瑞信-美股-医疗保健行业-牙医调查显示：牙科需求仍然不足-2019.1.28-30页.pdf

DISCLOSURE APPENDIX AT THE BACK OF THIS REPORT CONTAINS IMPORTANT DISCLOSURES,ANALYST CERTIFICATIONS,LEGAL ENTITY DISCLOSURE AND THE STATUS OF NON-US ANALYSTS.US Disclosure:Credit Suisse does and seeks to do business with companies covered in its research reports.As a result,investors should be aware that the Firm may have a conflict of interest that could affect the objectivity of this report.Investors should consider this report as only a single factor in making their investment decision.28 January 2019 Americas/United States Equity Research Healthcare Technology&Distribution Dental Update Research Analysts Erin Wilson Wright 212 538 4080 erin.wrightcredit- Charles Lederer,CPA 212 538 1822 charles.lederercredit- Katie Tryhane 212 325 2713 katie.tryhanecredit- George Engroff 212 325 2289 george.engroffcredit- CHANNEL CHECK Survey says:Dental demand still lacks bite 4Q Dental practice volume,revenue growth on par with 3Q trend:According to our proprietary survey of 75 US dental practitioners,47%of practices experienced positive revenue growth in 4Q,rising 0.5%(weighted avg.),consistent with our initial 3Q survey.New patient traffic(+1.0%)was the most meaningful driver of practice revenues,followed by pricing(+0.9%),bridges/implants(+0.8%),and preventative care(+0.6%).An encouraging dynamic,respondents were incrementally more optimistic on NTM trends with 71%expecting improving practice volume(vs.65%in 3Q),which bodes well for all our dental names.As a caveat,this is our second dental survey,and we expect more meaningful takeaways to our dental coverage with greater historical context.EquipmentDigital dentistry drivers w/caveats:While respondents were more optimistic on equipment purchasing over the NTM,with particular focus on intraoral scanners and CAD/CAM,we note that practitioners remain wary of larger cash outlays in an anemic demand environment,with dentists likely less inclined to make equipment purchases in light of growing macro concerns,as well as noted reimbursement pressures.That said,we highlight positive commentary on Dentsply Sironas(XRAY,Outperform)CEREC offering,noting its convenience and ease of use,despite continuing low overall penetration.While we view XRAY as a turnaround story LT and are optimistic on innovation opportunities in an IDS year,we acknowledge execution risk associated with salesforce,R&D,and cost structure initiatives.In terms of promotional activity,several respondents highlighted more aggressive discounting for ALGNs iTero,while XRAY equipment pricing was noted as relatively unchanged.Supply chain,Direct Dist.,Amazon update:Henry Schein(HSIC,Neutral)and Patterson Companies(PDCO,Outperform)were named as primary distributors by 40%and 17%of respondents,respectively.The majority(80%)is satisfied with its primary distributor,and 86%do not work with GPOs,an unsurprising dynamic(differs from Vet).While only 6%of standard medical consumables(e.g.gloves,cotton balls)are purchased through Amazon today,respondents expect purchases through Amazon could grow to 14%in 3-5 years.In terms of direct distribution,respondents currently purchase 22%of consumables direct from manufacturers,with 12%expecting to purchase more directly over NTM.每日免费获取报告1、每日微信群内分享7+最新重磅报告；2、每日分享当日华尔街日报、金融时报；3、每周分享经济学人4、行研报告均为公开版，权利归原作者所有，起点财经仅分发做内部学习。扫一扫二维码关注公号回复：研究报告加入“起点财经”微信群。