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European Healthcare European Healthcare A thought leadership publication from GE Healthcare Financial Services in association with mergermarket February 2009 Contents Foreword 1 European Healthcare Sector Overview 2 Healthcare Services 5 Euromedic Case Study 10 Life Sciences, Pharma & Biotech 12 Axellia Case Study 18 Medical Devices 19 ConvaTec Case Study 24 Historical Data 25 Contacts 27 ii European Healthcare Foreword 2008 proved a difficult year for global M&A in general so it is not surprising that there was a considerable drop off in activity within the European healthcare sector. Indeed according to mergermarket data, 2008 witnessed a total of 234 announced transactions worth a combined €12.7bn. Compared to 2007 numbers, this represents a significant 74% and 26% fall in deal value and volumes respectively. Yet despite this austere backdrop, the portents for future The level of M&A activity in 2009 will also be to a large extent M&A in this sector remain visibly strong. In pharmaceuticals, driven by the availability of debt financing. We expect markets the tough economic environment and the new administration will begin to normalise and support a sustained sense of at Capitol Hill intent on reform have added to the already confidence sufficient to promote investment, but this is not established problems of R&D inefficiencies, patent expected until late 2009. The level of M&A activity is therefore expirations, paragraph IV challenges and a hostile regulatory likely to remain low in the first half of the year. environment. This confluence of factors has undoubtedly We have once again teamed up with mergermarket to focused minds on M&A as way of overcoming some of these investigate the shifting M&A landscape of the European structural inefficiencies. healthcare sector. Their journalists were given access to Indeed, 2009 has already seen two sizeable deals get leading healthcare experts from GE to discuss the M&A underway with US listed Pfizer launching a €50.2bn offer outlook within the various segments of European healthcare. for its local rival Wyeth and Switzerland’s Roche launching mergermarket also tapped into its proprietary deals database a €33.8bn unsolicited tender offer for the remaining shares to chart historical deal activity over recent years. We also it did not own in US listed Genentech. While both of these have taken the opportunity to present three case-studies of are intrinsically US deals, what they infer for European investments made by GE Healthcare Financial Services. pharmaceuticals intent on M&A is that financing, for those at We hope you enjoy this second edition of European least at the top end of the investment grade level, is available Healthcare and we welcome your feedback on this report. despite obvious credit constraints elsewhere. Outside of pharma the financing picture is less robust, but Stephan Caron there remain further consolidation opportunities within Executive Director, Leveraged Finance European healthcare, despite the absence of private equity at GE Healthcare Financial Services the top end of the market. Long-term care consolidation has all but petered out in the UK although the markets in France, Part of GE Commercial Finance Germany and the Nordics remain either underpenetrated in terms of private provision or are demarcated by a number of smaller providers in a sector that continues to present very healthy underlying fundamentals. There is certainly ample room for further M&A activity in these countries over the next few years. In the acute care sector, the opportunity for further consolidation in Germany among mid-tier providers should see at least one or two transactions completing this year. And despite Montagu electing not to sell BSN Medical last year, consolidation in medical technology, especially the fragmented wound care sector, offers an interesting buy and build opportunity. Meanwhile, the buyouts of Euromedic and Biomnis last year is likely to whet investor appetite for further investment in the hitherto overlooked European medical diagnostics and laboratories market. European Healthcare 1 European Healthcare Sector Overview Effects of the global financial crisis witnessed in 2008 with a resounding 91% of announced European healthcare deals with a disclosed value falling in the Like every other industry in Europe and beyond, the €5m-€250m range. Large-cap deals in the sector will continue Healthcare space has suffered as a result of the credit to be mainly eschewed largely due to banks’ unwillingness to crunch and the recent global financial crisis. However, it provide debt financing in the current environment. In contrast, would appear that the sector should fare better than most 2007 witnessed some 16 transactions over €500m and areas over the next 12-24 months. The sector’s current and several mega-transactions, especially over the first half of the longer-term fundamentals look in good shape with an ageing year at