Nightingale Health Valuation Multiples

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.

UnitedHealth Group is one of the largest private health insurers and provides medical benefits to about 51 million members globally, including 1 million outside the US as of December 2024. As a leader in employer-sponsored, self-directed, and government-backed insurance plans, UnitedHealth has obtained massive scale in medical insurance. Along with its insurance assets, UnitedHealth's Optum franchises help create a healthcare services colossus that spans everything from pharmaceutical benefits to providing outpatient care and analytics to both affiliated and third-party customers.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

Roper Technologies is a holding company focused on acquiring, managing, and developing niche market-leading technology businesses. The company operates a decentralized business model whereby each portfolio company operates independently from the others. Roper positions itself as a free cash flow compounder, whereby excess free cash flow generated by its portfolio businesses is repatriated to the parent company, which is then utilized to acquire additional businesses. Presently, the company operates 30 distinct businesses with over three-fourths of the revenue coming from software products and over two-thirds of the revenue coming from recurring and recurring sources.

Natera Inc is a diagnostic and research company with proprietary molecular and bioinformatics technology. The company's key product offerings include its Panorama Non-Invasive Prenatal Test (NIPT) which screens for chromosomal abnormalities of a fetus as well as in twin pregnancies, typically with a blood draw from the mother, Horizon Carrier Screening (HCS) to determine carrier status for a large number of severe genetic diseases that could be passed on to the carrier’s children, Signatera molecular residual disease (MRD) test, which detects circulating tumor DNA in patients previously diagnosed with cancer to assess molecular residual disease and monitor for recurrence; and Prospera, to assess organ transplant rejection.

Iqvia is the result of the 2016 merger of Quintiles, a leading global contract research organization, and IMS Health, a leading healthcare data and analytics provider. The research and development segment focuses primarily on providing outsourced late-stage clinical trials for pharmaceutical, device, and diagnostic firms. The technology and analytics segment provides aggregated information and technology services to clients in the healthcare industry, including pharmaceutical companies, providers, payers, and policymakers, as well as data and analytics capabilities for clinical trials, including virtual trials. The company also has a small contract sales business.

Veeva is the global leading supplier of cloud-based software solutions for the life sciences industry. The company's best-of-breed offerings address operating and regulatory requirements for customers ranging from small, emerging biotechnology companies to departments of global pharmaceutical manufacturers. The company leverages its domain expertise to improve the efficiency and compliance of the underserved life sciences industry, displacing large, highly customized and dated enterprise resource planning systems that have limited flexibility. Its two main products are Veeva CRM, a customer relationship management platform for companies with a salesforce, and Veeva Vault, a content management platform that tackles various functions within any life sciences company.

DexCom designs and commercializes continuous glucose monitoring systems for diabetic patients. CGM systems serve as an alternative to the traditional blood glucose meter process, and the company is evolving its CGM systems to provide integration with insulin pumps from Insulet and Tandem for automatic insulin delivery. DexCom's CGMs are available through medical equipment distributors as well as retail pharmacies.

GE HealthCare Technologies is a leading medical technology firm with leading market share in imaging and ultrasound equipment. The company reports four major segments: imaging (45% of revenue), advanced visualization solutions (26%), patient care solutions (15%), and pharmaceutical diagnostics (14%). The company’s sales are geographically diverse, with the United States, EMEA, China, and the rest of the world accounting for 46%, 26%, 11%, and 17% respectively. We estimate approximately half of its revenue is recurring, which consists of servicing (about one third of revenue), pharmaceutical diagnostics (about 10%-15%), and digital solutions (just over 5%).

ResMed is one of the largest respiratory care device companies globally, primarily developing and supplying flow generators, masks and accessories for the treatment of sleep apnea. Increasing diagnosis of sleep apnea combined with ageing populations and increasing prevalence of obesity is resulting in a structurally growing market. The company earns roughly two thirds of its revenue in the Americas and the balance across other regions dominated by Europe, Japan and Australia. Recent developments and acquisitions have focused on digital health as ResMed is aiming to differentiate itself through the provision of clinical data for use by the patient, medical care advisor and payer in the out-of-hospital setting.

Shenzhen Mindray Bio-Medical Electronics Co Ltd is a developer, manufacturer, and supplier of medical devices. The company is focused on the medical industry in the fields of Patient Monitoring & Life Support, InVitro Diagnostics, and Medical Imaging.

Koninklijke Philips is a diversified global healthcare company operating in three segments: diagnosis and treatment, connected care, and personal health. Nearly 50% of the company's revenue comes from the diagnosis and treatment segment, which features imaging systems, ultrasound equipment, and image-guided therapy solutions. The connected care segment (under 30% of revenue) encompasses monitoring and analytics systems for hospitals, informatics business, and also houses the sleep and respiratory care segment. Personal health business (remainder of revenue) is mainly oral health and personal care product lines, which include electric toothbrushes and men's grooming and personal-care products.

Mettler-Toledo supplies weighing and precision instruments to customers in the life sciences (around 55% of sales), industrial (around 40%), and food retail (around 5%) industries. Its products include laboratory and retail scales, pipettes, pH meters, thermal analysis equipment, titrators, metal detectors, and X-ray analyzers. Mettler leads the market for weighing instrumentation and controls more than 50% of the market for lab balances. The business is geographically diversified, with the Americas accounting for about 37% of sales, Europe about 27%, China about 16% and the rest of the world about 20%.

Quest Diagnostics is a leading independent provider of diagnostic testing, information, and services in the US. The company generates over 95% of its revenue through clinical testing, anatomic pathology, esoteric testing, and substance abuse testing with specimens collected at its national network of roughly 2,300 patient service centers, as well as multiple doctors offices and hospitals. The firm also runs a much smaller diagnostic solutions segment that provides clinical trials testing, risk-assessment services, and information technology solutions.

