For personal use only

Size: px

Start display at page:

Download "For personal use only"

Vivien Oliver
5 years ago
Views:

Fisher & Paykel Healthcare Investor Day Introduction September 2013 Mike Daniell

10:00am Introduction Mike Daniell (MD & CEO) Lewis Gradon (Senior VP - Products &

Product Group) Michelle Muir (Senior Clinical Research Scientist, RAC Product

Clinical Manager, OSA Product Group) Andrew Somervell (General Manager, OSA

Marketing) 1:55pm Closing Comments Mike Daniell (MD & CEO) 2:00pm Finish Time

1 Fisher & Paykel Healthcare Investor Day Introduction September 2013 Mike Daniell Managing Director & CEO 1 Agenda - Sydney The Challenge Time Subject Presenters 10:00am Introduction Mike Daniell (MD & CEO) Lewis Gradon (Senior VP - Products & Technology) 10:15am Respiratory & Acute Care Matthew Payton (General Manager, RAC Product Group) Michelle Muir (Senior Clinical Research Scientist, RAC Product Group) 11:45am Lunch 12:15pm Obstructive Sleep Apnea Fiona Cresswell (Marketing & Clinical Manager, OSA Product Group) Andrew Somervell (General Manager, OSA Product Group) 1:15pm US Market Update - OSA Paul Shearer (Senior VP - Sales & Marketing) 1:55pm Closing Comments Mike Daniell (MD & CEO) 2:00pm Finish Time will be made available at the end of each presentation specifically for questions and answers. 2 3

Health Spending Growing 5% - 7% Per Year Demographics Driving Growth Population age and weight both increasing US pop. 65yrs+ to grow ~80% over next 20 years 1 US males 60-74 yrs, av.

4kg/yr since 1960 2 60% of US healthcare cost is after age 65yrs 3 Developing markets increasing healthcare spending China healthcare expenditure increased 19% in 2012 4, expected to triple by 2020.

Mean Body Weight, Height, and Body Mass Index (BMI) 1960-2002. US Centers for Disease Control and Prevention, 2004. 3. Berhanu Alemayehu, Kenneth E Warner.

2 Health Spending Growing 5% - 7% Per Year Demographics Driving Growth Population age and weight both increasing US pop. 65yrs+ to grow ~80% over next 20 years 1 US males yrs, av. weight increased 0.4kg/yr since % of US healthcare cost is after age 65yrs 3 Developing markets increasing healthcare spending China healthcare expenditure increased 19% in , expected to triple by OECD Health data 5 1. Grayson K. Vincent, Victoria A. Velkoff. The Next Four Decades. The Older Population in the United States: 2010 to US Census Bureau, Cynthia L Ogden, Cheryl D Fryar et al. Mean Body Weight, Height, and Body Mass Index (BMI) US Centers for Disease Control and Prevention, Berhanu Alemayehu, Kenneth E Warner. The Lifetime Distribution of Health Care Costs. Health Serv Res June; 39(3): Franck Le Deu, Rajesh Parekh, Fanging Zhang, Gaobo Zhou. Healthcare in China: Entering uncharted waters. McKinsey & Company, Typical Healthcare Cost Breakdown Lower Care Intensity = Lower Cost Utilities, Depreciation $50,000 $40,000 Drugs, Devices, Supplies & Food Hospital Costs Labour Mean cost (2008 US$) $30,000 $20,000 $10,000 $0 Outpatient cohort Urgent outpatient cohort ED cohort Standard admission cohort ICU cohort Source: Massachusetts Hospital Association, An Update to Hospital Costs in Context Report July 2010 Source: Anand A Dalal, Laura Christensen, 2 Fang Liu, and Aylin A Riedel. Direct costs of chronic obstructive pulmonary disease among managed care patients. Int J Chron Obstruct Pulmon Dis. 2010; 5:

Our Opportunities Improve patient care and outcomes Increase effectiveness of

Products & Technology 8 9 Respiratory and Acute Care Chronic Obstructive

diagnosed with COPD 1 (~15 million people) 4% - 10% COPD prevalence worldwide 2

each year 1 (~3 million patients) 1. Nicole M Kosacz, Antonello Punturieri et al.

US Centers for Disease Control and Prevention, 2012 2.

3 Our Opportunities Improve patient care and outcomes Increase effectiveness of care efficiency of care Reduce intensity of care Lewis Gradon Senior VP - Products & Technology 8 9 Respiratory and Acute Care Chronic Obstructive Pulmonary Disease (COPD) MORE CRITICAL LESS CRITICAL 6% of US adults have been diagnosed with COPD 1 (~15 million people) 4% - 10% COPD prevalence worldwide 2 (~400 million people) 18% of US COPD patients visit ER or admitted to hospital each year 1 (~3 million patients) 1. Nicole M Kosacz, Antonello Punturieri et al. Chronic Obstructive Pulmonary Disease Among Adults -United States US Centers for Disease Control and Prevention, R J Halbert, Sharon Isonaka, Dorothy George, Ahmar Iqbal. Interpreting COPD Prevalence Estimates. Chest. 2003; 123:

