global medical equipment and supplies...
TRANSCRIPT
GLOBAL MEDICALEQUIPMENT AND SUPPLIESREPORT 2014
A C l e A rwAt e r I n t e r n At I o n A l t e A m r e p o rt
Welcome
2014 thus far has been marked by a number of notabletransactions in the global medical equipment and suppliessector, as leading players sought to expand further into newmarkets and geographies while taking advantage of exciting newtechnologies.
The trend for big ticket deals this year - such as Medtronic'swhopping €31.6bn acquisition of Covidien, Thermo Fisher'stakeover of Life Technologies Corporation, and Zimmer's bid forBiomet - continues the drive that emerged in 2013. We alsothink the second half of 2014 promises plenty of action on theM&A front, typified by the intense speculation this summer overthe future of Smith & Nephew as it is courted by US players.
Although deal activity in the US dropped slightly last year, itremains by far the most active market for M&A activity in thesector with trade players leading the way. However a morerigorous regulatory climate is putting pressure on the industryespecially in the VC arena.
US buyers continue to look overseas with Europe remaining anattractive location, whilst Far East companies and investors arebecoming notably more adventurous. The trend is typified bythe likes of Chinese medical devices developer Mindray MedicalInternational acquiring Zonare Medical Systems of the US, andby the activity of Indian private equity firm Samara Capitalwhich has made a number of investments in the health market.
Such global activity is ultimately being driven by the fact thatmedical device companies across the world are facing the samesignificant resource and financial constraints at precisely the timethat new innovation is so paramount. In so doing it is creating alandscape that is both challenging and exciting in equal measure.
We hope you enjoy the read.
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ContentsGLOBAL M&AACTIVITY 4
The industry remains a major sourceof deal activity in the health sector
2013 M&A HIGHLIGHTS 6
Last year was notable for anumber of big ticket transactions
US MARKET 10
The US industry continues to lead the way in terms of M&A activity
EUROPEAN MARKET 14
The continent remains home to a number of leading companies in the industry
ASIAN MARKET 19
Ambitious new players from the Far East are spreading their global footprint
CLEARWATERINTERNATIONAL DEALS 22
A round-up of recent ClearwaterInternational transactions in thehealthcare industry
For the purposes of this report we havequoted all figures in euros using an average£/€ exchange rate.
2012 1.23 2013 1.18 2014 1.21
This report is published by Clearwater International Editors: Jim Pendrill & Sarah FernandezDesign: www.creative-bridge.comSubscription: [email protected] part of this publication may bereproduced or used in any form without prior permission of Clearwater International.
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 42
ramesh JassalDirector, UK
+44 845 052 [email protected]
the medical equipment and supplies sector can be broken down into the following sub-sectors:
Stents and pacemakers; cardiovascular equipment, therapies, and implant devices; solutions in
cardiovascular disease, soft tissue repair and critical care management; cardiology, radiology
and vascular surgery devices.
Cardiovascular
Dental equipment and supplies, dental implants and prosthetics, dental imaging systems, dental
waxes and mouldings, dental laser systems, and any other dental accessories.
Dental
General disposable equipment and supplies including gloves, syringes, catheters, electrodes,
bandages, plasters, first-aid kits, sutures, medical register paper, drainage bags, feeding bags, and
wound management and compression products.
DisposableEquipment & Supplies
Hospital, clinic and outpatient equipment and supplies (including non-disposable durable
equipment such as ventilation, patient handling products, rehab and medical furniture). Surgical
aesthetic and electrosurgical devices, instruments and apparatus including carts, tables and
consoles and hearing devices.
GeneralEquipment & Supplies
Chemistry, microbiology, immunology and genetic tests, diagnostic instruments and equipment
related reagents and test kits including blood diagnostic tests used in the detection and
monitoring of diseases and disorders.
In VitroDiagnostics,Equipment & Supplies
Any equipment used by laboratories including instruments, glassware and machines. Kits and
reagents for life science research, DnA sample storage equipment and technology, and
products used in protein interaction.
Life Science Tools& Services
Implants for neurovascular purposes, electrical stimulations, neurovascular equipment,
neuromodulation units, and medical devices for the treatment of neurological diseases.
Neurovascular
eye-related products including contact lenses, intraocular lenses, cataract surgical devices, eye
tracking devices, and laser vision correction products. ophthalmic instruments, imaging
systems and viscoelastic devices. optical scanners, coherence tomography diagnostic devices,
and optoelectronic measurement devices.
OphthalmicGoods, OpticalInstruments &Lenses
limb, hip, knee, shoulder, ear, nose, throat and mouth implants; jaw prosthetics; and
orthopaedic braces, plates, supports and shoes.
