Rex Bionics. The Robotic physiotherapist. Revolution in mobility and rehabilitation. Healthcare providers and insurance claims are key

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1 Rex Bionics The Robotic physiotherapist Initiation of coverage Tech hardware & equipment Rex Bionics is a pioneer in the field of medical exoskeletons. It is focused on rehabilitating and improvement in the mobility of patients with spinal cord injury. Its two key markets are rehabilitation centres and home use. Fourteen devices are currently in use, but clinical trials demonstrating the medical benefits to patients and commercial benefits to rehab centres has recently been initiated; with promising data from the first trial. A reverse DCF implies growth in sales to only 207 units by 2020 is required to justify the current share price, and the market therefore appears to be applying a significant discount for the uncertainty of success. Evidence of medical benefit from the clinical trials will be a key catalyst for upside. 27 February 2015 Price 67.5p Market cap 10m Net cash ( m) at 31 January Shares in issue 14.3 Free float 63% Code RXB Primary exchange AIM Year end Revenue ( m) PBT* ( m) EPS* (p) DPS (p) EV/Sales (x) 11/ (0.4) (1.4) 0.0 N/A N/A 11/ (0.5) (1.5) 0.0 N/A N/A 03/15e 0.2 (4.4) (30.5) N/A 03/16e 1.0 (5.7) (40.1) N/A 03/17e 5.0 (5.5) (38.4) N/A Note: *PBT and EPS are normalised, excluding acquired intangible amortisation, exceptional items and share-based payments. FY15e is a 16-month period to March Yield (%) Secondary exchange Share price performance N/A Revolution in mobility and rehabilitation Rex's exoskeletons have the potential to revolutionise the way people with mobility problems are rehabilitated and treated. It allows people with complete loss of movement in their legs to stand and walk upright with their hands free to use as they wish. There is little doubt that devices such as Rex s can transform people s lives, but it is likely that the medical benefits will need to be demonstrated through clinical trials before widespread adoption. Rex s devices are approved for sale in the EU for rehab and personal use and in the US for rehab use only. Healthcare providers and insurance claims are key The two main categories of customer for Rex Bionics are healthcare providers and individuals that request mobility devices such as Rex s, through personal injury claims and charities. In our view, relatively few people could afford the c $150k to purchase these types of mobility device from personal funding and the purchasing process for these categories of customers is therefore key to determining uptake. Valuation: Medical trials are the key catalyst Rex Bionics is trading at a significant discount to its peers on EV/sales and a reverse DCF with 15% WACC and 3% terminal growth implies that annual sales need to grow to only 207 units by 2020 to justify the current share price. The market therefore seems to be factoring in a low probability of success. If clinical trials demonstrate that using Rex s devices represents a clear medical benefit and FDA clearance is obtained for the US personal market, it is likely that Rex s share price could re-rate closer to that of its peers. The personal use market is key to achieving significant shareholder return and therefore demonstrating sales through charities and from personal claim awards will also be a catalyst for share price upside. % 1m 3m 12m Abs (3.6) (57.3) (53.5) Rel (local) (5.4) (59.0) (54.6) 52-week high/low 182.5p 67.5p Business description Rex Bionics develops and produces exoskeletons to help assist in the rehabilitation and improve the mobility of patients with spinal cord injury (SCI) and other lower limb mobility problems. Next events Annual results April 2015 Analysts Tom Grady +44 (0) Katherine Thompson +44 (0) Edison profile page Rex Bionics is a research client of Edison Investment Research Limited

2 Investment summary Company description: Robotic rehabilitation and mobility Rex Bionics produces exoskeletons to assist the rehabilitation and improve the mobility of people with spinal cord injury (SCI) and other mobility impairments such as stroke and MS. Two variants of the device are available: Rex, which is intended for use in rehabilitation centres, and Rex P, which can be used in the home. Both devices are approved for sale in Europe and Australia, and Rex is available for rehab use in the US but FDA clearance is required for use in the home in the US. Financials: Further funding required to reach profitability Rex Bionics was acquired by ISDX-quoted vehicle Union MedTech in May 2014 in a combined acquisition and AIM listing, which raised 9.6m. Revenue has been limited to date as clinical trials are required by many institutions to justify purchase, so we do not forecast significant unit sales until the completion of clinical trials in FY16. Current cash expenditure is c 5m per year and the cash balance as at 31 January 2015 was c 5.0m, so it is likely that further cash will need to be raised over the next 12 months. We assume 10.0m of debt is raised before profitability is reached in FY19, but this could also be funded through equity. We forecast peak annual unit sales of 2,500 at an ASP of 100k with gross margins improving from 40% to 72% by 2020 based on cost reductions and scale benefits. Components from units are purchased from a variety of third parties and assembled in Rex s facility in New Zealand, which has capacity for at least 20 units per month (assuming additional staff are hired as required). Relatively little additional capital expenditure is required for output growth and there appears to be relatively low risk in the supply chain as most components are multi-source and widely available. Sensitivities: Clinical trials and funding The key sensitivities around valuation are clinical trials, regulation and funding. Rex can be sold in Europe and Australia for rehab and personal use and in the US in rehab centres but requires FDA clearance to be sold as a personal device in the US. The UK and European markets are substantial, so obtaining FDA clearance for personal use is not critical but will help maximise the available opportunity. Clinical trials are expected