North America − Consolidation drives large and complex orders with long sales processes − Replacement market with growth potential in software and services • Western Europe − Stable and growing in line with GDP − Long waiting times and under-capacity in sever
Slide 17: Elekta is the market leader in 2 out of 3 regions
Elekta is the market leader in 2 out of 3 regions Linear accelerator market share North America EMEA Asia Pacific Accuray and Accuray and Accuray and others 7% others 5% others 10% Elekta 23% Varian 70% Varian 45% 50% Elekta Varian 44% 46% Elekta 17 Sources: Elekta. FY 2014/15, new sales of linear a
Slide 18: Turn around and drive growth in North America
Turn around and drive growth in North America • Bill Yaeger - New Executive Vice President North America − Head of sales, head of services, strengthening capabilities − Improvements in software installation capabilities • Launch of Leksell Gamma Knife® IconTM − 7 first orders - high level of interes
Slide 19: Strengthen our No.1 position in Western Europe
Strengthen our No.1 position in Western Europe • Continue to build momentum through recognition of industry leadership in innovation • Significant win replacing Siemens units in France at Institute Gustave Roussy (IGR) in Q1 • Large buying groups active in Europe • Recent acquisitions in Turkey and
Slide 20: Emerging markets – continued market demand
Emerging markets – continued market demand • Asia: good performance in China − China: stable and strong demand drives continued good growth − India: market expansion as demand for improved healthcare access continues • EMEA: mixed performance − Iran: underdeveloped market, growth expected following
Slide 21: Significant upside in adding value to the installed base
Significant upside in adding value to the installed base • Dedicated sales force and Elekta installed base tools to: No. of systems − Upsell software 4 000 CAGR − Upgrade hardware 3 500 8% − Grow service revenues 3 000 2 500 • Maximize opportunity from many 2 000 1 500 recent product releases: 1 000
Slide 22: 22
22
Slide 23: Atlantic – progress update
Atlantic – progress update Kevin Brown Global Vice President Scientific Research 23
Slide 24: MRI Guided Radiation therapy – ATLANTIC
MRI Guided Radiation therapy – ATLANTIC Treat the patient simultaneously while being imaged by a ‘conventional’ 1.5T diagnostic MRI • Fully integrate three subsystems • State of the art Radiotherapy system − Treatment volume coincident with MRI imaging volume − Linac rotates around the MRI magnet −
Slide 25: Elekta test facility fully operational
Elekta test facility fully operational
Slide 26: Installation of MDACC ring gantry
Installation of MDACC ring gantry 26
Slide 27: Delivery of the magnet into the wall access opening
Delivery of the magnet into the wall access opening 27
Slide 28: Moving the MR module into the Linac gantry
Moving the MR module into the Linac gantry 28
Slide 29: Installation of the RF shield and patient table
Installation of the RF shield and patient table 29
Slide 30: First Radiation at MDACC
First Radiation at MDACC • Stable beam • Unaffected by the presence of the MR 30
Slide 31: First images at MD Anderson Cancer Center
First images at MD Anderson Cancer Center • High quality 3D images • Image quality unaffected by radiation Images courtesy of Philips 31
Slide 32: ICR/Royal Marsden preparing for installation
ICR/Royal Marsden preparing for installation • Adding new MR Linac area to their existing RT department • Need to dig down to the existing department level • Install starts early in 2016 32
Slide 33: Atlantic project is on track for commercial launch
Atlantic project is on track for commercial launch MDACC system installed Next steps • 1.5 T MRI imaging quality for both 3D and 2D Cine • Elekta technical Verification and Validation • Image quality not affected by: • Consortium testing of system performance − Radiation and user workflow − Presence
Slide 34: Atlantic – launch and commercial orders from 2017
1. Atlantic – launch and commercial orders from 2017 Planning Ambition Delivery of all consortium systems By end 2016 Regulatory approvals - CE Mark, 510(k) During 2017 Launch and taking commercial orders 2017 Total orders during ramp up (until 2019) Expected market price 75 USD 8-10 M >700 MUSD ord
Slide 35: 35
35
Slide 36: I Can See Clearly Now… The Clinical Impact of the Elekta MR Linac
I Can See Clearly Now… The Clinical Impact of the Elekta MR Linac Beth Erickson MD FACR, FASTRO
Slide 37: Froedtert
Froedtert £3 COEVISAL Froedtert E4 Potash re IN
Slide 38: Layout of MR-Linac room in FH-MCW
Layout of MR-Linac room in FH-MCW Installation starting in early 2016
Slide 39: MR LINAC: International Participation
MR LINAC: International Participation
Slide 40: Tumor Site Groups (TSGs)
Tumor Site Groups (TSGs) Selected Sites • Goal – Identify and quantify added benefit of use • Brain of MRL within selected sites • Breast • Activities • Cervix – Discuss with other consortium members / Elekta / Philips • Esophagus – Provide requirements/needs MRL • Lung development • Oropharynx – Di
Slide 41: Pancreas Tumor Site Group: MR LINAC
Pancreas Tumor Site Group: MR LINAC F&MCW: Beth Erickson DSC MDACC: Eugene Koay F&MCW (physics): Allen Li F&MCW (clinical member besides DSC): William Hall RMH-ICR: Katharine Aitken NKI-AvL: not participating Sunnybrook: Sten Myrehaug UMCU: Marco van Vulpen MCRC-The Christie: Prakash Manoharan
Slide 42: I Can See Clearly Now…
I Can See Clearly Now… The Clinical Impact of the Elekta MR Linac I can see clearly now, the rain is gone, I can see all obstacles in my way Gone are the dark clouds that had me blind It's gonna be a bright, bright Sun-Shiny day. Johnny Nash
Slide 43: What do radiation oncologists need to be successful in fighting cancer?