OrthopaedicImplants &Prosthetics
equipment monitoring vital signs e.g. blood pressure monitoring. Imaging equipment (including
medical cameras) e.g. mrI, Ct, X-ray, ultrasound. other patient monitoring and intervention
products including defibrillators. remote monitoring products and radiography, radiotherapy
products and home therapy.
PatientMonitoringEquipment &Therapies
A C L E A R WAT E R H E A LT H C A R E T E A M R E P O R T 3
Sector split
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 44
The 10 largest transactions so far this year havecontributed to €16,159m of total deal values, averaginga 3.9x revenue and a 21.2x EBITDA multiple.
Thermo Fisher Scientific’s blockbuster €12.2bnacquisition of Life Technologies Corporation single-handedly accounted for 71% of value. Life Technologiesis a US company that forms cell culture productswhich are deployed in biological drug research,development and production. The acquisition willcatapult Thermo, the world's largest maker of scientificand laboratory equipment, to the forefront of thefledgling field of personalised medicine.
The first five months of 2014 have seen good levels of deal activity with 82 deals.
In 2013, there was a total of 283 deals in the medical equipment and supplies sector compared to 330 deals in 2012- a decline of 14%. Average deal size with values disclosed decreased from €251m to €219m in 2013, although theaverage figure for deals under €600m increased from €69m to €79m.
Global M&A activity
number of deals 330 283 82
Total deals 2012 2013 2014 (Jan - May)
number of deals 141 116 37
transaction value (€m) 35,449 25,405 17,217
Average deal size (€m) 251 219 465
Total deals (with values disclosed) 2012 2013 2014 (Jan - May)
number of deals 133 108 33
transaction value (€m) 9,093 8,515 2,487
Average deal size (€m) 69 79 75
Deals less than €600m(with values disclosed)
2012 2013 2014 (Jan - May)
5
0 200 400 600 800 1000 1200
€m
Fluidigm/ DVS
Oxford Instruments/Andor Technology
Integra Lifesciences/Surgical business
Microport Medical/Orthorecon business
Cardinal Health/AccessClosure
Accellent/Lake Region Manufacturing
bioMérieux/Biofire Diagnostic
Covidien/Given Imaging
GE Healthcare/Cell culture business
Smith & Nephew/Arthrocare
2014 top 10 deals (Jan - May)
A C L E A R WAT E R I N T E R N AT I O N A L T E A M R E P O R T
n Smith & nephew acquired ArthrocareCorporation, an innovative US company that
specialises in designing and manufacturing
surgical devices and implants for sports injuries,
for €1.1bn. the acquisition will enable Smith and
nephew to accelerate their strategy in
rebalancing the company towards higher growth.
the transaction was valued at 4.0x revenue.
n Ge Healthcare acquired thermo FisherScientific’s cell culture, gene modulation
and magnetic beads businesses for €782m.
the deal helps Ge expand and accelerate the
development of innovative technologies for cell
biology research, cell therapy and for the
manufacture of innovative biological medicines
and vaccines. the transaction was valued at
4.2x revenue.
n Covidien acquired Given Imaging, a developer ofinnovative swallowable imaging capsules for
endoscopy, diagnostic and monitoring technologies
for the digestive system, for €635m. the
combination of Covidien’s established global
presence and Given Imaging’s innovative capabilities
has the potential to transform this market. the
transaction was valued at 4.3x revenue.
n French company biomérieux acquired BiofireDiagnostics for €333m. Biofire is a US company
that develops, produces and markets a number of
automated molecular biology systems. the two
companies present strong strategic synergies,
especially in marketing, manufacturing and
innovation. the transaction was valued at 3.9x
revenue.
Notable key transactions so far in 2014:
† the above graph excludes the thermo Fisher / life technologies deal
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 46
the 10 largest transactions contributed to around
€18bn (71%) of total deal values in 2013, and
averaged a 6.0x revenue multiple and a 21.0x eBItDA
multiple. notable key transactions were as follows:
n Valeant pharmaceuticals acquired US opticalproducts manufacturer Bausch & lomb for
€6.7bn. the deal saw the integration of the two
companies’ ophthalmology businesses to create
a global eye health platform and allowed Valeant
to become a world leader in both dermatology
and eye health. the transaction was valued at
2.6x revenue and 12.1x eBItDA.
n Baxter International acquired Sweden-basedGambro, a dialysis equipment specialist, for
€2.6bn. the deal strengthened Baxter’s global
dialysis products offering by enhancing its
portfolio in the hemodialysis sector. the
transaction was valued at 7.2x revenue.
n Apax partners acquired US-based one CallCare management, a diagnostic imaging and
electrodiagnostic company, for €1.7bn. the
transaction was valued at 11.2x revenue.
n mcKesson Corporation acquired US-based pSSworld medical, a medical device equipment
wholesaler, for €1.7bn. the deal added extensive
distribution capabilities, technological expertise
and a broad portfolio of business services for
mcKesson in an expanding industry. the
transaction was valued at 1.1x revenue and
13.2x eBItDA.
n Cardinal Health acquired US-based Assuramed,a disposable direct-to-customer medical
supplies retailer, for €1.5bn. the deal expanded
Cardinal Health's ability to deliver cost-effective
solutions across the continuum of care,
broadening its product portfolio and scale. the
transaction was valued at 2.1x revenue.
n Bayer acquired Conceptus, a US leader in thedesign, development, and marketing of
innovative solutions in women's healthcare, for
€839m. the transaction was valued at 7.8x
revenue.