to start in H1 CY15 and an FDA 510k submission is expected in CY16. We have little doubt of the significant psychological benefit to users of the Rex device, but it is important that the trials demonstrate it is safe to use and the medical benefits are substantial enough to justify its cost to healthcare providers. Another important source of funding for personal use devices could be compensation awards for personal injury. Once a precedent is set for awarding these types of device, the number of devices bought via this route could grow significantly. There is competition from other device manufacturers, but the market is sufficiently large that we do not see this as the primary risk in the short term. Alternative SCI treatments (such as repair of spinal nerves) could reduce the need for devices such as Rex and Rex P, but in our view this is unlikely to happen in the short to medium term. Valuation: More upside than downside Using a reverse DCF with annual WACC of 15% and terminal growth of 3%, the market appears to be pricing in sales of 207 units by This compares to the annual incidence of spinal cord injury in the UK alone of c 1,000 and c 50,000 people in the UK who currently live with SCI. Rex is also intending to sell its devices into the US, where there is an annual SCI incidence of c 12,000 and 259,000 living with SCI nationally. If annual unit sales reach 750 by 2025, our DCF produces a per share valuation of Achieving this level of sales is dependent on Rex hitting a number of funding, regulatory and development milestones but, if successful, there could be significant share price upside. Rex Bionics 27 February

3 Company description: SCI rehabilitation and mobility Rex Bionics designs and manufactures a robotic device for assisting the rehabilitation and improving the mobility of patients with spinal cord injuries up to C4/C5 and other mobility impairments such as stroke and MS. The device comes in two variations: Rex P and Rex. Both devices are broadly the same, with the main difference that Rex P is customised to the user's individual size and Rex is adjustable to multiple different users and is intended for rehab use. Rex P also has sensors in the feet that allow it to walk upstairs and over uneven ground, which the rehab version cannot do. Rex s unique selling point is that it is inherently stable, which means it does not require the use of crutches as support and can therefore be used at a higher injury level. The initial focus is on European, US and Australian rehab centres, but ultimately the aim is to grow into the personal use market. A video demonstrating Rex P is available on YouTube. Company history Rex Bionics was founded by Richard Little and Robert Irving in 2007 after they started working on the concept of a robotic exoskeleton in Rex Bionics was acquired by Union MedTech (an investment company) in a combined acquisition and transfer to AIM from the ISDX Growth Market in May Rex Bionics is the sole investment of Union MedTech and it does not plan to make any further acquisitions. 10m (gross) was raised as part of the transfer to AIM, with 5.6m shares placed at 180p per share. The funds raised will be used for sales and marketing, R&D, scaling up manufacturing operations and working capital. Fourteen units are in use currently, but sales have been relatively limited as many healthcare providers globally are requesting the results of clinical trials to justify the purchase decision. Clinical trials are therefore a critical milestone for Rex. Regulation The focus of regulatory bodies is on ensuring that medical devices are safe to use rather than on whether they are effective. Exhibit 1 provides more detail on the different regulatory requirements and Rex s status with the key regulators. Exhibit 1: Relevant regulatory bodies and current Rex status Regulatory Rex status Comments body US Food and Drug Class I for The FDA classifies products into three classes numbered 1 to 3. Class I devices are the lowest risk and have limited regulatory Rehab use. requirements. Class II devices are moderate to high risk and need to conform to device-specific controls and assessment. Administration Rex P not yet Class III devices are the highest risk and require pre-market approval (PMA) which involves potentially lengthy trials before it (FDA) submitted for can be approved for sale. Rex has been self-certified as a Class I device under the powered exercise equipment category, clearance. since it is only used under medical supervision in a rehab facility and is therefore low risk. For personal use devices the risk is higher and therefore Class II requirements will need to be met. The FDA has recently created a new category of Class II device labelled powered exoskeleton. This means that any device the FDA deems to be substantially equivalent to a powered exoskeleton is considered Class II and therefore needs to file a 510(k) before it can be sold in the US (for either rehab or personal use). Filing this form kick-starts a process in the FDA that assesses the safety of the device. The timescale for assessment can vary significantly, but original de novo submission by ReWalk, which triggered the creation of the powered exoskeleton category, took 12 months so we would expect assessment of a 510(k) to be substantially shorter than this. UK MHRA (EU) Australian Therapeutic Goods Administration Class I certified Final stages of clearance. The EU has a series of directives that are implemented at the national level. It operates on a similar classification basis to the US with devices classified as either I, IIa, IIb or III in order from low risk to high risk. Rex has been self-certified as a Class I device, which means it has been granted the CE mark required for sales in Europe, but reclassification to Class II or III would require assessment by an approval body in the EU such as the UK MHRA. The fact that the US FDA has classified powered exoskeletons as a Class II device may cause the EU authorities to do the same, but we have not seen any indication that this might happen and the EU regulators do appear to take more of a light-touch approach. Rex P is also self-certified as Class I so can currently be used and sold in the EU without formal assessment by a notified body. Devices are categorised by the Therapeutic Goods Administration as either Class I, Class IIa, Class IIb, Class III or AIMD. Rex s peer ReWalk is currently the only exoskeleton device listed on the Therapeutic Goods register (categorised as Class II), but we understand from management that Rex is in the final stages of approval and has been approved for sale in the Australian market. Source: FDA, MHRA, Australian Therapeutic Drugs Administration, Edison Investment Research Rex Bionics 27 February