28 January 2019 Dental Update 2 Clear aligners remain in focus:The majority(68%)of clear aligner users expect demand to rise over the NTM,with volume likely supported by a rising base of trained practitioners.Align Technologys Invisalign(ALGN,Outperform)remains the market leader,with 60%of our entire cohort(88%of clear aligner users)offering Invisalign.While concerns over competition,DTC,and ASPs have weighed on ALGNs shares of late,we view there is room for several players in a highly underpenetrated clear aligner market,and we view ALGN is well ahead in terms of innovation,with several respondents highlighting its recently launched mandibular advancement offering,an underappreciated dynamic,in our view.28 January 2019 Dental Update 3 Dental Survey Takeaways We commissioned a survey of 75 practicing dentists dispersed across 21 states in the U.S.,with the highest number of responses in New York(13),California(9),Florida(9),Massachusetts(6),and Illinois(5).Our respondents range across a number of specialties including general dentist(48),orthodontist(15),periodontist(7),pedodontist(3),and oral and maxillofacial surgeon(2),with an average tenure of 23 years.About half of our respondents work as sole practitioners(38),while most other participants work with multiple other dentists at a single practice owned by dentists(27).Of note,3 respondents work for a DSO or dental management organization affiliated group practice.On average,our respondents see 123 patients on a weekly basis.4Q Snapshot:Relevant company survey highlights Dentsply Sirona(XRAY,Outperform):Overall,the survey results are mixed for Dentsply Sirona,where we are forecasting 4Q18 revenues to fall 3.1%,driven by a 2.7%rise in consumables and-11.4%growth in Equipment to reflect ongoing distributor-level inventory shifts.We remain optimistic on XRAYs salesforce execution push,where 33%of respondents currently purchase consumables directly from the company,with 12%expecting to purchase more directly from the manufacturer over the next twelve months.We also view XRAYs recently revised strategy,where it has foregone its longstanding approach to promote a more comprehensive chairside CAD/CAM systems(scanner+mill),shifting focus toward its standalone digital impression offering(with also a dedicated lab strategy),offers incremental opportunity to capture share,particularly as only 9%of our cohort of dentists currently use its CEREC offering.Importantly,while most of our respondents view XRAYs equipment pricing as unchanged,net-net our cohort views pricing is slightly more aggressive,potentially coinciding with de-stocking/inventory shifts at the distributor level.Focus on its earnings call will be on end-market fundamentals,equipment trends,and salesforce initiatives.Danaher(DHR,Outperform)Earnings Date 1/29:Danahers dental business continued to experience the impact of a lackluster consumables and equipment landscape in 3Q,though we are encouraged by strengthening sellout trends,where we expect+0.8%dental growth in 4Q,supported by managements recent preannouncement that noted an improving Dental experience.Moreover,we view DHRs business will continue to experience healthier growth in a strengthening demand environment,as indicated by our survey results(+2.2%NTM practice revenue growth)and as it invests in key business lines.As a reminder,DHR has recently announced its intention to execute a tax-free spinoff of its Dental business(est.$2.9 billion in 2018 revenue,14%of total),with the transaction expected to close in 2H19.DentalCos current President aims to replicate the DHR playbook(DBS),which should help it to drive+LSD organic growth(+MSD specialty,50%of DentalCo revs)and 50 bps ongoing margin expansion LT.Distributors Patterson Companies(PDCO,Outperform),Henry Schein(HSIC,Neutral):On balance,while expectations for distributors remain relatively low,we are cautiously optimistic on prospects for the respective dental businesses of Patterson Companies and Henry Schein based on the positive NTM outlook on dental traffic and volume trends amongst our cohort.We also highlight positive commentary as it relates to