Health Check: Fisher & Paykel Healthcare defies the hospital cost crunch with record revenue
Fisher & Paykel Healthcare posts record full-year revenue and shrugs off the US tariff threat
Truscreen signs Indian distributor
Renerve is off to the Middle East
New Zealand-based medical devices supplier Fisher & Paykel Healthcare (ASX:FPH) has shrugged off hospital budgetary pressures to post record revenue for the year to March of NZ$2.2 billion ($1.98 billion), 16% higher.
Net profit surged 43%, to NZ$377 million.
Assuming currencies remain constant, management has guided to current-year revenue of NZ$2.15 billion to NZ$2.25 billion.
Net profit is expected to come in at NZ$390-$440 million.
Crucially, this includes a 50-basis point impact of US tariffs on hospital products sourced from New Zealand.
'Our actions in response to any trade policy developments will be driven by our longstanding approach, which is to mitigate cost increases," CEO Lewis Gradon says.
This will be "by identifying and implementing continuous improvements and efficiency gains across all of our business processes."
The $19 billion market cap FPH's products cover respiratory and healthcare.
These include humidifiers, nasal cannulas and devices for high-flow therapy, anaesthesia and laparoscopic and open surgery.
FPH's obstructive sleep apnoea (OSA) masks and pumps compete directly with sector Big Daddy ResMed (ASX:RMD), especially in the US market.
Global reach
FPH demerged from mothership Fisher & Paykel Industries in 2001 and listed on the Australian and Kiwi bourses.
While FPH sells in 120 countries, 48% of its revenue derives from the US.
Revenue from FPH's hospital products – those used in respiratory, acute and surgical care – gained 18% to NZ$1.28 billion.
Hospital sales were driven by the company's launch of a new nasal high flow device, Airvo 3.
Homecare, which includes the OSA pumps and masks, rose 13% to NZ$740 million.
However, growth in this sector slowed in the second half, partly because of rivals introducing new masks in the US.
The business hopes to offset the impact with the recently launch of two new OSA masks, Nova Micro and Nova Nasal.
The company's gross margin improved 181 basis points to 62.9%, but still is below the long-term target of 65% and 66.9% just before the pandemic.
'Everything we did around the business made a positive impact,' said CFO Lyndal York, noting reduced freight costs.
'We are back to business as usual.'
Gradon said the hospital cost pressures were not new.
'I can't remember a time when these cost pressures didn't exist, or we felt like it had any material impact on us.'
On tariffs, management assumes the US impost of 10% on NZ goods will remain, although the company also manufactures in Mexico and China.
At least one product range – the OSA masks – look to be protected by the Nairobi Protocol. This global agreement stipulates duty-free treatment of devices for the 'disabled'.
The board declared a final dividend of NZ24 cent per share, taking the full-year payout to NZ42.5 cents (up 2%).
FPH shares were about 3% off the pace this morning – presumably because of some second half weakness - but have gained 30% over the last 12 months.
Truscreen strengthens its Indian foray
We're still on Kiwi companies.
The maker of a cervical cancer test that can be used without access to labs, Truscreen Group (ASX:TRU) has been anointed the Indian distributor of its Chinese partner's in-vitro diagnostic, for human papilloma virus (HPV).
The compact is with Hangzhou Dalton Bioscience Limited. This company makes DNA-based HPV tests as well as lab equipment for cervical cancer screening.
Truscreen notes that co-testing its eponymous AI-powered test with the HPV assay has increased the effectiveness of its own test.
A Chinese study showed a co-testing sensitivity rate – the ability to detect the disease – of 98.4% compared with Truscreen's 'already impressive' stand-alone 87.5%.
Truscreen recently re-entered India with its own test, via local distributor Renovate Biologicals.
Truscreen CEO Marty Dillon says the tie-up 'strengthens our product offering in the world's second most populous country and is a blueprint for similar agreements ... for other markets".
On that note, Truscreen currently sells its test in China and last month began a large-scale screening program in Vietnam's Ho Chi Minh City.
