幾隻機器人公司股票

昨天Bloomberg上一文談到世界上2/3的工作會被機器人取代。看了幾隻機器人公司股票， 去年都長得不錯：

Intuitive Surgical (ISRG): 醫用手術機器人。2016 銷售估計增長12.6%， 股票增長16.1%。

Mazor Robotics (MZOR)：醫用手術機器人。2016 銷售估計增長36%， 股票增長115.6%， 去年傍上了行業大佬Medtronics (MDT).

iRobot (IRBT)： 家用機器人。2016 銷售估計增長5.9%， 股票增長65.1%。

 

1. 簡況

ISRG， Intraday price $659, Enterprise value (EV) $22.6B. 去年Q3季報引發市場投資人對今後增長的擔心， 股票從$725下降。TRUMP當選後，因為擔心取消ObamaCare, 股票三天就掉到$620.  公司是行業龍頭老大， 直接競爭對手比較小 （見後麵的討論）。下麵的一個表是一些簡況：

ISRG	2016	2017		2016	2017	2018
Sales	2.69B	2.95B	EPS	22.19	24.57	27.54
Sales Growth	12.6%	9.7%	EPS Growth	15%	10.7%	12.1%
EV/Sales	8.4	7.7	P/E	29.7	26.8	23.9

 

MZOR， Intraday price $24.5, EV $0.50B

	2016	2017		2016	2017	2018
Sales	35.6M	50.33M	EPS	-0.79	-0.52	NA
Sales Growth	36.2%	41.6%	EPS Growth	-9.7%
EV/Sales	14.1	10	P/E	NM	NM	NM

 

IRBT， Intraday price $59, Enterprise value (EV) $1.36B

	2016	2017		2016	2017	2018
Sales	653M	750M	EPS	1.41	1.82	2.45
Sales Growth	5.9%	14.8%	EPS Growth	-4.1%	29.1%	34.6%
EV/Sales	2.9	1.8	P/E	41.8	32.4	24.1

 

 

2. 有關ISRG和MZOR的一些討論：

Changes to the Affordable Care Act

One of the biggest reasons that Intuitive Surgical's stock fell in 2013 was because hospitals began cutting back dramatically on spending in their budgets. The growth in the sales of da Vinci machines screeched to a halt. The cause: uncertainty about the effects of the Affordable Care Act.

Patient shareholders, however, were eventually rewarded as hospitals became more comfortable with their budgets and Intuitive came out with the new Xi machine, which has been very popular with surgeons.

But with the election of Donald Trump as president, and his promise to dramatically change how the ACA works, uncertainty and volatility in hospital budgets could resurface.

Though it is far too early to tell how this could play out, the bottom line for investors is this: Major changes in the healthcare law will likely create uncertainty. When their budgets are uncertain, hospitals will be conservative in their spending, which could lead to depressed levels of system purchases.

Negative reactions from the medical community

The second major risk that Intuitive shareholders need to accept before buying shares revolves around new guidelines based on medical research. This can be particularly troublesome because important findings can come out at any time, and often without any warning. Efficiency Concerns: Intuitive Surgical has been marketing its da Vinci system mainly on the premise of lower cost associated with robotic surgeries. However, the efficacy of robotic surgery in reducing costs is still debatable.

For instance, both prostatectomies (前列腺切除術) and hysterectomies (子宮切除術) used to be huge growth drivers for Intuitive Surgical. But five years ago, the United States changed its suggested protocol for prostate screening, and growth in prostate removal surgeries slowed. Then, in 2013, professionals started to openly question the efficacy of using the da Vinci system in benign hysterectomy procedures, and growth came to an absolute halt. A 2014 report by Columbia University suggested that surgeries performed using this system may actually cost significantly more than standard minimally invasive procedures, and without any major benefits. Though this study had minimal impact on the company’s sales in the past, such studies that raised concerns about robotic surgeries could potentially impact ISRG’s sales in future.

Right now, hernia operations (疝氣手術) are huge growth drivers for Intuitive Surgical.

International headwinds

One of the stated goals of Intuitive in the coming year is to increase its presence in Europe and Asia. In fact, growth in procedures abroad -- along with increases in hernia operations at home -- was a key driver of 2016's positive results. Intuitive Surgical is witnessing an increasing share of international sales that mainly come from Europe. The share of international revenues has increased from 20% in 2010 to 29% in 2015. The company is also expanding its operations in Japan and South Korea as the aging population and growing acceptance of robotic surgery in these countries provide significant growth opportunities. Going ahead, international expansion is likely to help Intuitive maintain its growth momentum.

But there are a number of different factors that could combine to dampen results in 2017. Among the most obvious are currency headwinds: As the dollar becomes stronger, it becomes more expensive for hospitals in other countries to buy a da Vinci Xi.

Furthermore, one of the biggest opportunities for Intuitive Surgical is in China. But the country's communist leaders have tight restrictions on the number of devices that can be sold in any given year. Sometimes, the country can provide a large chunk of international sales. Other times, it doesn't. As with the direction of medical findings coming out, how China will approach da Vinci sales in any given year can be very difficult to predict.