Respiratory & Acute Care Invasive Ventilation

Generally unconscious Ventilator breathes for the

circuits, connectors and filters Normal airway

system operates less effectively Need to deliver gas

temperature 44mg/L 100% saturated Opportunity:

Respiratory & Acute Care Non Invasive Ventilation

Ventilator assists patient s breathing through a mask

Masks, humidifier controllers, chambers, breathing

humidification Humidified air and oxygen through

controllers, AIRVO, chambers, breathing tubes, Adult

4 Respiratory & Acute Care Invasive Ventilation Respiratory & Acute Care Invasive Ventilation Almost always in the ICU Patients are intubated Generally unconscious Ventilator breathes for the patient Humidifier controllers, chambers, breathing circuits, connectors and filters Normal airway humidification is bypassed Mucociliary transport system operates less effectively Need to deliver gas at physiologically normal levels 37 o C body core temperature 44mg/L 100% saturated Opportunity: superior technology delivering gas at BTPS Respiratory & Acute Care Non Invasive Ventilation Optiflow Therapy, AIRVO Generally in HDU / ICU Ventilator assists patient s breathing through a mask Success improved by comfort, tolerance and compliance Masks, humidifier controllers, chambers, breathing circuits Opportunity: improved outcomes with humidification Humidified air and oxygen through nasal cannula (Adult & Neonatal) Humidifier controllers, AIRVO, chambers, breathing tubes, Adult Optiflow, Junior nasal cannula Opportunity: improved outcomes over standard care 14 15

Surgical Obstructive Sleep Apnea (OSA) Patients receive CO 2 gas to insufflate surgical site Humidification reduces risk of complications,

Temporary closure of airway during sleep 2% - 7% OSA adult prevalence 1 70% 80% of those affected remain undiagnosed Prevalence increases with

Proceedings of the American Thoracic Society, Vol. 5, No. 2 (2008), pp. 136-143.

with diabetes, cardiovascular disease, hypertension, stroke, obesity, depression Most common treatment is CPAP (Continuous Positive Airway

5 Surgical Obstructive Sleep Apnea (OSA) Patients receive CO 2 gas to insufflate surgical site Humidification reduces risk of complications, hypothermia, adhesion and infection Humidifier controllers, chambers, tubes, filters Opportunity: improved outcomes with humidification Temporary closure of airway during sleep 2% - 7% OSA adult prevalence 1 70% 80% of those affected remain undiagnosed Prevalence increases with age and obesity Estimate >50 million people in developed countries 1. Naresh M. Punjabi. The Epidemiology of Adult Obstructive Sleep Apnea. Proceedings of the American Thoracic Society, Vol. 5, No. 2 (2008), pp Obstructive Sleep Apnea Margin Expansion Opportunities Greatly impaired sleep quality, fatigue, sleepiness, strong independent association with diabetes, cardiovascular disease, hypertension, stroke, obesity, depression Most common treatment is CPAP (Continuous Positive Airway Pressure) Key issue with CPAP is compliance ThermoSmart, SensAwake, Pilairo, Simplus, Eson, InfoUSB Opportunity: grow market share with unique technologies New Products patient benefit user benefit payer benefit Premium Products 18 19

Margin Expansion Opportunities Margin Expansion

commissioned in NZ first Subsequent capacity increases

Initiatives Procurement Logistics Distribution

6 Margin Expansion Opportunities Margin Expansion Opportunities Mexico New products, processes commissioned in NZ first Subsequent capacity increases Mexico Currently ~ 25% consumables Supply Chain Initiatives Procurement Logistics Distribution Manufacturing Lean cost down Efficiency gains Q & A Respiratory and Acute Care 22 23

Respiratory and Acute Care Overview Adult Care Continuum Subject Care Continuum and Opportunities Invasive Ventilation Noninvasive Ventilation Optiflow Presenter Matthew Payton (General Manager, RAC

7 Respiratory and Acute Care Overview Adult Care Continuum Subject Care Continuum and Opportunities Invasive Ventilation Noninvasive Ventilation Optiflow Presenter Matthew Payton (General Manager, RAC Product Group) Michelle Muir (Senior Clinical Research Scientist) Product Portfolio MR 850 system Evaqua 2 MR810 System Evatherm Optiflow Airvo 2 Optiflow Junior Matthew Payton (General Manager, RAC Product Group) Invasive Ventilation Clinical Invasive Ventilation Level 3 Intubation prevents normal, physiological gas conditioning Level 1 Mechanisms of Action Level 2 Physiological Outcomes Clinical Outcomes Bypasses humidification system of nasopharynx Dry medical gas (15 o C, 0.3mgH 2 O/L) Inadequate humidity is associated with secretion clearance complications Drying or thickening of secretions Reduced mucociliary clearance Obstruction/occlusion ET or tracheostomy tube Compromised airway defence (pulmonary infection) Compromised ventilation (atelectasis) 26 27

8 Predictive Model Mucociliary Transport Video Predictive model of inspired humidity vs. mucosal function vs. exposure time Relationship between level of humidity and mucociliary clearance Williams R et al. Crit Care Med,

Secretion Quality Clinical Outcomes: Secretions Methods Surgical ICU, n=120 Prospective study using an algorithm to choose humidification devices n = 88* n = 32 Aim Determine the utility of a

humidification was made by recording quality of secretions following each suctioning procedure Branson RD et al. Chest.