Including Indonesia, the company has a presence in three of the four most popular nations (the US – which it's not targeting – is the glaring exception).
On Monday, Truscreen reported revenue of NZ$1.71 million for the year to March. This was down 18%, with a net loss of NZ$2.24 million compared with a previous NZ$2.05 million deficit.
Management attributed the revenue dip to delays in its Vietnam and Zimbabwe rollouts, as well as tardy product registration in Indonesia and Uzbekistan.
The company flags current year revenue of NZ$2.8 million.
Renerve wins Bahrain approval
Peripheral nerve repair outfit ReNerve (ASX:RNV) has won marketing consent for its flagship product in Bahrain, its first approval in the promising Middle Eastern region.
The approval was by way of Renerve's partnership with its Middle Eastern partner, Union Mediscience BSC.
The product is the Nervalign Nerve Cuff, a protective wrap naturally absorbed within six months of surgery.
The device already is approved in the US, where it is making a 'dramatic difference' to surgical results.
The Middle East/North Africa market is worth around US$80 million a year and growing at a 35% clip. Relative to the US, there are fewer competitors.
'We look forward to the commercialisation in Bahrain and further expanding our sales and marketing efforts in the region,' Renerve director Dr Julian Chick says.
Emyria is ecstatic over PTSD trial results
Better known as a party drug among the younger set, MDMA (Molly or ecstasy) appears to have hit the mark as a treatment for post-traumatic stress disorder (PTSD).
In a six-month follow-up to its early-stage trial, Emyria (ASX:EMD) reports that five out of eight patients had improved to the extent that they no longer met the criteria for PTSD diagnosis.
The company says the patients achieved an average 55.5% reduction in PTSD symptom severity, as measured by a five-point scale known as PCL-5.
On a self-reported measure, they also achieved a 121% improvement in quality of life.
Th company says these results suggest 'clinically meaningful and sustained improvements in a patient cohort previously considered treatment resistant'.
The ongoing trial has enrolled 30 patients across two Perth sites.
While psychiatrists oversee the patients, the results were achieved in a 'real world' setting.
Difficult to treat, PTSD affects up to 11% of Australian adults, or 800,000 individuals.
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ABC: podcast. You're listening to Pacific Pulse on ABC Radio Australia. Matthew Paxman: Part of the issue with scabies is you get these tiny little skin lesions and also through all the extra scratching your skin's inflamed. So you can get bacterial infections through the skin. Melissa Maykin: Have you ever had to scrub and lather to get rid of those relentless little mites called scabies? Australian scientists are now developing a world first rapid test that can spot scabies in just 10 to 20 minutes, no lab needed, and it even detects common bacterial skin infections. Scabies is a huge public health headache across the Pacific, with around 18 to 20% of people in Fiji, Solomon Islands and other places affected, especially children. For those who can't get rid of the mites, scabies can link to serious complications like secondary infections, heart and kidney disease. Thanks to Melbourne, Australia's Zip Diagnostics and trials held in Darwin, this portable battery powered test could revolutionise how remote communities fight this itchy, neglected tropical disease. To dive into the science, I'm speaking to the company's Scientific Director, Associate Professor Jack Richards, and the company's PhD Research Assistant, Matthew Paxman. Associate Professor Jack Richards: Look, it's an interesting disease in many regards. And so it's been of interest to us, firstly because it's actually a really common disease. It's all throughout the world, and estimates are in the range of 200 to even 500 million cases per year of this disease globally. So it's a very common disease. It's highly prevalent through the Pacific. So some of the countries that have the highest rates of this in the world are in the Pacific. So I think Fijian Vanuatu was recently identified as in the top five countries of the world. It has a huge impact on the quality of life for people. It's actually caused by a mite, a little insect that actually burrows into the skin. And actually, these burrows cause an inflammatory and allergic response and intense itching. So people that get these infections with scabies mites have a huge impact on their life because they're constantly itching, this through the day and the night, and it's unrelenting. That's sort of the impact of it. And then they also are highly at risk of getting secondary bacterial infections, which can be either localised in those same areas because of all the scratching, or they can actually spread and cause bloodstream infections and septicemia, and even special infections of the heart called rheumatic heart disease. From seemingly innocuous little insect that lives on the