CORPORATE PRESENTATION 29 TH ANNUAL PIPER JAFFRAY HEALTHCARE - - PowerPoint PPT Presentation

CORPORATE PRESENTATION

29TH ANNUAL PIPER JAFFRAY HEALTHCARE CONFERENCE NOVEMBER 28, 2017 DEPLOYING SYSTEM-BASED TECHNOLOGY FOR PERSONALIZED SPINAL CARE

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SAFE HARBOR

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• f information contained in a prospectus approved by the AMF or any other document of offer that would be made and issued by the Company in connection with this offer. The

distribution of this document in certain jurisdictions may be restricted by law and persons into whose possession this document comes should inform themselves about, and comply with, any such restrictions. Any failure to comply with these restrictions may constitute a violation of applicable securities laws. The information contained in this document (the “Information”) has not been independently verified and no representation or warranty, express or implied, is made as to the fairness, accuracy or completeness of the information or opinions contained herein. The Information is provided as at the date of this document and may change materially. The Company is under no obligation to keep current the information contained in this document and any opinions expressed in this document are subject to change without notice. Neither of the Company nor any of its affiliates, advisors or representatives shall have any liability whatsoever (in negligence or otherwise) for any loss whatsoever arising from any use of this document or its contents, or otherwise arising in connection with this document. It is not the purpose of this presentation to provide, and you may not rely on this document as providing, a complete or comprehensive analysis of the Company’s financial or commercial position or prospects. This document includes forward-looking statements that involve risks and uncertainties. The forward-looking statements are based on management’s current expectations or beliefs and are subject to a number of factors and uncertainties that could cause actual results to differ materially from those described in the forward-looking statements. Given the uncertainty of the forward-looking statements, readers are advised that they do not constitute a guarantee, by the Company or anyone, to achieve the objectives and projects of the

• Company. Neither the Company nor any other person assumes liability for the accuracy and completeness of such forward-looking statements. The forward-looking statements

contained in this document apply only to this document. Even if the Company’s financial condition, results of operations and cash flows and the development of the industry in which the Company operates are consistent with the forward-looking statements contained in this document, those results or developments may not be indicative of results or developments in future periods. The Company does not undertake any obligation to review or confirm analysts’ expectations or estimates or to release publicly any revisions to any forward-looking statements to reflect events that occur or circumstances that arise after the date of this document.

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THE FUTURE IS NOW

A NEW ERA IN SPINE SURGERY

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Medicrea’s “Adaptive Spine Intelligence” is the convergence of adaptive healthcare information technology and FDA-cleared

• utcome-centered spinal implants to

scientifically deliver improved clinical results while providing system-wide cost reductions.

Co Compre mprehen hensiv sive e pe pers rsonaliz

• nalized

ed ca care re fo for the r the co comp mplex lex sp spine ne mar marke ket

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• IN

INNOVATIVE OVATIVE DAT ATA-DRIVEN, DRIVEN, SE SERVICE VICE-ORIENTE ORIENTED D AP APPROACH OACH TO COMPLEX MPLEX SP SPINE NE

• FIRST TO MARKET PATIENT-SPECIFIC IMPLANTS FOR THE SPINE WITH UNID™ RODS
• COMPREHENSIVE 3D

3D-PRI PRINTE NTED D PATIENT NT-SPECIF ECIFIC C PLATFO FORM RM IN-HOUSE

• $4 BILLION U.S. MARKET OPPORTUNITY WITH LIMITED COMPETITION
• PUBLICLY TRADED ON EURONEXT GROWTH: ALMED
• 2016 REVENUE OF €29.4M, ATTRACTIVE GROSS MARGINS
• RAISED €20 MILLION IN AUGUST WITH LEADING U.S. INVESTORS LED BY ATHYRIUM CAPITAL
• CENTRALIZED HEADQUARTERS AND MANUFACTURING FACILITIES IN LYON, FRANCE AND NEW

YORK CITY

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Denys SOURNAC Founder, Chairman & CEO

Successful entrepreneur in the medical supply and orthopaedics industry with over 30 years’ experience creating, building and managing companies.