4 Demonstrate clinical and economic effectiveness through trials Rex has completed its first clinical trial, RAPPER I (Robot Assisted Physiotherapy Exercises with Rex), which was an 11-patient study to assess the feasibility of carrying out sophisticated physiotherapy with the Rex. The trial has been completed and full results will be presented at medical conferences over the next few months. There were no adverse events (injuries or undue stress) and 10 of the patients were able to complete the exercises and use the Rex joystick effectively. The 11th patient could not participate in the trial because they did not meet the size requirements. A second trial (RAPPER II) involving 100 patients will focus on the safety and feasibility of the Rex as an assistive rehabilitation device from both the patient s and the rehab centre s points of view. We see this as the key trial that should accelerate adoption, because if it can demonstrate a clear economic benefit to rehab centres it should be easier to persuade them to purchase a device. The principal medical investigator has been assigned, an ethics committee approval is expected within the next few weeks and the first patient is expected to be recruited soon after that. Trials may also be conducted for other indications such as stroke and MS. These will be conducted separately because of the differing levels of mobility and rehabilitation requirements. Clinical trials will also be important in persuading insurance companies to reimburse users for both personal injury claims and health insurance purposes. One of Rex s peers has announced that its device is covered by a major German insurance company, which is good news for the whole industry because it shows that at least some insurers are willing to reimburse users for exoskeleton devices. We assume 1.5m will be spent on trials in FY16 and 1m in FY17. Research and development The main focus of research and development is on the Rex P102, which is an adjusted version of the current Rex device that will be submitted for FDA clearance. The following generation of device will then be the Rex 3, which should be lighter, quicker and cheaper to produce. Initially (at IPO) the intention was that the Rex 3 would be the first device to be submitted for FDA Class II clearance, but management has decided it needs to accelerate the clearance process and is therefore now developing the Rex P102 to submit for clearance with the FDA in Milestones for adoption Exhibit 2 sets out some of the key milestones that are required for more widespread adoption of Rex s devices. Exhibit 2: Key milestones Milestone Timescale Description Initiation of clinical trials Now RAPPER I is now complete with a positive outcome with full details expected to be presented over the coming months. We expect RAPPER II trial to have the most significant impact on sales, since if it demonstrates a clear economic advantage to rehab centres they are more likely to be inclined to purchase a device. US clinical trial to secure FDA 510(k) clearance for personal use in the US File 510(k) by end of H116 The European market is significant and therefore access to the US personal market is not critical at this stage in the company s development. But it does significantly extend the available market opportunity and therefore is important to maximising the potential of Rex. Recruitment of further reference centres Recruitment of distribution partners Complete development of next generation of device Rex 3 Obtain FDA clearance for Rex 3 10 reference centres by end FY15 Ongoing Source: Edison Investment Research, Rex Bionics Rex currently has signed reference centres in the UK, US and New Zealand and hopes to sign 10 by the end of FY15. Reference centres will be used to conduct the trials and will also be used for marketing by providing Rex devices for use to people who wish to try them out. Distribution partners could greatly accelerate uptake and allow Rex to access geographies that it doesn t operate in directly. At the moment the main priority is around building awareness and Rex is doing this through exhibiting at international exhibitions and conferences such as the Arab Health Conference in Dubai Development of the Rex 3 generation has been pushed back six months due to the focus on getting the current generation of devices through FDA clearance and clinical trials. Development of Rex 3 is now expected to be completed by 2017, at which point it will be submitted for FDA trials and European CE mark review The Rex 3 device will also need to obtain clearance from the FDA for personal use. The length of the process might be shortened if the current device is cleared, but it will still be necessary to gain approval. Rex Bionics 27 February

