Showing posts with label strategy. Show all posts
Showing posts with label strategy. Show all posts

Monday, 9 September 2013

Mylan Pursues Global Generics Dominance Strategy

Mylan (MYL) is a pharmaceutical company included in the Nasdaq 100. Mylan has a very different model than most of the biotechnology stocks I follow and invest in, which typically have pipelines of novel therapies in clinical development that have a likely future value that is not fully priced into the stock. Instead Mylan mainly manufacturers a wide variety of generic drugs and has several divisions and subsidiaries, many of them outside the United State of America.

Mylan, therefore, has to be analyzed in aggregate, rather than therapy by therapy. It may turn out that Mylan has a better risk/potential profile than the smaller pharmaceutical companies I will be looking at for this round of investment. With healthcare costs a growing concern, and a growing population of seniors who often take over 6 generic drugs for the remainder of their lives, perhaps owning a generic drug company would be a smart move. Eventually, but not in this article, I will compare Mylan to the other biotechs I am researching to consider for my new round of investment.

It is notable that Mylan and its competitors cannot manufacture and sell a drug just because it has gone off patent. Each generic must demonstrate to the FDA (or equivalent agency in other nations) that it is as safe and effective as the private label therapy it is replacing. So by knowing which drugs are falling off-patent and which Mylan is planning to apply to manufacture, and by studying the competition, it is possible to project future new income. The difference is that it is rare for any single new therapy to move the needle much. Instead the needle usually moves from dozens or even hundreds of new product introductions each year.

Q2 2013 numbers (released August 1) were not very impressive from a revenue growth standpoint. Revenue was up just 1% y/y to $1.70 billion. Even eliminating the effect of the yen and rupee, revenue was up just 2% y/y. Mylan claims the launch of a particular generic therapy, Escitalopram, in Q2 2012 also made for a difficult y/y comparison, given the high inventory build upon its introduction.

However, the efficiency of the operation improved y/y, so that EPS was up 13% on a non-GAAP basis to $0.68, and up 39% on a GAAP basis to $0.46.

Generally speaking revenue and profits have ramped significantly each of the past 5 years. Much of the ramp was through acquisitions of companies or products, which left Mylan with a rather high debt for a biotechnology company, $5.8 billion. The cash and equivalents balance was just $277 million, a somewhat narrow margin for a company doing so much business.

Cash from operating activities was $283 million, but $126 million was made in capital expenditures, leaving free cash flow of $157 million. If all free cash flow were used to pay off debt, that would take about nine years. In addition more debt will be added to acquire Agila Specialties for $1.6 billion when the deal closes in Q4.

Mylan management has a clear vision of how make the company into both a profit-making machine and also the largest generic (and possibly overall) drug company in the world. Cash flow is expected to ramp over the years, enabling paying down the debt at a reasonable pace, if all goes as planned.

Guidance paints this picture in numbers. Q3 non-GAAP EPS is expected to jump sequentially to between $0.77 and $0.79 per share. Full year non-GAAP EPS is expected between $2.75 and $2.95. 2014 non-GAAP EPS is expected up another 19%, or to between $3.27 and $3.51 per share.

Most dramatically, and with all the usual caveats, non-GAAP EPS in 2018 is expected to exceed $6 per share. If that is the case, and if free cash flow growth is roughly proportional to EPS growth, and it the growth is achieved without more expensive acquisitions, then the debt is not a problem if everything goes according to plan.

The Mylan vision is attractive in ways that are not just reflected in the guidance numbers. Mylan has invested in state-of-the-art manufacturing facilities and the scientific capability to get its own new generic approvals, lessening the need to expand through acquisitions in the future. In addition to making a push in HIV anti-retroviral drugs, Mylan is prepared to bring biosimilars to market. Biosimilars like monoclonal antibodies and insulin analogs are much, much harder to manufacture than most generic drugs, which are small molecules. That means less generic competition and likely more revenue and better margins per drug introduced.