Competition from other players

Intuitive Surgical faces little competition in the robotic surgery market, as there are significant barriers to entry and the company holds more than 1,000 patents worldwide. So far Intuitive has enjoyed a free run. TransEnterix was expected to be the challenger with its SurgiBot Systems. However, the company failed to secure FDA approval for its system. Other players such Mazor Robotics (Nasdaq:MZOR, alliance with Medtronic which bought 7.27% stake of Mazor for $32M), Smith & Nephew, Stryker, etc. are either small or focused on very niche areas of surgery. Though we don’t expect any competitor to challenge the company’s dominant position in the near-term, the cost of entering the market could decline and competition is likely to increase going forward, as Intuitive’s patents begin to expire and the efficacy of robotic surgery is clearly established. This could cause some pressure on Intuitive’s pricing and, therefore, margins.

Expansion of Procedures

The company’s surgical systems have been widely adopted for select procedures, but there are still many for which they have not been adopted. In 2015, the most common procedures were gynecological (婦科), which accounted for approximately 50% of total procedures using da Vinci systems. The company believes that wider adoption of other procedures is likely. A wider range of possible procedures will likely result in greater demand for the company’s systems.

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Robotic Surgery: More Complications, Higher Expense for Some Conditions

For benign ovarian surgery (卵巢手術), conventional laparoscopy (常規腹腔鏡檢查)causes fewer complications, is less expensive, than robot-assisted surgery

October 8, 2014

Posted in: Surgery

NEW YORK, NY (October 8, 2014)—For benign gynecologic conditions, robot-assisted surgery involves more complications during surgery and may be significantly more expensive than conventional laparoscopic surgery, according to a study by researchers at Columbia University Medical Center (CUMC). The results were published online today in Obstetrics & Gynecology.

Robot-assisted surgery was first widely used for radical prostatectomy. For procedures such as prostatectomy, where there were previously no minimally invasive options, robot-assisted laparoscopy often offered a dramatic improvement. But in the two gynecologic surgeries looked at in this study—oophorectomy (removal of one or both ovaries) and cystectomy (removal of an ovarian cyst) —surgeons already had laparoscopic options. The rate of robot-assisted surgery increased from 3.5 percent in 2009 to 15.0 percent in 2012 for oophorectomy and from 2.4 percent in 2009 to 12.9 percent in 2012 for cystectomy.

The CUMC researchers analyzed data on conventional laparoscopic and robot-assisted procedures performed on 87,514 women for benign gynecologic conditions between 2009 and 2012. The procedures took place at 502 U.S. hospitals.

The study showed a small but statistically significant overall increase in intraoperative (during surgery) complications, mainly ureteral and bladder injuries, with the robot-assisted procedures—3.4 percent for robot-assisted oophorectomy vs. 2.1 percent for conventional laparoscopic oophorectomy; 2.0 percent for a robot-assisted cystectomy vs. 0.9 percent for a conventional laparoscopic cystectomy. It is possible that the rate of complications will decline as surgeons become more experienced in robotic technology.

“The findings raise questions about the potential utility of robotic-assisted surgery for ovarian cancer and suggest that further studies are needed prior to considering these procedures as a standard of care,” said co-author Jason Wright, MD, Sol Goldman Associate Professor of Gynecologic Oncology and chief, Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons.

The researchers also found robot-assisted procedures to be more expensive. The median total cost for robot-assisted oophorectomy was $7,426, while for conventional laparoscopic oophorectomy it was $4,922. The median total cost for robot-assisted cystectomy was $7,444; for conventional laparoscopic cystectomy it was $4,133.

“With the rapid rise in the cost of cancer care, we need to make sure that public policies encourage comparative studies prior to widespread dissemination of new technologies,” said another co-author, Dawn L. Hershman, MD, MS, associate professor of medicine at the College of Physicians and Surgeons, associate professor of epidemiology at Columbia’s Mailman School of Public Health, and leader of the Breast Cancer Program at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia.

About:

The paper is titled, “Comparative Effectiveness of Robotic-Assisted Compared to Laparoscopic Adnexal Surgery for Benign Gynecologic Disease.” The other authors are: Alessandra Kostolias, MD (CUMC), Cande V. Ananth, PhD, MPH (CUMC), William M. Burke, M (CUMC), Ana I. Tergas, MD (CUMC), Eri Prendergast, MS (CUMC), Scott D. Ramsey, MD, PhD (Fred Hutchinson Cancer Research Center), and Alfred I. Neugut, MD, PhD (CUMC).

Dr. Wright (R01CA169121-01A1) and Dr. Hershman (R01 CA166084) are recipients of grants and Dr. Tergas is the recipient of a fellowship (R25 CA094061-11) from the National Cancer Institute.

The authors declare no financial or other conflicts of interest.

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.