skin and burrows in the skin, you've got this huge impact globally on health and just the way of life of people. So we think that's a really important issue to deal with. It's what we call a neglected tropical disease because most people in the world are not interested in really dealing with it or don't have the resources to look at this disease because it really occurs in areas of remote communities and low to middle income countries. The people that suffer the most are the poorest people in the world and often don't have the resources and access to health services. Despite being really common and having a huge impact on their life, not many people are helping to address this issue. Yeah, that's sort of part of the reason. And the other one is really that the diagnostics themselves are very poor. Generally speaking, the current approach to this is that healthcare professionals have a look at somebody's skin and they usually make their best guess of whether this is scabies or not. And in some cases, if they've got access to a laboratory or a microscope, they might send off some skin scrapings and try and identify this scabies insect under the microscope. So we think we can offer something to that. Melissa Maykin: Yeah, that's really another side of this whole issue. So what you talked about having secondary illnesses as a result of the scabies, are you able just to explain quickly what happens in the body due to that infection and the kind of secondary issues that can arise? Associate Professor Jack Richards: Yeah, sure. Matt, do you want to? Matthew Paxman: Yeah. So part of the issue with scabies is you get these tiny little skin lesions and also through all the extra scratching, your skin's inflamed. So you can get bacterial infections through the skin from that. So particularly group A strep and staphylococcus aureus, these two bacteria that can grow and cause infections on the skin. So that potentially could cause more severe types of skin lesions, but sometimes they can go deeper into the tissue, into the bloodstream and cause some severe complications like rheumatic fever, rheumatic heart disease, Jack said before. And you get issues such as sepsis and toxic shock, but these conditions are potentially life threatening. So it's really important to control scabies to make sure these bacterias are getting through. The skin needs to stay intact to keep these bacteria that is sometimes commensally on the skin outside of your internal system. Melissa Maykin: Mm. No, thank you for that. It's really good to keep it at layman's level for not just myself, but for anyone who's really not too aware of the kind of health science behind scabies. But I was always of the belief that scabies was contracted from animals. So what carries scabies? Where does it mostly spread from? Matthew Paxman: So animals are affected by scabies as well, but humans won't generally get scabies from an animal. Scabies transmits through skin to skin contact with another infested person. And sometimes the scabies can actually survive on materials like the bed sheets or fabrics. So you need to have your skin exposed to a fertilized mite to contract scabies from another human. So that's why overcrowding is a major risk factor for this disease. Not necessarily hygiene, it's just that close skin to skin contact that causes these high level of transmission in overcrowded regions. Melissa Maykin: Thank you. So just jumping forward to the diagnostic test, are you able to just explain how this tool works? Matthew Paxman: Yeah, so we're looking at molecular diagnostics. So the difference with molecular diagnostics compared to the current diagnostic methods for scabies is we're trying to detect the genetic material of the mites or the particles that they leave behind on the body. So the previous methods, as we mentioned, involves trying to look at the skin and see evidence of mites or eggs. But with the molecular test, it would be a standardized sampling method. Essentially what we're doing is we're adopting the LAMP technique, which is a nucleic acid amplification system called loop-mediated isothermal amplification. So in concept, it's similar to PCR, but it tends to be faster and more specific. And the big benefit of LAMP is you can run it at one single temperature. So that means the instruments that it can run on can be simpler, more portable, and able to be implemented into these resource limited settings that we're really interested in. So that's what we're doing at the moment is we're designing the LAMP assay. So all the constituents that go into it. And then another important aspect is we're trying to design a simplified sample preparation workflow that so any untrained users, healthcare workers, will be able to easily process and run the tests. Melissa Maykin: Yeah, fantastic. I can't really visualize it at the moment, but what does it look like? Yeah, if you're standing in the lab, you're about to run some tests on the scabies. Matthew Paxman: I can, I have some things right next to me. This might not be that relevant for radio, but