5 Rehabilitation device market There are two target markets for Rex: rehab centres and personal use. Physiotherapy centres can use Rex to enable patients with mobility problems (such as those with SCI, stroke, MS) to stand upright and move. Simply enabling people to do this is widely believed (although clinical trials are still necessary to prove it) to have numerous health benefits including reduced bladder and urinary tract complications, reduction in pressure sores, improved bowel function, improvement in bone density and a significant psychological benefit. People with complete spinal cord injuries are those that are likely to benefit most from the use of Rex units since there is likely to be a complete loss of mobility in the legs. Exhibit gives a summary of the types of spinal cord injury and some statistics on the rate of incidence in the UK and US. EU-wide statistics are not currently available. Exhibit 3: Spinal cord injury statistics Total number people with injury Annual incidence Description Incidence Injury Description US UK US UK (%) level Complete tetraplegia 20.4% C1-C8 52,836 10,200 2, A complete break in the cervical region of the spine usually means at least some loss of sensory or motor control of the arms and complete loss of sensory and motor control in the trunk and legs. Ekso and ReWalk can currently be used up to C7 injuries if motor control of the arms is retained. Incomplete tetraplegia Complete paraplegia Incomplete paraplegia 30.1% C1-C8 77,959 15,050 3, The injury is at a relatively high level in the spine, resulting in weakness in the arms and chest. Incomplete injury means some motor function or sensory perception remains below the level of the injury. 25.6% T1-L5 66,304 12,800 3, There is a complete break in the thoracic or lumbar region of the spinal cord. Complete loss of motor and sensory function in legs but control of hands and arms is typically retained. 18.5% T1-L5 47,915 9,250 2, Depending on the extent of the damage to the spinal cord, the degree of the resulting disability can vary significantly, from loss of some sensory perception to almost complete loss of motor control. For this reason it is very difficult to assess what proportion of these individuals would benefit from the use of an exoskeleton. Other 5.4% 13,986 2, Total 259,000 50,000 12,000 1,000 Source: The University of Alabama at Birmingham National Spinal Cord Injury Statistical Center Spinal cord Injury Facts, Spinal Research Facts and figures Robot-assisted physiotherapy There are many claimed benefits of robot-assisted physiotherapy, both from the patient s point of view and the physiotherapist's. Patients with SCI tend to spend a significant amount of time sitting and lying down, which can cause numerous complications such as pressure sores and loss of bone density, and so are encouraged to spend time standing to help reduce the likelihood of these complications. This can be achieved using various methods such as manual assistance from physiotherapists, standing frames, tilt tables or the use of devices such as Rex. The psychological benefit for the patient using Rex cannot be underestimated. Much of the evidence for these various medical benefits is anecdotal at this stage and trials are therefore important to provide more solid evidence to feed into purchasing decisions. The benefit of using a device such as Rex from the physiotherapists and healthcare provider s point of view is that it could potentially reduce the number of physiotherapists needed per patient, thereby allowing more patients to be treated at the same time. There could also be cost savings from the potential reduction in complications that result from long periods of sitting or lying down, which will also factor into the purchase decision. Reference centres In early December 2014, PhysioFunction, a small UK-based provider of specialist neurological physiotherapy and rehabilitation technology, announced it was launching a physiotherapy service using Rex units. One Rex unit will initially be made available for private payers at an outpatient clinic, in the hope that it will be extended to PhysioFunction s 14 other neurological physiotherapy Rex Bionics 27 February

6 facilities. Rex will provide the device for no initial cost and will instead receive a share of customer fees. PhysioFunction will also act as a reference centre for clinical trials and as a test centre for users who are considering purchasing or leasing a Rex unit. The Houston Methodist Hospital in Texas and Healthvision in New Zealand have also been signed up as reference centres and management hopes to sign up a total of 10 centres by the end of Funding crucial to adoption in Personal Use Market There are a number of funding methods that could be used to purchase Rex devices: healthcare providers, charities, health insurance companies, personal injury claims and private payment from individuals. We view charities and healthcare providers as the main source of revenue initially, followed by personal unit sales paid for either by charities or through personal injury claims. Estimates on Jeffries-Solicitors.com suggest that up to 1,200 spinal cord injuries occur every year in the UK with most of these caused by road traffic accidents. According to claims.co.uk there are 50,000 people in the UK who have to live with paralysis. For funding to be provided through personal injury claims it is important that the courts set a precedent for awarding these devices for home use. We believe there is a case going through the courts at the moment for an award to include funding for a Rex device, but the outcome is to be announced. Claims awards are likely to be driven by positive user statements, case studies and positive outcomes from clinical trials. Rehab facilities and providers of healthcare funding may also be incentivised to use the Rex unit because of the cost savings from requiring fewer physiotherapists per patient and the reduced cost of medical complications as a result of the patients sitting or lying down for long periods. Competition Exhibit 4: Comparison of alternative products Product Est price Crutches req Battery FDA status life Ekso Bionics $120k Yes 6 hrs 510(k) submitted in Dec 2014 ReWalk $70k Yes 4 hrs Cleared for personal and rehab use (Class II) Indego (Parker Hannifin) $70-100k Yes 4 hrs Submission planned for early 2015 Rex Bionics $150k No 2 hrs Submission planned for H215 CYBERDYNE $15-20k N/A 3 hrs Achieved CE marking in Europe and submitted an application to the FDA in Nov 2014 Description Source: Parker Hannifin, Cyberdyne, Rex Bionics, Ekso Bionics, ReWalk The key advantage of Ekso's exoskeleton is the ability to provide variable levels of assistance, which is suitable for those with partial SCI and other mobility impairments where some degree of control remains. ReWalk is currently the only exoskeleton that is approved for home use by the FDA. It has a similar walking speed to Ekso's exoskeleton and is intended to be used by people with SCI from T4-L5 in a rehab setting or from T7 to L5 by a specially trained companion. It is currently developing a system that uses additional support