Paxman AB

Paxman AB

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Q3 FY2025 · Earnings Call TranscriptNovember 14, 2025

Operator

Good morning, everyone, and welcome to DNB Carnegie. My name is Maria, and I'm an analyst here at the bank.

Today, I am thrilled to be joined by Richard Paxman, CEO of Paxman. Please welcome, Richard.

We are going to dig into the Q3 numbers, talk about the Dignitana integration, and the CIPN process, and many more things, I think. I think we'll start with a presentation from you, Richard, and then we'll continue on with the Q&A.

Please feel free to ask questions in the chat.

Richard Paxman

All right. Thank you, Maria, and great to be here again and looking forward to presenting our Q3 results and some other information.

I think you all know me by now, or most of you do. Richard Paxman.

Just talking a little bit about the organizational structure, no major changes from the last time we presented in terms of overall numbers at 142. I think it's important to understand, although we've made certain changes in the Dignitana organization, technically those that are leaving are still employed by the group.

We'll soon see some reductions in the Dignitana AB business just down to two employees. Then you'll see a little bit of a stabilization for a short period before we start then looking at further employees to support our CIPN commercialization plans, which is exciting.

Continue to have a strong leadership within the group and a really great team, and can't thank them enough for what's happened this year. It's been a busy year, and they all continue to perform wonderfully.

Just taking a look at the consolidated figures, the new group achieved net revenue of about 86.9 million SEK, compared to 64.8 million SEK in the same period in 2024. That's a 34% growth, and our highest level of sales to date, which is fantastic.

If you only comprise of 1.1 million SEK of organic growth from 2024, that's partially because of the VA order that we had back in 2024, which meant the growth does not look as good from a comparable period, and about 21 million SEK of acquired revenues. If we actually look, though, at the UK entity, we achieved really strong revenues of 3.4 million SEK, on budget, and about 2.9 million the prior year.

In line with what our expectations were. The US entity achieved $3.6 million, compared to 4 point $4.2 million that prior quarter as well, and that really is back down to that Veterans Affairs order, which was about a million dollars overall.

If you look at our cost structure and EBITDA, of course, there's going to be some impact from our CIPN commercialization activities, which have weighed on margins, as well as, of course, the work that we're doing with Dignitana. The company delivered an EBITDA of about 7.8 million SEK, which is a 9% margin, and an operating profit of about a million SEK overall.

Profit and loss, as I said, was affected by the merger, which equated to about 7.5 million SEK impact: so 3.4 million SEK of Dignitana costs and 1.6 million SEK, of about 1.6 million SEK estimated as our goodwill amortization. I think, taking a step back and looking at these overall, we are really, really pleased with where we're at.

We think we've got a strong-performing business. Back to where we thought we were from a budgetary perspective, we're up on the UK business and about a million dollars behind where we thought we were as a US entity.

That's primarily the direct provider or the insurance-based billing model not delivering quite where we wanted just yet, but still strong expectations for the next year. Cash flow, of course, has been affected by the acquisition and restructuring, so that's led to a negative operating cash flow of about 6 million SEK.

Investments have totaled about 6.8 million SEK for the period: again, 2.5 million Dignitana-related, 1.3 million related to CIPN, and then the rest with those typical investments you normally see. An overall cash outflow of nearly 20 million SEK.

That does seem probably our highest cash outflow overall for I think our history. Let's not forget what we're doing: investing in Dignitana, paying off some of those debts that Dignitana had, and also investing in the future CIPN, which is exciting.

We're still in a very, very strong position: 130 million SEK of cash in the bank, giving us a solid base for that commercialization going forward and completion of the Dignitana integration. Just looking about where sales are coming from around the world, that US piece is growing because it's actually a stronger part of the business than overall, but that's where we're putting our investments.

We've got to remember that. We've put a large proportion of effort and focus into the US market as opposed to rest of world markets.

They do continue to perform, though. UK is reasonably static year-on-year at the moment.