this is instruments. So at Zip Diagnostics, we have a point of care diagnostic platform called the P2. So it's this instrument here. It's got a touchscreen that provides all the prompts to do the steps. And essentially, our tests are these little lyophilized cartridges. So that's got the LAMP assay in there. And you're going to be able to process the sample on this deck and set up the test and run it within this little light, small, portable instrument. This is a platform approved by the TGA. So we can use it for clinical purposes here in Australia and can probably talk about elsewhere. Yeah, Associate Professor Jack Richards: and Matt's raised some really important points there. Where this disease occurs is in these remote settings in most cases, and they can be really far away from laboratory services. And so it's really important that we take the test to the people that have it. And what Matt's showing us here is a test, which is small, it's very portable, can run off a battery. And it really makes use of the best technology that we've got in the world to detect the DNA of these organisms. So it's a highly sensitive test. And yeah, and it's got to be highly usable for the people that are going to operate this in these environments. And so it's got to be a simple test to run. And it's also got to have components to the test which don't require cold chain supply. So it's no good being in these environments where there's no refrigeration or freezing access. So we have these freeze dried components to the assay which allow it to be then deployed and stored out in those environments. You're ABC: listening to Pacific Pulse on ABC Radio Australia. Melissa Maykin: On the show today, you're hearing from Dr. Jack Richards from Zip Diagnostics and PhD researcher and research assistant, Matthew Paxman. We're talking about a groundbreaking new SCABES test. In 2022, Solomon Islands became the first country to distribute ivermectin to its entire population to tackle SCABES, a disease that affects one in four people there and is linked to serious infections like blood poisoning and kidney disease. The ABC's Jordan Fennell had this report. Prianka Srinivasan ABC: Solomon Islands has become the first country in the world to have the anti-parasitic drug ivermectin distributed to its entire population to treat SCABES. The drug attracted controversy during the pandemic after it was linked to coronavirus misinformation. But as Jordan Fennell reports, health experts are optimistic about the success of the rollout. Jordan Fennell: In a clinic in Honiara, patients are furiously scratching themselves. Oliver Sokana: SCABES is quite distemping in any way we try to describe it. But they will spend time in itching and scratching the body and try to get themselves to feel comfortable. It's really distemping. Jordan Fennell: Oliver Sakana from the Solomon Islands Ministry of Health is overseeing the rollout of ivermectin to treat SCABES. He estimates they're helping more than 200 people a day. Oliver Sokana: That means we already treated more than 5,000 people in provinces that they already started. Jordan Fennell: In a country with a population of more than 680,000 people, one in four suffer from the skin disease. But relief from the pain will come quickly. Just two doses of ivermectin over the space of a week will get rid of SCABES. Sarah Anderson: Ivermectin is an antiparasitic drug and SCABES is a parasite. And so the ivermectin works to actually kill the little SCABE mite that has dug under the skin and made its home in somebody's skin. Sarah Jordan Fennell: Anderson is the Murdoch Children's Research Institute's World SCABES Program Manager. She says it's not just a disease that makes you itchy. If left untreated, it can lead to serious consequences. Sarah Anderson: So it can lead to very serious skin infections. As kids start scratching the SCABES, the skin breaks and then infection can get into the skin. And then that has been shown to be able to lead to very serious bacterial skin infections, but also to blood infections. And there's also a connection to kidney disease and heart disease. Jordan Fennell: During the start of the COVID-19 pandemic, ivermectin became a controversial drug when former US President Donald Trump urged people to use it to treat coronavirus, but doctors were advising against it. Ms Anderson says while it might not be effective to deal with COVID, for years it has worked to treat antiparasitic diseases like SCABES. Sarah Anderson: Ivermectin for the use of SCABES and other parasites has long been researched and shown to be effective in very, very good trials. Jordan Fennell: She says this distribution project in Solomon Islands is the result of more than 10 years of research and aims to give everyone in the country a treatment of ivermectin to stop the transmission over the next few months. Oliver Sukarna says his team of thousands are working hard to deliver the medicine. We Oliver Sokana: have the evidence. We have the evidence that SCABES is really a public health problem in Solomon Islands. So