to enable people with a higher level injury to use the exoskeleton. Although it is capable of climbing stairs the FDA de novo submission states that it is not intended to do so. Parker Hannifin s Indego exoskeleton is only available in Europe and the US for research purposes in clinical settings. Commercial availability is expected in mid-2015 in Europe and late 2015 in the US. It is currently undergoing trials with 40 people at five rehabilitation centres. Its key benefits are that it is compact enough to be fitted while the user is still in a wheel chair and it can provide variable assistance for those who are rebuilding leg strength. It can be used for injuries at C5 or lower. Rex s key competitive advantage is its crutch-free operation meaning that the user s hands are free to complete tasks while it is in use. It has already been used by a surgeon while conducting surgery and an employee of Rex uses it day-to-day in Rex s factory. Hands-free operation also means it can be used with a higher level of injury. Rex management suggests that it can be used for up to C4/C5 injuries. The trade-off of its inherent stability is that the unit is heavier and cannot employ the shifting weight of the user to help it move, which therefore increases the amount of work that needs to be put in by the motors. The battery life is therefore lower but this should improve for the next-generation device. The cost should also come down with the next generation of device. Cyberdyne s system relies on a degree of electrical signals reaching muscles and it is therefore not suitable for those with complete or severe spinal cord injuries and is mainly intended for those with stroke and other mobility issues where there is some muscle control. We do not view it as a direct competitor to Rex. It also produces and sells other devices such as robotic vacuum cleaners for offices. Rex Bionics 27 February

7 There are a number of companies developing exoskeleton-type devices that aim to assist rehabilitation and improve the mobility of patients with SCI and stroke. Exhibit 4 compares various aspects of each of the competitor devices. The market is still very immature and each device has advantages and disadvantages that make it suitable for different niches. Rex s key advantage is its inherent stability, which means crutches are not required and consequently it can be used by individuals with a higher-level SCI and by those who want to leave their hands free to perform other tasks. In some ways it is therefore complimentary to the competitor devices and management has reported a case where an insurance claim has been submitted for both a Rex device and one of the competitor s devices. Management The board of directors and management team has extensive experience in developing and bringing medical devices to market. Before Rex, Crispin Simon (CEO) was chief executive of Biocompatibles International, where he led a team that developed three medical product businesses (cardiovascular stents, contact lenses and drug-eluting beads), which were sold to third parties for a total of 390m. Peter Worall (CFO) has also been involved in a number of medical companies, including as CFO of venture capital start-up Vanguard, which went through an IPO in May 1996 and eventually merged with British Biotech to become Vernalis. Co-founder Richard Little (CTO) is still involved with the company and has held senior leadership roles in a number of medical and engineering companies and Jeremy Curnock Cook (deputy chairman) was formerly managing director of the Rothschild Bioscience Unit, where he was responsible for investing $1bn in over 160 companies. He is currently also managing director of Bioscience Managers, where he is responsible for a bioscience and healthcare fund. Sensitivities Financing: the amount of additional cash required for development will depend on the pace of uptake, but it is likely that additional cash will be needed at some point over the next two years to cover existing costs. Our current forecasts assume 10m of debt is raised before profitability is reached, but this could be funded through equity and is sensitive to the number of sales achieved. At 30 November 2014 Rex had c 5.8m of cash and is using 5m of cash per year. Clinical trials: a positive outcome from clinical trials will be important in providing the evidence required by healthcare providers to justify the purchase of a Rex device for rehabilitation purposes. If the benefits are not significant or cannot justify the cost, it may be more difficult for Rex to drive adoption on the rehab side. Regulations: FDA 510(k) clearance for personal use is one of the key sensitivities that will determine the pace and degree of uptake. While Europe by itself is a significant opportunity, access to the US personal use market will be key to realising Rex s full potential. Proving the safety of the Rex device is likely to be the prime concern of the FDA when assessing it for clearance. Personal injury claim awards: for the use of Rex as a personal use device we view clinical trials as less important as there is undoubtedly a significant psychological benefit to using Rex. What is more important for the personal use market is funding from personal claim awards and reimbursement from health insurance schemes. Setting a precedent for the award of Rex units could therefore be an important boost to the personal use market. Competition: in recent years there have been a number of companies providing exoskeleton and rehabilitation orthoses for those with SCI. While Rex is currently unique in that it is Rex Bionics 27 February