2013 M&A highlights
CASE STUDY:
Stryker bets on robotics
Stryker Corporation’s €1.2bn acquisition of
mako, a pioneer in robotic arm assisted
surgery in orthopaedics, was a particularly
notable deal in 2013.
Founded in 2004, mako markets the rIo®
robotic Arm Interactive orthopedic
System and reStorIS® family of implants
to enable its flagship mAKoplasty partial
Knee resurfacing procedure for the
treatment of early to mid-stage
osteoarthritis.
Stryker has now combined this expertise
with its own innovations in joint
reconstruction and surgical instruments. It
says mako’s technologies have considerable
long-term potential in joint reconstruction,
and the combined expertise of the two
companies offers the potential to simplify
procedures, reduce variability and enhance
the surgeon and patient experience.
A C L E A R WAT E R I N T E R N AT I O N A L T E A M R E P O R T 7
0 1000 2000 3000 4000 5000 6000 7000 8000
€m
Valeant/Bausch + Lomb
Baxter/Gambro
Apax/One Call Care Management
McKesson/PSS World Medical
Cardinal/AssuraMed
Stryker/Mako
Bayer/Conceptus
Investor AB/Permobil
Stryker/Trauson
Mitsui/Heraeus Kulzer
2013 top 10 deals
Global medical equipment and supplies deals in 2013
0
5
10
15
20
25
30
35
40
num
ber
of deal
s
Jan Feb mar Apr may Jun JulJul Aug Sep oct nov Dec
� 2012 � 2013
In 2013, more than half of deals were in the followingsub-sectors: general equipment & supplies; disposableequipment & supplies; and patient monitoring equipment& therapies.
The majority of acquirers in 2013 came from the US, with 50% (142) of the deals. Buyers from France, the UKand Germany accounted for 14% (41) of the deals. Bycontrast, companies in emerging markets such as Chinaare still predominately acquiring inbound opportunities -as has been the trend in recent years. This continued focuson domestic companies can be linked to the stringentconditions implemented by the Chinese authorities.
Target acquisitions have been predominately located inthe US with 45% (127) of the deals. The UK, Germany,India and Canada accounted for 18% (52) oftransactions. The majority of Spanish targets wereacquired by domestic companies, showing furtherconsolidation in that market. Of late, Spain has not beena destination of choice for inbound cross-border activitydue to its sovereign debt and a public funding squeeze.However, the country is still attractive for businesseslooking for acquisition targets with strong export andinternational sales in regions where they have littleprescence or want to access key protected domesticservices and products.
The UK has grown as a source of interest foracquisitions with particular interest from the US, butalso interest from Denmark. For instance SSB acquiredTap Biosystems Group for €33m, a deal which allowsSSB to add depth to its upstream bioprocessing unitand benefit biopharma customers. Another deal sawDanish venture capital firm Lundbeckfond Venturesacquire DySIS Medical, a specialist in the detection ofcancerous and pre-cancerous lesions.
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 48
Who bought global medical equipment and suppliescompanies in 2013
In 2013, trade buyers remained the most active investors by volume with249 deals compared to 288 in 2012. By contrast, there were only 34 PrivateEquity (PE) deals in 2013 compared to 42 in 2012.
� General Equipment & Supplies
� Disposable Equipment & Supplies
� Patient Monitoring Equipment & Therapies
� Orthopaedic, Implant & Prosthetics
� Ophthalmic Goods, Optical Instruments & Lenses
� In Vitro Diagnostics, Equipment & Supplies
� Life Science Tools & Services
� Dental
� Cardiovascular
Sector breakdown split of deals in 2013 Geographic breakdown
0
50
100
150
200
250
300 288
249
4234
num
ber
of deal
s
trade pe
� 2012 � 2013
31%
14%
14%
11%
8%
7%
6%
5%4%
PE deal highlights
Investor acquired permobil for €610m. permobil
is a global leader in advanced powered
wheelchairs and has been transformed in recent
years from a family firm into an international
market leader. Focusing on the complex rehab
segment, every wheelchair is built to order and
custom-fit to meet the unique medical needs of
each individual. today the company exports to
more than 30 countries.
linden Capital partners acquired Young
Innovations, a manufacturer and marketer of
supplies and equipment used in the dentistry
sector, for €235m.
