Forum Topics AVR AVR Business Model/Strategy

Pinned straw:

Last edited a month ago

63add098175530417596798037d865862d22af.png

Anteris IPO Roadshow

I had a brief look and it seems to be a pretty slick presentation that Anteris has put together [link to roadshow presentation], which is CEO Wayne Paterson’s speciality. Worth a look for anyone wanting to understand the current value proposition. I’m anticipating a successful IPO, and there may still be weeks or months of opportunity for upside if anyone was to purchase the CDIs on the ASX — and they would be purchasing a substantially de-risked company from where it was even a year ago.

PabloEskyBruh
Added a month ago

I've had the chance to watch this in its entirety now. A couple of key takeaways:

  • It starts to get most interesting (in terms of new information/details) from about slide 24. This is the first time I've seen a written reference to the Pivotal Study as being 'Phase 3'. I've did a bit of research and it's not incorrect - just a term I usually associate with drug or vaccine schedules. I think it is used here to show how late-stage Anteris' product is to the new US IPO audience and perhaps just shorthand to help US analysts understand. It is interesting because I never really saw Anteris reference the Early Feasibility Study as being either a 'Phase 1' or 'Phase 2'. CEO Wayne Paterson has often been at pains to differentiate med-tech from pharma (especially when noting med-tech is less likely to have a catastrophic 'Phase 3' failure), but he appears to be just rolling with it now.
  • The same slide also details that it will be a 1:1 randomisation with the control products being either Edward's Sapien TAVR or Medtronic's Evolut. I suspect that the choice of which competitor product will be that of the surgeon or individual centre (there will be a total of 80 sites).
  • Precisely how costs work in these trials I don't know. US healthcare is hard enough for me to understand as it is. However, the average TAVR operation is $60,000 US, with about half of this being for the device itself (which, just quietly, leaves a fair chunk for overheads including a surgeon's labour costs which seems to be a good gig if you can get it). It would be interesting to know how much of the device is being paid for by Anteris during the trial -- if it is a large portion you can see hour $100 million can go pretty quickly.
  • I didn't see or hear a specific number of patients on this one, but previous presentations and announcement have put it at between 500 to 1000 patients. It seems like a lot of surgeries but slide 4 puts that it some context where it shows that in 2019 73,000 TAVR surgeries were performed in the United States.
  • The trial -- in terms of actual surgeries -- is to begin with first patient by end of September 2025 and last patient by end of December 2026. Its possible FDA approval could take until 2027 or beyond but the true value of Anteris well be known to the market before then. This isn't an area where it pays to anticipate the first free cashflow positive quarter to make your stake.
  • You might see on slide 25 the mention of revenue (during trials and review) of $25,000 per device. I think this will be more than offset by the costs discussed above (even if it is the patient & insurance companies paying for all devices and surgeries) -- it will just not be done at enough scale to move the dial and Anteris should be considered a pre-revenue company for several years still. You can see how that arithmetic changes should Anteris win even just a 10% share of just the US TAVR market (that's 7,300 operations on just the 2019 US TAM) after eventual FDA approval for sale.

12

PabloEskyBruh
Added a month ago

I thought I would just run a little experiment in furtherance of my last bullet point. Looking at Edwards Life Sciences current price to sales ratio which is presently at 7.38. This is the dominant TAVR player but is currently slowly losing market share.

My current valuation for Anteris presumes a 2030 market cap of 8 billion USD with 67.6 million shares on issue, with 10% global TAVR market share.

If we take the cheaper $25,000 sale of the device mentioned in slide 25 (which assumes no premium) and multiple that by the conservative 7,300 patients of the 2019 (US only) TAVR market that gives sales of $182,500,000 USD. If we take the 7.38 price to sales multiple to that we get a market cap of just 1.35 billion USD. Divide that by the 1.7 x dilution I am expecting between post-IPO and 2030 (so a total of 67.6 million shares) and that gives a share price of only $19.90 USD. Discount that back by 10% a year to now and we have a share price of only $12.35, well below my $73.48 USD valuation.

Although not enough to shake me from my higher valuation, it does point out where some of the vulnerabilities are in my valuation and give pause for thought. I should point these out as to what my higher valuation is assuming:

  • Accuracy in the projected global TAM for TAVR. Slide 4 puts the project TAM at $9.9 billion USD by 2028. Keeping with the low-ball $25,000 per surgery would suggest about 396,000 operations per year (not as crazy at is sounds) -- with 10% of that market being 39,600, not the 7,300 in my calculation. A higher price per device also gets to an estimate of TAM higher, but with less operations per year.
  • Not too much happening to to shake up the effective duopoly of there being only enough room for a couple of major players - my valuations assumes that Anteris is pretty much the only up-and-coming competitor worth mentioning (which I think at this stage is true), and the process of being that competitor happens as slow as we are witnessing. Too much competition could bring the price of the valve unit well below the $25,000 I'm using in my calculations; and finally
  • Anteris -- due to it's growth prospects required to go from 73 patients to 7,300 per year and beyond -- attracting higher multiples than the incumbents.


10

Strawman
Added a month ago

I'm sure you feel like you're on an island of one for Anteris @PabloEskyBruh , but I'm loving the work and thinking you're putting into it.

Definitely feels like there's some potential here too, although probably still a tad early for me personally. But keen to keep following the story -- especially as you tell it so well!

(love the Christmas themed avatar too)

14

PabloEskyBruh
Added a month ago

Haha thanks @Strawman. Probably a wise move. I think this is what Anteris Island looks like…ddac432a2d49684f282390fdaac1e503c8a265.jpeg

17