【桑葛石原研翻译系列】风险投资蜂拥投资医疗科技创新的背景分析
由于新冠疫情的持续，医疗科技行业的并购出现下滑，但2020年，医疗科技的估值表现强于大多数生命科学行业。2021年前几个月该行业复苏速度高于预期，更多投资者重返医疗科技领域——主要目标包括诊断和远程患者监测等子领域。
全球医疗生态系统面临应对新冠的新冠疫情以及应对老龄化人口日益增长的需求，医疗科技在未来几年将至关重要。通过创造新产品，改善健康数据、支持远程护理和将工作流程数字化，医疗科技领域是私营企业和风险投资的一个巨大机会。
据Sky医疗科技公司的Bernard Ross说，“医疗科技行业近年来出现了大幅增长，这一趋势预计将继续下去，欧洲医疗科技市场估计价值超过1200亿美元，德国、法国和英国在新医疗设备的研发和实施方面处于领先地位。”
事实上，在2019年新冠新冠疫情之前，全球医疗科技行业的年总收入为5100亿美元，在全球医疗行业所占的份额不断增加。到2025年，全球医疗设备行业的估值预计将达到6127亿美元，年复合增长率为5.4%。
增长有几个驱动因素：首先，全球医疗支出的很大一部分已被转移用于直接抗击新冠，包括为医院购买医疗物资等。其次，人口老龄化所面临的挑战以及慢性病的日益流行，因此需要提供可获得的、具有成本优势的数字健康解决方案。
最后，医疗科技领域的创新，特别是在人工智能、机器学习、移动和云计算等领域，正在以惊人的速度加速前进，以满足这些需求。综上所述，这些趋势使医疗科技成为未来投资的成熟领域。
医疗科技行业的现状
虽然医疗科技在全球医疗市场的份额越来越大，但它不是一个单一的整体。广义来说，该行业可以分为五个核心部分，这些是：
l 医疗设备（如核磁共振和超声波）
l 医疗器械（如人工关节和支架）
l 医用耗材（一次性产品，如绷带等或个人防护用品）
l 体外诊断（用于人体血液或人体组织的生物样本的检验）
l 生命科学工具
目前，医疗科技市场正处于高度分散的状态。由于有机会收购和合并多家公司，并通过成本协同效应实现收入增长，这种分散化对私募股权投资者来说是一个有吸引力的。根据BGG网站的数据，十大医疗科技公司仅占市场的40%左右，而没有一家公司收入超过总收入的8%。
在就业方面，数据显示，该行业相对较好地度过了新冠疫情的冲击。例如在美国，目前有10.6万人在医疗科技行业工作，已经从2020年的轻微低迷中恢复过来，超过了2019年的数字。这意味着自2016年以来五年中，就业人数增长了31%。在欧洲，3.2万家医疗科技公司直接雇佣了超过73万名员工。
人口老龄化
到本世纪中叶，英国将多有860万65岁及以上的人口，这大致相当于整个伦敦的人口数量。据测算到2050年，地球上将有六分之一的人口达到退休年龄。
人口老龄化对医疗具有巨大的影响，更多的人将依赖医疗，但是如果按比例计算提供医疗服务的人数会更少。并且在当前的医保体系下，就业人口减少意味着支付这些日益增长的资金也将减少。虽然这一趋势在新冠疫情爆发之前就已经开始了，但长期以来对全球医疗系统积累的压力几乎被疫情推到了临界点。
人口老龄化意味着糖尿病或心脏病等慢性疾病发病率随之上升，这些情况产生了对创新的迫切需求，以改善当前这类疾病的诊断和治疗。通过促进定制、个性化护理和更有针对性的治疗，医疗科技（如可穿戴设备或智能吸入器）对帮助人们延长寿命、更有质量的生活至关重要。
此外，医疗科技还可以提高全球医疗系统的效率和可持续性。直到现在，这些系统一直受到琐碎的护理路径的困扰，并依赖于有限的资源。随着医疗专业人员和患者对医疗科技产品的需求不断增加，在医疗科技市场的投资有一个巨大的机会，特别是在新兴市场。
创新
医疗科技为医疗中的一些主要问题提供了一种创新的解决方案。随着越来越多的创新技术的诞生，医疗科技组织可以开发更便宜更高效的产品，以满足更多的健康需求。
医疗科技行业是STEM中最具创新性的行业之一。2019年，它们向欧洲专利局(EPO)申请了近1.4万项医疗科技专利，占申请总数的7.7%。在欧洲所有的技术部门中，医疗科技在专利申请方面仅次于数字通信领域。事实上，医疗科技的应用是生物技术的两倍多，也远远超过了制药公司。
尽管新冠疫情最初使专利申请下滑，但对疫情的应对，加上医疗科技解决紧急问题的能力，使该行业继续引领创新的道路。根据最新的EPO数据，2020年医疗技术在发明数量方面处于领先地位。事实上，美国在该领域处于领先地位，在2019年EPO授予的10480项医疗科技专利中，有4300项（41%）的成功申请来自美国。
新冠疫情导致的创新加速包括生产疫苗和测试，同时医疗服务转向人工智能的使用和远程护理，许多医疗科技公司的股价已经大幅上涨。斯特莱克(SYK)、雅培(SYK)和Owens&Minor(OMI)等医疗科技股去年的估值大幅飙升。事实上，在2020年，MedTech100指数（由世界上最大的医疗科技公司组成）总额从86.86美元增长到104.55美元，增长了20.4%。
总之，这些趋势表明该行业有上升轨迹。增长强劲的同时投资者仍需要担心的一些小问题。
定价可以说是最显著的症结，特别是随着政府在医疗产品和服务上的支出的上升，但又表现出不可持续性的财政趋势。为了减少高额的支出，政府和支付者越来越要求产品展示其价值，以了解一种产品或服务与更便宜的替代品的区别。
这些挑战也为医疗科技公司带来了机会，正如BCG所说，“有远见的公司正在开发更全面的解决方案，可以在治疗的整个过程中创造价值。”从长远来看，这种模式可以通过优化医院和其他医疗设施的运营效率来达到降低成本的目的。
医疗科技的投资者在寻找什么
BCG说，“对私募股权投资者来说，医疗科技行业有着巨大的前景，具有强劲的盈利能力、有弹性的需求和令人鼓舞的增长前景。”
由于投资存在风险因素，医疗科技投资的驱动因素与之前概述的市场增长的主要驱动因素略有不同。私募股权投资者关注着六个特定的主题（BCG）：
l 提供卓越的结果，例如可以显著提高患者生活质量的旗舰产品。
l 专注于创新。
l 病人病例的所有权，特别是对那些持续的慢性疾病。
l 制造健康消费的能力，例如糖尿病细分市场中的患者监测应用程序。
l 开发高质量、有价值定价的产品。
l 提高效率，降低医疗科技领域的高成本结构。
对于医疗科技公司来说，通过上述六点来展示差异，将有助于它们在潜在投资者面前脱颖而出。对于投资者来说，要想取得成功，了解持续塑造这个行业及其未来的动力是必不可少的。
【原文】
Why VCs are rushing to invest in medtech innovation
