Towards a world where everyone has access to the best cancer care Annual Report 2020/21 LIMA, PERU MAY 14, 06:15 AM Content THIS IS ELEKTA This is Elekta 1 BUSINESS OVERVIEW A global leader in CEO comment 6 Market and trends 8 Precision Radiation Strategic framework 11 Offering 18 Geographical overview 30 Medicine Risk management 34 The share 39 Elekta is a global leader in radiotherapy solutions to fight cancer and neurological diseases. In fact, we are IN-DEPTH SUSTAINABILITY REPORT the only independent radiotherapy provider of scale. We Introduction 42 have a broad offering of advanced solutions for deliver- Access to Healthcare 44 ing the most efficient radiotherapy treatments. Green Processes 48 Business Ethics 51 Elekta’s offering allows clinicians to treat more patients People in Focus 55 Sustainability governance with increased quality, both with value-creating and reporting principles 63 innovations in solutions and AI-supported service based GRI content index 67 on a global network. At present Elekta has an installed Auditor’s report 70 base of CORPORATE GOVERNANCE Chairman’s comment 72 Corporate governance report 2020/21 73 > 6,650 Internal control 81 systems globally. Board of Directors 84 Executive Management 86 Auditor’s report 88 Remuneration report 2020/21 89 FINANCIAL REPORTING Solutions ~60% of net sales Board of Director’s report 94 Consolidated income statement 104 Consolidated statement of comprehensive income 104 Oncology Informatics Solutions Consolidated balance sheet 106 Changes in consolidated equity 108 Consolidated cash flow statement 110 Financial statements – MR-Linac Linac Parent Company 112 Solutions Solutions Notes 114 Signatures of the Board 147 Auditor’s report 148 Glossary 152 Brachy Neuro Definitions 154 Solutions Solutions Alternative performance measures 155 Five year review and key figures 158 Annual General Meeting 2021 160 Service ~40% of net sales About the Annual Report Pages 92–147 constitute the statutory annual report, which has been audited. The Annual Report also includes Elekta’s sustainability infor- Delivering high quality after-market mation, corporate governance and remuneration reports. Elekta presents a sustainability report services, generating recurring revenues prepared in accordance with the GRI Standards, Core option, and a sustainability report in accor- dance with the Swedish Annual Accounts Act. Hope for everyone dealing with cancer Elekta’s purpose is to inspire hope for anyone dealing with cancer. Through our strategy, ACCESS 2025, we improve patient access to the best cancer care by: • Accelerating innovation with customer utilization in mind • Driving partner integration across the cancer care ecosystem • Being the customer lifetime companion • Driving market adoption across the globe Sales and EBITA development Impacted by Covid-19 during the last two years. NET SALES EBITA AND EBITA MARGIN NET DEBT/EBITDA SEK M SEK M % MULTIPLE 16,000 3,000 2,709 24 3.0 15,000 13,763 2,500 21 2.5 14,000 2,000 18 2.0 13,000 1,500 19.7 15 1.5 12,000 1,000 12 1.0 9 11,000 500 0.5 0.25 10,000 0 6 0.0 18/19 19/20 20/21 18/19 19/20 20/21 18/19 19/20 20/21 ELEKTA ANNUAL REPORT 2020/21 1 MAY 13, 5:15 PM MAY 13, 10:45 PM KOLKATA, INDIA ALEXANDRIA, EGYPT ACCESS GAP OF ~1,400 LINACS ACCESS GAP OF ~100 LINACS Even if the cancer burden is global – most of the world lacks access to radiotherapy. 2 ELEKTA ANNUAL REPORT 2020/21 MAY 14, 06:15 AM MAY 14, 07:10 AM LIMA, PERU SEMARANG, INDONESIA ACCESS GAP OF ~50 LINACS ACCESS GAP OF ~500 LINACS Currently there is a shortage of >15,000 linacs globally. We need to close this gap. ELEKTA ANNUAL REPORT 2020/21 3 Our innovations push boundaries for what is possible to treat. Based on functionalities such as seeing what to treat, precision and adaption, Elekta accelerates innovation to become even more agile and faster in improving cancer care around the globe. Read more about our offering on page 18. 4 ELEKTA ANNUAL REPORT 2020/21 BUSINESS OVERVIEW ELEKTA ANNUAL REPORT 2020/21 5 BUSINESS OVERVIEW / CEO COMMENT Accelerating innovations to elevate cancer care We managed to increase orders, gaining market shares and grow the installed base in a pandemic affected market, giving more cancer patients access to radiotherapy. The successful execution of our new strategy will lead us towards a world where everyone has access to the best cancer care. Supporting our customers during an unprecedented year This year was unprecedented in many ways. The effects of the pandemic continued to cause uncertainty and many “We can be fast challenges. We focused on supporting our customers to keep cancer treatments up and running. Despite endless obstacles, and agile in clinicians all over the world were determined to maintain radia- tion therapy treatments and our task was to ensure that we did turning needs into everything we possibly could to help them. Thanks to tremen- dous efforts by our customers and by our employees truly new innovations.” heroic