A C L E A R WAT E R H E A LT H C A R E T E A M R E P O R T 9
Global sector breakdown split of deals in 2013
0
5
10
15
20
25
30
35
50%
8%
4%4%
2% 2%2%
1%
27%
� US
� Other
� UK
� China
� France
� Germany
� Japan
� Sweden
� Netherlands
� US
� Other
� UK
� Spain
� India
� Canada
� Germany
� China
� Finland
Acquirer split 2013
45%
26%
8%
4%
4%
4%3%
3% 3%
Target split 2013
num
ber
of deal
s
Jan Feb mar Apr may Jun Jul Aug Sep oct nov Dec
� General Equipment & Supplies
� Patient Monitoring Equipment & Therapies
� Life Science Tools & Services
� Disposable Equipment & Supplies
� Orthopaedic, Implant & Prosthetics
� In Vitro Diagnostics, Equipment & Supplies
� Ophthalmic Goods, OpticalInstruments & Lenses
� Dental
� Cardiovascular
� Neurovascular
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 410
M&A ActivityThe first five months of 2014 have seen a good levelof deal activity with 39 deals.
In 2013, deal activity dropped 18% with 142 deals inthe medical equipment and supplies sector comparedto 174 deals in 2012. Transactions above €600m madeup 78% and 58% of the total deal value in 2012 and2013 respectively. This has distorted the average dealsize, so in order to understand the underlying trend, wehave concentrated on deals below €600m.Interestingly, although the total volume of deals in thisarea decreased by 30% in 2013, average deal sizeactually increased by 28% in the same period.
Venture Capital (VC)An analysis of VC activity in the US, based onThomson Reuters data, reports that VCs spent €1.6bn on 308 medical device investment deals in2013 - a 17% fall in value and 4% drop in volume.
The drop has been blamed on a more rigorousregulatory climate which has added more costs tothe med tech industry, thereby making early-stageVC investments less common and less VC fundsavailable. The flux created by the much-publicised UShealth reforms have also affected spending onmedical technology.
In comparison, pharmaceutical and biotechnologyventure funding is on the increase with a highervolume of deals. There were 615 announced and/orclosed transactions involving targets in thebiopharmaceutical and diagnostic industry, versus 456the year before – an increase of 34%. This has beendriven by recent government schemes making iteasier for companies to list more easily and providean incentive for investors to realise value.
number of deals 174 142 39
Total deals (with values disclosed) 2012 2013 2014 (Jan to May)
number of deals 72 52 19
transaction value (€m) 28,510 13,660 15,494
Average deal size (€m) 396 263 815
Deals less than €600m (with valuesdisclosed)
2012 2013 2014 (Jan to May)
number of deals 67 47 16
transaction value (€m) 6,390 5,769 1,400
Average deal size (€m) 96 123 88
Total deals 2012 2013 2014 (Jan to May)
US market
A C L E A R WAT E R H E A LT H C A R E T E A M R E P O R T 11
2014 highlights
notable deals below €600m so far this year:
n Accellent acquired lake region manufacturingfor €284m. lake region is a US manufacturer of
minimally invasive devices and delivery systems
to the cardiology and endovascular markets. the
deal creates a leading interventional vascular
business with more scale and a broader product
offering.
n Cardinal Health acquired AccessClosure, a USmanufacturer and distributor of extravascular
closure devices, for €230m. the acquisition will
broaden the company’s offering in physician
preference items. the transaction was valued at
4.0x revenue.
n Integra lifesciences acquired Covidien’sConfluent surgical business for €195m. the
acquired product lines include surgical sealants,
adhesion barriers and DuraSeal™. the deal
complements Integra’s global neurosurgery
growth strategy aimed at providing a broader
set of solutions for surgical procedures.
n Fluidigm acquired DVS Science, a Canadianmanufacturer and global distributor of
bioanalytical solutions, for €151m. For Fluidigm
the deal adds a high-parameter single-cell protein
analysis platform to its single-cell genomics
platforms to create a portfolio of advanced
technologies serving the rapidly growing single-
cell genomics and proteomics markets.
n Stryker acquired Berchtold, a German surgicalroom equipment maker, for €125m. the
company’s product line will complement
Stryker’s existing portfolio of operating room
equipment.
2013 highlights
notable deals below €600m in 2013:
n Carefusion acquired Ge Healthcare’s Vital Signsdivision in the US, China and other geographies,
for €367m. the acquisition doubled the size of
Carefusion’s specialty disposables business. the
transaction was valued at 2.0x revenue.
n Kinetic Concepts acquired UK woundcarespecialist Systagenix wound management for
€354m, as part of its drive to diversify its
revenue streams and expand geographically. the
transaction was valued at 4.3x revenue.
n Illumina acquired Verinata Health, a US providerof non-invasive tests for the early identification
of foetal chromosomal abnormalities, for
€348m. the deal strengthened Illumina’s
position in the reproductive health sector.
n Abbott laboratories acquired optimedica, a USprivately-held ophthalmic device company, for
€302m. the acquisition expands Abbott's vision
care business into the femtosecond laser-
assisted cataract surgery market.
n Argon medical Devices, a portfolio company of pefirm roundtable Healthcare partners, acquired
the interventional products business of Angiotech
pharmaceuticals for €281m. the company
manufactures and markets disposable and re-
usable biopsy, drainage catheter and vascular
interventional products.