9 Secretion Quality Clinical Outcomes: Secretions Methods Surgical ICU, n=120 Prospective study using an algorithm to choose humidification devices n = 88* n = 32 Aim Determine the utility of a humidification algorithm in MV patients, using both a HME and heated humidifier Patients with bloody secretions, thick tenacious sputum, and core temperature <32 o C were given HH Adequacy of humidification was made by recording quality of secretions following each suctioning procedure Branson RD et al. Chest.1993 Adapted from Branson RD et al. Chest.1993 *Descriptive data no statistical analysis Endotracheal Tube Patency Endotracheal Tube Patency Methods Reduction in ETT volume (Day 5) (Day 10) HH (37 o C / 44mgH 2 O/L) and HME Aim Assess impact of HH and HME on in vivo ETT patency in patients ventilated long-term (> 7 days) Medical ICU patients (n=60) Acoustic reflection method used to estimate ETT inner volume and resistance Measurements carried out mid-mv (5 3.3 days) and end-mv ( days) Mean SD, ** P <0.01 Increase in ETT Blasius resistance Mean SD, ** P <0.001 During long-term MV, HH should be the technique of choice for adequate humidification Jaber S et al. Anesthesiology Jaber S et al. Anesthesiology

Adult Care Continuum Noninvasive Ventilation Essential Humidity to Maximise NIV Success 36 37 NIV: Patient Tolerance Clinical opinions on humidified NIV NIV can be an uncomfortable therapy that some

doubt that failure to humidify gas, even during short term NIV, results in patient discomfort Branson & Gentile, Respir Care, 2010 As patient comfort is important to NIV success, humidification

10 Adult Care Continuum Noninvasive Ventilation Essential Humidity to Maximise NIV Success NIV: Patient Tolerance Clinical opinions on humidified NIV NIV can be an uncomfortable therapy that some patients find difficult to tolerate Up to 70% of NIV patients experience adverse effects 1 Leak occurs in almost every NIV patient % have problems tolerating the therapy 1 There is little doubt that failure to humidify gas, even during short term NIV, results in patient discomfort Branson & Gentile, Respir Care, 2010 As patient comfort is important to NIV success, humidification probably improves NIV success Branson & Gentile, Respir Care, 2010 Humidification of the upper airway is important to improve comfort and tolerance Nava & Hill, Lancet, Hill 1997, 2 Mehta

Humidification Guideline May 2012 Adult Care Continuum Recommendations Active humidification for NIV is

increases WOB and PaCO 2 Restrepo & Walsh 2012; American Association of Respiratory Care 40 41 What is Optiflow?

Optiflow offers the ability to comfortably deliver a complete range of oxygen concentrations and flows to extend

11 Humidification Guideline May 2012 Adult Care Continuum Recommendations Active humidification for NIV is suggested to improve adherence and comfort Passive humidification (HME) is not recommended for NIV as it increases WOB and PaCO 2 Restrepo & Walsh 2012; American Association of Respiratory Care What is Optiflow? What is Optiflow? Optiflow offers the ability to comfortably deliver a complete range of oxygen concentrations and flows to extend the traditional boundaries of oxygen therapy This is achieved through the integration of heated humidification and a dynamic blend of air and oxygen delivered via an innovative nasal cannula Oxygen Therapy Optiflow 42 43

12 Key Mechanisms of Optiflow Key Mechanisms and Benefits of Optiflow The combination of Optimal Humidity and Flow provides the 5 key mechanisms of Optiflow: Level 2 Level 3 Clinical Outcomes Level 1 Physiological Outcomes Mechanisms of Action Patient and Economic Benefits Key Mechanisms of Optiflow Key Mechanisms Optiflow Physiological and Clinical Outcomes of Optiflow Patient and Economic Benefits Mucociliary Clearance Comfort Washout of Anatomical Deadspace Accurate Oxygen Delivery Comfort/Tolerance Therapy success Improved lung volumes A reduction of escalation of care Increased patient and caregiver satisfaction Low Level Pressure Reduced respiratory rates Reduced length of stay in ICU Improved Oxygenation Reduced cost of care Fewer desaturations 46 47

Key Mechanisms of Optiflow Optimal Humidity 1

C, 44 mg/l) optimises mucociliary clearance Improves

for transport out of the airway Reduces the risk of

Mechanisms of Optiflow 2 Comfort Patient Comfort

13 Key Mechanisms of Optiflow Optimal Humidity 1 Mucocilary Clearance Delivering Optimal Humidity (37 C, 44 mg/l) optimises mucociliary clearance Improves secretion quality Maintains mobility of secretions for transport out of the airway Reduces the risk of respiratory infection Optimal Humidity Key Mechanisms of Optiflow 2 Comfort Patient Comfort Patient Compliance More Effective Care Better Patient Outcomes 50 51

