Our Business

We improve people’s mobility

Össur is a global leader in non-invasive orthopaedics; innovating, producing, and providing advanced technological solutions within prosthetics and bracing & supports. Our mission is to improve the mobility of our users, so they can live their Life Without Limitations ®.

Össur was founded in 1971 and has since grown through innovation and acquisitions in both prosthetics and bracing & supports. Today, Össur has a strong global position in the industry and key markets being the second largest player worldwide in both segments and in a good position to leverage future growth opportunities. Össur has been listed since 1999 and since 2009 on Nasdaq Copenhagen. Össur has operations in over 25 countries and more than 3,000 employees.

Our users are at the core of everything we do

Every year there are individuals who are born without a limb or lose a limb at different stages of their life due to vascular diseases, diabetes, or trauma. There are also individuals who develop knee pain, are diagnosed with osteoarthritis in their joints, incur fractures to their ligaments or injure themselves resulting in movement impairment. Össur’s mission is to help these individuals regain their mobility by developing, producing, and providing them with prosthetic and bracing solutions.

World class innovation capabilities

Össur is a pioneer of advanced technology where our brand recognition is based on innovative and scientifically-proven solutions that deliver effective clinical outcomes. By researching and understanding people’s needs and pushing the boundaries of advanced technology, we continue to develop amongst the most effective solutions and services available in the fields of prosthetics and bracing & supports. Every year between 4-5% of Össur’s sales is re-invested in research & development with roughly 150 full-time employees working on new innovative products for the benefit of our users.

Our segments

Össur operates within two market segments of the orthopaedic market: bracing & supports and prosthetics. Prosthetic products include artificial limbs and related products for amputees. Bracing & supports products are primarily used to support joints and other body parts, both for preventive and therapeutic purposes.

Our Segments
Our Segments

Our products

Prosthetic solutions

For years Össur has helped people focus on new goals rather than limitations by offering comprehensive solutions that are designed with the needs of the user top of mind. Össur’s prosthetics portfolio includes a full spectrum of premium lower and upper limb prosthetic components. The portfolio ranges from solutions to support less active individuals who may struggle to maintain the ideal balance of safety, comfort, and mobility all the way to solutions designed to enable especially active people to engage in high-impact endeavors.

Bracing & supports: OA solutions

Össur’s osteoarthritis (OA) solutions are designed to enhance quality of life, reduce pain, and improve mobility for people living with osteoarthritis. The Össur Unloader® brand name has become synonymous with OA bracing, representing OA Solutions’ technology as the industry standard, with more than 15 clinical studies demonstrating its efficacy. Össur offers the Unloader One® and Unloader One® Lite knee braces that relieve pain from knee osteoarthritis, as well as the Unloader ® Hip which is designed to reduce pain by optimizing load dispersion for patients suffering from mild and moderate osteoarthritis of the hip.

Bracing & supports: Injury Solutions

Össur’s injury solutions are designed for people recovering from fractures, ligament injuries or for those in need of post-operative treatment solutions. These solutions are designed to enhance the healing process of bone and soft tissue injuries. Össur Injury Solutions are globally recognized, primarily under the brand names CTi ®, Rebound®, Miami® and Form Fit®. Many Rebound® solutions furthermore come with the Functional Healing seal which identifies Össur Rebound products designed for indication-based protocols. It signifies a healing solution that helps enhance the body’s natural healing process while maximizing mobility.

Our strategy

Össur’s vision is to be the leading company in the non-invasive orthopaedic market. Össur’s business improves people’s mobility through innovative technologies within the fields of bracing & supports and prosthetics. Össur will continue to generate value for individuals and healthcare systems by focusing the business strategy on successful product and concept innovation, operational efficiency, and sustainable growth.

Main Focus Area

Innovation

Execute Ideas that add Value

We embrace innovation in all our actions by creating value for our customers. We will be at the forefront of indication-related innovation to ensure our consistently strong position in the market.

Growth

Maintain Sustainable Growth

We will achieve growth by successfully commercializing our innovation through our local go-to-market strategy and commitment to our customers’ needs. We will further develop our business and leverage untapped market opportunities.

Efficiency

Conduct Business Efficiently

We strive to increase efficiency and drive continuous improvement. We run efficient operations in the most optimal locations, hire passionate employees and deliver strong profit and cash flow.