0 50 100 150 200 250 300 350 400
€m
Carefusion / Vital Signs divisions
Kinetic Concepts / Systagenix
Illumina / Verinata Health
Abbott Laboratories / OptiMedica
Argon / Interventional products business
Heartware / Circulite
FMC / Epax
Linden Capital / Young Innovations
Abbott Laboratories / Idev
Cynosure / Palomar Medical
Boston Scientific / Bard Electrophysiology
CR Bard / Medafor
CR Bard / Rochester Medical
Teleflex / Vidacare
Medtronic / Cardiocom
St. Jude Medical / Nanostim
St. Jude Medical / Endosense
Assuramed / Invacare Supply
LVB Acquisition / Lanx
MedImmune / Amplimmune
2013 top 20 deals below €600m
US medical equipment and supplies deals in 2013
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 412
0
5
10
15
20
num
ber
of deal
s
Jan Feb mar Apr may Jun JulJul Aug Sep oct nov Dec
� 2012 � 2013
US buyers acquiring overseas in 2013In total, 26% (37) of deals were overseas, with theUK, Germany and Canada the main points of interestfor strategic US buyers. Bar the acquisition of Trausonby Stryker in China, the most notable deals abroadoccurred in mainland Europe. Orthopaedic, implants& prosthetics, and patient monitoring equipment& therapies were the sub-sectors with the most deal activity.
A C L E A R WAT E R H E A LT H C A R E T E A M R E P O R T 13
18%
15%
11%
8%
7%
4%
4%3%
1%
29%
19%
16%
14%
8%
8%
8%
27%
� General Equipment & Supplies
� Patient Monitoring Equipment & Therapies
� Disposable Equipment & Supplies
� Orthopaedic, Implant & Prosthetics
� Life Science Tools & Services
� In Vitro Diagnostics, Equipment & Supplies
� Cardiovascular
� Dental
� Ophthalmic Goods, Optical Instruments & Lenses
� Neurovascular
� UK
� Germany
� Canada
� Israel
� Denmark
� India
� Other
Who bought US medical equipment and suppliescompanies in 2013
In 2013, trade buyers remained the most active investors by volume with123 deals compared to 153 deals in 2012. There were slightly fewer PEdeals during 2013, 19 compared to 21 in 2012.
0
50
100
150
200
153
123
21 19
num
ber
of deal
s
trade pe
� 2012 � 2013
Sector breakdown split of deals in 2013In 2013, 73% of deal activity occured in the generalequipment & supplies, patient monitoring equipment& therapies, and disposable equipment & suppliessub-sectors.
US PE deal highlights
Juniper Investment Company acquired
theragenics, a medical device specialist serving
the surgical products and prostate cancer
treatment markets, for €46m. the deal expands
Juniper’s breadth of offerings in its range of
surgical products businesses. the transaction was
valued at 0.8x revenue.
Goldman Sachs acquired Bpl medical
technologies for €21m. Bpl distributes products
such as electrocardiographs and defibrillators
through dealers across India.
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 414
the first five months of 2014 had a good level of deal activity with 34 deals.
In 2013, the level of deal activity dropped slightly to 105 deals in the medical equipment and supplies sector
compared to 111 in 2012. Deals above €600m made up 43% and 59% of the total deal value in 2012 and 2013
respectively. this has distorted the average deal size, so in order to understand the underlying trend we have
concentrated on deals below €600m.
number of deals 111 105 34
Total deals (with values disclosed) 2012 2013 2014 (Jan to May)
number of deals 38 37 13
transaction value (€m) 4,177 3,863 1,670
Average deal size (€m) 109 104 128
Deals less than €600m (with valuesdisclosed)
2012 2013 2014 (Jan to May)
number of deals 36 35 12
transaction value (€m) 2,391 1,579 1,034
Average deal size (€m) 66 45 86
Total deals 2012 2013 2014 (Jan to May)
European market
A C L E A R WAT E R H E A LT H C A R E T E A M R E P O R T 15
2014 M&A highlightsNotable deals below €600m so far this year:
n MicroPort Medical acquired Wright MedicalGroup Inc’s Orthorecon business, a USmanufacturer of orthopaedic medical devices for€213m. The transaction will enable MicroPort tofocus on its core business improving salesproductivity and strengthen its competitiveness inthe global market.