While the medtech sector saw a downturn in merger and acquisitions (M&A) due to COVID disruption, medtech valuations performed stronger than most life sciences sectors throughout 2020. With the sector recovering quicker than expected in the first months of 2021, more investors are returning to the medtech space — with top targets including sub-sectors like diagnostics and remote patient monitoring.
As pressure builds on global health ecosystems to meet the pandemic and face the growing demands of an ageing population, medical technology will prove vital for years to come. By creating innovative new products that can improve health data, support remote care, and digitise workflows, the medtech sector is a huge area of opportunity for private and venture capital.
According to Bernard Ross of Sky Medical Technology, “the medtech sector has seen substantial growth in recent years and that trend is expected to continue — the European medical technology market is estimated to be worth more than €120bn [£102.5bn or $141bn], with Germany, France, and the United Kingdom leading the way in research, development, and implementation of new medical devices.”
Indeed, prior to the pandemic in 2019, the total annual revenue of the global medtech industry stood at $510bn (£370.9bn or €434.4bn) — representing an increasing substantial share of the overall global healthcare sector. By 2025, the global medical devices industry is expected to reach a valuation of $612.7bn (£440.5bn or €521.8bn), growing at 5.4% CAGR.
There are several drivers for this growth. Firstly, a substantial portion of global healthcare spending has been diverted to directly combat the pandemic, including the purchase of medical technologies for hospitals. Secondly, the challenges of ageing populations and a greater prevalence of chronic health conditions necessitate the need for accessible, cost-effective digital health solutions.
Finally, innovation in medtech — particularly in fields such as AI, machine learning, mobility, and the cloud — is speeding ahead at breakneck pace to meet these demands. Taken together, these trends make medtech an area ripe for future investment.
The state of the medtech sector
While medtech encompasses an increasingly large share of the global healthcare market, it is far from a monolithic block. Broadly speaking, the sector can be divide into five core segments. These are:
l Medical equipment (e.g. MRI and ultrasound machines)
l Medical devices (e.g. artificial joints and stents)
l Medical consumables (single-use products such as bandages or PPE)
l In-vitro diagnostics (IVDs — tests used on biological samples of human blood or body tissue)
l Life science tools
Currently, the medtech market is highly fragmented. With the opportunity to buy and merge multiple companies and achieve revenue growth through cost synergies, such fragmentation is an attractive proposition for private equity investors. According to the BGG website, the ten largest medtech companies collectively hold only about 40% of the market in aggregate, while no company generates more than 8% of the overall revenue.