Industries and markets

Aging and more active population

The global population of 65 and older is increasing and will underpin market growth as an aging society brings an increase in the frequency of vascular diseases and diabetes, which are the two main causes of amputation. These individuals will also have an increased amount of fractures, joint instability, and joint afflictions such as osteoarthritis, which increases the demand for different forms of bracing and supports products.

Healthcare expenditure

Healthcare providers are constrained by budgets and, accordingly, they demand cost effective solutions without compromising quality. This has led to substantial investment in demonstrating and providing functional, clinical, and economical outcomes to potential payers. The demand for lower healthcare expenses creates opportunities for lower-cost bracing as alternatives to high-cost surgery.

Technology development

New technologies and technological combinations, as well as new materials, continuously yield improved products. Such technological advances lead to total market growth as demand is created for more technically advanced and expensive solutions, such as mind-controlled prosthetics and powered bionic bracing.

From volume to value/premium

The demand for higher quality products creates opportunities for technology trade-up in our business.

Stroke, diabetes, and OA on the rise

With the growing number of people afflicted by diabetes and vascular diseases, the demand for prosthetics is expected to increase. Osteoarthritis is also expected to increase in correlation with, for example obesity, resulting in demand for bracing & supports products.

Changing healthcare requirements

Two vital requirements for any market player in the orthopaedics industry are the ability to adapt to changing healthcare requirements and tailoring product offerings to meet the prevailing regulatory system.

Consolidation in patient care

We are seeing an increase in the mergers of healthcare solutions and product providers with increasing cost pressures and the need for scale. This trend creates opportunities for forward integration in the healthcare industry.

Improved treatment options

Surgery, wound care, and early accessible pain medication provide alternatives to bracing and prevent amputations but also encourages higher value customer service which is one of Össur’s key competencies.

Our Markets

Business model in brief

Össur manufactures a wide range of prosthetics and bracing solutions with high standards of quality and excellence. These high-end products are developed with an indication based innovation approach to solve the needs of our end-users. The products are delivered to the end-users through our customers (healthcare providers) who specialize in assisting individuals who suffer from movement impairment. The end-users are referred to these healthcare providers by prescribers and the products are in more than 95% of the cases reimbursed by public or private insurance (payers). With the profits made, Össur reinvests significantly to further advance products and technologies for the benefit of all stakeholders

Business Model

The end-users

The end-users are at the core of everything we do as they drive us to continuously innovate through our entire business model. Our end-users include lower and upper extremity amputees who have lost a limb due to, for example, vascular diseases including diabetes, trauma, cancer, and congenital diseases. We also help individuals who require support as they may have, for example, developed osteoarthritis in knee or hip ligaments, incurred temporary immobilization, or require enhanced healing after surgery.

By collaborating closely with the end-users, we gain a better understanding of their needs and challenges. In turn, we help them to improve their mobility by providing new technologically advanced products to achieve their goals. Our involvement with the end-user is not limited to research and development because we also aim to provide them with quality services, directly through clinics operated by Össur or indirectly through our customer service programs.

The end-users

> 500,000

new lower limb amputees per year

~75%

of amputations are due to vascular related diseases

65

is the average age of the amputations population

30-40%

of new leg amputees are fitted with prosthetic solutions

Research & Development

Össur’s research & development approach is indication based, meaning that only products that have medical indication and are clinically validated are brought to market. The aim is to deliver cost effective medical solutions that provide value for patients and the healthcare system. When a product is designed, Össur accumulates medical and biomechanical data during the development process to verify product safety and efficacy before launch. Also, to obtain independent clinical evidence for product outcomes as well as health economic data, Össur initiates and promotes clinical studies in cooperation with leading scientists, institutions, and healthcare professionals in the field.

Indication

Össur furthermore supports open collaboration within the industry and academia. An example of such an initiative is the recent joint investment by Össur and Comau in IUVO, a spin-off company of The BioRobotics Institute (Scuola Superiore Sant’Anna) in the field of wearable technologies. The objective of IUVO is to create wearable, intelligent and active tools for a better quality of life. The first concrete examples are bionic bracing (robotic exoskeletons) capable of aiding and improving the quality of life for workers in industrial and service fields, and for patients in need of improved mobility.