Pierre e OLIVIE IER CEO, Medicrea crea USA USA

Over 25 years’ experience in Marketing and Project Management, mainly in the United States, particularly in sales launches of new innovative products. Fabrice abrice KILFI LFIGER GER Chi hief f Fin inancia cial l Offi ficer cer Over 25 years’ experience in finance, including over 10 years heading the finance divisions of listed companies. Dav avid id RYAN Chi hief f Oper erating ting Officer ficer Biomechanical Engineer with more than 11 years’ experience in

• rthopedics. Former R&D Director,

Scient’x (Alphatec Spine). 11/27/2017

Thomas MOSNIE IER Chief ef Scient entif ific ic Office cer

PhD with over 15 years’ experience in spinal research beginning at the Biomechanics Laboratory of ENSAM

Richar hard d Washbur urn EVP - UNiD ASI

Over 20 years experience in new product development,

• perations, and medical device

commercialization.

Joseph eph Walland EVP - Sales

Over 15 years’ commercial leadership experience in spine, most recently with Stryker Spine.

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$4 $4 BIL BILLON ON UN UNiD TECH iD TECHNOL NOLOGIE OGIES S U.S .S. . MA MARK RKET ET OP OPPO PORTUNITY RTUNITY

1. 2015 Instrumented Thoracolumbar Procedures annually (409,100). 2013 Millennium Research Group, Inc., Table 87 “Thoracolumbar Fusions, by Indication.”

PATIENT SPECIFIC UNiD 3D INTERBODY DEVICES & VERTEBRAL BODY REPLACEMENT SYNTHETIC BIOACTIVE BONE GRAFT EXTENDER

ANNUAL COMPLEX SPINE CASES1

116,000

ANNUAL DEGEN CASES1

221,000

AVG REVENUE PER DEGEN CASE

$11,200

AVG REVENUE PER COMPLEX CASE

$30,000

PATIENT SPECIFIC DUAL-DIAMETER ROD PATIENT SPECIFIC ROD

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Pre- Operative

Planning

IBDS

Selection and Insertion

SCREWS

Selection and Insertion

RODS

Bending and Insertion

• X-Rays of patient’s spine reviewed
• Patient determined to be candidate for surgery
• Surgery approved (or denied) by payer
• Minimal scientifically-based pre-operative planning
• Implants chosen from a large tray of standard sizes
• Often requires forceful hammering and/or bone and

tissue displacement to achieve desired placement

• Implant fit determined using trial and error

during surgery

• Surgeon manually contours rod using basic tool
• Correctness is “eye-balled” by comparing rod to x-ray
• Rod shape and placement determined by hand by

surgeon during surgery

DURING SURGERY

• Identified one-by-one from tray of 400+ screws of

various lengths

• Specific screw length and width determined during

surgery

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1. Moal B, Schwab F, Ames CP, et al. Radiographic Outcomes of Adult Spinal Deformity Correction: A Critical Analysis of Variability and Failures Across Deformity Patterns. Spine Deform. 2014.

2. Rothenfluh DA, Mueller DA, et al. Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J (2015) 24:1251-1258

• 3. Smith JS, Shaffrey CI, Klineberg E, et al. Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal
• deformity. J Neurosurg Spine 21:994–1003, 2014.
• 4. Frymoyer JW, Matteri RE, Hanley EN, et al: Failed lumbar disc surgery requiring second operation. A long-term follow-up study. Spine 3:7-11,

1978

• 5. Jang J-S, Lee S-H, Min J-H, Kim SK, Han K-M, Maeng DH. Surgical treatment outcomeof failed back surgery syndrome due to sagittal
• imbalance. Spine (Phila. Pa. 1976). 2007

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INCREASED RISK OF ADJACENT LEVEL DISEASE2

ROD FRACTURE SAGITTAL MALALIGNMENT ADJACENT DISEASE

CURRENT TREATMENT METHODS FAIL TO ACHIEVE QUALITY OUTCOMES

• High revision rates
• High levels of adjacent

disease

• Increased cost to all

stakeholders

• Legal liability issues

OF REVISIONS FAIL TO ACHIEVE ADEQUA TE LUMBAR LORDISIS

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62%

OF P A TIENTS ARE MALALIGNED POST-OP

1

9%

OF MANUALL Y BENT RODS FRACTURE

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22%

FRACTURE-RA TE WITH PSO

3

OF P A TIENTS REQUIRE REVISION

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23%

63%

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Source: Iyer, Lenke, et al., 2016

• 1. Iyer S, Lenke LG, Nemani VM, Albert TJ, Sides BA, Metz LN, Cunningham ME, Kim HJ (2016) Variations in sagittal alignment parameters based on age: a prospective study of asymptomatic volunteers using full-body radiographs. Spine