What do radiation oncologists need to be successful in fighting cancer?
Slide 44: They need to be able to "see" what they are doing
• They need to be able to “see” what they are doing: – Treat the tumor and others tissues at risk of harboring cancer cells. “I can see clearly now, the rain is gone”…
Slide 45: They need to be able to "see" what they are doing
• They need to be able to “see” what they are doing: – Is the treatment working? – Can we know before the treatment is complete? “I can see clearly now, the rain is gone”…
Slide 46: They need to be able to "see" what they are doing
• They need to be able to “see” what they are doing: – Avoid the normal tissues that can suffer collateral damage from radiation. “I can see all obstacles in my way”….
Slide 47: Technology has progressed in radiation oncology
• Technology has progressed in Radiation oncology from film- based radiation planning to CT-based radiation planning. • CT simulators and CBCT scanners built into Linear accelerators are standard. “Gone are the dark clouds that had me blind…”
Slide 48: Pancreas Cancer-A look inside
Pancreas Cancer-A look inside
Slide 49: Target definition: CT
Target definition: CT – Excellent definition of relationship of tumor to vessels – Poor definition of the actual tumor(GTV) – Sometimes the tumor is not visible on CT
Slide 50: Seeing Clearly: MR Target definition
Seeing Clearly: MR Target definition: – Excellent soft tissue resolution which facilitates target and normal organ delineation – Can dose escalate to the tumor rather than the entire head, body or tail – Can image every day while under treatment and assess motion and changes in volume and signal ove
Slide 51: Seeing Clearly: MR Target Definition
Seeing Clearly: MR Target Definition Late arterial phase post-contrast, Fat-suppressed T1:normal pancreatic fat-suppressed T1: tumor head delineation delineation
Slide 52: Seeing Clearly: The obstacle in my way
Seeing Clearly: The obstacle in my way • The duodenum lives close to the pancreas and can be injured with high doses. • Dose/volume tolerance of the duodenum and stomach are under study. • The duodenum and pancreas move during treatment. “I can see all obstacles in my way”….
Slide 53: Dose Escalation for Unresectable Pancreatic Cancer
Dose Escalation for Unresectable Pancreatic Cancer • MRI-defined volumes • 4DCT based planning • Daily gated CT guided gated delivery • Soft-tissue based IGRT or online ART MR-Guided PTV1 = pancreatic head/body/tail +5 mm margin duodenum PTV 2 PTV2 = SIB to CTV pancreatic tumor +3 mm margin GTV PTV1
Slide 54: Seeing a Moving Target
Seeing a Moving Target • The pancreas moves with breathing.. • Account for target motion with 4DCT and now 4D MRI. • 4D MRI can be done before and during treatment. * Huguet et al IJROBP 83(5):1355-1364, 2012*
Slide 55: Atlantic images and detects the target in real time
Seeing a moving target: Atlantic images and detects the target in real time simultaneous with irradiation • Localization results for Pancreas • Alternating coronal and sagittal slices • Acquired and processed in 500 ms Real time MRI
Slide 56: Seeing the Target in a Different light
Seeing the Target in a Different light • Functional imaging to assess response before, during and after radiation • Diffusion-weighted imaging can be used as an imaging biomarker of response • Decreases in DWI signal can be sensitive to and correlated with treatment response/cell death prior to a re
Slide 57: The MR Linac comes to MCW..