Manufacturing & Quality

Össur is constantly striving for increased efficiency which includes maintaining a strong global manufacturing function. Manufacturing of advanced prosthetic solutions, including bionics, takes place in Iceland. Manufacturing of mainstream prosthetics solutions, components and premium bracing solutions mostly takes place in Mexico. We outsource the manufacturing of soft goods within our bracing segment to China. At Össur we continuously strive for profitability improvements, which includes further growth of the Mexico manufacturing facility and optimization of the manufacturing footprint.

As a healthcare company, Össur complies with various quality requirements and the company has had a certified quality system in place since 1993. We place great emphasis on quality, and being a manufacturer of medical device products, it is highly important that quality is an intrinsic part of our processes. Össur is currently certified with ISO9001:2008, ISO13485:2003/2012 and ISO14001:2015, and is currently in the process of implementing updated versions of the 13485 and 9001 standards.

Sales & Marketing

Össur operates within a highly specialized industry. Össur’s primary customers are specialized healthcare providers who provide and fit individuals with Össur products. Various public and private insurance schemes generally reimburse the products.

Össur sells its products through its own direct sales network as well as distributors. Össur has developed a strategic partnership service with providers to assist them with activities such as patient documentation and reimbursement. As a result, the Company has better access to the key stakeholders: payers, providers, prescribers and finally the patient (end-user).

Payers, providers, and prescribers

Prescribers include healthcare professionals who prescribe products based on the clinical indication of the users. These include orthopaedic surgeons, non-surgical physicians, and emergency physicians as well as other professionals providing medical diagnosis.

Providers are healthcare professionals who provide users with prosthetic and bracing products, and related services. These include certified prosthetists and orthotists (CPOs) working at orthopaedic and prosthetic (O&P) clinics, durable medical equipment (DME) clinics, orthopaedic clinics, and hospitals. Many providers not only recommend specific products but also fit and tailor-make certain products. For non-reimbursed products a provider can be a pharmacy or sports store.

Payers include government reimbursement plans or insurance companies with over 95% of Össur’s sales reimbursed by a third party. It should be noted that reimbursement systems vary substantially between countries. In other cases, the end-user would pay for the products out of pocket (e.g. at a pharmacy).

Key figures

Össur at a Glance*

Sales USD

569 million

Organic Growth

5%

EBITDA margin

18%

*As presented in Össur’s Annual Report, 2017

Financial Highlights and Key Ratios

USD m 2017 2016 2015 2014 2013
 
Income Statement
Net sales 569 521 483 509 436
Gross profit 355 328 303 323 270
Operating expenses (excl. other income) 280 256 226 237 210
EBITDA 97 94 97 104 75
EBITDA before special items 103 98 99 104 80
EBIT 75 72 77 86 60
Net profit 58 51 51 59 41
Sales growth
Sales growth USD % 9 8 (5) 17 9
- Organic growth in LCY % 5 4 5 5 2
- Currency effect % 1 (1) (10) (1) 1
- Acquired/divested business % 4 5 1 13 6
Balance Sheet
Total assets 793 746 653 678 706
Equity 500 467 463 442 448
Net interest-bearing debt (NIBD) 121 119 58 93 108
Cash Flow
Cash generated by operations 90 88 84 98 73
Free cash flow 55 42 42 68 49
Key ratios
Gross profit margin % 62 63 63 63 62
EBIT margin % 13 14 16 17 14
EBITDA margin % 17 18 20 20 17
EBITDA margin before special items % 18 19 20 20 18
Equity ratio % 63 63 71 65 63
Net debt to EBITDA 1.2 1.2 0.6 0.9 1.3
Effective tax rate % 16 25 25 24 26
Return on equity % 12 11 11 13 10
CAPEX / Net sales % 3.4 4.7 4.9 3.3 3.9
Full time employees on average 2,948 2,710 2,420 2,214 1,765
Market
Market value of equity 1,871 1582 1,546 1,311 880
Number of shares - Millions 437 443 446 454 454
Diluted EPS - US cents 13.3 11.6 11.5 13.1 9.1
Diluted cash EPS - US cents 18.5 16.5 16 17.2 12.5