achievements were accomplished. It has been a privi- lege to take part in all those stories of dedication throughout the year. I am especially proud that both our customer and hand in hand with clinicians and our partners to continuously employee satisfaction rates increased substantially across develop innovative, outcome-driven and cost- efficient solu- all areas. tions that provide lasting clinical difference. And we can be Elekta demonstrated resilience and acceleration this year. fast and agile in turning needs into new We managed to grow our orders by six percent, and we gained innovations. market share. The acceleration of orders in the last quarter During the year, we have launched several new solutions shows the suppressed need for cancer care equipment post the that have the potential to improve patient outcomes and pandemic. Our revenue grew by one percent, low by historical make workflows more effective. Our new linac, Harmony, comparison, but explained by difficulties accessing hospitals to introduced in September, recently treated its first patient. install systems during the pandemic. Our strong margins were Harmony has the potential to be a valuable asset in mature supported by lower expenses and cash flows were healthy market cancer centers, and at the same time serve as the key throughout the year. I am especially pleased that we grew our in bridging the gap in access to radiation therapy in emerging installed base by five percent, giving more cancer patients markets. On the software side, we released MOSAIQ 3 our access to radiation therapy treatments around the world. latest version of oncology informatics and Monaco 6 in treatment planning as well as the latest treatment optimizer Accelerating innovation with for the Leksell Gamma Knife, Lightning. We leveraged our customer utilization in mind acquisitions in the tumor planning tool, ProKnow, and patient- During the first part of the year, we focused on resilience initia- reported data application, Kaiku, with very promising results. tives and digitalization of our processes, enabling acceleration Our brachy business launched Elekta Studio, which can for innovation projects in the second half of the year. Elekta’s improve treatment outcome significantly for a therapy essen- priority is to be world class in precision radiation medicine, tial to cancer care in underserved markets. but we have always believed in taking an open and proactive We also drove the paradigm shift towards MR-Linac with approach to building strong partnerships in the cancer care Elekta Unity, which moved into the second phase of commer- ecosystem. We use our precision radiation expertise to work cialization in the beginning of the year. When we closed the 6 ELEKTA ANNUAL REPORT 2020/21 CEO COMMENT / BUSINESS OVERVIEW “Our mission at Elekta is to not just provide technology; we provide hope for everyone dealing with cancer.” year we celebrated the 100th Unity order and Unity has now the patients. Our mission at Elekta is to not just provide tech- treated more than 2,500 patients for over 40 indications with nology; we provide hope for everyone dealing with cancer. outstanding clinical feedback. The MOMENTUM study is cur- Our ACCESS 2025 must be delivered in a sustainable way. rently generating the clinical data that will be the basis for the Providing cancer care to low- and middle-income countries is ongoing and future reimbursement processes. our most important contribution in building a more sustain- After the fiscal year, we strengthened our existing strategic able world. But we are also leveling up our ambition on the partnership with Philips to include both R&D and distribution environmental area, our social responsibility and governance, collaboration agreements. This will unlock opportunities pro- committed to doing our part in a world that needs to change. viding better patient outcomes, easier selection by clinicians Since we signed the UN Global Compact in 2017, we have con- of the optimal treatment strategy, and more efficient and tinued to push the agenda forward and now we have also effective therapy delivery. committed to set science-based targets in accordance with the Paris agreement. Our strategy – ACCESS 2025 – delivered in a sustainable way Towards a world where everyone has access Moving forward, we see two main growth drivers in our market: As we end this year and look towards accelerating innovation a steadily increasing cancer incidence, and increased demand in radiation therapy, I look back at a year that everyone in for better healthcare in both mature and emerging markets. Elekta should be proud of. I would like to extend my gratitude With a successful execution of our recently launched strategy, to all customers, partners and Elekta employees who through- ACCESS 2025, we want to do our part to move towards a world out this year have done their utmost to support the journey where everyone has access to the best cancer care.