However, if you look at our rest of world markets, we're seeing that 20% growth year-on-year, which I think is strong, and we can't forget that. That's without significant investment at the moment, and that's the trend we'll continue to see as our focus remains primarily US, reimbursement, and peripheral neuropathy.

Long-term, that, of course, will change as we start to develop those new markets. ADTR revenue, of course, is growing, amounted to $52,000 for Q3 2025.

That was actually a decrease if you look at it without Dignitana and again without the VA, but you look at what it looks like with Dignitana in the mix: 70 nearly 80 million $80,000 per day, 14 1.9% increase from Q3 2024. Very excited about what this means for the organization and even more excited about what this means when we can start to see that driving reimbursement and really start pushing forward with that strong utilization when we remove those cost barriers.

We all know why we carried out the directed issue earlier in the year, but I'll just remind ourselves: commercialization of CIPN, I'll touch on that later; our new facility, which I'll touch on also later; and then future investments into novel therapies, which is a work that we've not actually started yet and we expect to look into that early into the new year, although discussions are well on the way. In terms of where our spend has been in terms of that raise so far, just about 5 and a half million SEK of P&L impact, that's really on headcount, reimbursement work for CIPN, rebranding and positioning of the business, non-capital R&D, some marketing and regulatory work, of course.

From a cash impact, it's around 10.5 million SEK, but overall heavier spend will start in the new year and then when we start to roll out capital for the CIPN commercialization. The merger, I think everyone wondering how this is progressing, and I've got to say I'm delighted with the progress.

It's been a learning curve for us all, of course. This is my first merger or acquisition, and my team's, but I think I'm delighted at how we've performed, how Dignitana have welcomed us, as I've said in previous meetings.

We now have 100% of the shareholding in Dignitana, which is fantastic. Looking at terms of cost and associated costs from a P&L impact, we're about 7 million SEK, as we've previously said, and a cash impact at the moment of about 6 million SEK.

We do expect some larger cash impact happening next in Q4, and that's really about the squeeze-out and buying back those shares that didn't transact during the offer period. Again, this is all planned for and expected.

No hidden surprises. Integration progressing very well.

Just got back from Philadelphia, where we had all our US teams together for the first time, and it was great to see how everyone was building relationships and actually excited for the future, and we really do believe we will be stronger together. I think this map demonstrates that, looking at now those 940 42 locations we've got across the United States, which is incredibly exciting.

We look at the revenues we are generating today, we look at the improved utilization when we change to IBBM. This really allows us to put ourselves in a position where we can drive revenues, drive utilization, and keep ourselves ahead of the game and in a very, very strong position.

We've been looking at a new structure. It's a relatively simple business, Dignitana, so far, thankfully.

The Dignitana AB business will pretty much close down other than two people, who will support our international efforts. That will have all finished by the end of the year, and we're grateful for the Lund team for all that they've done.

Our main focus will be on the US business, of course. That is the main interest from the acquisition, with the large volumes of sales that are already showing an impact and profitability to Paxman AB.

We've had some changes and put some new reporting structures in place. Overall, we're working on better processes, more support, reviewing appraisal processes, standardizing salaries, etc., and focusing on improving culture going forward, and I think we're making a really good start there.

In terms of feedback and looking at how the integration's progressed from a people perspective, which is important to me and my colleagues, and we've had about a 94% response rate to our post-merger integration survey from the Dignitana team. It's been overwhelmingly positive.

I'm not going to go through all of these, but from the survey, but also being in Philadelphia, it is wonderful to hear the positive feedback. Now, we've not always got it right.

We've got some positive feedback, but we've also got some feedback in how to improve in terms of communication, and that's key going forward, and that's something that we're going to continue to invest in and make sure that culturally, but also process-wise, we're working well together. I think we'll definitely achieve that by the end of the year.

Touching on reimbursement, which is obviously a key consideration for us all, I think it's important to understand that although that Q3 2 results, Q4 results didn't look as good as we might have expected, and actually the year-on-year, if we looked at insurance-based billing income, that actually rose nearly 12% from the prior year, and then self-pay income actually rose 25%. Where at the beginning of this year we were expecting a slightly different mix, what we've seen is still strong levels of growth throughout, which is good, and I think we should be happy with that.