8 inherently stable (meaning it can be used for higher-level injury and provides hands-free use), other companies may develop a product that provides similar functionality. Financials Rex is in the process of changing its accounting period and therefore the current financial period will be 16 months long and end on 31 March Subsequent financial years will run from 1 April to 31 March. Revenue Although 14 devices are currently being used and PhysioFunction is providing a Rex device for private payers, we are not forecasting material sales growth until clinical and regulatory trials are completed. Awareness of Rex and the awarding of Rex devices in personal injury claims is only likely to come after more widespread use in rehabilitation centres, so we also forecast limited shortterm growth in personal unit sales. Our forecasts assume clinical trials have a positive outcome that will accelerate uptake. There remains a high degree of uncertainty over the pace of uptake so sensitivity analysis is key, but our forecasts assume sales of 1,250 units by 2020 and peak unit sales of 2,500 units per year by This could be exceeded if the trial data are positive and reimbursement by insurance providers becomes the norm. However, due to the uncertainty over forecasts we view the sensitivity analysis as the key tool for understanding valuation. Revenue is recognised upfront, although there is the potential for devices to be leased. As the number of units in use grows, service and maintenance, together with training fees, will also start to contribute materially to revenue. We assume 3% of the value of Rex units in use is spent on service and maintenance from the point of sale in 2015 growing to 10% by We also assume three days' training is provided at 750 per day. Three-year lifetime and 7,500 units used at peak Our forecasts are based on the adoption profile shown in Exhibit and assume a three-year average lifetime of each unit. The peak number of units in use at any one time is assumed to be just over 7,500, which is just 2.4% of the US and UK combined tetraplegic and paraplegic populations. This level of sales can be achieved through a combination of personal use devices and rehab centres, but is likely to require a significant proportion from personal sales. Exhibit 5 puts these sales figures in context by giving some statistics on wheelchair users and SCI cases. Exhibit 5: Units sales in context Exhibit 6: Assumed adoption curve 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000, ,000 - Wheelchair users in EU Wheelchair users in the UK Wheelchair users in the US Total SCI cases US Units sold (per annum) 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1, Units sold Cumulative units in use Source: Edison Investment Research Source: Edison Investment Research Rex Bionics 27 February

9 Uptake assumptions lower than peers Exhibit 7: Unit sales comparison with peers Units sold M 2014 Rex Bionics ReWalk Ekso Bionics Source: ReWalk, Ekso Bionics, Rex Bionics We have taken a conservative stance and forecast lower unit sales growth for Rex than its peers ReWalk and Ekso have experienced. If the trials are successful and insurance companies reimburse the costs of the device for those with spinal cord injury, the unit sales growth could greatly exceed forecasts. Exhibit shows the historic growth profile for ReWalk, Ekso and Rex. The last three quarters in particular have shown strong growth at both ReWalk and Ekso and so demand for these types of device clearly exists and is increasing. We attribute the slower uptake of Rex compared to Ekso and ReWalk primarily to the length of time that Rex has operated in the European and US markets compared to its peers. Rex has only been able to ramp up marketing efforts since listing last year, whereas Ekso and ReWalk have been in those markets for longer. We therefore believe it has similar growth potential once clinical trials are complete, the FDA gives clearance and the sales and marketing effort has been given the time to pay off. Significant manufacturing savings as scale increases The average selling price is assumed initially to be $150k, but we forecast this will fall to $100k in This is higher than peers, partly due to its requirement to be inherently stable, but we also expect it to come down significantly. Gross margins are initially assumed to be 40%, but we expect them to improve over time despite the ASP reduction due to significant cost savings from scale production. At the moment many components are 3D printed, which makes production flexible but expensive. Moving to larger-scale production methods should lower production costs significantly. We forecast gross margins improving to 72% by Operating expenses Rex s main expenditure is staff costs. It is a business with relatively low capital requirements and current manufacturing capacity could produce c 25m worth of sales. We therefore forecast only a low level of maintenance capex of c 165k in FY15 growing to 250k in FY16 and 300k in FY17. Rex currently has 32 employees (10 manufacturing, six sales and marketing, nine in R&D and seven in corporate and admin. We forecast the total annual salary expense to be c 2.6m in FY15 with manufacturing and sales staff increases as the business grows. We assume that each device takes a three-man team a month to produce and capex required for additional capacity of 250 units per year is c 100k. We forecast 1.5m is paid towards the cost of clinical trials in FY16 and 1m in FY17 with other costs (utilities, premises, etc) to cost 1.4m in FY16 and 2.3m in FY17. We cap the long-term operating margins at 20% as we believe this would be a reasonable operating margin target for a high-tech medical device company such as Rex. Balance sheet Rex Bionics has a relatively simple balance sheet with only 4m goodwill and 14m intangibles related to the acquisition of Rex Bionics, 0.3m of PPE and 0.2m of working capital. The last Rex Bionics 27 February

