ORTHOPEDIC INDUSTRY OVERVIEW May 2014 Investment banking services are provided by Harris Williams LLC, a registered broker-dealer and member of FINRA and SIPC, and Harris Williams & Co. Ltd, which is authorised and regulated by the Financial Conduct Authority. Harris Williams & Co. is a trade name under which Harris Williams LLC and Harris Williams & Co. Ltd conduct business.
ORTHOPEDIC PRODUCTS MARKET OVERVIEW The $35.5 billion worldwide orthopedic products market is forecasted to grow 3.5% annually to reach $38.0 billion by 2015P. Industry growth is supported by demand drivers such as the aging of the population, individuals desire to remain active later in life, the increasing prevalence of obesity, and the expansion of healthcare coverage. Spine, knees, hips, and trauma products make up more than 65% of the total orthopedic products market. Increased outsourcing by OEMs and supplier consolidation will drive above-market growth for outsourced precision manufacturers. WORLDWIDE ORTHOPEDIC PRODUCTS MARKET For the Years Ended and Ending December 31, 2007 2015P ($ in billions) $40 $35 $30 $25 $27.2 $30.3 $31.4 $32.6 $33.9 $34.4 $35.5 $36.6 $38.0 Biologics Dental Imp. Sports Med. CMF Extremities Trauma $20 Hips $15 $10 Knees $5 Spine $0 2007 2008 2009 2010 2011 2012 2013 2014E 2015P 1
GROWTH IN ORTHOPEDIC IMPLANTS Orthopedic procedures are anticipated to grow 3 4% annually through 2015P. Stable and growing demand for orthopedic implants is driven by: An aging population will require more orthopedic implants; by 2015P, the U.S. population over 65 years old will reach 48 million, an increase of over 18% from 2010 A rise in osteoporosis-related fractures and musculoskeletal diagnoses are driving increased orthopedic procedure volume, particularly for individuals age 65 or older Medical expenditures related to obesity have doubled over the last decade and currently represent an annual spend of approximately $150 billion in the U.S. Active lifestyle trends have resulted in increased implant volumes for younger demographics Technology advances are making devices last longer, fueling younger patient acceptance of life-long implants FAVORABLE SECULAR DEMOGRAPHIC TRENDS DRIVE SUSTAINED ORTHOPEDIC PROCEDURE VOLUME GROWTH 20% 15% 10% 5% 0% 100% 80% 60% 40% 20% 0% 40% 35% 30% 25% 20% United States Population 65 or Older (1) % of Musculoskeletal Diagnoses Which are for Individuals 65 or Older (1) 25.0% Dislocations 40.3 41.4 43.1 22.3% 33.0% 35.0% Infective Arthritis Back Problems 42.0% 43.0% Rheumatoid Arthritis Sprains / Strains 57.0% % of Obese Americans Over Time (2) 30.3% 30.6% 32.3% 76.0% 86.0% Osteoarthritis Osteoporosis Hip Fracture 34.7% 33.9% 35.9% '88-'94 '99-'00 '01-'02 '03-'04 '05-'06 '07-'08 '09-'10 47.7 2010 2011 2012 2015P 2020P 2025P 56.0 65.1 For the Years Ended and Ending December 31, 2010 2015P (3) (procedures in millions) 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 3.11 3.23 3.34 3.46 3.57 3.69 2010 2011 2012 2013 2014E 2015P Spine Knees Hips Extremities (1) 2012 Ortho Industry Annual Report. (2) CDC. (3) MedTech Insight. 2
OUTSOURCED ORTHOPEDIC PRECISION MANUFACTURING MARKET OVERVIEW The outsourced orthopedic precision manufacturing market is forecasted to grow from $3.0 billion in 2012 to $4.2 billion in 2017P, an increase of 6.9%. Market growth is projected to outpace the broader orthopedic products market as OEMs increasingly outsource precision component manufacturing. The outsourced orthopedic precision manufacturing market includes manufacturers of implants, instruments, and cases & trays. Implants represent the largest and fastest growing segment and are expected to grow from $1.7 billion to $2.4 billion, representing a 8.0% CAGR Instruments are the second largest and second fastest growing manufacturing segment at and are projected to grow at 5.6% CAGR The cases & trays segment is