I think if you look at number of locations driving revenue, 18 less than 18% of our locations are part of insurance-based billing, and that's driving 35% of our revenues. Again, it shows, doesn't it, that when we're switching, we're getting better utilization at those locations.

I'm hopeful by the end of the year to provide you some more utilization statistics, we can really start to understand more about that impact as well, and we may even share some of those data points at the Capital Markets Day in the next couple of weeks. Coverage still remains strong where we're actually collecting benefits investigations.

Over 3,000 patients now treated on or 3,000 benefits investigations now carried out, still showing 75% of coverage. We do believe longer term that will improve, and that will improve based on CPT 1 coverage, but CPT 1 coding, but also the work that we're doing on coverage and payment discussions.

We're really focusing on the simple switch. We have to get better at moving to where customers are on our new model, and that has been a little bit of a struggle.

We're not where we wanted to be. We've just run a webinar.

Some of you actually, I think, joined. What a response!

What an interest! I'm also just back from Accelerate, a US Oncology and Unity Onmark conference, very much about the community oncology base, and there is an overwhelming interest in the new model.

What we need to do, though, is give them confidence that this is a de-risked opportunity for them, which gives better access for the patient. We believe it, but we've got to demonstrate it.

I think the first part of the year will be focusing really hard on the payers, getting those coverage policies right, getting customers to switch, giving them the support that they need to get confidence to move forward. The legislative mandates are flying in.

It's brilliant. Two more have just been published, both in Ohio and in Pennsylvania.

We all know about the New York bill and the Louisiana bill, and the other bills are progressing as well. An area which we have been really standoffish for a while, but based on our integration with Dignitana, based on the fact we've got more people now in our organization, we're actually able to put some more focus into this.

There is a lot of hype around these bills and actually a lot of potential success to support those coverage policies going forward. Excited at where these will continue to go, and we'll keep you updated on what's happening over the coming months.

These rulings that we've all been waiting for have been delayed. MPFS, which is the community oncology in reality ruling, has come out, the final rule.

It is pretty much as it was. We're going to give more detail shortly, but we're reasonably satisfied where MPFS sat anyway.

We would have liked it been higher, but actually we're not too concerned about where it ended up. The conversations I've been having with community oncology providers actually think, 'Oh, if you break even with Medicare, that's a really good start.'

That's a good and confidence-boosting piece of information. The final rule for OPPS is yet to be delivered, very frustrating, but we hope by the end of the month we will have that.

I wake up every morning, check it—I think Maria does as well—and, unfortunately, no news yet. Let's hope they're working on some positivity for scalp cooling.

It's taking them a bit longer. From a peripheral neuropathy development standpoint, we're making really good headway.

We recently presented our latest data at ESMO with some hard-hitters from the US, which was fantastic. 200 people attended the session.

That's hard. It's a competitive conference, but really well attended, lots of interest, and so excited about the potential for this product.

As I said, we presented the data at ESMO. We've shared this in a press release.

For me, the biggest highlight is the levels of patients that can continue without dose reduction, which really affects outcomes, but also typically in the historical data, the data that's available for us all, we're seeing 30 to 40% of patients with taxane-based therapies have grade 2 peripheral neuropathy. That can be debilitating, painful, creates lots of sensitivity, difficulty to walk.

Our results have reduced that to 2 and a half percent of patients. That is impressive.

It has such a huge impact on the patient's quality of life, but also the cost burden. Hopefully, again, at the meeting in a couple of weeks, I'm going to share some of that information on cost burden with you so you can understand the real financial impact, not only the quality of life impact, to patients.

We continue to progress well with our US study. We've got 483 patients in, which is excellent and positive feedback so far.

We've got a slight delay in our Dana-Farber study, only five patients in, but we're going to put a little bit more investment in there just to support with the research nurses so we can get through the patients. Really the bottleneck at the moment is the research nursing staffing requirement.