Patterson,where respondents who utilize it as a primary distributor are more satisfied with the salesforce knowledge,on average,than competitors.Moreover,Amazons penetration remains low,only currently accounting for 2%and 3%of dental-specific consumables products and equipment,respectively.As a caveat,direct purchasing from manufacturers will also be a dynamic that we will monitor going forward in our survey work.28 January 2019 Dental Update 4 Align Technology(ALGN,Outperform)Earnings Date 1/29:While news of several new entrants into the clear aligner space has increasingly pressured shares along with recent pricing degradation that is expected to persist into 2019,we deemphasize the competitive threat,with the view that the highly underpenetrated clear aligner market is large enough for several players.Moreover,Aligns continuous innovation proves just how far behind competitors are on the innovation and learning curve,with several respondents highlighting the benefits of its recently launched mandibular advancement offering.Currently,ALGN represents 90%of the clear aligner market,where our cohort of dentists expects demand to grow+3.1%over the next twelve months,with volume growth also supported by a growing base of trained dental professionals.Also of note,several respondents highlighted iTero price discounting,which will likely support unit volume sales and scanner penetration.All in,we forecast-3.1%EPS growth fueled by+22.5%topline growth,supported by+20.9%clear aligner growth and+33.0%iTero growth,offset by 176 bps margin contraction in 4Q.Investor focus will be on 2019 commentary and guidance,with folks looking for evidence of continuing robust volume growth to offset aforementioned ASP pressure.State of the Industry Despite what should be favorable demographic and macro dynamics,dental consumable trends have not experienced a meaningful,sustained pick-up in demand since the 2008 recessionary timeframe,likely driven by rising out-of-pocket healthcare spend,representing a growing percentage of total discretionary income for consumers,share shifts to specialty,among other potential factors.While dental consumables trends were mixed across the majority of the major dental companies in 3Q,industry commentary continues to point to a healthier experience near term,with seemingly stabilizing sell-out trends.That said,we remain cautious in suggesting a broader stabilization or pick-up in demand in 4Q,particularly given several company specific issues.Figure 1:Recent quarterly Dental demand trends as reported by industry constituents Source:Company data,Credit Suisse Patient volume&practice revenues According to our survey,47%of respondents experienced 0%to+5%+growth in patient visits in 4Q18,with total traffic increasing 0.5%on a weighted average basis(vs.+0.2%in 3Q).Nearly a third of respondents(31%)reported flat patient volume growth over the past three months.Notably,only 23%of respondents reported declines in patient visits during 4Q(vs.31%in 3Q).1Q162Q163Q164Q161Q172Q173Q174Q171Q182Q183Q18Consumables+LSD+LSD+LSD-NegativeNegative-MSD-L-MSD-LDD+Slightly-MSDEquipment-LSD+MSD+MSD-Positive+LSD+LSD-MSD-HSD+Slightly-MSDConsumables3.3%0.9%-2.5%-2.8%-4.3%-3.6%-4.4%-7.4%-6.7%-5.2%-2.2%Equipment-6.9%5.4%4.2%-1.0%-16.9%-15.1%-17.7%-10.6%-20.2%5.4%-0.9%Consumables4.6%1.8%1.8%1.9%2.5%0.8%1.3%1.9%2.7%4.7%4.3%Equipment13.5%2.7%13.3%2.7%-5.5%14.8%-0.7%18.1%4.4%6.2%5.9%Consumables1.6%4.5%2.7%2.5%8.0%1.4%3.4%-2.6%2.4%3.0%3.5%Equipment4.3%3.1%4.2%-3.9%3.1%3.6%2.6%7.7%3.1%4.7%-4.2%Consumables4.5%3.8%-0.3%3.5%2.4%2.0%4.3%3.9%-1.3%3.3%-3.0%Technologies6.8%0.8%0.2%0.0%-12.7%-10.0%-1.1%5.9%-1.6%-1.1%-9.3%3MOral Care5.0%3.0%0.0%-1.0%5.0%0.0%3.0%3.0%0.0%3.0%2.0%Dentsply SironaDanaherPattersonHSIC N.A.HSIC Intl 28 January 2019 Dental Update 5 Figure 2:Dental practice visits(Y/Y growth)Respondent distribution(+0.5%weighted average vs.