Optimal Flow Optimal Flow 3 Accurate Oxygen Delivery Optiflow Optiflow Face Mask Face Mask 4 Washout of

fresh gas in the upper airway, ready for the next inspiration Allow for better ventilation and oxygenation 52 53

2009 compared the level of positive airway pressure generated by Optiflow with traditional face mask oxygen

14 Optimal Flow Optimal Flow 3 Accurate Oxygen Delivery Optiflow Optiflow Face Mask Face Mask 4 Washout of Anatomical Deadspace This washout effect aims to: Reduce re-breathing of expired CO 2 Create a reservoir of fresh gas in the upper airway, ready for the next inspiration Allow for better ventilation and oxygenation Optimal Flow Key Mechanisms and Benefits of Optiflow 5 Low Level Pressure Level 3 Study Parke et al compared the level of positive airway pressure generated by Optiflow with traditional face mask oxygen therapy Results Optiflow generated a low-level pressure Level 1 Mechanisms of Action Level 2 Physiological Outcomes Clinical Outcomes 54 55

15 Physiological Outcomes Key Mechanisms and Benefits of Optiflow Compared to standard oxygen therapy, Optiflow: Decreases respiratory rate Increases tidal volume Increases end expiratory lung volume Improves oxygenation Reduces work of breathing Level 1 Mechanisms of Action Level 2 Physiological Outcomes Level 3 Clinical Outcomes Corley A. BJA. 2011; Roca O. Respir Care 2010; Lenglet H. Respir Care. 2012; Parke R. Br J Anaesth. 2009; Groves N. Aust Crit Care. 2007; Ritchie JE. Anaesth Intensive Care. 2011; Riera J. Respir Care. 2013; Kernick J. Aust Crit Care. 2010; Sztrymf B. Intensive Care Med Clinical Outcomes A growing body of evidence now demonstrates that Optiflow is more effective than traditional oxygen delivery devices: Clinical Outcomes Randomised controlled trial comparing face mask oxygen therapy to Optiflow: 44% failed face mask oxygen therapy 10% failed Optiflow Optiflow reduced escalation of therapy Implications: - Greater therapy success = less escalation = faster ICU discharge and increased cost avoidance Parke R. et al. Respir Care,

16 Clinical Outcomes: Emerging Evidence Clinical Outcomes: Homecare Optiflow to avoid escalation to invasive ventilation Preliminary evidence suggests Optiflow may avert the need for invasive ventilation in up to 70% of patients with severe hypoxemia Optiflow after invasive ventilation Preliminary evidence suggests that Optiflow immediately after invasive ventilation reduces the likelihood of needing invasive ventilation again Going back to invasive ventilation increases mortality risk and cost The clinical utility of long-term humidification therapy in chronic airway disease Rea et al. 2010, Respiratory Medicine 108 patients diagnosed with COPD or bronchiectasis Daily humidification therapy 12 months Usual care for 12 months Measured outcomes Exacerbation rates Lung function spirometry Quality of life Exercise capacity Measures of airway inflammation recorded at baseline, 3 and 12m Clinical Outcomes: Homecare Compelling Cost Reduction Results Decreased exacerbation days (-44%) Increased days to first exacerbation (57 vs. 27 days) Decreased antibiotic use (22.8% vs. 38.5% of days) Compliance: 41/53 of patients (77%) chose to continue with humidification post-12 month study Case Study: Bon Secours St. Francis Health System, South Carolina, USA Situation Bon Secours St. Francis Health System was looking to identify ways of driving efficiencies within their hospitals Solution After hearing about heated humidification and Optiflow they installed 10 Optiflow units in their 15-bed ICU Benefits Optiflow helped get patients off Bi-Level support and out of the ICU faster Better outcomes for patients and delivered savings for the hospital Joseph Whitten, Director Respiratory Care Services, Bon Secours St. Francis Health System, South Carolina, USA

Compelling Cost Reduction Case Study: Bon Secours St.

Proactive use of Optiflow delivered results which could be directly attributed to

17 Compelling Cost Reduction Case Study: Bon Secours St. Francis Health System, South Carolina, USA Results Clinical objectives Conclusion Proactive use of Optiflow delivered results which could be directly attributed to significant cost savings Joseph Whitten, Director Respiratory Care Services, Bon Secours St. Francis Health System, South Carolina, USA Mechanisms of action Physiological Outcomes Similar to adult populations Promoting Developmental Care Feeding Parental bonding Conserving energy for growth and development 66 67

Clinical Outcomes High-flow Nasal Cannulae vs Nasal CPAP for Post- Extubation Respiratory Support of Very Preterm Infants: A Multicentre, Randomised Non-Inferiority Trial Brett J Manley, The

nasal high flow with CPAP in neonates Evaluating safety and efficacy when using nasal high flow as an alternative to CPAP Consensus of evidence Optiflow equivalent to neonatal CPAP in terms