10 reported cash position was at 31 January 2015, at which point there was 5.0m cash and no debt. This cash is sufficient to support the business for another 12 months, but we believe further cash will need to be raised before profitability is reached. Our model assumes peak net debt of 9.9m before Rex reaches profitability in 2019, but this funding could also be raised through equity. Exhibit shows how the peak net debt requirement changes with assumed unit sales in The payment terms for suppliers and customers will develop as sales grow, but we currently assume payment within 60 days. If the leasing business model takes off, the working capital requirement will be higher but we have not incorporated this in our forecast. Exhibit 8: Peak net debt sensitivity analysis 2018 Unit sales Peak net debt Source: Edison Investment Research Valuation Given the relative immaturity of the market and the uncertainty over the growth rate and market size, we believe a DCF valuation with sensitivity analysis is the key valuation tool. Exhibit shows the DCF valuation produced under various unit sales assumptions by different dates and with 15% WACC and 3% terminal growth from 2030 and an operating margin cap of 20%. The grey square in Exhibit 9 reflects a per share valuation roughly equal to the current share price and indicates that sales will have to grow to 207 units by 2020 to support this valuation. If unit sales reach 500 by 2020 the DCF produces a valuation of 261p. If that level of sales is reached in 2024 instead, the DCF produces a valuation of 164p. Exhibit 9: DCF Sensitivity analysis Annual unit sales in specified year ,000 1, N/A N/A N/A Source: Edison Investment Research. Note: Green indicates prices above the current share price. Figures within table are DCF per share valuation in GBP. Year A peer comparison like the one presented in Exhibit is also useful to indicate how Rex is priced against its peers on an EV/Sales basis. It is clearly at a significant discount to all its peers. Some of this discount may be justified due to the unproven nature of the product, but the discount should narrow if the clinical trials have a positive outcome, insurers start reimbursing devices, the FDA gives clearance for personal use and the number of sales demonstrably increases. Exhibit 10: Peer valuation table Market cap Units Net cash Sales (US$m) Operating income (US$m) Est next sales EV EV/sales (US$m) in use (US$m) FY13 9m14 FY13 9m14 (US$m) (US$m) (x) Ekso Bionics Holdings (10.3) (11.9) ReWalk Robotics (8.7) (14.6) CYBERDYNE 1, (5.7) (10.9) , Rex Bionics (0.5) N/A Source: Edison Investment Research, Bloomberg. Note: Priced at 25 February Ekso estimated sales next year is the total value of devices sold assuming revenue is recognised upfront. Est next Sales is for FY16 for those with December year end (Ekso and ReWalk) and FY17 for those with March year end (Cyberdyne and Rex). The success of Rex is highly dependent on the outcome of the clinical trials and whether the FDA approves the device for personal use. We believe it is highly likely that the exoskeleton market will grow significantly over the next years and that that is the timescale where the most gains can be made. Rex is priced at a level where the upside is very much greater than the downside, but there is still a high degree of uncertainty around whether the device will be successful. The early Rex Bionics 27 February

11 indications are encouraging, but clinical trial results and FDA clearance are key milestones to reduce risk and accelerate uptake. Exhibit 11: Financial summary '000s m 2015e 2016e 2017e 31-March IFRS IFRS IFRS IFRS IFRS PROFIT & LOSS Revenue ,000 4,954 Cost of Sales (437) (1,978) Gross Profit ,976 EBITDA (358) (498) (4,249) (5,276) (5,037) Operating Profit (before amort. and except.) (358) (498) (4,353) (5,329) (5,089) Intangible Amortisation 0 0 (800) (876) (818) Exceptionals Other Operating Profit (358) (496) (5,153) (6,205) (5,907) Net Interest (400) (400) Profit Before Tax (norm) (358) (498) (4,353) (5,729) (5,489) Profit Before Tax (FRS 3) (358) (496) (5,153) (6,605) (6,307) Tax Profit After Tax (norm) (358) (496) (4,353) (5,729) (5,489) Profit After Tax (FRS 3) (358) (496) (5,153) (6,605) (6,307) Average Number of Shares Outstanding (m) EPS - normalised (p) (1.4) (1.5) (30.5) (40.1) (38.4) EPS - normalised and fully diluted (p) (1.4) (1.5) (30.5) (40.1) (38.4) EPS - (IFRS) (p) (1.4) (1.5) (36.1) (46.2) (44.1) Dividend per share (p) Gross Margin (%) N/A N/A EBITDA Margin (%) N/A N/A N/A N/A N/A Operating Margin (before GW and except.) (%) N/A N/A N/A N/A N/A BALANCE SHEET Fixed Assets ,532 16,853 16,283 Intangible Assets ,268 16,392 15,574 Tangible Assets Investments Current Assets ,403 10,988 6,222 Stocks 0 0 1, Debtors Cash ,214 10,519 4,660 Current Liabilities (112) (390) (514) (2,025) (2,996) Creditors (112) (390) (514) (2,025) (2,996) Short term borrowings Long Term Liabilities (10,000) (10,000) Long term borrowings (10,000) (10,000) Other long term liabilities Net Assets 274 (206) 22,421 15,816 9,509 CASH FLOW Operating Cash Flow (109) (208) (6,279) (4,191) (6,257) Net Interest (400) (400) Tax 0 0 1,031 1,146 1,098 Capex 0 0 (321) (250) (300) Acquisitions/disposals Financing , Dividends Net Cash Flow 382 (208) 4,040 (3,695) (5,859) Opening net debt/(cash) 0 (382) (174) (4,214) (519) HP finance leases initiated Closing net debt/(cash) (382) (174) (4,215) (519) 5,340 Source: Edison Investment Research, Rex Bionics AIM admission document. Note: FY15e is for the 16-month period to 31 March 2015, which is the current reporting period and is being used to transition from the November year end of Union MedTech to the March year end of Rex Bionics. Rex Bionics 27 February

12 Contact details Thame Park, Thame Park Road Thame, Oxfordshire OX9 3PU United Kingdom +44 (0) Revenue by geography CAGR metrics Profitability metrics Balance sheet metrics Sensitivities evaluation EPS 13-17e N/A ROCE 16e N/A Gearing 16e N/A Litigation/regulatory EPS 15-17e N/A Avg ROCE 13-17e N/A Interest cover 16e N/A Pensions EBITDA 13-17e N/A ROE 16e N/A CA/CL 16e 0.5 Currency EBITDA 15-17e N/A Gross margin 16e 41.1% Stock days 16e Stock overhang Sales 13-17e 116.4% Operating margin 16e N/A Debtor days 16e 57.0 Interest rates Sales 15-17e N/A Gr mgn / Op mgn 16e N/A Creditor days 16e Oil/commodity prices Management team CEO: Crispin Simon CFO: Peter Worrall Crispin has led and developed a number of medical products business over his Peter also has significant experience in the medical industry. He was CEO of 25-year career in the industry. While chief executive at Biocompatibles Pharminox and corporate development director of Vernalis, which was formed International, he developed three medical products business that were ultimately through the merger of Vanguard Medica Group, where Peter was CFO, and sold for a total of 390m. He has also previously been a director in the UK British Biotech. Peter joined Vanguard as CFO when it was just starting up with government's Department of Business, Innovation and Skills and a nonexecutive director of