Put a bit more resource into that and we'll start to be able to collect that data much quicker. Timeline is as it was: everything submitted by December with a view for FDA clearance in March.

Still need to determine exactly where we commercialize, but this puts us in a really strong position to deliver. The building continues to take far too long.

We are expecting to go to planning committee in the next couple of weeks. We have everything crossed.

We're pretty confident we will get it. It is just a process.

Very excited for our first state-of-the-art facility for Paxman. We have temporary location.

Don't worry, that's not our warehousing. It's not that messy.

We have space to start building our CIPN product, and we will be moving into that facility within the coming weeks. Again, very excited about that progress, and nothing is holding us back.

Thank you very much. Look forward to responding to any questions that you might have, and thank you for your continued support.

Operator

All right. Let's dig out some details that I have gotten some questions here in the chat, but I think I'll start with a pretty general one on the top line.

It's a record quarter, but most of it came from Dignitana. What were the underlying trends in the US?

What happened there in this quarter?

Richard Paxman

Yeah. If you look at the US figures, overall, those had improved.

We did still see growth. What you need to look at is the UK figures.

It was actually our sales into the UK market which were lower than the prior quarter, as well as, I believe, our overall rest of world sales. That pulled the overall growth from quarter to quarter down a little bit.

Am I concerned? No.

Timing. I think we've delivered pretty much quarter-on-quarter for many quarters, we're confident in what we're doing.

We need to push harder with the insurance-based billing to catch up with where our overall expectations are. If you look at our budgets, as I sort of mentioned, we're actually roughly where we thought we were.

The board and myself are really pleased with our performance.

Operator

A little bit of a follow-up on that here from the chat. Would you say that the time, resources that were attributed and are attributed to the Dignitana integration have some kind of a negative impact on sales development, meaning that maybe sales focus is a bit lower at the moment?

Richard Paxman

No, I'd like to say that was a good reason, but no, I wouldn't be telling the truth. No.

Our sales teams ultimately are out and not being affected by the integration. People like myself are affected, and the senior leadership team, but it shouldn't deter sales.

It's just timing more than anything. We're confident in progression.

The biggest slowdown that we have in terms of where we should be relates to ultimately this switch of insurance-based billing. If you look at our projections from a US perspective, ignoring rest of world, although that was where probably the weakness was for Q3, is about we thought we would have more customers switched onto the new business model.

Switching on the new business model drives utilization, and that drives revenue growth. If they're not switching at a rate that we thought they were, we're not seeing that same utilization increases as we'd like to see.

It's our job really to focus on getting those customers switched.

Operator

If we continue on the level type of thinking here, we talked a little bit about the top line. Gross margins, with the Dignitana now included, could you provide some details how that picture is going to look maybe in the next quarter and why it looked the way it looked now?

Richard Paxman

Gross margin's overall a little bit lower, some higher service costs, sales mix is always a little bit different, so that does affect margin. Adding Dignitana, excluding the AB business and not looking at doing capital sales, if that makes all sense for everyone, really actually drives and improves our margins.

Dignitana have some great gross margins in the US business, longer term, we expect to improve margins throughout.

Operator

You named utilization that you were going to maybe provide some more detail info for us towards the end of the year, but what are the underlying trends that you've seen in the quarter, maybe?

Richard Paxman

Yes, it's a bit patchy if you look at it overall from a sort of new group perspective, so that's why we need to pull out and look at the revenue in a bit more detail. I'm trying to get some more accurate figures in terms of what are our IBBM sites and how are they performing.

We have general trends that IBBM sites perform much better than self-pay sites in utilization, but I'd be wrong to give you any more detail than that. We're hoping to have some more granular work.

The idea would be new location on a self-pay, new location on an insurance-based billing, and then switched self-pay site from IBBM site, and we can look at what the impact is overall. That's the plan, just getting the data right.

Then we're going to try and share some utilization figures from Dignitana as well.

Operator

Perfect. There's a little follow-up to the gross margin question here in the chat if tariffs had something to do with that.

It's quite a short one.