In a world where healthcare costs have climbed, and in a nation like the U.S. where healthcare costs have bubbled, quality generics are a big part of the economic and health solution. Mylan sees a coming globalization of the drug market. By bringing the highest U.S. quality standards to global generics, and competitive global prices to the U.S. and developed nations, Mylan could become the dominant player. The key to doing that is not just volume, but efficiency in cost of goods sold and operating costs, including R&D expenses. Efficiency plus volume means cash flows for reinvestment and to reward shareholders.

Mylan's 52 week high was $37.47, against a 52 week low of $23.25. Mylan has a P/E 22 on trailing GAAP EPS of $1.63 price and a non-GAAP trailing P/E of 13 on non-GAAP EPS of 2.78. MYL closed at $35.93 on September 4, 2013.

These P/Es are very reasonable, even given the heavy debt load. If long-term guidance is correct, MYL as it stands today is a bargain, with minimal risk and a likely 20% per year upside. [I use the term likely in the statistical sense.] That is a very good long term proposition for most investors.

Mylan pays no dividend, nor should it given the debt load. While few biotechnology companies pay dividends, I like dividends and so that would bias me to the ones that do pay them like Amgen (AMGN) (1.6%).

To do better than MYL (in my coming biotechnology investment round) I would have to find several much smaller, riskier, companies with undervalued pipelines and a higher expected return. I will be looking for them, and reporting my findings here. While risks can be reduced with a properly chosen group of such stocks, they cannot be eliminated. In the end I may choose to add less-risky Nasdaq 100 biotechs like Mylan, Amgen, Intuitive Surgical (ISRG) or Alexion (ALXN) to the ones that I continue to hold that served me so well these last 5 years: Gilead (GILD), Biogen Idec (BIIB), and Celgene (CELG).

Disclosure: I am long GILD, CELG, BIIB. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article. (More...)


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Thursday, 5 September 2013

Procurement strategy is blocking NHS value for money

X-ray showing a hip replacement A single NHS contract to supply orthopaedic hip and knee replacements would save money and secure quality. Photograph: Rex Features

If we pooled all of the expertise within the NHS, we would have one of the best-equipped and most capable procurement teams in the world. It would hold all the cards to find cost savings while improving services for patients. The problem is that we don't pool expertise.

The government's NHS procurement strategy is dividing rather than uniting us. Bringing competition into the healthcare market is considered vital to ensure services are delivered a high standard. But, in many situations, this is contrary to procurement best practice, where pooling resources, knowledge and buying power delivers real savings.

NHS procurement needs more than a makeover. It requires fundamental changes in attitude to cope with the conflicting priorities of competition and collaboration.

The entire clinical strategy is geared up to seek best value services in a competitive market, but the national procurement strategy says we should be collaborating. Why should trusts seek to collaborate with each other when they are increasingly in competition on the provision of health services?

It is common knowledge that the competitiveness of your supply chain has a direct impact on the competitiveness of your products and services. That relates both to price and quality.

Try applying that logic to the health sector: as trusts, we're expected to share price information in order to drive best value, but that's tantamount to putting our competitive information directly into the hands of our rivals. And yet we should be seeking to consolidate nationally price and quality from suppliers. Take orthopaedics as an example. One national hip and knee contract for the whole of the NHS, rather than an undulating standard of price and quality, would hardly be a revolutionary idea. But it's sadly lacking today.

We should be pooling information and working together to drive best value and standardised quality through supplier contracts. This would give the entire NHS a quality baseline in terms of the services they deliver. Competition then comes into the equation in terms of service and specialisation in different trusts, but not in terms of price and not at the cost of squandering quality standards.

My personal approach to NHS procurement would be to split the strategy on an 80:20 basis between single national contracts and areas that remain open to competition.

Where the priority is best value and standardised quality, and in areas of little impact to health provision such as utilities, catering and office supplies, we should seek to collaborate on the widest scale possible. This would probably represent 20% of all NHS expenditure. The other 80% of spend, perhaps where local supply or specific products and services are priorities and there is less opportunity for consolidation, could remain competitive. As soon as the concept has been proven, inroads could then begin on the remaining 80%.

