Last year half the medtech companies that floated did so outside the US. This trend seems to be continuing into 2018, with at least four device makers heading on to exchanges in Europe and Asia.
Grail, the liquid biopsy developer, has strong ties to Hong Kong, so rumours that it plans to list there in a deal that could raise $500m carry the ring of truth. And European IPOs are popular too, with one deal done yesterday and two more in the pipeline. Perhaps these companies simply prefer to stay close to home – though the US medtech indices have shown greater volatility than the European ones so far this year, which can hardly have helped the US cause.
It is not as if the European floats are smaller deals. Last year they were larger, on average, than the US-based IPOs (US listings disappoint in quiet year for medtech floats, January 22, 2018). This is highly likely to remain true in 2018, since this year will see Siemens float a share of its Healthineers business on the Frankfurt market in a deal that could be worth as much as $10bn.
Making their bones
But smaller companies are seeking capital on the European markets too. Yesterday the Finnish group BBS-Bioactive Bone Substitutes floated 12.5% of its shares at €5.50 on the Nasdaq First North Finland and Sweden markets, raising €3.5m ($4.3m). The company makes Artebone, an injectable paste designed to treat bone defects or fractures during orthopaedic and trauma surgery. Artebone is not yet CE marked, and BBS-Bioactive Bone Substitutes is pre-revenue.
The Nordic exchanges saw a lot of action last year, so BBS-Bioactive Bone Substitutes is following a well-trodden path. Not so Medartis, which intends to launch its offering on the Six Swiss Exchange in the first half of the year. Six Swiss sees maybe half a dozen IPOs per year, and no medtech has listed here for several years.
Basel-based Medartis is focused on bone fixation, with implants designed to allow surgeons to repair various broken bones, including those in the hands, wrist and face. While it has not said how much it hopes to raise it intends to use the cash to push currently sold products – it had revenues of SFr105m ($111m) last year – into new markets, as well as launching new devices.
One of Medartis's hand implants
In contrast to the European groups Grail is not staying home. The company is based in Silicon Valley but is rumoured to be intending to cross the Pacific for an IPO.
If this is the case it might not be too surprising. Grail bought a Hong-Kong-based company, Cirina, in May, and plans to launch a DNA-based test for nasopharyngeal carcinoma it acquired from Cirina in southeast Asia. The condition is far more common in southern China, including Hong Kong, than in other areas.
The rumoured figure of $500m would represent a fraction of the company’s value. Investors including Bill Gates and Jeff Bezos – the only two people ever to have had personal fortunes worth twelve figures – have pumped $1.3bn into Grail over the course of just two years.
The Chinese market is obviously very important to Grail. But there could be another reason for its alleged choice of IPO location. The Hong Kong exchange is drafting new rules that would make it possible for pre-profit or pre-revenue companies that produce small molecule drugs, biologicals, and medical devices and diagnostics to list on the main board even if they “do not meet any of [its] financial eligibility tests”.
Siemens’ IPO, expected this month, will be medtech’s biggest. It might not be the most interesting.