ResMed has a strong position in the structurally growing sleep apnea market

Business Strategy and Outlook

ResMed is taking a “smart devices” and Big Data approach to further entrench itself as one of the two leading players in the global obstructive sleep apnea, or OSA, market. With cloud-connected devices, physicians can monitor patient compliance and encourage continued use. Higher adherence supports both reimbursement rates from payers and the resupply of masks and accessories. ResMed also plays a key role in producing clinical data that demonstrates treatment can minimise related risks such as hypertension, stroke, heart attack and Alzheimer’s disease. Through its own testing devices and education, ResMed seeks more widespread diagnosis and treatment of OSA. The global OSA homecare device market, is a two-player duopoly with over 80% estimated market share split between ResMed and Philips, with ResMed the market leader in the majority of the 140 countries it competes in. The market offers a large global growth opportunity as penetration within developed markets is estimated at one fifth of the roughly 15% prevalence, and emerging markets are essentially untapped. In the U.S. it is estimated that roughly half of the 22 million people diagnosed with OSA are treated with continuous positive airway pressure, or CPAP, with another 34 million remaining undiagnosed. ResMed operates in over 140 countries with over 900 million people estimated to have sleep apnea globally, indicating the long runway for growth.

ResMed has made acquisitions of home healthcare software platforms as it seeks to leverage the trends of digital health and providing care in a lower-cost setting. Brightree, acquired in 2016, and MatrixCare, acquired in 2019, offer business management software for a range of home health providers. ResMed is currently directing significant capital to this area, and although high returns have largely been unproven, the move has been strategically sound given the structural industry tailwinds. ResMed has a minority stake in Nyxoah who are developing a neurostimulation implant to treat OSA. Although little near-term risk from this therapy can be seen due to the higher cost and invasive surgery needed, ResMed’s minority stake hedges some risk from emerging competition.

Financial Strength

ResMed is in a strong financial position. Free cash flow conversion of earnings prior to acquisition spending has averaged 106% over the last five years and has allowed ResMed to quickly repay the debt funding its acquisitions. At the end of fiscal 2021, ResMed reported USD 360 million in net debt representing net debt/EBITDA of only 0.3 times. Free cash flow to grow to USD 1,469 million by fiscal 2026 from USD 556 million in fiscal 2021, and in the absence of major acquisitions, the company should be in a net cash position over the five-year forecast period. ResMed commenced paying a dividend in fiscal 2013 and doesn’t have a fixed payout ratio policy. 28% payout ratio is lower than the trailing three-year average of 34% of underlying net income mainly due to ResMed’s significant uplift in earnings. Still it can be implied that dividends grow at a five-year 15% CAGR versus a trailing five-year CAGR of 6%, and ResMed is likely to seek optionality for further acquisitions in the software-as-a-service segment.

Bulls Say’s

The long-term growth opportunity for respiratory homecare devices is sizable as both developed and emerging markets are still significantly underpenetrated.

The focus on cloud-connected devices has led to increased adherence, supporting both reimbursement rates and the resupply of masks and accessories.

ResMed stands to benefit from Philips’ significant product recall and the launch of its new flagship product, AirSense 11.

Company Profile

ResMed is one of the largest respiratory care device companies globally, primarily developing and supplying flow generators, masks and accessories for the treatment of sleep apnea. Increasing diagnosis of sleep apnea combined with ageing populations and increasing prevalence of obesity is resulting in a structurally growing market. The company earns roughly two thirds of its revenue in the Americas and the balance across other regions dominated by Europe, Japan and Australia. Recent developments and acquisitions have focused on digital health as ResMed is aiming to differentiate itself through the provision of clinical data for use by the patient, medical care advisor and payer in the out-of-hospital setting.

(Source: MorningStar)

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