One challenge lies at the heart of the NHS procurement issue: a lack of joined-up information. Because we're all using different systems and processes for managing procurement and spending, there is no single picture of what the healthcare sector spends.

Until the NHS as a whole has a level of visibility through its systems and software it will be difficult to build a strategy that delivers simply because could be founded on inaccurate information. As a sector, we need a change of culture to affect a strategy led first by quality standards and second by selective competition. Until that happens, the NHS procurement makeover will prove little more than skin deep.

Malcolm Preston is associate director of procurement at County Durham and Darlington NHS Foundation Trust.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.


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Wednesday, 4 September 2013

Five minutes with ... a director of strategy and policy

Toby Lambert, director of strategy and policy at Monitor Toby Lambert, director of strategy and policy at Monitor. Photograph: Monitor

Describe your role in one sentence. I lead on what Monitor is doing on a range of health care policies, such as enabling integrated care and how we are going to achieve it.

Why did you want to work in healthcare? My grandfather was a surgeon and always wanted me to follow in his footsteps, but, I studied history instead. Subsequently, I came into healthcare because of the opportunity to make a difference and because simplifying complex problems is what I do best.

How do you want to see the sector change in the next five years? I want to see a leap in how healthcare organisations bring about improvement. This could lead to more integration between the health and social care sectors. In turn, this should enable the sector to provide patients with more responsive, person-centred co-ordinated care.

My proudest achievement at work was ... shaping healthcare reform in Egypt. We got off to a good start then the revolution happened.

The most difficult thing I've dealt with at work is ... trying to join up the work of the national arm's-length bodies so that we pull together in supporting the frontline in treating patients.

The biggest challenge facing the NHS is ... maintaining quality and access in the current financial climate. So, we'll have to find new ways of preventing and managing disease, which in turns means creating new models of care which could mean integration.

The people I work with are ... highly committed and professional.

I do what I do because ... it is the best place where I can make a difference.

Sometimes people think that ... I'm focused on the analysis. Which is true – a few facts always help and increase the chances we might get a workable answer. Doesn't mean I'm not passionate though.

Right now I want to ... get local commissioners to use their freedoms to develop new – and possibly integrated – models of care.

At work I am always learning that ... there's always more to learn.

The one thing always on my mind at work is ... that Monitor treats precisely no patients, but through our work we can effectively promote and protect their interests.

If I could go back 10 years and meet my former self I'd tell them ... to have more fun.

If I could meet my future self I'd expect them to be ... still trying to have more fun.

What is the best part of your job? Working with lots of talented, nice and passionate people.

What is the worst part of your job? The sheer amount of stuff I have to juggle but that's also what makes it fun.

What makes you smile? Sailing, I find it relaxing.

What keeps you awake at night? Reading, normally trashy fantasy novels.

If you would like to feature in our 'Five minutes with ...' series, or know someone who would, then you can let us know by emailing healthcare@theguardian.com

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.


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Thursday, 15 August 2013

New strategy to disarm the dengue virus brings new hope for a universal dengue vaccine

Main Category: Tropical Diseases
Also Included In: Infectious Diseases / Bacteria / Viruses;  Immune System / Vaccines
Article Date: 14 Aug 2013 - 2:00 PDT Current ratings for:
New strategy to disarm the dengue virus brings new hope for a universal dengue vaccine
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A new strategy that cripples the ability of the dengue virus to escape the host immune system has been discovered by A*STAR's Singapore Immunology Network (SIgN). This breakthrough strategy opens a door of hope to what may become the world's first universal dengue vaccine candidate that can give full protection from all four serotypes of the dreadful virus. This research done in collaboration with Singapore's Novartis Institute of Tropical Diseases (NITD) and Beijing Institute of Microbiology and Epidemiology is published in the PlosPathogens journal, and is also supported by Singapore STOP Dengue Translational and Clinical Research (TCR) Programme grant[1].