n Oxford Instruments acquired Andor, a UKsupplier of high performance cameras,microscope systems and software for the physicalscience and life science industries, for €213m.Andor will spearhead Oxford Instruments’expansion into the nanobiotechnology arena. Thetransaction was valued at 2.7x revenue and 15.3xEBITDA.
n Maquet, part of the Swedish Getinge Group,acquired Pulsion Medical for €109m. Pulsion is a German provider of solutions foradvanced haemodynamic monitoring. The dealallows Pulsion to gain access to a significantlylarger sales footprint and will commerciallyreinforce Getinge’s recently introduced solutionfor continuous glucose and lactate monitoring.The transaction was valued at 4.0x revenue and8.7x EBITDA.
n Irish-headquartered Covidien acquired NewWave, the US manufacturer of a defogging heatedendoscopic lens protector system for €73m. Thedeal helps raise capital for the expansion andgrowth of the business. The transaction was valuedat 9.4x revenue.
n PE firm LDC acquired Prism Medical, a UKcompany that manufactures and provides specialistmovement and handling solutions, for €36m. Thedeal will help fund accelerated growth throughorganic expansion and strategic acquisitions. Thetransaction was valued at 1.2x revenue.
2013 M&A highlights
Notable deals below €600m in 2013:
n Elekta Medical acquired Nucletron, a Spanishmedical and orthopaedic products wholesaler for€378m. The acquisition is in line with Elekta’sambition of building a leading position in thecancer care market and enables it to expand itsreach and product offering in emerging marketssuch as Asia-Pacific. The transaction was valued at3.9x revenue.
n HemoCue was acquired by the RadiometerGroup for €231m. HemoCue develops andmarkets medical diagnostic products whichperform common blood and urine tests at thepoint of care. This acquisition will enable bothHemoCue and Radiometer to acceleratecompany growth and innovation in patient testing.The transaction was valued at 3.5x revenue and 18.4x EBITDA.
n bioMérieux SA acquired Aes Chemunex EspañaSA, a Spanish biotechnology research equipmentmanufacturer, for €190m. The deal allowsbioMérieux to reinforce its leading position inindustrial applications. The transaction was valuedat 2.6x revenue and 14.2x EBITDA.
n Roche Holding acquired US based ConstitutionMedical Investors, a developer of an innovativehaematology testing system, designed to providefaster and more accurate diagnosis of blood-related diseases, for €171m. The newhaematology capabilities will support Roche’sgrowth and strengthen its competitive position inthe laboratory haematology testing business.
n Alvimedica acquired Carbostent & ImplantableDevices, an Italian medical device companyoperating in the interventional cardiology sector,for €50m. The acquisition enables Alvimedica tofurther strengthen its position in the industrythrough product and brand recognition.
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 416
European medical equipment and supplies deals in 2013
0
5
10
15
20
25
num
ber
of deal
s
Jan Feb mar Apr may Jun JulJul Aug Sep oct nov Dec
� 2012 � 2013
0 50 100 150 200 250 300 350 400
€m
Radiometer / Hemocue
Elekta Medical / Nucletron
bioMérieux / Aes Chemunex
Roche Holding / Constitution Medical
Ambu / King Systems
William Demant / Neurelec
Alvimedica / Carbostent & Implantable Devices
Össur / Teamolmed Nord
Grifols / ProgenikaBiopharma
2IL Orthopaedics / Corin Group
Smith & Nephew / Adler Mediequip
Ssb / Tap Biosystems
Life Sciences Partners / Lombard Medical
Trinity Biotech / IMMCO
K Care / Oxford Group
Spectris / NanoSight
Dcc Healthcare / Leonhard Lang
EMSA Capital / Żywiecka Fabryka
Lundbeckfond Ventures / DySIS Medical
Halma / Baoding; Langer Instruments
2013 top 20 deals below €600m
A C L E A R WAT E R H E A LT H C A R E T E A M R E P O R T 17
Sector breakdown split of deals in 2013
In 2013, more than 80% of deal activity was in thegeneral equipment & supplies; disposable equipment &supplies; in vitro diagnostics, equipment & supplies;opthalmic goods, optical instruments & lenses; andorthopaedic, implants & prosthetics sub-sectors.
European buyers acquiring overseas in 2013
In total, 24% (25) of deals were overseas, with the US,India, Canada and Brazil being the main points ofinterest for strategic European buyers. The US madeup 56% of these deals with India, Canada and Brazilaccounting for 24%.
8%
20%
56%
8%
8%
6%
2%
32%
14%
6%
7%
11%
11%
11%
� General Equipment & Supplies
� Disposable Equipment & Supplies
� In Vitro Diagnostics, Equipment & Supplies
� Opthalmic Goods, Optical Instruments & Lenses
� Orthapaedic, Implants & Prosthetics
� Patient Monitoring Equipment & Therapies
� Life Science Tools & Services
� Dental
� Cardiovascular
� US
� Other
� India
� Canada
� Brazil
Who bought European medical equipment and suppliescompanies in 2013
In 2013, trade buyers remained the most active investors by volume with 88% of deals. There were slightly fewer PE deals during 2013, 13 compared to 15 in 2012.