this MDA rollout is very significant in the control of SCABES in this country. Jordan Fennell: A similar rollout will go ahead in Fiji in September, and if they're able to get more funding, Ms Anderson hopes to take the life-changing treatment to more Pacific countries. Sarah Anderson: SCABES tends to be kind of like the disease that doesn't get a lot of attention. It definitely is an area where we would love to see more people joining this sort of mission to get rid of SCABES. Melissa Maykin: And that's what we're talking about today. That was Sarah Anderson, Murdoch Children's Research Institute World SCABES Program Manager, ending that report by Jordan Fennell for Pacific Beat. But a new diagnostic tool to detect SCABES early is in the works and could be a game changer for Pacific nations and their communities. Here's Zip Diagnostics Associate Professor Jack Richards. Associate Professor Jack Richards: So it's not as simple as just making a widget that just gets thrown at people. What we really want to do is work with communities and work with local experts and stakeholders just to really understand the setting and the need that they've got and the capability that they've got. We want to design this to be a test that's really suitable for them in those environments. So we're just beginning that process now. We're working with a great team up at Menzies who do a lot of work with First Nations communities up in the top end of Australia and beginning to liaise with people across the Pacific. We've done lots of work with PNG in the past and Fiji and Vanuatu. And so we're going to really continue that work to make sure that this test is actually designed and is appropriate for use in those settings. And I think a diagnosis does several things. One is, at the moment, you've got this situation between a patient and a healthcare professional where both of them are trying to make their best guess. Is this scabies or is it something else? Is it a mosquito bite or is it an allergic reaction eczema or something like that? And it creates a really difficult dynamic in the clinical decision making process because there's uncertainty. So one of the aspects of bringing a test like this in is we want data driven clinical decision making and that's a process that occurs between the patient and the healthcare professional. So the patient gets better data and is a participant in a point of care setting of their own clinical management and having access to data that confirms the diagnosis really provides them an incentive to get on with treatment and to complete treatment. And that's actually really important and it's particularly important for scabies. The treatment usually takes the form of a cream, as you mentioned, and that cream is an anti insecticide sort of cream that's applied usually from the neck down to the feet. So it's actually quite a tricky one to apply. Melissa Maykin: It is, yeah. Associate Professor Jack Richards: It's not that fun. You've got to douse yourself literally from head to toe in this cream and usually sit it out for overnight generally and then get up in the morning and wash it all off again. That's the most common form of treatment and usually you've got to back that up with a second round of that treatment one to two weeks later. There is a form of treatment that you can use, which is a tablet, but that's not always available in some of these settings. That's a little bit easier to administer, but it again also requires a sort of follow up dose. So you can see for both of these, having knowledge that this is the disease that you've got and therefore the need to do this sort of treatment because it is laborious can actually really help with doing that treatment course properly. Melissa Maykin: Yeah. Save a lot of people's time and resources going straight to what they know is needed to be done. And yeah, my friend did have to douse herself in the cream. The most tedious part was when she missed a spot and then the scabies didn't go away. So she had to just keep doing it on repeat until she hits. It took months. I was really shocked by how difficult it was for her to get rid of it. And I guess there's also that social stigma too, of feeling quite dirty and quite infested with a disease. There's layers to the feeling of contracting something like that. This I'm sure is going to make a big difference for people to get on top of it really quickly. But maybe Matt, if you can answer this, what other types of common skin infections has this also helped detect? Matthew Paxman: So for our test, we're also going to be designing targets that will detect the two main bacterial infections that often go along with scabies. So that's group A strep and Staph aureus. These are bacteria that commonly are pathogenic to humans, but sometimes they just live on the skin and not cause issues. But then with the scabies, you get the lesions and they can enter your system and cause some severe diseases. So it will be the same sample. So you will only have to take samples or inspect the patient once. A lot of the other