Establishment Labs Valuation Multiples

Samsung Electronics is a diversified electronics conglomerate that manufactures and sells a wide range of products including smartphones, televisions, home appliances, telecommunications network equipment, as well as electronic and device components such as semiconductors and flat panel displays. Samsung is the world's largest manufacturer of smartphones and televisions as well as memory semiconductor products. The Manufacturing and sale of mobile phones and semiconductors make up >70% of both the company’s revenue as well as its profit.

Eli Lilly is a drug firm with a focus on neuroscience, cardiometabolic, cancer, and immunology. Lilly's key products include Verzenio for cancer; Mounjaro, Zepbound, Jardiance, Trulicity, Humalog, and Humulin for cardiometabolic; and Taltz and Olumiant for immunology.

Johnson & Johnson is the world's largest and most diverse healthcare firm. It has two divisions: innovative medicine and medtech. These now represent all of the company's sales following the divestment of the consumer business, Kenvue, in 2023. After restructurings in 2023-24, the drug division focuses on three main therapeutic areas: immunology, oncology, and neurology. Geographically, just over half of total revenue is generated in the United States.

AbbVie is a pharmaceutical firm with a strong exposure to immunology (with Humira, Skyrizi, and Rinvoq) and oncology (with Imbruvica and Venclexta). The company was spun off from Abbott in early 2013. The 2020 acquisition of Allergan added several new products and drugs in aesthetics, including Botox. The 2024 acquisitions of Cerevel (neuroscience) and ImmunoGen (oncology) help supplement AbbVie's portfolio.

Roche is a Swiss biopharmaceutical and diagnostic company. The firm's bestselling pharmaceutical products include a variety of oncology therapies from acquired partner Genentech, and its diagnostics group was bolstered by the acquisition of Ventana in 2008. Oncology products account for 50% of pharmaceutical sales, and centralized and point-of-care diagnostics for more than half of diagnostic-related sales.

Merck makes pharmaceutical products to treat several conditions in a number of therapeutic areas, including cardiometabolic disease, cancer, and infections. Within cancer, the firm's immuno-oncology platform, led by Keytruda, is a major contributor to overall sales. The company also has a substantial vaccine business aimed at preventing pediatric diseases, as well as Gardasil for human papillomavirus. Additionally, Merck sells animal health-related drugs. From a geographical perspective, 47% of the company's sales are generated from US human health (pharmaceuticals and vaccines).

A merger between Astra of Sweden and Zeneca Group of the United Kingdom formed AstraZeneca in 1999. The firm sells branded drugs across a number of major therapeutic areas, including oncology (about 40% of total revenue), cardiovascular, renal, and metabolic (25%), rare disease (17%), and respiratory and immunology (15%). The majority of sales comes from international markets, with the United States representing close to one third of its sales.

Novartis develops and manufactures innovative drugs. Key areas of drug development are oncology, immunology, neuroscience, respiratory, and cardiovascular, renal, and metabolic. It also has an established medicines business, which includes off-patent franchises. The company sells its products globally, with the United States constituting close to one-third of total revenue.

Siemens is a multi-industry company focused on the areas of automation, electrification, mobility, and healthcare. Its top three geographic regions—the United States, Germany, and China—contribute over half of group revenue. Siemens has a 71% investment in separately listed Siemens Healthineers. Recent portfolio activity included the listing of Siemens Energy, spinning out its power and gas and Siemens Gamesa business divisions in 2020.

With roughly one-third of the global branded diabetes treatment market, Novo Nordisk is the leading provider of diabetes care products in the world. Based in Denmark, the company manufactures and markets a variety of human and modern insulins, injectable diabetes treatments such as GLP-1 therapy, oral antidiabetic agents, and obesity treatments. Novo also has a biopharmaceutical segment (contributing less than 10% of revenue) that specializes in protein therapies for hemophilia and other disorders.

Thermo Fisher Scientific sells scientific instruments and laboratory equipment, diagnostics consumables, and life science reagents. The firm operates through four segments as of year-end 2024 (revenue figures include some cross-segment revenue): analytical technologies (17% of sales); specialty diagnostic products (11%); life science solutions (23%); and lab products and services, which includes CRO services (the remainder).

Amgen is a leader in biotechnology-based human therapeutics. Flagship drugs include red blood cell boosters Epogen and Aranesp, immune system boosters Neupogen and Neulasta, and Enbrel and Otezla for inflammatory diseases. Amgen introduced its first cancer therapeutic, Vectibix, in 2006 and markets bone-strengthening drugs Prolia/Xgeva (approved 2010) and Evenity (2019). The acquisition of Onyx Pharmaceuticals bolstered the firm's therapeutic oncology portfolio with Kyprolis. Recent launches include Repatha (cholesterol-lowering), Aimovig (migraine), Lumakras (lung cancer), and Tezspire (asthma). The 2023 Horizon acquisition brought several rare-disease drugs, including thyroid eye disease drug Tepezza. Amgen also has a growing biosimilar portfolio.