The MR Linac comes to MCW.. • MR linac arrives in early 2016 • First phase-scanning only to assess motion, ideal sequences and changes in target over time • Second phase-Institutional treatment trials • Third/Fourth phase: MR Photo from the Utrecht installation consortium designed trials
Slide 58: The Clinical Impact of the Elekta MR Linac
The Clinical Impact of the Elekta MR Linac • MR-based radiation planning and treatment delivery – Can visualize the target – Can visualize the critical normal structures – Can do it in real time – Can adapt plan as the tumor and normal organs shrink and move “It's gonna be a bright, bright Sun-Shiny
Slide 59: Comprehensive Oncology Solutions
Comprehensive Oncology Solutions Todd Powell Executive Vice President, Comprehensive Oncology Solutions 59
Slide 60: Today's global challenges
Today’s global challenges Drive quality and Deliver an integrated, Volume to value-based Readmission streamlined Rates customer reduce costs experience Manage patient Improve patient populations and Bundled Payments ACOs satisfaction coordinate care Deliver on a vision of Information-guided care™ 60
Slide 61: The future of cancer care management
The future of cancer care management • Automation and decision support • Expert content • Quality measurement • Workflow simplification • System integration 61 Confidential Information
Slide 62: Comprehensive Oncology Solutions
Comprehensive Oncology Solutions Care Treatment Knowledge Lifecycle Management Management Management Management Intent driven Treatment delivery Data analytics Installed base workflows inc. control system Clinical discovery management Plan of Care Adaptive Data sales Infrastructure Imaging & MM inve
Slide 63: Elekta's Comprehensive Oncology portfolio opportunities
Elekta’s Comprehensive Oncology portfolio opportunities Drive efficiency and competitiveness Imaging Add value to Control Achieve greater Atlantic integration current platform systems 63
Slide 64: Atlantic drives value
Atlantic drives value The Atlantic innovation portfolio addresses many Integrated Imaging needs within the Monaco 5.30 installed base Online adaptive Installation / Service 64
Slide 65: Application Convergence
Application Convergence Registration & contouring Optimization & calculation REFERENCE PLAN CREATION Treatment simulation Plan evaluation Treatment Session Mgr Motion Management TREATMENT DELIVERY Online imaging Online plan adaptation Offline image review Offline motion review REVIEW & ASSESSMENT Of
Slide 66: Beyond the care plan
Beyond the care plan Automates Planning & Evaluation Rx delineation Optimization constraints Dosimetric specifics Metabolic specifics Automates on-line adaptation Pre-treatment imaging Rx evaluation constraints IGRT-specific constraints Automates off-line assessment Rx evaluation constraints Dose ac
Slide 67: Elekta Knowledge Management
Elekta Knowledge Management • Healthcare Analytics • Registries • Oncology Imaging Management 67 Confidential Information
Slide 68: Elekta cloud solutions
Elekta cloud solutions Optimize and scale Control costs and Recover quickly Accelerate new solutions eliminate unplanned with business Elekta software expenses continuity services adoption Elekta Cloud Solutions (ECS) enables oncology departments to drive better user experience and patient care by u
Slide 69: Complete range of linear accelerators
Complete range of linear accelerators Versa HD™ Elekta Infinity™ Elekta Synergy® Precise Treatment System™ Elekta Compact™ Not all models are available in all markets. 69 Please contact your local Elekta sales representative for more information
Slide 70: Versa HD
Versa HD™ Single solution with unmatched versatility >2X Faster MLC leaf speed • Greater versatility • Improved efficiency 3X • Higher quality patient Higher dose rate care 2X Larger high-definition field size Not available in all countries. 70 Please contact your local Elekta sales representative f
Slide 71: The Elekta experience at ASTRO 2015
The Elekta experience at ASTRO 2015 71
Slide 72: 72
72
Slide 73: The future of cranial radiosurgery
The future of cranial radiosurgery Veronica Byfield Sköld VP Product & Services Commercialization, Elekta 73
Slide 74: Leksell Gamma Knife®
Leksell Gamma Knife® 74
Slide 75: Leksell Gamma Knife® – leading solution for cranial radiosurgery
Leksell Gamma Knife® – leading solution for cranial radiosurgery Radiation sources • 192 simultaneous beams converge on a target in the brain Isocenter (target in the brain) • Steep dose fall off keeps dose to healthy tissue extremely low • Few moving parts reduce risk of mechanical error and Patien
Slide 76: The most precise delivery of dose
The most precise delivery of dose 2-4x lower dose to healthy brain tissue than other systems 5-130x lower extracranial dose than other systems Superior dose deposition essential for proximity to critical structures, retreatment, and treatment of benign conditions Case example: Four metastases of whi