projected to maintain stable growth of 5.3% as the majority of these products are already outsourced The top six OEMs represent approximately 70% of the total orthopedic products market and are served by a highly fragmented base of outsourced precision manufacturing partners. Those expected to experience the fastest growth are outsourced precision manufacturers with specialized, full-service capabilities Full-service precision manufactures are particularly well positioned for growth as they offer OEMs a one-stop-shop solution As a result, many OEMs are consolidating their base of suppliers to a select group of manufacturers with a broad set of capabilities GROWTH IN OUTSOURCED PRECISION MANUFACTURING SEGMENTS For the Years Ended and Ending December 31, 2005 2017P ($ in millions) 12 17P CAGR 5,000 4,000 3,000 2,000 1,000 0 $2,465 $1,960 $2,195 360 295 325 715 805 905 $4,205 $3,932 489 466 $2,750 1,005 880 930 1,000 970 1,021 1,075 1,150 1,210 1,274 400 350 370 390 377 396 415 444 $2,630 $2,780 $2,990 $3,010 $3,217 $3,438 $3,678 950 1,065 1,200 1,345 1,400 1,480 1,600 1,663 1,800 1,948 2,084 2,256 2,442 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014E 2015P 2016P 2017P Implants Instruments Cases & Trays 7% 5% 6% 8% Source: Industry research. 3
INCREASED OEM OUTSOURCING Global medical device OEMs continue to aggressively outsource non-core functions. Most medical device companies are increasingly focusing their resources primarily on research, product development, and marketing. Outsourcing manufacturing allows OEMs to increase speed to market by concentrating on core competencies Outsourced manufacturing is a valuable cost reduction tool, allowing OEMs to maintain a variable cost structure. Outsourced implant manufacturing is projected to outpace the broader orthopedic manufacturing industry, growing 8.0% annually from 2012 to 2017P, driven by an increase in outsourcing penetration. GLOBAL ORTHOPEDIC OEM IMPLANT SPEND For the Years Ended and Ending December 31, 2012 2017P ($ in billions) $6 Outsourced Implant Spend Insourced and Other OEM COGS $5.5 12 17P CAGR 6% $5 $4 $4.2 $3.1 4% $3 $2.5 $2 $1 $1.7 $2.4 8% $0 2012 2017P Outsourcing as % of COGS 39.6% 44.3% Source: Industry research. 4
PROVIDER OF SCALE MARKET SHARE GAINS Providers of scale will benefit disproportionately as OEMs continue to consolidate their supplier base. The outsourced orthopedic precision manufacturing industry remains highly fragmented, while the medical device OEM customer base has consolidated. Major outsourced precision manufacturers represent approximately 30% of the total outsourced market Full-service precision manufacturers of scale are projected to grow faster than the broader outsourced manufacturing market. Industry trends are pushing business to larger manufacturers with a highly valuable set of broad and differentiated capabilities Smaller operators lack the resources to keep up with stringent regulatory requirements and are being pressured to sell SIGNIFICANT PENETRATION GROWTH EXPECTED IN IMPLANTS For the Years Ended and Ending December 31, 2012 and 2017P ($ in billions) $6 $5 $4 $3 $2 $1 $0 $4.2 Outsourced 40% Insourced 60% $5.5 Outsourced 44% Insourced 56% 2012 2017P OEMs desire to focus on core competencies and leverage outsourced manufacturing partners will drive further penetration of the insourced opportunity. OUTSOURCED ORTHOPEDIC PRECISION MANUFACTURING INDUSTRY REMAINS HIGHLY FRAGMENTED Major Outsourced Precision Manufacturers 31% 2013 Market Size $3 Billion Thousands of Other Small Companies 69% OUTSOURCED PARTNERS SERVE A LIMITED NUMBER OF MEDICAL DEVICE OEMS All Others 32% Biomet 6% 2013 Market Size $35.5 Billion Medtronic 7% Smith & Nephew 8% DePuy Synthes 22% Zimmer 10% Stryker 15% Source: Industry research and Orthopedic Industry Annual report. 5
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