Gilead Sciences develops and markets therapies to treat and prevent life-threatening infectious diseases, with the core of its portfolio focused on HIV and hepatitis B and C. Gilead's acquisition of Pharmasset brought rights to hepatitis C drug Sovaldi, which is also part of newer combination regimens that remain standards of care. Gilead is also growing its presence in the oncology market via acquisitions, led by CAR-T cell therapy Yescarta/Tecartus (from Kite) and breast and bladder cancer therapy Trodelvy (from Immunomedics).

Abbott manufactures and markets cardiovascular and diabetes devices, adult and pediatric nutritional products, diagnostic equipment and testing kits, and branded generic drugs. Products include pacemakers, implantable cardioverter defibrillators, neuromodulation devices, coronary stents, catheters, infant formula, nutritional liquids for adults, continuous glucose monitors, and immunoassays and point-of-care diagnostic equipment. Abbott derives roughly 60% of sales outside the United States.

Pfizer is one of the world's largest pharmaceutical firms, with annual sales of roughly $60 billion. While it historically sold many types of healthcare products and chemicals, now prescription drugs and vaccines account for the majority of sales. Top sellers include pneumococcal vaccine Prevnar 13 and cardiology drugs Vyndaqel and Eliquis. Pfizer sells these products globally, with international sales representing 40% of total sales. Within international sales, emerging markets are a major contributor.

Intuitive develops, produces, and markets a robotic system for assisting minimally invasive surgery. It also provides the instrumentation, disposable accessories, and warranty services for the system. The company has placed more than 10,000 da Vinci systems in hospitals worldwide, with more than 6,000 installations in the US and a growing number in emerging markets.

In 1984, Danaher's founders transformed a real estate organization into an industrial-focused manufacturing company. Then, through a series of mergers, acquisitions, and divestitures, Danaher now focuses primarily on manufacturing scientific instruments and consumables in the life sciences and diagnostic industries after the late 2023 divestiture of its environmental and applied solutions group, Veralto.

Stryker designs, manufactures, and markets an array of medical equipment, instruments, consumable supplies, and implantable devices. The product portfolio includes hip and knee replacements, extremities, endoscopy systems, operating room equipment, embolic coils, hospital beds and gurneys, and orthopedic robotics. Stryker remains one of the three largest competitors in reconstructive orthopedic implants and holds the leadership position in operating room equipment. Roughly one-fourth of Stryker's total revenue currently comes from outside the United States.

Bristol Myers Squibb discovers, develops, and markets drugs for various therapeutic areas, such as cardiovascular, cancer, and immune disorders. A key focus for Bristol is immuno-oncology, where the firm is a leader in drug development. Bristol derives close to 70% of total sales from the US, showing a higher dependence on the US market than most of its peer group.

Vertex Pharmaceuticals is a global biotechnology company that discovers and develops small-molecule drugs for the treatment of serious diseases. Its key drugs are Kalydeco, Orkambi, Symdeko, and Trikafta/Kaftrio, and Alyftrek for cystic fibrosis, where Vertex therapies remain the standard of care globally. Vertex has diversified its portfolio through Casgevy, a gene-editing therapy for beta thalassemia and sickle-cell disease, and Journavx, a non-opioid pain medication approved for the treatment of moderate-to-severe acute pain in adults. Additionally, Vertex is evaluating small-molecule inhibitors of APOL1-mediated kidney diseases. Vertex is also investigating cell therapies to deliver a potential functional cure for type 1 diabetes.

Sanofi develops and markets drugs with a concentration in immunology, vaccines, and rare diseases. Although the company offers a diverse array of drugs, its highest revenue generator, Dupixent, accounts for approximately 30% of total sales. Profits for this immunology blockbuster drug are shared with Regeneron. About 45% of total revenue comes from the United States, 20% from Europe, and 6% from China.

In the pharmaceutical industry, GSK ranks as one of the largest firms by total sales. The company wields its might across several therapeutic classes, including respiratory, antiviral, and vaccines, and has been growing its presence in oncology and immunology, as well. GSK uses joint ventures to gain additional scale in certain markets like HIV.