18 Clinical Outcomes High-flow Nasal Cannulae vs Nasal CPAP for Post- Extubation Respiratory Support of Very Preterm Infants: A Multicentre, Randomised Non-Inferiority Trial Brett J Manley, The HIPERSPACE Trial Team Article in press Clinical Outcomes Three large randomised controlled trials have been completed Manley et al n=303 Yoder et al n=432 Collins et al n=132 Comparing nasal high flow with CPAP in neonates Evaluating safety and efficacy when using nasal high flow as an alternative to CPAP Consensus of evidence Optiflow equivalent to neonatal CPAP in terms of safety and efficacy Less nasal trauma No clinically significant adverse events were described In addition More acceptable to patients and their families Simplifies care for the care giver 70 71

Q & A Respiratory and Acute Care Product Portfolio 72 73

Continuum Can be used with single patient use and reusable

Solution is patented Evaqua technology Evaqua 2 also has

19 Q & A Respiratory and Acute Care Product Portfolio Evaqua 2 Able to deliver all therapies of the Care Continuum Can be used with single patient use and reusable consumables High humidity gas can damage ventilators Solution is patented Evaqua technology Evaqua 2 also has patented, improved inspiratory limb Kitted with the MR290 autofeed chamber 74 75

20 Noninvasive Ventilation Semi-reusable tube Primarily for use in developing markets

21 Delivering Optiflow F&P Optiflow Adult Nasal Cannula Wide bore cannulae designed to deliver high flows without gas jetting Ergonomically designed for exceptional comfort around the nasal septum Lightweight and flexible Mobile condensate is reduced by the unique breathable film delivery tube Lanyard with quick release takes the weight of the circuit Flexi-tube Easy-Click Connector Wigglepads and Butterfly Base Soft-touch Nasal Prongs 82 83

Q & A Lunch Break 84 85 Obstructive Sleep

Subject ICON+ ThermoSmart SensAwake Info

Mask Products F&P Pilairo and F&P Eson F&P

Group) Paul Shearer (Senior Vice President

22 Q & A Lunch Break Obstructive Sleep Apnea Obstructive Sleep Apnea Overview Subject ICON+ ThermoSmart SensAwake Info Technologies InfoSmart Web InfoUSB New Mask Products F&P Pilairo and F&P Eson F&P Simplus F&P Pilairo Q US Sleep Market Overview Presenter Fiona Cresswell (Marketing & Clinical Manager, OSA Product Group) Fiona Cresswell (Marketing & Clinical Manager, OSA Product Group) Andrew Somervell (General Manager, OSA Product Group) Paul Shearer (Senior Vice President Sales & Marketing) 86 87

with SensAwake Meeting the changing market

all experience subconscious waking through

is likely to occur Detect Relieve Return 1.

23 with SensAwake Meeting the changing market needs. Simplified user experience Simplifies equipment set-up and patient instruction Stylish new colour Smart clinical technologies SensAwake ThermoSmart Optimising Patient Comfort SensAwake - Responsive Pressure Relief AWAKE ASLEEP We all experience subconscious waking through the night at which time pressure intolerance is likely to occur Detect Relieve Return 1. OSA sufferers only need CPAP when they are sleeping 2. If intolerance to CPAP is going to occur it will be during awake state 90 91

develops due to dry CPAP air In line with peer-reviewed guidelines 1 for CPAP titration Most patients prefer CPAP with SensAwake to conventional CPAP 2,3

et al 2011; 3 Powell et al 2011 92 93 ThermoSmart ThermoSmart Delivering air close to physiologic conditions overcomes this vicious cycle and eliminates

environments (temp/flow) Benefits are clinically proven Nilius 2008 Virtually eliminates condensation and improved sleep quality Massengill 2009 10% less

24 SensAwake...It s Intuitive! ThermoSmart Simulates a sleep technician s response to prevent disturbance to sleep/make their first CPAP experience a good one DRYNESS & CONGESTION develops due to dry CPAP air In line with peer-reviewed guidelines 1 for CPAP titration Most patients prefer CPAP with SensAwake to conventional CPAP 2,3 HIGH UNDIRECTIONAL FLOW exacerbates drying INCREASED NASAL AIRWAY RESISTANCE promotes mouth breathing MOUTH LEAK DEVELOPS 1 Kushida et al, 2008, 2 Cumin et al 2011; 3 Powell et al ThermoSmart ThermoSmart Delivering air close to physiologic conditions overcomes this vicious cycle and eliminates the increase in nasal resistance ThermoSmart is a heated breathing tube humidifier Delivers physiologic levels of humidity Compensates for changing environments (temp/flow) Benefits are clinically proven Nilius 2008 Virtually eliminates condensation and improved sleep quality Massengill % less pressure required on CPAP titration Nilius, In Press More nights used vs. no humidification Clinically proven for a better night s sleep Powell 2010 Equivalent to a nasal steroid for CPAP compliance & nasal symptom reduction Almasri 2007 Greater comfort & better perceived sleep quality 94 95

initial 90 day period 96 97 Evolving, Creating Simple, Flexible Solutions InfoTechnologies - InfoCloud