0
20
40
60
80
100 9692
15 13
num
ber
of deal
s
� 2012 � 2013
trade pe
European PE deal highlights
2Il orthopaedics acquired Corin Group, a
leading designer, manufacturer and distributor of
orthopaedic products, for €35m. the deal
represented an attractive opportunity for 2Il due
to Corin’s brand position in the market and its
product portfolio, distributor network, customer
relationships, and potential as a platform for
further growth. the transaction was valued at
6.0x revenue and 9.9x eBItDA.
life Sciences partners acquired medical devices
company lombard medical technologies for €33m.
UKJudges Scientific acquired Scientifica, a specialistmanufacturer of electrophysiology equipment, for€15m. The acquisition is the largest made by JudgesScientific to date and is expected to be earningsenhancing with immediate effect. The transaction wasvalued at 1.4x revenue.
AngioDynamics Inc acquired Microsulis Medical for€12m. The medical device company specialises inminimally invasive, microwave ablation technology forthe coagulation of soft tissue. The transactionstrengthens AngioDynamics' position as the clearmarket-leading innovator in the growing global tissueablation market, with a complete offering of thermaland non-thermal technologies.
DenmarkDanish company Ambu acquired US-based KingSystems, an anaesthesia and airway managementdevices manufacturer, for €114m. The deal reinforcesAmbu’s market position in single use solutions for thehospital and emergency market. The transaction wasvalued at 1.9x revenue.
William Demant Holdings acquired Neurelec, aFrench cochlear implants developer, manufacturer andsupplier, for €58m. William Demant is one of theworld's leading players in diagnostic instruments. Thedeal was valued at 3.1x revenue.
GermanyBIT Analytical acquired Source Scientific, an in vitrodiagnostic and medical analytical instrumentcompany. The acquisition followed a planned five-year transition period, during which BIT owned 50%of the business.
Merz acquired the cosmetics, OTC, and Rx skincarebusiness of Swiss company Neocutis. The acquisitionstrengthens Merz’s presence in the US aestheticsmarket, especially as Neocutis’ skin care productscomplement the current portfolio of aestheticinjectable products. Merz also picked up anotherSwiss business, Anteis, which develops biomedicalproducts in the area of aesthetics. The two companieshave been working together for many years.
SpainPlasma products manufacturer Grifols acquiredProgenika, a specialist in the design and manufacture ofin vitro genome-based diagnostic tests, diseaseprognosis, and responses to pharmacologicaltreatment. Since 2010, Grifols has held globaldistribution rights to Progenika's blood genotyping testBloodChip®. Progenika also makes the PharmaChip®
for identifying genetic variants that impact drugmetabolism, and the LipoChip®, an array-based test fordiagnosing familial hypercholesterolemia.
Q Diagnostica acquired CRC Corporacion Sanitaria(Productive Unit), a medical imagery business, for €7m.
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 418
Country analysis
A C L E A R WAT E R H E A LT H C A R E T E A M R E P O R T 19
notable deals below €600m in 2013:
n mitsui acquired HeraeusKulzer, the dentaldivision of Heraeus Holding, for €452m. the
acquisition allows mitsui to significantly expand
its international activities in the dental sector.
the transaction was valued at 1.3x revenue.
n DHr Holding India pvt ltd acquired QuestDiagnostics India pvt ltd’s medical device
wholesaling business, a diagnostic testing service
company for €234m.
n mindray acquired Zonare, a US ultrasoundtechnology leader in high-end radiology, for €79m.
the deal strengthens mindray’s high-end ultrasound
r&D and US sales capabilities, furthering the
company's goal of becoming a leading global
provider of high-quality imaging products.
n photop technologies Inc acquired Aegislightwave Inc, a US based optical telecom
channel monitoring products manufacturer, for
€38m. the acquisition allows the company to
accelerate the sales of their market leading
optical channel monitors and fused fibre devices
in the global market.
n Samara acquired lotus, an Indian medicalconsumables manufacturer, for €30m. the deal
follows healthcare investments from Samara in
pharma chain Guardian and diagnostic services
provider thyrocare technologies.
one notable deal in 2014 saw Shinva medical Instrument acquire Vastec medical, a Hong Kong-based medical
instrument manufacturer, for €46m. this transaction will enable Shinva to strengthen its medical device business
in Hong Kong.