Chain of correlation linking alignment of the lower extremities to the pelvis, spine, and occiput as well as global alignment parameters.1

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ALIGNMENT PARAMETERS VARY BASED ON THE PATIENT’S AGE AND COMPENSATORY FACTORS.1

Source: Barrey et al., 2011

COMPENSATORY MECHANISMS FOR SAGITTAL MALALIGNMENT

COMPLEX ALIGNMENT CONSIDERATIONS

10 BONE GRAFT SOLUTIONS SPECIALIZED SYSTEMS FOR COMPLEX SPINE PERSONALIZED SAGITALLY ALIGNED RODS PERSONALIZED INTERBODY DEVICES

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UNiD™ HUB: Redefining the surgical treatment paradigm

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› Surgical planning, analytics, and data visualization software › Integrates surgical planning through machine learning with patient-specific design and manufacturing techniques › Leverages data science to drive improved surgical outcomes and economic efficiencies

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Selected Screws Personalized or Selected Cages

Case Plan Memo

Sagitally-Aligned Personalized Rods

Screws selection Ø & length

› Proprietary process based on routine images (X-rays) › Typical tray includes 400 screws, reduce screws by ~75% › Personalized Caddie for each surgery › Inventory & sterilization costs reduction

Cages selection Footprint, height & lordosis

› Implant selection from a huge range of 3D printed Cages › Planning to design a patient specific interbody device

Rod design and manufacture Shape & positioning

› Patient-specific rod, pre-bent to meet patient’s needs and surgeon’s preference › Laser-marked to indicate optimal implantation position › Eliminate need for intra-operative bending

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Post-Op Fracture Rates Standard Rod UNiD Rod Reduction in Fracture Rate Using UNiD Rod ASD Patients 14.9% 1.8% 88% ASD Patients w/ PSO 22.0% 3.1% 86%

Utilizing patient-specific rods designed and manufactured by Medicrea’s UNiD technology significantly reduces the incidence of rod fracture in complex spine surgery patients

Source: Patient-Specific Rods show a reduction in rod breakage incidence, reviews a cohort of more than 450 Adult Spinal Deformity (ASD) patients with at least 1 year from the surgical implantation of patient-specific UNiD™ Rods, generated by Medicrea’s UNiD A SI™ systems-based technology for personalized spinal care. The above excludes results from cases in which surgeons manually bent UNiD rods. Including those cases, the reduction in fracture rates for ASD patients = 85%, the reduction in fracture rates for ASD patients with PSO = 79%.

MEANINGFUL CLINICAL BENEFIT FROM PATIENT SPECIFIC RODS

vs

Standard rod –bent manually

French Bender Acute Bend Notching

88% reduction 86% reduction

10. McCarthy IM, Hostin RA, Ames CP, et al. Total hospital costs of surgical treatment for adult spinal deformity: an extended follow-up study. Spine J. 2014

SUBSTANTIAL LONG-TERM SAVINGS FOR ALL STAKE- HOLDERS

Increase in the overall average costs of adult spinal deformity surgery for patients requiring revisions and reoperations10

70%

Costs associated with hospital readmission10

$80,000

REDUCED RISK OF REVISION AND TIME-SAVING TECHNOLOGY

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• 13. Range of $22/min to $133/min, across 100 hospitals in the U.S. Shippert RD. A Study of Time-Dependent Operating

Room Fees. The American Journal of Cosmetic Surgery, 2005 Vol. 22, No. 1.

• 14. Survey of U.S. Spinal Surgeons on Rod Bending Time. Medicrea Survey Results. 2015.

ASSOCIATED TIME & COST REDUCTION BENEFITS

US spinal surgeons, on national average, spend 15 minutes manually bending spinal rods in the O.R.13 $100 / minute national average cost in the O.R.14 Potential savings by procedure by minimizing manual rod bending in the O.R.

$1,500

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Adaptive Spine Intelligence

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SURGEONS MEDICREA ENGINEERS

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IN-HOUSE PATIENT SPECIFIC ROD & IMPLANT MANUFACTURING

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› PATIENT SPECIFIC RODS AND IMPLANTS MANUFACTURED ON CASE-BY-CASE BASIS UTILIZING UNID PLATFORM PREDICTIVE TECHNOLOGIES › UNID RODS – CUSTOM MANUFACTURED FOR U.S. DEGEN & DEFORMITY MARKET › UNID IBDS & VBRS – 3D PRINTED TITANIUM PATIENT SPECIFIC IMPLANTS