One of the largest medical-device companies, Medtronic develops and manufactures therapeutic medical devices for chronic diseases. Its portfolio includes pacemakers, defibrillators, transcatheter heart valves, stents, insulin pumps, spinal fixation devices, neurovascular products, advanced energy, ablation laser therapy, and surgical tools. The company primarily markets its products to healthcare institutions and physicians in the United States, Western Europe, and Japan. Foreign sales account for roughly 50% of the company's total sales.

Chugai Pharmaceutical is a Japanese drug developer and subsidiary of Roche Holding, which owns roughly 60% of the company. Founded in 1925, Chugai deals primarily in the Japanese market, where it generates roughly half of its revenue. It has been the leader in Japan’s oncology market for the past decade, largely due to drugs licensed from its parent’s portfolio. The company also develops its own innovative medicines. It is an industry leader in antibody technology with several flagship therapies, including Hemlibra for hemophilia A patients and Actemra for treating rheumatoid arthritis and covid patients.

Boston Scientific produces less invasive medical devices that are inserted into the human body through small openings or cuts. It manufactures products for use in angioplasty, blood clot filtration, kidney stone management, cardiac rhythm management, catheter-directed ultrasound imaging, upper gastrointestinal tract diagnostics, interventional oncology, neuromodulation for chronic pain, and treatment of incontinence. The firm markets its devices to healthcare professionals and institutions globally. Foreign sales account for roughly 36% of the firm's total sales.

Japan Tobacco primarily sells cigarettes and reduced-risk products, organized in three clusters consisting of Asia (which includes its home market and countries in Asia Pacific), Western Europe, and EMA (which includes Eastern Europe, the Middle East North Africa, Turkey, Americas, and duty-free). Its leading cigarette brands include Winston (non-US), Camel (non-US), Mevius, and LD. Its reduced-risk brands include Logic in vaping, Ploom in heated tobacco, and Nordic Spirit in nicotine pouches, though these generates less than 5% of tobacco sales.

Merck KGaA operates in three main segments: Life Science, Electronics, and Healthcare. The Life Science segment provides laboratory consumables and instruments to researchers in academia and applied fields, including the biopharmaceutical industry. The Electronics segment offers specialty materials to manufacture a variety of products, such as semiconductors and flat-screen televisions. In the healthcare segment, Merck develops, manufactures, and sells branded pharmaceuticals with significant therapeutic concentrations in oncology, multiple sclerosis, and fertility. In 1995, the E. Merck KG family publicly sold part of the company, resulting in the current 30% public ownership of the firm.

Regeneron Pharmaceuticals discovers, develops, and commercializes products that fight eye disease, cardiovascular disease, cancer, and inflammation. The company has several marketed products, including low-dose Eylea and Eylea HD, approved for wet age-related macular degeneration and other eye diseases; Dupixent in immunology; Praluent for LDL cholesterol lowering; Libtayo in oncology; and Kevzara in rheumatoid arthritis. Regeneron is also developing monoclonal and bispecific antibodies with Sanofi, other collaborators, and independently, and has early-stage partnerships that bring new technology to the pipeline, including RNAi (Alnylam) and Crispr-based gene editing (Intellia).

UCB is a Belgium-based biopharma firm focused on the development of novel therapies for the treatment of central nervous system and immunologic diseases. Historically, revenue was derived from allergy medicine Zyrtec and epilepsy drug Keppra, which have both lost patent protection. The firm's key products are Cimzia (immunology), Vimpat (epilepsy), Neupro (Parkinson's disease and restless leg syndrome), Briviact (epilepsy), Bimzelx (psoriasis), Evenity (osteoporosis), Nayzilam (cluster seizures), Fintepla (Dravet Syndrome and Lennox-Gastaut Syndrome), and Kygevvi (rare mitochondrial disease).

Celestica Inc offers supply chain solutions. The company has two operating and reportable segments: Advanced Technology Solutions (ATS) and Connectivity & Cloud Solutions (CCS). The ATS segment consists of the ATS end market and is comprised of the Aerospace and Defense, Industrial, health tech, and Capital Equipment businesses. Its Capital Equipment business is comprised of the semiconductor, display, and robotics equipment businesses, and the CCS segment consists of Communications and Enterprise end markets, The Enterprise end market is comprised of its servers and storage businesses. The company generates a majority of its revenue from the Connectivity & Cloud Solutions segment.

Spun off from Baxter International in 2000, Edwards Lifesciences designs, manufactures, and markets a range of medical devices and equipment for advanced stages of structural heart disease. It has established itself as a leader across key products, including surgical tissue heart valves, transcatheter aortic valves, and transcatheter mitral and tricuspid valve technologies. The firm derives about 60% of its total sales from outside the US.