Early studies have shown that a sufficiently weakened virus that is still strong enough to generate protective immune response offers the best hope for an effective vaccine. However, over the years of vaccine development, scientists have learnt that the path to finding a virus of appropriate strength is fraught with challenges. This hurdle is compounded by the complexity of the dengue virus. Even though there are only four different serotypes, the fairly high rates of mutation means the virus evolve constantly, and this contributes to the great diversity of the dengue viruses circulating globally. Furthermore, in some cases, the immune response developed following infection by one of the four dengue viruses appears to increase the risk of severe dengue when the same individual is infected with any of the remaining three viruses. With nearly half the world's population at risk of dengue infection and an estimated 400 million people getting infected each year[2], the need for a safe and long-lasting vaccine has never been greater.

The new strategy uncovered in this study overcomes the prevailing challenges of vaccine development by tackling the virus' ability to 'hide' from the host immune system. Dengue virus requires the enzyme called MTase (also known as 2'-O-methyltransferase) to chemically modify its genetic material to escape detection. In this study, the researchers discovered that by introducing a genetic mutation to deactivate the MTase enzyme of the virus, initial cells infected by the weakened MTase mutant virus is immediately recognised as foreign. As a result, the desired outcome of a strong protective immune response is triggered yet at the same time the mutant virus hardly has a chance to spread in the host.

Animal models immunised with the weakened MTase mutant virus were fully protected from a challenge with the normal dengue virus. The researchers went on to demonstrate that the MTase mutant dengue virus cannot infect Aedes mosquitoes. This means that the mutated virus is unable to replicate in the mosquito, and will not be able to spread through mosquitoes into our natural environment. Taken together, the results confirmed that MTase mutant dengue virus is potentially a safe vaccine approach for developing a universal dengue vaccine that protects from all four serotypes.

The team leader, Dr Katja Fink from SIgN said, "There is still no clinically approved vaccine or specific treatment available for dengue, so we are very encouraged by the positive results with this novel vaccine strategy. Our next step will be to work on a vaccine formulation that will confer full protection from all four serotypes with a single injection. If this proves to be safe in humans, it can be a major breakthrough for the dengue vaccine field."

Associate Professor Leo Yee Sin, Clinical Director of Communicable Diseases Centre and Institute of Infectious Disease and Epidemiology at Tan Tock Seng Hospital who heads the Singapore STOP Dengue Translational and Clinical Research (TCR) Programme said, "We are into the seventh decade of dengue vaccine development, this indeed is an exciting breakthrough that brings us a step closer to an effective vaccine."

Acting Executive Director of SIgN, Associate Professor Laurent Rénia said, "Dengue is a major public health problem in many of the tropical countries. We are very delighted that our collaborative efforts with colleagues in Singapore and China have made a promising step towards a cost-effective and safe dengue vaccine to combat the growing threat of dengue worldwide."

About the Singapore Immunology Network (SIgN)
The Singapore Immunology Network (SIgN), officially inaugurated on 15 January 2008, is a research consortium under the Agency for Science, Technology and Research (A*STAR)'s Biomedical Research Council. The mandate of SIgN is to advance human immunology research and participate in international efforts to combat major health problems. Since its launch, SIgN has grown rapidly and currently includes 250 scientists from 26 different countries around the world working under 28 renowned principal investigators. At SIgN, researchers investigate ????immunity during infection and various inflammatory conditions including cancer and are supported by cutting edge technological research platforms and core services.

Through this, SIgN aims to build a strong platform in basic human immunology research for better translation of research findings into clinical applications. SIgN also sets out to establish productive links with local and international institutions, and encourage the exchange of ideas and expertise between academic, industrial and clinical partners and thus contribute to a vibrant research environment in Singapore.

For more information about SIgN, please visit www.sign.a-star.edu.sg.