CUSTOM SAGITALLY ALIGNED RODS CUSTOM INTERBODY DEVICES

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PATIENT MEDICREA 3RD PARTY PAYER HOSPITAL SURGEON

IM PROVED OUTCOM ES TIM E SAVINGS REDUCED COST OPTIM IZED INVENTORY POSITIVE DIFFERENTIATION PATIENT SELECTION

CONSTITUENTS BENEFITS

INTRA-OP CONFIRM ATION

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1 MORE SURGEONS USING UNiD PLATFORM AND RODS 2 CONVERTED SURGEONS INCREASING UNiD UTILIZATION 3 INTRODUCE NEW TECHNOLOGY

UNID RODs UNID IBDs PROPRIETARY BIO-ACTIVE BGE PEDICLE SCREWS

Least commoditized Low conversion sensitivity Most commoditized Higher conversion sensitivity

ENGAGE FULLY CONVERT

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SALES AND MARKETING

› HYB YBRI RID DIRE RECT CT + + DIST STRIBUTO RIBUTOR MOD ODEL EL › DRI RIVE VE RE REVE VENUE NUE GROW ROWTH TH WITH TH INT NTEGR EGRATED ATED PR PROD ODUCT UCT SO SOLUTIO UTIONS NS TH THROUG ROUGH UNi NiD TE TECH CHNOL NOLOGY OGY ADOPTIO PTION › BUILD LD BOD ODY Y OF OF EVI VIDENCE DENCE FOR OR PA PATI TIEN ENT-SPEC SPECIFI IFIC C UNi NiD RO ROD › INC NCRE REASE ASE PR PRESE SENCE NCE WITH TH KO KOLS IN ST N STRA RATEGIC TEGIC HOS OSPI PITALS TALS AND ND CE CENT NTERS ERS › INC NCRE REASE ASE AWAREN RENESS ESS WITH TH UNi NiD WARRA RRANTY NTY PR PROG OGRAM RAM › EXP XPAND ND ON ONLINE NE MARKE RKETI TING NG CA CAMPA PAIGN IGN AIMED ED AT T US PA S PATI TIEN ENTS TS

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4Q-14 1Q-15 2Q-15 3Q-15 4Q-15 1Q-16 2Q-16 3Q-16 4Q-16 1Q-17 2Q-17 3Q-17 US OUS

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FDA

CLEARED 11/27/2017

DRIVING UNiD SURGEON ADOPTION

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INCREASING PROCEDURE BREADTH

Weighted average levels per procedure

Deformity Degen

# of levels per procedure

25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

9 10

4Q-14 1Q-15 2Q-15 3Q-15 4Q-15 1Q-16 2Q-16 3Q-16 4Q-16 1Q-17 2Q-17 3Q-17 U.S. O.U.S.

FDA

CLEARED

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UNiD Introduced 4Q14 11/27/2017

UNiD CASE STUDY: ADOPTION + UTILIZATION

UC - Denver

2014

› UNiD introduced Nov. 2014 › 2 active UNiD surgeons

2015

› Total procedure volume +72% YoY › UNiD utilized in 26% of all cases › 2 active UNiD surgeons

2016

› UNiD procedure volume +108% YoY › UNiD utilized in 30% of all cases › 3 active UNiD surgeons

2017 (thru 9/30)

› UNiD procedure volume +78% YoY › UNiD utilized in 47% of all cases › 3 active UNiD surgeons › Commenced Degen UNiD cases

2013 Rev

$0.8m

2017 Rev (thru 9/30)

$2.6m

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GLOBAL UNiD PROCEDURE GROWTH

21 25 51 47 46 70 97 84 95 98 139 114 23 51 64 51 56 89 68 47 68 86 94 75

44 76 115 98 102 159 165 131 163 184 233 189

4Q-14 1Q-15 2Q-15 3Q-15 4Q-15 1Q-16 2Q-16 3Q-16 4Q-16 1Q-17 2Q-17 3Q-17 US UNiD OUS UNiD

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Q1 ‘18

NEW TECHNOLOGY DEVELOPMENT

• UNiD HUB SOFTWARE, ONLINE DATA-DRIVEN CASE PORTAL
• LAUNCH UNiD ROD FOR MIS APPLICATIONS
• LAUNCH COMPATIBLE TOP-LOADING SYSTEM
• FDA CLEARANCE OF SURGEON-SPECIFIC 3D-PRINTED INTERBODY

