Bellevue Digital Health

Global stocks (MSCI World Net Index -2.0%) and the broad healthcare sector as measured by the MSCI World Healthcare (-4.8%) retreated in October. The Bellevue Digital Health (Lux) Fund (-3.4%) performed better than the overall healthcare sector but was not impervious to the general market decline. A solid jobs report and slightly higher-than-expected inflation in the US pushed up US bond yields; 10-year US Treasury yields, for instance, rose by 0.5% to 4.2%, and the US dollar strengthened against other major currencies, which was a positive factor for European investors. The fund’s performance in euro (-0.7%) and Swiss franc (-1.0%) was significantly better.

Ten of the 33 stocks in the fund's portfolio made a positive contribution to performance. The top performance drivers in October were Penumbra (+17.8%), Procept BioRobotics (+12.3%), Omnicell (+11.6%), Illumina (+10.5%), Dexcom (+5.1%) and Intuitive Surgical (+2.6%). These gains were fueled by better-than-expected third-quarter results. Quarterly sales at Procept BioRobotics surprised on the upside and management increased its full-year outlook. The company’s new Hydros Robotic System has already been successfully placed in the market. The company took advantage of strong investor demand and raised approximately USD 200 mn from a share offering, which will help to fund the company’s rapid growth. Details of a clinical trial comparing the company’s novel therapy to conventional prostate surgery in localized prostate cancer were also published. We assume that the trial will quickly commence and be successful. Dexcom impressed investors with its announcement of record-high new customer additions in Q3 and the filing of a 15-day G7 CGM sensor to the FDA for approval. After the slump in growth in the second quarter, it appears that Dexcom's management is on track to resolve its biggest problems by the end of the year and return to a growth trajectory in 2025. Intuitive Surgical, the largest position in the portfolio, reported excellent results for the third quarter of 2024, driven by strong sales of instruments and increasing placements of its advanced robotic, AI-assisted da Vinci 5 surgical system. The installed base grew by more than 15% year-on-year, which is a good indicator of strong instrument sales growth in 2025.

Portfolio performance was hurt by TransMedics (-47.8%), Phreesia (-19.7%), Align (-19.4%), 10X Genomics (-29.0%), Evolent Health (-17.4%) and GN Store Nord (-13.3%). TransMedics fell short of consensus estimates. Although sales rose by 64% year-on-year to USD 109 mn, sequential quarterly growth was 5% lower. This was attributed to general weakness in the US organ transplant market, but growth had already picked up at the beginning of the fourth quarter. Although reported sales were for the first time only in line with the underlying organ transplant market growth, meaning TransMedics did not widen its share of the market, we do not see any fundamental change in the competitive environment. Unanticipated shortages of surgical capacity and the generally unpredictable timing of organ transplantations are in our eyes the more likely factors behind this recent development. TransMedics is already developing a next-generation solution for transportation of donor hearts and lungs. Four clinical trials are scheduled for launch in 2025 with the aim of demonstrating the superiority of TransMedics OCS over conventional "cooled" storage and transportation methods. In addition, the aim is to be able to safely prolong storage and transplantation times so that all transplants can begin on a predictable schedule in the morning. This means a surgical team could perform up to three transplants in one day instead of just one. This would be an important factor in overcoming the shortage of donor organs and the long waiting lists.

The Chinese stocks in the portfolio, which have a low weighting (2.8%), were unable to defend their gains from the prior month (government announcement of a fiscal stimulus program). JD Health (-20.6%), Alibaba Health (-26.6%), Ping An Healthcare and Technology (-20.5%) had a negative impact of -0.6% on absolute performance. All performance data is in USD / B shares.

From a fundamental point of view, digital health companies have reported stable above-average growth and that is expected to continue in 2024.

In their discussions with investors during February and March, the executives of many companies made positive remarks about business in the first quarter and for 2024 as a whole. The approval and subsequent launch of relevant new products will continue to bolster sales growth, too. Examples here are Inspire Medical's new Inspire 5 device for obstructive sleep apnea, Dexcom's Stelo and G7 blood glucose sensors, Intuitive Surgical's new da Vinci 5 surgical robot, and Insulet's Omnipod 5 patch pump.

As witnessed during the last two years, even outstanding sector-specific fundamentals can be overridden by macroeconomic developments and shifting investor preferences. In 2024, we expect our investment solution to benefit from several factors: Cuts in US interest rates (which usually benefits growth stocks the most), attractive valuation levels (price/sales multiples close to historical lows), an expected increase in M&A and IPO activity, a general repositioning as investors drop last year's outperforming stocks and buy high-quality stocks, and the underwhelming growth outlook for the world economy (which in the past has been a relatively good setting for non-cyclical subsectors such as the digital health) underpin our optimism and make a good case for investing in the Bellevue Digital Health (Lux) Fund.