Argenx is a Dutch biopharmaceutical company focused on developing antibody-based therapies for rare autoimmune diseases. The company's lead product, Vyvgart (efgartigimod), was approved by the FDA in December 2021 for the treatment of generalized myasthenia gravis (gMG). In 2022, Argenx also received FDA approval for Vyvgart Hytrulo, a subcutaneous formulation of Vyvgart, offering a more convenient option compared with Vyvgart's intravenous administration. In 2024, the FDA approved Vyvgart Hytrulo for Chronic Inflammatory Demyelinating Polyneuropathy, a rare immune-mediated neuromuscular disorder of the peripheral nervous system. Argenx is focused on innovation and developing its pipeline for treatments such as primary immune thrombocytopenia, thyroid eye disease, and Sjogren's Disease.

Galderma was formed in 1981 as a joint venture between Nestle and L’Oreal. It subsequently became a subsidiary of Nestle, called Nestle Skin Health, before being carved out and launched as a stand-alone company in 2019, acquired by a consortium led by Sweden-based EQT fund. The company went public in March 2024 and is listed on the SIX Swiss exchange. Galderma’s science-based portfolio spans multiple dermatology categories, including injectable aesthetics, dermatological skincare, and therapeutic dermatology. It derives around 40% of net sales from the US and employs around 7,00 people.

Takeda Pharmaceutical is Japan’s largest pharmaceutical company, with revenue of JPY 4.6 trillion in fiscal 2024. The company’s five core therapeutic areas are oncology, gastroenterology, neuroscience, rare diseases, and plasma-derived therapies, which account for more than 80% of revenue. Its geographic footprint is well diversified, with over 50% derived from the US, 20% from Japan, 20% from Europe and Canada.

Jiangsu Hengrui Pharmaceuticals Co Ltd is a biopharmaceutical company that engages in the research, development, manufacture, and sale of drugs. It is engaged in the field of cancer treatment drugs, surgical medicines, endocrine therapy drugs, cardiovascular drugs, and anti-infection medications. The company specializes in the research and development of new medicines in areas of antineoplastics, endocrine system, cardiovascular, and the immune system.

Sun Pharmaceuticals Industries Ltd is India's generic pharmaceutical manufacturing company. The company’s substantial markets are the U.S. and India to make up the majority of revenue. The remaining is spread across both emerging and developed markets. In addition to generics, the company also produces and distributes name-brand formulas to specific geographies. It maintains manufacturing and research and development facilities globally to serve its markets but is majorly based in India.

Wuxi AppTec Co Ltd provides a portfolio of research and manufacturing services throughout the discovery, development, and manufacturing spectrum for small molecule drugs, development of computer software and databases as well as consulting services for combinatorial chemistry and pharmaceuticals. The services offered by the company include drug research and development testing, clinical research services, an end-to-end CRDMO platform for peptide, oligonucleotide, and small molecules, and integrated biology services and solutions for drug discovery. The company's reportable segments are WuXi Chemistry, which derives maximum revenue, WuXi Testing, WuXi Biology, and Others. Geographically, it derives key revenue from the United States of America, followed by China, Europe, and other regions.

Siemens Healthineers is engaged in therapeutic imaging, radiotherapy, laboratory, and point-of-care diagnostics. The imaging segment (56% of sales in fiscal 2025) includes magnetic resonance imaging, computed tomography, X-ray systems, molecular imaging, and ultrasound. The Varian segment (18% of sales) offers radiotherapy and other oncology solutions. The diagnostics segment (19%) includes in vitro diagnostics and point-of-care diagnostics. The advanced therapies (now part of precision therapy) segment (9%) products are designed to support image-guided minimally invasive treatments in cardiology, interventional radiology, and surgery. The Americas represents 44% of total sales, Europe, Middle East, and Africa 32%, and Asia-Pacific, including China (11%), the remainder.

Lonza Group is a contract development and manufacturing organization. It operates under four segments: small molecules, biologics, cell and gene, and capsules and health ingredients. Lonza derives its revenue primarily from long-term supply agreements with pharmaceutical customers. The company provides development and manufacturing services throughout the entire lifecycle of a product, from drug research to commercial supply. The majority of Lonza's customers are pharmaceutical and biotechnology companies, academic institutions, and government research organizations.

Idexx Laboratories primarily develops, manufactures, and distributes diagnostic products, equipment, and services for pets and livestock. Its key product lines include single-use canine and feline test kits that veterinarians can employ in the office, benchtop chemistry and hematology analyzers for test-panel analysis on-site, reference lab services, and tests to detect and manage disease in livestock. The firm also offers vet practice management software and consulting services to animal hospitals. Idexx derives roughly 35% of its revenue from outside the United States.