Richard Paxman

Tariffs could have had a little bit to do with that, although we tried to push on pricing at the other side, but there may be some timing and delays where pricing is not had a full impact as yet, and then the prior quarter, we wouldn't have had the full impact of the tariffs because we'd have had stock without tariffs in the business as well. I think we'll manage to resolve that throughout the year, and it just might be a bit bumpy.

You've also got in the US a fixed service cost as well associated with the business, so that doesn't help. Driving growth will ultimately give us stronger margins as well.

Operator

Here is another question on the installed system space in US. You've installed nine systems in North America during Q3.

What is the reason for this relatively low number?

Richard Paxman

Good question. Timing, probably.

I'd need to just double-check on that. That does seem low.

Let me just pull that figure up. That is well-spotted.

I actually think that could well be a typo on the report. Embarrassing, but I like to be transparent and honest.

Typically we would be installing about 30 systems into the US, let me check that and we will make a small tweak. We probably won't make a change to the actual report, but I think it is most likely a reporting error that we've all not picked up.

We're a bit later on our reporting than typical this year based on a lot of moving parts.

Operator

We appreciate the transparency always here in the market. [laughs] Good thing.

It's best. [laughs] Here's another question about IBBM revenues: 'grows 12%, but looking at the number of delivered caps, it looks more like 35%.

Can you provide some explanation?'

Richard Paxman

Good question. You're seeing growth of 12%, but you're saying it looks like 35%—

Operator

On delivered caps, it says here, yes. —on delivered caps.

Richard Paxman

Again, let me check that figure. It could be timing with McKesson and Patient Assistance Program caps, a mixture of things.

Yeah.

Operator

All right. Since you've named McKesson, you've mentioned quite high interest in the talks that you've been having, but can you give us some more details on what you're hearing in the field about scalp cooling?

The permanent codes are going to go live soon, and what's the general sentiment? What do you hear out there?

Richard Paxman

Yeah. The sentiment is good, but still some hesitancy.

As I said, I was at the McKesson conference, and they have a large community oncology group called US Oncology and Florida Cancer Specialists. Take up a large proportion of the community sites.

They seem reasonably positive. Not all groups.

I think they're all keen on probably someone starting before them, if that makes sense. We need someone to commit.

I think we've got a commitment from one of the large groups. We're just working on that at the moment, so that's positive.

Then from an OPPS perspective, we're keen on getting that final rule out. I think more importantly, we're already seeing contracting.

We've had contracting from NYU, contracting from Yale, another large health system. That's about them contracting now and then starting in the new year.

I do think it's important to understand it is not a light switch on January the 1st. We're calling it simple switch, but it's not as simple as one might think.

That first quarter is going to be bumpy. I think then we'll start to see some more traction.

It takes time for the codes to work their way through the system, if that makes sense as well. We're going to be investing in some support from our consultants and partners to make sure we can handle those questions and difficulties.

We can start working with the payers very closely and communicating with them appropriately to say, 'Look, these are the problems we're seeing on the field. Why are we seeing them in the field?

What are you going to do about them?' so we can resolve them quickly and efficiently and not get people to lose confidence.

Operator

We are approaching the end of this interview, but we're also approaching the end of 2025. I'd like if we zoom out from the Q3 a little bit, what are your top reflections for the year, and what are you looking most forward to in the next coming year?

Richard Paxman

Perfect. Top reflections: Dignitana integration has been phenomenal, and the progress with our peripheral neuropathy product, and the future looks incredibly exciting.

I think going into the new year, for me, it's all about the simple switch. It's got to be.

We have to see that momentum as well as pushing for FDA clearance, European regulatory approvals, and launching the product. I think the integration at that point will be fine, and we will become one, and it will be a smooth process going forward.

Excited for 2026 and starting to see that substantial growth again, that positive momentum that we've seemed to falter a little bit back end of the year, but still 100% confident in where we're heading.

Operator

Perfect. Thank you very much, Rich, for joining us, and thank you, everyone, for joining us online to watch this earnings call.

Talk to you in Q4.

Richard Paxman

Look forward to it. Thank you.

Bye-bye.