25 InfoTechnologies Compliance Monitoring The market is facing increased requirements for compliance monitoring, driven either by Government, Insurer or Physician There is also increasing need for information after the initial 90 day period Evolving, Creating Simple, Flexible Solutions InfoTechnologies - InfoCloud Simplicity Efficiency Streamline processes Proactive processes for identifying revenue risk Keep patients compliant longer 98 99

26 InfoUSB InfoGSM Fast, free, web-based The system calls the patient to upload their data Patient can upload data from any internet connected PC Hands-off solution Daily updates Full compliance and efficacy reporting InfoView InfoSmart Web Direct from the display of the device No added cost Fits with existing call centre programs Integrity verified with a checksum Simply driving efficiency through proactive patient management

solutions deliver simplicity and efficiency Simplifying integrated data management Unique and cost

27 Proactive Compliance Management Remote Prescription Management Compliant report and file Non-Compliant - intervene No Data intervene or wait InfoCloud Services Info Technologies Summary Info Technology solutions deliver simplicity and efficiency Simplifying integrated data management Unique and cost effective data transfer options Proactive patient management Flexible services to suit any scale of business

28 For personal use only Q&A New Mask Introductions APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FY The Brief An innovative auto-adjusting sealing technology A nasal mask which optimises ease of use Fewer parts FEB MAR APR MAY JUN JUL FY14 AUG SEP

The Technology Three key components 1. RollFit Seal 2. Easy Frame 3.

complicated T-piece adjustments Minimises pressure on bridge of nose Incorporates Integrated

Easy Frame A single frame attaches with an effortless Easy-Clip to all three seal sizes

Q-Cover Super-quiet use and minimal partner draft Ball and Socket Elbow - freedom of movement

to self-locate high on the rear of the head Allows for maximum head movement without

29 The Technology Three key components 1. RollFit Seal 2. Easy Frame 3. ErgoFit Headgear The RollFit Seal Rolls on the bridge of the nose Adjusts fit automatically, no complicated T-piece adjustments Minimises pressure on bridge of nose Incorporates Integrated Stability Panels Optimal sealing performance Stability and support all night long The Easy Frame A single frame attaches with an effortless Easy-Clip to all three seal sizes Simplifying inventory for the dealer Simplifying re-assembly for the patient Fitted with Q-Cover Super-quiet use and minimal partner draft Ball and Socket Elbow - freedom of movement Teflon elbow - silent use Low-profile for stability The ErgoFit Headgear Ergonomically designed to self-locate high on the rear of the head Allows for maximum head movement without dislodgement Embedded VELCRO Tabs with Easy-Clip Hooks Fast and easy fitting and removal Adjustable Crown Strap Helps enhance mask stability

Overview An advance on our truly revolutionary Pilairo

sealing performance even with movement at higher pressures

increased versatility 116 117 AirPillow Seal Stretchwise

reduces inventory for the lab and dealer Double sealing

self-inflate with CPAP flow, seals even at high pressures

Miniaturised single strap for attachment not required for

30 Overview An advance on our truly revolutionary Pilairo Small, light (52gms) and visually appealing Exceptional sealing performance even with movement at higher pressures Virtually silent with new Q-cover Two headgear options for increased versatility AirPillow Seal Stretchwise Headgear World s first one convenient size, fits most and reduces inventory for the lab and dealer Double sealing mechanism, seals in the nares and around the nose Micro-fine contoured seal (0.04 inches), soft and comfortable Ergonomically designed to self-inflate with CPAP flow, seals even at high pressures Provides freedom of movement without compromising the seal Miniaturised single strap for attachment not required for stability Special stretch properties Automatically customises to the wearer One convenient size / no adjustments

Q-Cover Adjustable Headgear Alternative New Q-Cover diffuses the exhaust flow for virtually

conventional headgear alternative Still very light and minimalist Adds flexibility and

rolling effect Position Seal off-the-lip Flexible Tube Lightweight and very flexible Ball

Dealer Reduced inventory No sizing required Quick and simple fitting for a greater range of

31 Q-Cover Adjustable Headgear Alternative New Q-Cover diffuses the exhaust flow for virtually silent and draft-free use No sleep disturbance for user or for bed-partner More conventional headgear alternative Still very light and minimalist Adds flexibility and versatility Additional Features Summary Stabilizers Additional Support frame Limit rolling effect Position Seal off-the-lip Flexible Tube Lightweight and very flexible Ball and Socket Elbow Allows for more movement and less drag FREEDOM AND EFFICIENCY For Lab and Dealer Reduced inventory No sizing required Quick and simple fitting for a greater range of patients For Patient No adjustment required Minimal headgear Optimal sealing Simple cleaning and assembly

The Design Brief A full face mask that easily integrates with daily life Minimal parts Take comfort, seal and easy use to a

automatically Minimises pressure on nose, no complicated T-piece adjustments Integrated Stability Panels for optimal sealing

Headgear Thermoformed with additional foam layers which provide rigidity Ergonomically designed, breathable, self-locates

