Specialist
President at Allina Health System
Agenda
- Competitive positioning of key players including Ambu (CSE: AMBU.B), Boston Scientific (NYSE: BSX), Verathon (NYSE: ROP) and Olympus (TYO: 7733)
- Ambu's aScope 4 Cysto, its use case and key benefits
- Continued trend towards single-use scopes including uptake expectations
- Key decision criteria behind using single vs disposable scope, including key costs
Questions
1.
Could you outline the use case for Ambu’s aScope 4 Cysto, including the patient population and how that might trend?
2.
You mentioned that your clinic has converted 100% to the Ambu single-use flexible cystoscope, but that isn’t necessarily the norm. Is there much stronger uptake of the single scope cystoscopes in the hospital setting, particularly with Ambu, such as the emergency room and operating room? How might uptake there compare to a clinic? How should we think about single use vs reusable adoption at a traditional clinic? You suggested that your clinic is a bit of an anomaly.
3.
To what extent might the Ambu scopes’ price need to reduce to encourage stronger uptake, particularly in freestanding clinics?
4.
What’s your 3-5-year outlook for reimbursement? You mentioned reimbursements have been going down, and these are obviously a huge factor in uptake.
5.
You mentioned one of the Ambu scope’s competitive factors is that you don’t need any disinfectant time. How many reusable scopes might you need to conduct 8-10 cystoscopes in a day?
6.
I understand that reduced reprocessing time allows a larger patient volume with Ambu’s aScope, particularly in the clinic setting, but price seems to be the biggest sticking factor here. What else might drive a physician to use the Ambu scope for a larger percentage of their cystoscopes? I’m struggling to understand why physicians may swap, given the price.
7.
How frequent are breakages? What’s the lifespan of cystoscope products before they need to be replaced?
8.
You’ve mentioned that a lot of these practices are being done in the clinic such as in the hospital setting. How can we think about the performance of cystoscopies being performed over the next 3-5 years? Do you think the bigger shift towards the freestanding clinic setting will continue?
9.
What percentage of cystoscopies do you think will be performed in the freestanding clinics over the next 3-5 years?
10.
How do you think a shift to the more freestanding type of reimbursement – which obviously is a much lower reimbursement – might impact the uptake of Ambu’s aScope in the hospital setting? Do you think there will be a slower uptake due to the cost?
11.
Who do you consider to be Ambu’s key competitor or a key challenger to its position? There are reusable players, the EndoSheath and you mentioned Olympus.
12.
What are the key benefits of Ambu’s aScope 4 Cysto besides not requiring reprocessing? What about limitations around image sensors or steering direction?
13.
How have the various stages of the pandemic and waves of coronavirus variants impacted the volume of cystectomies that your practice has been performing? Has that perhaps impacted any of your purchasing decisions around potential delays to procedures?
14.
You seem to be saying that prolonged staff shortages, particularly among health workers, could act as a drive towards single use. Do you think uptake could increase in many of these settings of single-use products such as the aScope? Could this become a sustained trend once things start to recover?
15.
Ambu has continuously mentioned supply chain issues recently. Have you noticed any issues in your hospital inventory levels for single-use scopes? Have you had more general issues sourcing single-use scopes from Ambu, or sourcing scopes from any other manufacturer?
16.
How is Ambu perceived by customers? How would you describe its reputation in the market, particularly among physicians? How is its commercial team perceived?
17.
Could you elaborate on the China-based players you mentioned who are producing cheaper options in the ureteroscope sector and providing competition to larger players such as Boston Scientific?
18.
Ambu’s aScope 4 uses two steering directions for cystoscopy, along with bronchoscopy. These are four directions that we typically get with the gastroscopes. Why is there this difference in steering directions? Is this a significant difference? How much of a benefit might a shift to a four-direction scope be?
19.
What is your outlook for cystectomy volume recovery across H1 2022 and 2022 more broadly? What might be the key concerns here, particularly as Omicron plays out?
20.
Ambu has a next-generation cystoscope and its ureteroscope is launching in 2022. Do you have any thoughts or expectations on these upcoming launches?
21.
What do you want from any upcoming launches, either from Ambu’s aScope in terms of a next-generation product or more generally from the reusable or single-use scope players?
22.
How much of a limiting factor is the aScope’s lack of enhanced features that you get with the reusable scopes? What key enhanced features do you get with the reusable scopes that you think are essential to have with future generations of the aScope?
23.
What are the key costs related to the aScope’s monitor? How could costs be saved if Ambu could enable its scopes to be linked up to any laptop, similar to what happens with the NeoScope?
24.
What might be the key head- or tailwinds to single use take-up in the cystoscope setting over the next 3-5 years?