the NHS Trust Development Authority. public funding rounds. backing from venture capitalists and saw it through a number of private and CTO: Richard Little Richard Little is a Scottish engineer who co-founded Rex Bionics in 2007 In New Zealand with fellow engineer Robert Irving. Richard s previous experience was in marine engineering, IT, programme management and R&D. N/A Principal shareholders (%) No 8 Ventures 15 Hunter Hall 13 Paul Matthews 12 Asia Pacific Healthcare II 12 FMR (Fidelity) 10 Richard Little 5 Robert Irving 5 Companies named in this report ReWalk, Ekso Bionics, Parker Hannifin, Cyberdyne Edison, the investment intelligence firm, is the future of investor interaction with corporates. Our team of over 100 analysts and investment professionals work with leading companies, fund managers and investment banks worldwide to support their capital markets activity. We provide services to more than 400 retained corporate and investor clients from our offices in London, New York, Frankfurt, Sydney and Wellington. Edison is authorised and regulated by the Financial Conduct Authority (www.fsa.gov.uk/register/firmbasicdetails.do?sid=181584). Edison Investment Research (NZ) Limited (Edison NZ) is the New Zealand subsidiary of Edison. Edison NZ is registered on the New Zealand Financial Service Providers Register (FSP number ) and is registered to provide wholesale and/or generic financial adviser services only. Edison Investment Research Inc (Edison US) is the US subsidiary of Edison and is regulated by the Securities and Exchange Commission. Edison Investment Research Limited (Edison Aus) [ ] is the Australian subsidiary of Edison and is not regulated by the Australian Securities and Investment Commission. Edison Germany is a branch entity of Edison Investment Research Limited [ ]. DISCLAIMER Copyright 2015 Edison Investment Research Limited. All rights reserved. This report has been commissioned by Rex Bionics and prepared and issued by Edison for publication globally. All information used in the publication of this report has been compiled from publicly available sources that are believed to be reliable, however we do not guarantee the accuracy or completeness of this report. Opinions contained in this report represent those of the research department of Edison at the time of publication. The securities described in the Investment Research may not be eligible for sale in all jurisdictions or to certain categories of investors. This research is issued in Australia by Edison Aus and any access to it, is intended only for "wholesale clients" within the meaning of the Australian Corporations Act. The Investment Research is distributed in the United States by Edison US to major US institutional investors only. Edison US is registered as an investment adviser with the Securities and Exchange Commission. Edison US relies upon the "publishers' exclusion" from the definition of investment adviser under Section 202(a)(11) of the Investment Advisers Act of 1940 and corresponding state securities laws. As such, Edison does not offer or provide personalised advice. We publish information about companies in which we believe our readers may be interested and this information reflects our sincere opinions. The information that we provide or that is derived from our website is not intended to be, and should not be construed in any manner whatsoever as, personalised advice. Also, our website and the information provided by us should not be construed by any subscriber or prospective subscriber as Edison s solicitation to effect, or attempt to effect, any transaction in a security. The research in this document is intended for New Zealand resident professional financial advisers or brokers (for use in their roles as financial advisers or brokers) and habitual investors who are wholesale clients for the purpose of the Financial Advisers Act 2008 (FAA) (as described in sections 5(c) (1)(a), (b) and (c) of the FAA). This is not a solicitation or inducement to buy, sell, subscribe, or underwrite any securities mentioned or in the topic of this document. This document is provided for information purposes only and should not be construed as an offer or solicitation for investment in any securities mentioned or in the topic of this document. A marketing communication under FCA rules, this document has not been prepared in accordance with the legal requirements designed to promote the independence of investment research and is not subject to any prohibition on dealing ahead of the dissemination of investment research. Edison has a restrictive policy relating to personal dealing. Edison Group does not conduct any investment business and, accordingly, does not itself hold any positions in the securities mentioned in this report. However, the respective directors, officers, employees and contractors of Edison may have a position in any or related securities mentioned in this report. Edison or its affiliates may perform services or solicit business from any of the companies mentioned in this report. The value of securities mentioned in this report can fall as well as rise and are subject to large and sudden swings. In addition it may be difficult or not possible to buy, sell or obtain accurate information about the value of securities mentioned in this report. Past performance is not necessarily a guide to future performance. Forward-looking information or statements in this report contain information that is based on assumptions, forecasts of future results, estimates of amounts not yet determinable, and therefore involve known and unknown risks, uncertainties and other factors which may cause the actual results, performance or achievements of their subject matter to be materially different from current expectations. 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Frankfurt +49 (0) Rex Schumannstrasse Bionics 34b 27 February High Holborn 245 Park Avenue, 39th Floor Level 25, Aurora Place Level 15, 171 Featherston St Frankfurt Germany London +44 (0) London, WC1V 7EE United Kingdom New York , New York US Sydney +61 (0) Phillip St, Sydney NSW 2000, Australia Wellington +64 (0) Wellington 6011 New Zealand

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