As for employment, the figures suggest that the industry has weathered the COVID-19 storm relatively well. In the United States, for example, >106,000 people currently work in the medtech sector — recovering from a slight downturn in 2020 to exceed 2019’s figure. Taken over the last five years, this represents a 31% increase in employment since 2016. In Europe, the medtech sector directly employs over 730,000 people across 32,000 companies (Medtech Europe).
Ageing populations
By mid-century, there will be an extra 8.6 million people aged 65 and over in the UK -- roughly equivalent to the population of London. Globally, it is estimated that 1 in 6 people on Earth will be retirement age by 2050.
An ageing population has huge implications for healthcare. More people will rely on healthcare, but there will be a smaller pool (proportionally speaking) of health workers to provide it. There will also be fewer people in employment to pay for these growing health demands.
This trend was already well underway before COVID-19 struck, and the pressures long exerted on healthcare systems across the globe were almost pushed to breaking point by the pandemic.
Of course, an ageing population means a concomitant rise in the prevalence of chronic illnesses such as diabetes or heart disease — creating an urgent demand for innovations that can improve the diagnosis and treatment of such diseases. By facilitating a drive towards bespoke, personalised care and more targeted treatments, medical technologies (e.g. wearables or smart inhalers) are critical to helping people live longer, healthier lives. In the process, they also contribute to an improved quality of life for patients.
Moreover, medtech can also boost efficiencies and sustainability in global healthcare systems that until now have been beset by fractured care pathways and rely upon finite resources. With greater demand for medtech products from both medical professionals and patient-consumers, there is a huge opportunity for investment in the medtech market — particularly in emerging markets.
Innovation
Medtech offers an innovative solution to some of the main problems in healthcare. With increasingly innovative technologies at their disposal, medtech organisations can develop cheaper and more efficient products that address more niche health demands.
The medtech industry is one of the most innovative in STEM. In 2019, nearly 14,000 medical technology patents were filed with the European Patent Office (EPO) — 7.7% of the total number of applications. Of all technical sectors in Europe, medtech is second only to digital communication for patent applications. Indeed, medtech applications were more than double that for biotechnology and far surpassed pharmaceuticals.
Though the initial shock from COVID saw a downturn in patent applications, the response to the pandemic — coupled with medtech’s capacity to solve urgent problems — has seen the industry continue to lead the way for innovation. According to more recent EPO data, in 2020, medical technology was the leading field for inventions in terms of volume.
The European medtech sector is in a healthy place, but the U.S. is leading the way for innovation in the space. Of the 10,480 medtech patents granted by the EPO in 2019, 4,300 (41%) of successful applications came from the United States.
With innovation accelerating due to the pandemic — including efforts to produce vaccines and testing while pivoting to artificial-intelligence-based and remote care — many medtech companies have seen their share prices climb substantially.
Medtech stocks such as Stryker (SYK), Abbott Labs (ABT), and Owens & Minor (OMI) have seen their valuations soar over the last year. Indeed, over the course of 2020, the MedTech 100 Index (made up of the world’s largest medtech companies) grew from a total of $86.86 to $104.55. This represented an increase of 20.4%.
All in all, these trends suggest an upward trajectory for the industry. Despite strong growth, there are some small areas of concern for investors.
Pricing pressure is arguably the most notable sticking point, especially as the rise in government spending on healthcare products and services demonstrates the unsustainability of fiscal trends. In seeking to reduce such high spending, governments and payers are increasingly demanding proof of value to see how a product or services differentiates from cheaper alternatives.
That said, such challenges also present opportunities for medtech. As stated by BCG, “rather than primarily selling products on a per-unit basis, forward-thinking companies are developing more comprehensive solutions (including services) that can create value throughout a patient’s journey.” Despite having a higher pricing point, such models can save money in the long run by optimising operational efficiencies in hospitals and other healthcare facilities.
What medtech investors are looking out for
“For private equity investors, the medical technology industry holds significant promise, with a record of strong profitability, resilient demand, and encouraging growth prospects.”
— BCG
With investment carrying an element of risk, the drivers for investment in medtech are slightly different to the main drivers of market growth outlined earlier. According to BCG, there are six specific themes things that private equity investors look out for in a medtech company. These are:
The delivery of superior outcomes, e.g. flagship products that can significantly improve quality of life for patients.
l A focus on innovation.
l Ownership of the patient journey, particularly for those with ongoing chronic conditions.
l The ability to capitalise on the consumerisation of health, e.g. patient monitoring apps within the diabetes segment.
l The development of high-quality, value-priced products.
l Improved efficiencies to bring down the high cost structure in medtech.
For medtech companies, demonstrating differentiation by ticking the boxes above will help them stand out to potential investors. For investors, understanding the dynamics that continue to shape the industry — and its future — is imperative for success.