Slide 77: By far the most clinically proven technology
By far the most clinically proven technology Close to 3,000 peer-reviewed publications 3x more than competition combined 3000 2500 2000 1500 1000 500 0 1967 2015 Total number of Gamma Knife papers posted to PubMed through March 2015 Papers reporting ≥30 patients posted to PubMed through March 2015 7
Slide 78: The most reliable system
The most reliable system Hours Downtime over the prior three months 90 80 80 75 70 Highest reported downtime 60 Upper quartile 50 Lower quartile 50 40 Lowerst reported downtime 40 Median 30 20 15 12 10 0 0 Accuray Accuray Varian Varian Varian Elekta Elekta CyberKnife Tomo TrueBeam Trilogy Clinac Inf
Slide 79: More than 300 sites with the highest customer satisfaction
More than 300 sites with the highest customer satisfaction 7 out of 10 top neuro centers in the US choose Leksell Gamma Knife® for brain SRS US News and World Report, 2014-2015 79
Slide 80: The potential of Radiosurgery (SRS)
The potential of Radiosurgery (SRS) Increasing importance for both cancer & functional disease 80
Slide 81: Strong growth of radiosurgery expected
Strong growth of radiosurgery expected Brain/CNS cancer patient services 2013-2023 SRS 71% Emergency Department visits 19% Other radiation therapy 16% Surgical 15% Imaging and diagnostics 14% The highest growth rate among brain Eevaluation & Management visits 13% cancer therapies Chemotherapy 12% Ho
Slide 82: Increasing evidence supporting radiosurgery for brain metastases
Increasing evidence supporting radiosurgery for brain metastases Landmark study published in June 2015 • Multicenter, randomized trial But less than 50% of Gamma Knife • 213 patients: WBRT + SRS vs SRS alone treatments are for cancer • +50% risk of neurocognitive decline with WBRT added to SRS, no s
Slide 83: Potential of radiosurgery for functional disease
Potential of radiosurgery for functional disease Large patient populations Incidence per million (% potentially treatable w/ GKRS) Trigeminal Neuralgia 126-289 (50%) Science is building 50% Essential Tremor 237 (50%) growth of functional Parkinson’s Disease 120-146 (15%) cases treated with Epilepsy
Slide 84: What will it take to tap into this potential?
What will it take to tap into this potential? 84
Slide 85: Leksell Gamma Knife® Icon™
Leksell Gamma Knife® Icon™ Precision Radiosurgery with Online Adaptive DoseControl™ 85 Leksell Gamma Knife® Icon™ is CE marked and is 510(k) cleared
Slide 86: New technology
Leksell Gamma Knife® Icon™ New technology • Precise frameless workflow • Integrated stereotactic CBCT imaging • Online Adaptive DoseControl™ for continuous quality control 86 Leksell Gamma Knife® Icon™ is CE marked and is 510(k) cleared
Slide 87: Significant customer value
Leksell Gamma Knife® Icon™ Significant customer value UNLIMITED FLEXIBILITY FOR CRANIAL SRS • Frame/frameless, single session/fractionation, any target(s), SRS/microradiosurgery THE HIGHEST PRECISION • The most targeted dose delivery with the highest accuracy – for all workflows CONTINUOUS QUALITY C
Slide 88: Leksell Gamma Knife® Icon™ commercial status
Leksell Gamma Knife® Icon™ commercial status • Successful launch at ESTRO, April 2015 • Positive market access development − CE mark on June 5 − FDA 510(k) clearance on August 4 − Registration in Japan expected within 8 months • Strong commercial start − First European sites up and running − First A
Slide 89: First American sites signed up
Strong interest in the US market First American sites signed up 89 Leksell Gamma Knife® Icon™ is CE marked and is 510(k) cleared
Slide 90: First European sites already up and running
First European sites already up and running Hôpital de la Timone (Marseille, France) University Medical Centre Mannheim (UMC, Mannheim, Germany) Bristol Gamma Knife Centre, University Hospitals Bristol NHS Foundation Trust (Bristol, UK) The Leeds Gamma Knife Centre at St James's Institute of Oncolog
Slide 91: Significant potential
Significant potential • Increased flexibility and broader application Installed Upgrade installed base • Easy upgrade available for Perfexion (200 systems) base • Total potential 200 MUSD Solidify position in • Broader application of precision in neurosurgical setting neurosurgery • Superior tool fo
Slide 92: Significant potential
Significant potential Price premium Incremental Incremental after sales new sales Double-digit growth for Gamma Knife business from 2016/17 and onwards 92 Leksell Gamma Knife® Icon™ is CE marked and is 510(k) cleared
Slide 93: 93
93
Slide 94: Elekta is on track…
Elekta is on track… • Back to growth • Cost efficiency • Cash flow • Strong pipeline of new innovation 94
Slide 95: 95
95