Samsung BioLogics Co Ltd is a biopharmaceutical company engaged in drug development and manufacturing services. The company operates two segments: Biopharmaceutical Development and Commercialization, and Contract Development and Manufacturing Organization (CDMO). The Biopharmaceutical Development and Commercialization segment focuses on developing and commercializing biosimilars across therapeutic areas, including autoimmune, oncology, ophthalmology, and hematology. The Contract Development and Manufacturing Organization (CDMO) segment provides biopharmaceutical contract manufacturing along with cell line and process development services. It generates the majority of its revenue from the CDMO segment.

Bayer is a German healthcare and agriculture conglomerate. Healthcare provides close to half of the company's sales and includes pharmaceutical drugs (39% of total sales in 2024) as well as vitamins and other consumer healthcare products (13% of total). The firm's crop science business (49% of total) sells seeds, pesticides, herbicides, and fungicides, which was expanded through its 2018 acquisition of Monsanto.

Haleon is one of the largest consumer health companies in the world. Formed by a combination of consumer health divisions of GSK, Pfizer, and Novartis, Haleon separated from GSK and went public in July 2022. The firm generates 60% of sales from global power brands including Sensodyne, Advil, Centrum, and Poligrip, that play in many geographies and are often leaders in their respective categories. It also has a number of local brands, including Emergen-C, Eno, Tums, and Caltrate, that are more tailored to regional needs and have strong local brand equity. Overall, Haleon’s brands tackle a variety of silos within consumer health including oral care, digestive health, pain relief, and nutrition.

Teva Pharmaceutical, based in Israel, is the leading generic drug manufacturer in the world. Teva derives half of its sales from North America and makes up a high-single-digit percentage of the total number of generic prescriptions in the US. It also has a significant presence in Europe, Japan, Russia, and Israel. Besides generics, Teva has a portfolio of innovative medicines and biosimilars in three main therapeutic areas: the central nervous system with Copaxone, Ajovy, and Austedo; respiratory with Qvar and ProAir; and oncology with Truxima, Herzuma, and Bendeka/Treanda. Teva also sells active pharmaceutical ingredients, offers contract manufacturing services, and owns Anda, a US-based generic and specialty drug distributor.

Alnylam Pharmaceuticals is a leader in the study of RNA interference (RNAi) therapeutics. RNAi is a naturally occurring biological pathway in cells that enables sequence-specific silencing and regulation of gene expression. Alnylam has five drugs on the market: Onpattro and Amvuttra for hATTR amyloidosis, Givlaari for acute hepatic porphyria, Oxlumo for primary hyperoxaluria type 1, and Leqvio for hypercholesterolemia. It also has several clinical programs across various therapeutic areas: genetic medicines; cardio-metabolic diseases; hepatic infectious diseases, and CNS/ocular diseases. Upfront fees from research partnerships have boosted Alnylam's cash levels, and the company stands to see additional milestones and royalties from drugs commercialized under collaboration partnerships.

Originally spun out of Hewlett-Packard in 1999, Agilent has evolved into a leading life science and diagnostic firm. Today, Agilent's measurement technologies serve a broad base of customers with its three operating segments: life science and diagnostics, cross lab operations consisting of consumables and services, and applied end markets. Over half of its sales are generated from the biopharmaceutical, chemical, and advanced materials end markets, which we view as the stickiest end markets, but it also supports clinical lab, environmental, forensics, food, academic, and government-related organizations. The company is geographically diverse, with operations in the US and China representing the largest country concentrations.

Otsuka Holdings Co Ltd is a Japan-based company that operates in pharmaceuticals, nutraceuticals, and consumer products. It operates through four reportable segments: Medical-related Business, Nutraceutical-related Business, Consumer-related Business, and Other Business. The Medical Business manufactures and sells therapeutic drugs and infusions, the Nutraceutical Business produces functional foods, beverages, and nutritional supplements, the Consumer Business offers mineral water, beverages, and foods, while the Other Business provides storage services and manufactures chemicals and analytical equipment. It generates the majority of its revenue from the medical-related business segment.

Water sells liquid chromatography, mass spectrometry, and thermal analysis tools. These analytical instruments provide essential information on various products, such as their molecular structures and physical properties, to help clients enhance the health and well-being of end users. As a percentage of sales in 2024, Waters generated 58% from biopharmaceutical customers, 31% from industrial clients, and 11% from academic/government institutions. In early 2026, Waters plans to merge with BD's life science and diagnostics business, which will substantially change those concentrations. Waters will wind up with more concentration in diagnostics (versus none now) and discovery-related life science tools.