32 The Design Brief A full face mask that easily integrates with daily life Minimal parts Take comfort, seal and easy use to a new level in the full face category The RollFit Seal RollFit Seal rolls on the bridge of the nose - adjusts automatically Minimises pressure on nose, no complicated T-piece adjustments Integrated Stability Panels for optimal sealing performance Soft, fine silicone where it matters Stability + Softness + Auto-adjustment = Seal with Comfort The ErgoForm Headgear Thermoformed with additional foam layers which provide rigidity Ergonomically designed, breathable, self-locates high on the rear of the head Allowing for maximum head movement Embedded VELCRO Tabs with Easy-Clip Hooks Fast and easy fitting and removal

The ErgoForm Headgear ErgoForm incorporates Stretch and

stability and sizing The Easy Frame One frame - three seal sizes

after cleaning Ball and Socket Elbow - freedom of movement

Having tried masks from all of the major suppliers of CPAP

the easiest to use and most comfortable CPAP full face mask on

33 The ErgoForm Headgear ErgoForm incorporates Stretch and Non-stretch Panels Adjustable Crown Strap Helps enhance mask stability and sizing The Easy Frame One frame - three seal sizes S,M,L Easy-click seal/frame attachment - effortless assembly after cleaning Ball and Socket Elbow - freedom of movement Teflon swivel - silent use In The Market What else are they saying? Available in Australia, Canada, Europe Global roll-out ongoing Having tried masks from all of the major suppliers of CPAP masks, I am convinced that the Fisher & Paykel Simplus is by far the easiest to use and most comfortable CPAP full face mask on the market today. (Patient Sleep Blog) Simply Cleans quick + easy The percentage of sleep trial patients who said

What else are they saying? What else are they saying?

overall seal performance as good or very good Simply Desired The

Simplus moving forward 132 133 Summary Summary Market reception has

including the RollFit seal and the ErgoForm headgear to offer a mask

34 What else are they saying? What else are they saying? Simply Seals The percentage of sleep trial patients who reported the overall seal performance as good or very good Simply Desired The percentage of sleep trial patients who would like to use the F&P Simplus moving forward Summary Summary Market reception has been exceptionally positive Several unique features are incorporated including the RollFit seal and the ErgoForm headgear to offer a mask that.simply Fits and Performs A fully integrated system with a focus on comfort, simplicity and efficiency

Q & A US Sleep Market Overview 136 137 Paul Shearer Senior VP Sales & Marketing US Sleep Market Overview US Competitive Bidding Bidding Round 1 & 2 Subject Competitive Bidding Update Home Sleep

3 million beneficiaries* Round 2 +100 CBAs 20 million beneficiaries** Round 1 and 2 cover 8% of insured population 2016 +14.3 million beneficiaries Total 36.

3m Other Advantage Round 1 and 2 Year 2016 138 139 *Morgan, David. U.S. expects big Medicare savings from competitive bid program. Reuters.com. January 30, 2013.

35 Q & A US Sleep Market Overview Paul Shearer Senior VP Sales & Marketing US Sleep Market Overview US Competitive Bidding Bidding Round 1 & 2 Subject Competitive Bidding Update Home Sleep Testing (HST) Market Trends F&P Strategy Presenter Paul Shearer (Senior Vice President Sales & Marketing) Round 1 9 CBAs 2.3 million beneficiaries* Round CBAs 20 million beneficiaries** Round 1 and 2 cover 8% of insured population million beneficiaries Total 36.6 million fee for service beneficiaries covered by competitive bidding, 14% of insured population Total US Insured Population 218m 14.3m 13.4m 22.3m Other Advantage Round 1 and 2 Year *Morgan, David. U.S. expects big Medicare savings from competitive bid program. Reuters.com. January 30, Accessed August 10, 2013 **According to CMS, in 2012 there were 36,566,000 Fee-for-Service Medicare Beneficiaries (2013 Medicare &Medicaid Research Review/2013 Statistical Supplement Table 2.5); According to CMS, in 2012 there were 2,300,000 Fee-for-Service Medicare Beneficiaries in RD1 (CMS Press Release. Competitive Bidding Update One Year Implementation Update. April 17, 2012.) According to Reuters, there were 20,000,000 Fee-for-Service Medicare Beneficiaries in RD2 (Morgan, David. U.S. expects big Medicare savings from competitive bid program. Reuters.com. January 30, Accessed August 10, 2013.)

Competitive Bidding Round Round 2 2 Competitive Bidding 100 CBAs 55% of Medicare beneficiaries effective July 1 2013 45% average reduction, 47% for CPAP* Rates Non Bid RD1 RD2 Private CPAP/HHT/Nasal