About STOP Dengue Programme
The 5-year STOP Dengue programme is funded by the National Medical Research Council's S$25 million Translational and Clinical Research (TCR) flagship grant. Started in December 2008, the programme aims to overcome major gaps in the treatment and management of dengue diseases through the translation of our recent research findings. The goal of STOP Dengue TCR is to target zero death from dengue infection in Singapore adults. For more information, please visit http://www.stopdengue.sg. Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our tropical diseases section for the latest news on this subject. [1] http://www.nmrc.gov.sg/content/nmrc_internet/home/grant/compgrants/tcrinfec.html
[2] Nature, 2013 Apr 25;496(7446):504-7, “The global distribution and burden of dengue”

Rational Design of a Live Attenuated Dengue Vaccine: 2'-O-Methyltransferase Mutants Are Highly Attenuated and Immunogenic in Mice and Macaques

PLoS Pathog 9(8): e1003521. doi:10.1371/journal.ppat.1003521

Roland Züst, Hongping Dong equal contributor, Xiao-Feng Li, David C. Chang, Bo Zhang, Thavamalar Balakrishnan, Ying-Xiu Toh, Tao Jiang, Shi-Hua Li, Yong-Qiang Deng, Brett R. Ellis, Esther M. Ellis, Michael Poidinger, Francesca Zolezzi, Cheng-Feng Qin, Pei-Yong Shi, Katja Fink

Agency for Science, Technology and Research (A*STAR)

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Monday, 29 July 2013

Potential cause of Parkinson's disease discovered that points to a new therapeutic strategy

Main Category: Parkinson's Disease
Article Date: 27 Jul 2013 - 0:00 PDT Current ratings for:
Potential cause of Parkinson's disease discovered that points to a new therapeutic strategy
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Biologists at The Scripps Research Institute (TSRI) have made a significant discovery that could lead to a new therapeutic strategy for Parkinson's disease.

The findings, recently published online ahead of print in the journal Molecular and Cell Biology, focus on an enzyme known as parkin, whose absence causes an early-onset form of Parkinson's disease. Precisely how the loss of this enzyme leads to the deaths of neurons has been unclear. But the TSRI researchers showed that parkin's loss sharply reduces the level of another protein that normally helps protect neurons from stress.

"We now have a good model for how parkin loss can lead to the deaths of neurons under stress," said TSRI Professor Steven I. Reed, who was senior author of the new study. "This also suggests a therapeutic strategy that might work against Parkinson's and other neurodegenerative diseases."

Genetic Clues

Parkinson's is the world's second-most common neurodegenerative disease, affecting about one million people in the United States alone. The disease is usually diagnosed after the appearance of the characteristic motor symptoms, which include tremor, muscle rigidity and slowness of movements. These symptoms are caused by the loss of neurons in the substantia nigra, a brain region that normally supplies the neurotransmitter dopamine to other regions that regulate muscle movements.

Most cases of Parkinson's are considered "sporadic" and are thought to be caused by a variable mix of factors including advanced age, subtle genetic influences, chronic neuroinflammation and exposure to pesticides and other toxins. But between 5 and 15 percent of cases arise specifically from inherited gene mutations. Among these, mutations to the parkin gene are relatively common. Patients who have no functional parkin gene typically develop Parkinson's-like symptoms before age 40.

Parkin belongs to a family of enzymes called ubiquitin ligases, whose main function is to regulate the levels of other proteins. They do so principally by "tagging" their protein targets with ubiquitin molecules, thus marking them for disposal by roving protein-breakers in cells known as proteasomes. Because parkin is a ubiquitin ligase, researchers have assumed that its absence allows some other protein or proteins to evade proteasomal destruction and thus accumulate abnormally and harm neurons. But since 1998, when parkin mutations were first identified as a cause of early-onset Parkinson's, consensus about the identity of this protein culprit has been elusive.

"There have been a lot of theories, but no one has come up with a truly satisfactory answer," Reed said.

Oxidative Stress

In 2005, Reed and his postdoctoral research associate (and wife) Susanna Ekholm-Reed decided to investigate a report that parkin associates with another ubiquitin ligase known as Fbw7. "We soon discovered that parkin regulates Fbw7 levels by tagging it with ubiquitin and thus targeting it for degradation by the proteasome," said Ekholm-Reed.