+0.2%in 3Q)Source:Credit Suisse,n=75 Practice revenues increased 0.5%on a weighted average basis in 4Q18,a stable,though admittedly lackluster trend(in line with 3Q).Practice revenues were driven by new patient traffic(+0.9%),pricing(+1.0%),bridges and implants(+0.8%),and preventative(+0.6%).As a caveat,this is our second dental survey,and we expect more meaningful takeaways to our dental coverage with greater historical context in future surveys.Figure 3:Dental practice revenues(Y/Y)Respondent distribution(+0.5%weighted avg.,in line with 3Q)Source:Credit Suisse,n=75 8%13%10%27%19%13%9%5%4%13%31%32%5%9%0%5%10%15%20%25%30%35%40%+5%or more3Q184Q1847%of respondents have experienced+1%to 5%+in patient visits during 4Q188%12%9%25%21%9%17%8%7%9%29%25%12%9%0%5%10%15%20%25%30%35%+5%or more3Q184Q1847%of respondents have experienced+1%to 5%+practice revenues during 4Q18 28 January 2019 Dental Update 6 Figure 4:Factors impacting practice revenues New patient traffic,acute care remain prominent drivers Source:Credit Suisse,n=75 NTM Outlook:Strengthening fundamentals Sentiment from respondents was optimistic for the next 12 months with 71%of dentists expecting stronger results in patient traffic in the coming months.On a weighted average basis,respondents expect patient visits to rise 1.9%over the next 12 months,compared to 1.6%in our 3Q survey.Only 8%of dentists in our survey expect declines in patient visits(vs.12%in our 3Q survey).Figure 5:Clinic traffic outlook NTM Respondent distribution(+1.9%weighted avg.vs.+1.6%in 3Q)Source:Credit Suisse,n=75 Dentists also remain optimistic regarding practice revenues,expecting a weighted average increase of 2.2%over the next 12 months.The majority of respondents broadly expect strengthening overall demand,consistent with our view of favorable dental fundamentals.0.1%0.3%0.3%3%0.3%0.6%0.4%0.6%1.0%0.8%0.1%0.3%0.3%0.3%0.3%0.4%0.6%0.8%0.9%1.0%CosmeticAcute VisitsEndodonticOrthodonticExisting Patient TrafficRoutine VisitsPreventativeBridges and ImplantsPricingNew Patient Traffic0.0%0.2%0.4%0.6%0.8%1.0%1.2%4Q183Q181%4%6%23%34%19%12%1%1%5%21%36%20%15%0%5%10%15%20%25%30%35%40%45%+5%or more3Q184Q1871%of respondents have experienced+1%to 5%+in patient visits during 4Q18 28 January 2019 Dental Update 7 Figure 6:Practice revenue outlook NTM Respondent distribution(+2.2%weighted avg.vs.+1.6%in 3Q)Source:Credit Suisse,n=75 Dental Supply Chain Based on our survey,Henry Schein is the most commonly used distributor,with two thirds(67%)of our respondents utilizing its services.Importantly,nearly half(49%)of respondents purchase supplies from the manufacturer directly.Figure 7:Which of the following distributors have you used in the past 12 months?Source:Company data,Credit Suisse estimates Based on our survey,Henry Schein and Patterson Companies were the most common primary distributors,representing 40%and 17%share of the cohort,respectively.Only 1%of survey participants reported Amazon as their primary distributor.Notably,in 4Q18,respondents reportedly purchased 71%of consumables and 55%of equipment through their respective primary distributor.1%1%7%19%29%20%23%0%5%10%15%20%25%30%35%40%+5%or more3Q184Q1872%of respondents have experienced+1%to 5%+in patient visits during 4Q181%5%13%15%16%41%47%49%67%0%10%20%30%40%50%60%70%Supply ClinicBurkhart Dental SupplyDarby DentalBencoOtherPattersonAmazonDirect from ManufacturerHenry Schein4Q18 28 January 2019 Dental Update 8 As a reminder the$20 billion North American dental distribution market is highly concentrated with the top three players,Henry Schein,Patterson,and Benco Dental Supply,representing 85%of the market.Henry