36 Competitive Bidding Round Round 2 2 Competitive Bidding 100 CBAs 55% of Medicare beneficiaries effective July % average reduction, 47% for CPAP* Rates Non Bid RD1 RD2 Private CPAP/HHT/Nasal Mask $1,569 $1,020 $830 Comparable to RD2 CPAP/HHT/FF Mask $1,628 $1,069 $868 Comparable to RD2 2,558 CPAP contracts, 799 individual suppliers Apria 100/100, Lincare 96/100, AHP 81/100, Rotech 18/100 Review $202 million in savings in year 1 of the program (RD1, 9 CBAs)* Projected Medicare savings $42.8 billion over 10 years 25.7 billion Medicare/taxpayers 17.1 billion for beneficiaries (e.g., copays) Growing proportion of business shifted to national providers F&P ASP s within historical range Round 2 directly impacts <2% of F&P global business * * Round 11 Re-compete Review Same 9 CBAs as Round 1 (1/1/ /12/2013) Categories expanded and combined Oxygen concentrators and CPAP devices in single category Supplier must supply both Bids submitted 14 December 2012 Rates and winners announced late 2013 Contract period: 1/1/ /12/2016 Re-supply Estimate that the average compliant patient that is in an active program replaces a mask two times per year 1.2 masks per year on average New CMS rule requires the provider to document that the patient has exhausted any current supplies and that the item being replaced is dysfunctional The policy applies only to Medicare patients and was effective July 2012 Analysis over the past 12 months indicates Medicare resupply volumes reduced ~10% Impact fully absorbed in prior 12 months

Home Sleep Testing (HST) (HST) Home Sleep Testing (HST) (HST) Currently represents ~25% of total sleep test market HST expected to grow over the next 5 years Most major payers now require

80% of insurance carriers reimburse for HST Utilization management companies implementing programs to manage HST adoption Delivery Models Traditional Sleep Centers Independent Diagnostic Testing

37 Home Sleep Testing (HST) (HST) Home Sleep Testing (HST) (HST) Currently represents ~25% of total sleep test market HST expected to grow over the next 5 years Most major payers now require pre-authorization for PSG. 80% of insurance carriers reimburse for HST Utilization management companies implementing programs to manage HST adoption Delivery Models Traditional Sleep Centers Independent Diagnostic Testing Facilities (IDTF) Pulmonary/Cardiology/ENT Specialists Primary Care Practitioners Homecare Providers Home Sleep Testing (HST) (HST) Market Trends Growth Drivers for HST utilization Increased awareness More service providers Easier access for patients Lower costs for patients Utilization management companies Increased requirement for documented compliance Linked to reimbursement/re-supply Increase emphasis on technology that will improve acceptance, compliance and reporting Raising barriers to entry Increased use of HST diagnostics Increase patient volumes Increased use of auto CPAP devices Reducing reimbursement Emphasis on acquisition cost and technology that will improve efficiencies, reduce labour and drive reoccurring revenue

F&P Strategy F&P Sales Sales Strategy Strategy Provide technology that: Improves customer business efficiency Reduces customer operating cost Increases customer revenue opportunity Raises barrier to

Technologies Strategy Strategy F&P CPAP CPAP Strategy Strategy Flexible Efficient Low Cost Improve compliance Monitoring compliance has become the standard to authorise full payment Info Technologies

38 F&P Strategy F&P Sales Sales Strategy Strategy Provide technology that: Improves customer business efficiency Reduces customer operating cost Increases customer revenue opportunity Raises barrier to entry Flexible Efficient Low cost Improve compliance Simple Efficient ThermoSmart SensAwake Improve compliance Simple Efficient Less waste Improve compliance F&P Info Info Technologies Technologies Strategy Strategy F&P CPAP CPAP Strategy Strategy Flexible Efficient Low Cost Improve compliance Monitoring compliance has become the standard to authorise full payment Info Technologies - flexible and cost efficient InfoSmart Web simplified work flow and targeted reporting InfoCloud services seamless data integration and efficient work flow process Efficient, cost reduction, revenue generating, raises barriers Simple Efficient ThermoSmart SensAwake Improve compliance New ICON+ ThermoSmart SensAwake Info Technologies drives ICON+ sales myairvo Efficient, cost reduction, revenue generating, raises barriers

F&P Mask Mask Strategy Strategy Q&A Simple Efficient Less waste Improve compliance Eson

Improved acceptance and compliance Efficient, cost reduction, revenue generating, raises

Reduce operating cost Info Technology: ICON+, Eson, Pilairo Q, Simplus Increase customer

Info Technology: ICON+, Eson, Pilairo Q, Simplus, myairvo 152 153 Closing Comments

39 F&P Mask Mask Strategy Strategy Q&A Simple Efficient Less waste Improve compliance Eson NEW Pilairo NEW Simplus NEW High level of comfort Quick fitting Less labour Less waste Improved acceptance and compliance Efficient, cost reduction, revenue generating, raises barriers Improve business efficiency Info Technology: ICON+, Eson, Pilairo Q, Simplus Reduce operating cost Info Technology: ICON+, Eson, Pilairo Q, Simplus Increase customer revenue Info Technology: ICON+, Eson, Pilairo Q, Simplus, myairvo Raise barrier to entry Info Technology: ICON+, Eson, Pilairo Q, Simplus, myairvo Closing Comments Fisher & Paykel Healthcare Investor Day September 2013 Mike Daniell Managing Director & CEO 154

For personal use only

For personal use only Fisher & Paykel Healthcare Goldman Sachs Australasian Investment Forum 1 London - September 2013 Investment Highlights A leader in respiratory and OSA treatment devices Consistent growth strategy Estimated