DEVICES

• SCREW AND INTERBODY PLANNING SERVICES
• PREDICTIVE PLAN DELIVERY THRU MACHINE LEARNING BIG DATA
• FDA CLEARANCE FOR PATIENT-SPECIFIC 3D-PRINTED INTERBODY

AND VERTEBRAL BODY REPLACEMENT DEVICES

Q3 ‘17 Q4 ‘17

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GLOBAL UNiD REVENUE GROWTH

$8.1 $6.4 $8.9 $7.9 $7.5 $7.7 $8.8 $7.5 $8.3 $7.4 $8.6 $7.5 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% $0.0 $1.0 $2.0 $3.0 $4.0 $5.0 $6.0 $7.0 $8.0 $9.0 4Q-14 1Q-15 2Q-15 3Q-15 4Q-15 1Q-16 2Q-16 3Q-16 4Q-16 1Q-17 2Q-17 3Q-17 UNiD $ PENETRATION GLOBAL REVENUE ($ millions) Global UNiD Revenue Global Total Revenue UNiD $ Penetration

FDA

CLEARED

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U.S. REVENUE – UNiD GROWTH

$4.8 $3.4 $5.5 $5.0 $4.3 $4.4 $5.6 $5.0 $4.5 $4.1 $5.5 $4.7

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% $0.0 $1.0 $2.0 $3.0 $4.0 $5.0 $6.0 4Q-14 1Q-15 2Q-15 3Q-15 4Q-15 1Q-16 2Q-16 3Q-16 4Q-16 1Q-17 2Q-17 3Q-17 UNiD $ Penetration Revenue ($ millions) US UNiD US Other UNiD $ Penetration

FDA

CLEARED

1Q-17 2Q-17 3Q-17 UNiD YoY Revenue Growth +15% +22% +27%

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• 2016 revenue of €29.4M
• High gross margins
• Significant capex spending in 2016 & 2015 to increase in-

source of production and manufacturing efficiency

• EBITDA positive since 2010
• 175+ Headcount
• Transformative € 20M fundraising in August 2016 with U.S.

investors and € 13M in June 2017 from French investors

AT A GLANCE

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• INNOVATIVE SERVICE-ORIENTED APPROACH TO COMPLEX SPINE
• PATIENT SPECIFIC IMPLANTS DRIVE OPTIMAL PATIENT OUTCOMES
• DIFFERENTIATED UNiD TECHNOLOGY BENEFITS ALL KEY STAKEHOLDERS
• SIGNIFICANT GLOBAL MARKET OPPORTUNITY WITH LIMITED COMPETITION
• EXPERIENCED MANAGEMENT TEAM FOCUSED ON COMMERCIAL EXECUTION
• ATTRACTIVE FINANCIAL PROFILE

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UNiD : A New Era In Patient Care https://www.youtube.com/watch?v=jRwrDg_bca4 UNiD in the NEWS : New Frontiers https://www.youtube.com/watch?v=OaOccVBrJpk FDA Approved : Medicrea Announces UNiD Cervical Rod https://www.youtube.com/watch?v=Z55zvgtqvVs Patient-facing website www.personalizedspinalimplants.com Medicrea US Website Newsroom http://www.medicrea.com/usa/newsroom-usa/

VIDEOS PATIENT-FACING PRESS RELEASES

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QUOTES

“The patient-specific rod is very much ahead of its time. When we finish the

• peration, we’ve left them with the best possible appearance for the rest of their
• lives. The curve is not going to worsen and there is less likelihood of them having

pain.”

• Dr. Andrew King, Children’s Hospital New Orleans

“We now realize how important it is to provide a specific alignment of the spine that is unique to each patient. If we do not achieve the optimal alignment during surgery, then we are too-often revising that patient later. UNiD™ is using precision technology and analysis to solve this clinical issue for patients as well as providing an invaluable support service and feedback loop for surgeons.”

• Dr. Evalina Burger, University of Colorado Hospital

“Understanding and restoring sagittal alignment is key towards providing better patient outcomes and preventing the need for reoperations, a major factor in rising health care costs. By providing rod customization, UNiD™ allows surgeons to precisely execute their preoperative plan and frees them from the antiquated technique of freehand bending, ensuring individual patients receive the most accurate and effective treatment. Having a more precise, personalized rod ready before even stepping foot in the operating room is a game-changer for spine surgery.” – Dr Schwab, HSS, New York

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Prof

• fit

it & Lo & Loss ss

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Ba Bala lance nce Sh Shee eet