Loss of parkin, they found, leads to rises in Fbw7 levels, specifically for a form of the protein known as Fbw7ß. The scientists observed these elevated levels of Fbw7ß in embryonic mouse neurons from which parkin had been deleted, in transgenic mice that were born without the parkin gene, and even in autopsied brain tissue from Parkinson's patients who had parkin mutations.

Subsequent experiments showed that when neurons are exposed to harmful molecules known as reactive oxygen species, parkin appears to work harder at tagging Fbw7ß for destruction, so that Fbw7ß levels fall. Without the parkin-driven decrease in Fbw7ß levels, the neurons become more sensitive to this "oxidative stress" - so that more of them undergo a programmed self-destruction called apoptosis. Oxidative stress, to which dopamine-producing substantia nigra neurons may be particularly vulnerable, has long been considered a likely contributor to Parkinson's.

"We realized that there must be a downstream target of Fbw7ß that's important for neuronal survival during oxidative stress," said Ekholm-Reed.

A New Neuroprotective Strategy

The research slowed for a period due to a lack of funding. But then, in 2011, came a breakthrough. Other researchers who were investigating Fbw7's role in cancer reported that it normally tags a cell-survival protein called Mcl-1 for destruction. The loss of Fbw7 leads to rises in Mcl-1, which in turn makes cells more resistant to apoptosis. "We were very excited about that finding," said Ekholm-Reed. The TSRI lab's experiments quickly confirmed the chain of events in neurons: parkin keeps levels of Fbw7ß under control, and Fbw7ß keeps levels of Mcl-1 under control. Full silencing of Mcl-1 leaves neurons extremely sensitive to oxidative stress.

Members of the team suspect that this is the principal explanation for how parkin mutations lead to Parkinson's disease. But perhaps more importantly, they believe that their discovery points to a broad new "neuroprotective" strategy: reducing the Fbw7ß-mediated destruction of Mcl-1 in neurons, which should make neurons more resistant to oxidative and other stresses.

"If we can find a way to inhibit Fbw7ß in a way that specifically raises Mcl-1 levels, we might be able to prevent the progressive neuronal loss that's seen not only in Parkinson's but also in other major neurological diseases, such as Huntington's disease and ALS [amyotrophic lateral sclerosis]," said Reed.

Finding such an Mcl-1-boosting compound, he added, is now a major focus of his laboratory's work.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our parkinson's disease section for the latest news on this subject.

“Parkin-Dependent Degradation of the F-box protein Fbw7 ß Promotes Neuronal Survival in Response to Oxidative stress by Stabilizing Mcl-1,” Susanna Ekholm-Reed, Matthew S. Goldberg, Michael G. Schlossmacher and Steven I. Reed, Published ahead of print 15 July 2013, doi: 10.1128/MCB.00535-13

Funding for the study was provided in part by the National Institutes of Health (NS059904 and CA078343).

Scripps Research Institute

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Friday, 26 July 2013

New strategy for fiber tracking in human brain

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cancer / oncology section for the latest news on this subject.

Article: " Diffusion tensor imaging fiber tracking with reliable tracking orientation and flexible step size" by Xufeng Yao1, 2, Manning Wang2, Xinrong Chen2, Shengdong Nie1, Zhexu Li1, Xiaoping Xu1, Xuelong Zhang1, Zhijian Song2 (1 Shanghai Medical Instrument College, School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200091, China; 2 Digital Medical Research Center, Shanghai Medical School, Fudan University/The Key Laboratory of MICCAI of Shanghai, Shanghai 200032, China)

Yao XF, Wang MN, Chen XR, Nie SD, Li ZX, Xu XP, Zhang XL, Song ZJ. Diffusion tensor imaging fiber tracking with reliable tracking orientation and flexible step size. Neural Regen Res. 2013;8(16):1481-1490.

Full text: Download file here

Neural Regeneration Research

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