2013 saw 25 deals in the medical equipment and supplies sector, compared to 32 in 2012. Deals above €600m
made up 92% of total deal values in 2012. In 2013, there were no deals above €600m.
number of deals 32 25
Total deals (with values disclosed) 2012 2013
number of deals 23 21
transaction value (€m) 2,658 1,061
Average deal size (€m) 116 51
Deals less than €600m (with valuesdisclosed)
2012 2013
number of deals 21 21
transaction value (€m) 210 1,061
Average deal size (€m) 10 51
Total deals 2012 2013
Asian market
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 420
0 50 100 150 200 250
€m
Athanas / Claris Lifesciences
DHR / Medical Device Business
Mindray / Zonare Medical Systems
Photop / Aegis Lightwave
Samara Capital / Lotus Surgical
Comfort Enterprise / Ogawa World
Toyobo / Spinreact
Ascent Capital / Skanray
Shenzhen / Shanghai Hanguang Lab Equip
Changchun / Changchun Yuheng Optics
Sho-Bi / Melly Sighte Co
Benq Medical / Lily Medical
Changchun / Suzhou Weiyeda
Luyan / Goodman Medical
China Resources(CR) / CR Medical Instrument
Asahi Lite / Asahi Lite Optical
Zhuhai Hokai / Zhuhai Hongsheng Biological
Q & M Dental / Ar Dental Supplies
Body Organ / Aeon Astron Europe
Trauson / Jiangsu Chuangyi Medical
2013 top 20 deals below €600m
Asian medical equipment and supplies deals in 2013
0
1
2
3
4
5
num
ber
of deal
s
Jan Feb mar Apr may Jun JulJul Aug Sep oct nov Dec
� 2012 � 2013
A C L E A R WAT E R H E A LT H C A R E T E A M R E P O R T 21
14%
43%14%
29%
� US
� Netherlands
� Denmark
� Spain
Asian buyers acquiring overseas in 2013
In total, 28% (7) of deals were overseas, with the USand the Netherlands the main points of interest forAsian buyers.
Sector breakdown split of deals in 2013
The majority of deal activity was in general equipment &supplies; ophthalmic goods, optical instruments & lenses;and disposable equipment & supplies sub-sectors.
Who bought Asian medical equipment and suppliescompanies in 2013
In 2013, trade buyers remained the most active investors with 23 dealscompared to 26 in 2012. There were two PE deals during 2013,compared to six in 2012.
0
5
10
15
20
25
30
26
23
6
2
num
ber
of deal
s
trade pe
� 2012 � 2013
Asian PE deal highlights
one deal saw Ascent Capital acquire Skanray, an
Indian company that manufactures radiology and
critical care products, for €18m. Ascent has
ambitious growth plans for the company and is
planning to set up units in Brazil and west Asia.
4%
36%
20%
12%
12%
16%
� General Equipment & Supplies
� Ophthalmic Goods, Optical Instruments & Lenses
� Disposable Equipment & Supplies
� Patient Monitoring Equipment & Therapies
� Dental
� In Vitro Diagnostics, Equipment & Supplies
Manufacturer of medicalproducts
Clearwater International advised thevendor on the sale to TG Eakin
pelICAn HeAltHCAre
Provider of safe patienthandling equipment
Clearwater International advisedNASDAQ listed Prism Medical onthe sale of its UK subsidiary to LDC
prISm meDICAl
UK’s leading provider of dentalproducts and services
Clearwater International advised thebuyer Synova Capital on theacquisition of the business
Market leader in special caretransport servicesin Denmark
Clearwater International advised thevendor on the sale to Catacap
HAnDICAp-BeForDrInGAnD ColUm-BUS
Supplier of single use anddisposable medical devices
Clearwater International advisedGraphite Capital on the sale to TheRiverside Company
SUmmIt meDICAl
Manufacturer of proteinpurification products used indiscovery and development
Clearwater International advisedUnilever on the sale to LifeTechnologies Corporation
BAC BV
Provider of products andsystems within healthcare andlife sciences industries
Clearwater International advised the buyer Getinge Group on theacquisition of Acare Medical Science Ltd
GetInGe GroUp
World leaders in femalesurgical contraception
Clearwater International advised thevendors, Barclays, on the sale to UtahMedical Products Inc
FemCAre
UK specialists in independentliving solutions
Clearwater International advised thevendor on the sale of DCC’smobility and rehab products divisionto Patterson Medical
DAYS HeAltHCAre
Leading stem cells processor
Clearwater International advised thevendors on the sale to Cord BloodAmerica
VIDAplUS
Leading Spanish medicaldistribution group
Clearwater International advised thebuyer Grupo Prim on the minorityacquisition of Scient’x
GrUpo prIm
Respiratory pharmaceutical/device products distributor
Clearwater International advised thevendors on the sale to DCC plc
neolAB
G L O B A L M E D I C A L E Q U I P M E N T A N D S U P P L I E S R E P O R T 2 0 1 422
DentAl BUYInG GroUp
International reach,Excellent client outcomes
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