the peak of the M&A boom, with Schering Plough’s population continuing to drive demand and significant supply €11bn acquisition of Organon BioSciences, the Netherlands issues in many segments. In addition, the defensive nature based pharmaceuticals division of Akzo Nobel, being the top of the sector means that many Healthcare firms generally deal of the year. have a lower exposure to direct consumer spending, while decreasing enterprise value multiples should ensure that Looking at the geographic split of Healthcare deal flow, the UK M&A deal flow, as well as company growth, remain relatively has dominated the M&A landscape in the sector, accounting resilient in these testing times. for around one third of deals both in terms of volume (27%) and value (32%). However, going forward it is foreseeable This is not to say that Healthcare M&A will not suffer in the that the UK’s share of overall M&A activity in Europe may short term. Rather unsurprisingly, deal activity has trended fall as the effects of the credit crunch continue to be felt. downwards in recent times with 2008 witnessing 276 The abovementioned Zentiva deal may be indicative of a transactions worth a combined €13bn. These figures are down geographic shift occurring in the sector with buyers beginning markedly compared to 2007 activity, falling 25% in terms to more actively acquire higher growth targets in the Central of deal volume and a staggering 73% when looking at deal and Eastern Europe (CEE) region. valuations. The decline in deal volume is comparable to the fall witnessed in the wider European M&A market (19%), although In recent years, a significant proportion of UK Healthcare the decrease in the value of deals is more than severe. service deals have been financed heavily by debt. This has principally taken the form of property-backed financing Indeed the deterioration in the debt markets has made it which enabled firms to take advantage of the abundant very difficult for Healthcare companies to finance large-cap liquidity available before the credit crunch, in a sector acquisitions in 2008. As a result, Europe witnessed only five underpinned by increased valuations over the last 5 years. deals over €500m in this period, the largest being the $4.1bn As a result, a number of UK companies acquisition of Convatec, formerly part of US pharmaceutical in the sector such as Four Seasons firm Bristol-Myers Squibb, by Nordic Capital and Avista Capital Healthcare, the long-term care Partners in early May. This was followed by the €1.91bn business, are struggling to refinance purchase of a 75.12% stake in Zentiva, the listed Czech existing bridges and are in search pharmaceutical group, by Sanofi-Aventis, the listed French of a solution to support their pharmaceutical group. Early in 2009 the US witnessed the development needs. In the short blockbuster €50.2bn acquisition of Wyeth by Pfizer. However, term, illiquid debt markets will this deal will most likely be the exception to the rule, likely lead to a fall in private equity especially in Europe, where the lower end of the mid market is activity across Europe, although set to witness the bulk of Healthcare M&A in 2009. the effects of this will be felt mostly in the UK where Mid-market in continental Europe set to financial investors have remain active traditionally been In terms of deals that may be brokered in the coming months, most active. Indeed it is expected that the mid-market will continue to be most deals exhibiting very active. This has already been high debt to equity 2 European Healthcare European Healthcare Sector Overview ratios, whether they involve trade or financial buyers, are far Hard times ahead for early stage Biotech less common in mainland Europe where transactions are While Healthcare M&A activity over the first half of 2009 more conservatively financed. will be slow across the board, early stage Biotech will be hit particularly hard. Investment from venture capital funds Private equity in the short to medium term is likely to continue to fall due to economic conditions and the asset class’ reliance on a With many private equity buyers focused on value creation/ number of very successful deals, which are not necessarily preservation in existing portfolio companies, the bulk of materialising, to prop up the less lucrative investments. European Healthcare M&A will likely derive from trade buyers Furthermore, the Biotech space is also adversely affected in the coming months. However, financial buyers are likely to by a deteriorating Initial Public Offering (IPO) market, which return to the market in the medium term, arguably, with a shift saw only one European IPO of a Biotech company in 2008 in attention towards mainland Europe. with Molmed, the Italian based biotech company focusing on The principal reasons governing this wider shift in emphasis oncology, raising €56m in February 2008. In comparison, 2007 towards mainland Europe are numerous.
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