diagnostic methods sometimes overlook bacterial infections because if your patient comes in and they're complaining about severe itching, they might not be looking for bacterial infections. So it's really important to be able to diagnose those because they require a different treatment than scabies. So in scabies, you'll need antimicrobial sort of medicines or creams in that case. Melissa Maykin: And a little side to this, I was talking to Dr. Mark Jacobs, World Health Organization, maybe last year about the rise of antimicrobial resistance. It's especially an issue, I guess, in the region, in the Pacific, where antibiotics is scarce. The right antibiotics isn't often administered. Are you working around antibiotics in this way? And is this something that you have to be aware of? Associate Professor Jack Richards: Yeah, it's a really important issue and it's becoming increasingly problematic globally. And it's driven by lots of different factors. But one of the factors is, as you're saying, the lack of diagnostics to really guide, do we need antibiotics in this instance or not? Are we making the right decision to give this patient antibiotics? And more particularly, are we giving the right antibiotics when we do that? And obviously, the best information we can have is, yes, there's this infection here and it is susceptible to this particular antibiotic. So we've even chosen the right antibiotic for this particular bug. So they're the sort of aspirations that we have. And part of that will be part of this test as we develop it. Melissa Maykin: Yeah, great. What happens next now that you've developed this test? Where are things at for you guys? Associate Professor Jack Richards: It's still under development. So it's in the early phases of the development. So Matt is doing the design of that at the moment and making good progress. So we're about to start doing some initial clinical studies with the collaborators that we've got at the Menzies in Darwin so that we can really start to understand if this test is working properly. And then we, as an Australian company, the first Australian company to ever get a point of care molecular test approved by the TGA. So we're going to use all of those learnings and that effort that we put into making this test in Australia. So we're really proud of being able to do that and have Australian made products like this that hopefully are globally important products. And so, yeah, keep people up to date over the next year or two as this goes through the formal clinical studies and the regulatory approval processes. It's a fair journey, obviously, to get these things into use for humans. Melissa Maykin: Yeah, absolutely. Yeah, Matt, was there anything, did you have any comment about how you guys are tracking? Matthew Paxman: Not too much extra than what Jack said. Melissa Maykin: Yeah, that's okay. I just might ask you, Matthew, because this is a PhD area of yours, if I can ask, I guess what fascinates you most about this area? I think you contribute hugely to communities that are very much in need. But yeah, you're able to share just finally a little bit about what drives your motivation in this area of research. Matthew Paxman: So my original study, I was trained as like a biochemist and working at Zip Diagnostics, I've got involved with looking at infectious diseases and different pathogens. And that's really fascinated me. And one area that I was excited about was having a look at different bacterial infections. And then I was pretty naive to scabies before this project started, which makes sense. It's a neglected disease. People in these remote communities know about it, but in other areas, it's not very widely discussed. So it was really interesting, a really interesting disease and really important with this like hidden, massive global prevalence. So I thought it was really important. And I also very much appreciate how important these issues are to regions such as like Indigenous Australian populations and other sort of low middle income areas like the Pacific Islands and certain areas in Africa. So that really fascinates me. Melissa Maykin: A really big thank you to Associate Professor Jack Richards, the Scientific Director of Zip Diagnostics and Research Assistant and PhD candidate Matthew Paxman for their time on the show today. This has been Pacific Pulse with me, Melissa Makin. If you missed any part of this episode and you'd like to listen back, you can search for us on the ABC Pacific website at Pacific Pulse or find us on your favorite streaming platform. If you'd like to hear more conversations about health care in the Pacific, consider listening to the latest episode of PoliTalk with Scott Widear. Basic medications like paracetamol and antibiotics are very hard to come by in many Pacific countries at the moment, and this is leaving doctors and patients struggling under the strain of sickness. You can find them by searching for PoliTalk, P-O-L-I-T-O-K on the ABC Pacific website. This episode was produced on the lands of the Jagera and the Turrbal people.