Labcorp is one of the nation's two largest independent clinical laboratories, with roughly 20% of the independent lab market. The company operates approximately 2,000 patient-service centers, offering a broad range of 5,000 clinical lab tests, ranging from uncomplicated routine blood and urine screens to complex oncology and genomic testing.

Steris is an Ireland-domiciled medical technology company focused on sterilization services and infection prevention. The company is the global leader in contract sterilization services, ensuring the safe delivery of single-use and implantable medical equipment to hospitals around the world. Steris also sells sterilizers, washer-disinfectors, and other decontamination equipment and supplies for use by care provider facilities and in biopharma manufacturing sites. Domiciled in the United States before its inversion to Ireland, the firm derives approximately 70% of its revenue from Healthcare Services, 19% from Applied Sterilization Technologies, or AST, and 11% from life sciences services after the divestment of its dental products business.

Sartorius Stedim Biotech is a leading provider of bioprocessing solutions. Its sells equipment and consumables for fermentation, filtration, fluid management, purification, and cell culture media for manufacturing biologic drugs and has a focus on single-use technology. It is a subsidiary of Sartorius AG, which has 71.5% ownership and 83% voting control. The business is geographically diverse, with 35% of sales from the Americas, 42% from Europe, the Middle East, and Africa, 15% from Asia excluding China, and 8% from China.

Exact Sciences, headquartered in Madison, Wisconsin, provides cancer screening and diagnostic test products in the United States and internationally. Exact’s Cologuard screening test is a noninvasive stool-based DNA test for colorectal cancer. The company also competes in the precision oncology market with Oncotype DX, a suite of tissue-based genomic tests for estimating recurrence risk and likelihood of benefit from chemotherapy for breast and colon cancer, and OncoExTra, a liquid-based comprehensive genomic profiling test. It also has a pipeline of blood-based tests for molecular residual disease, colorectal cancer screening, and multicancer screening.

Guardant Health, based in Redwood City, California, is a leader in liquid-based cancer tests for clinical and research use. The company's main franchises are Guardant360 for genomic profiling of tumors, Reveal for molecular residual disease testing, and Shield for colorectal cancer screening. Additionally, Guardant offers research development services such as regulatory approval consultancy and clinical trial referrals.

JD Health is the largest healthcare e-commerce platform in China in terms of revenue. The company offers pharmaceutical drugs and healthcare products on its platform, both as a marketplace that connects merchants to consumers and as a first-party, or 1P, direct retailer. It also offers online consultation from real life doctors and separately partners with offline pharmacies that can provide location-based 24/7 delivery as part of an omnichannel initiative to complement its core e-commerce business. Its closest competitors are Alibaba Health and Meituan for its e-commerce business. As of Dec. 31, 2024, the platform has over 200 million active annual users and over 70,000 merchants. JD Health is 67.49% owned by its parent company, JD.com.

Zimmer Biomet designs, manufactures, and markets orthopedic reconstructive implants as well as supplies and surgical equipment for orthopedic surgery. With the acquisitions of Centerpulse in 2003 and Biomet in 2015, Zimmer holds the leading share of the reconstructive market in the United States, Europe, and Japan. Roughly two-thirds of total revenue is derived from sales of large joints; another fourth comes from extremities, trauma, sports medicine, and related surgical products. The firm spun out its dental and spine businesses in 2022.

Sonova is one of the world's largest manufacturers and distributors of hearing aids. The company is based in Switzerland and distributes its products in more than 100 countries through its internal sales team and independent retailers. It also sells cochlear implants and audio technologies.

Shionogi & Co Ltd is a specialty and generic drug manufacturing company. The company focuses on the manufacturing and distribution of pharmaceuticals, diagnostic reagents, and medical devices. The company engages in manufacturing, formulation, packaging, and analysis as part of its commercialization research that spans late-stage drug discovery through commercial production. It provides products and services in Japan, Europe, North America, and other regions.

Shanghai United Imaging Healthcare Co Ltd provides customers with high-performance medical imaging equipment, radiotherapy products, life science instruments, and medical digitalization and intelligent solutions. The company’s products include MRI systems, CT scanners, X-ray imaging equipment, molecular imaging systems, radiotherapy linear accelerators, and life science instruments.

Tenet Healthcare is a Dallas-based healthcare services organization. It operates acute and specialty hospitals (50 as of December 2025) and hundreds of ambulatory surgery centers and other outpatient facilities across the US, primarily in the South. Through its Conifer segment, Tenet also provides revenue cycle management solutions.

In spring 2024, 3M spun out its legacy healthcare segment as a stand-alone firm, Solventum. At that time, the firm comprised four segments. The smallest one—purification and filtration—has since been sold. Now, medsurg is the largest business, contributing roughly 64% of consolidated revenue, and includes advanced wound care and wound prevention. Dental solutions (restorative composites and orthodontia) and health information systems (mainly revenue cycle management) each contribute 18% of total revenue.

Fisher & Paykel Healthcare is one of the three largest respiratory care device companies globally. It is the market leader in hospital use humidifiers, masks, and related consumables, and the number three player in the at-home treatment of sleep apnea using respiratory devices. Both the hospital and homecare markets for respiratory devices are growing strongly in the developed markets in which Fisher & Paykel has a presence. The company earns 42% of its revenue in the US, 27% in Europe, 21% in Asia-Pacific, and the remaining 10% in emerging markets. Fisher conducts its own R&D and has thousands of patents and pending applications. It manufactures in New Zealand and Mexico and has a multichannel distribution model.

Medpace is a late-stage contract research organization that provides full-service drug-development and clinical trial services to small and midsize biotechnology, pharmaceutical, and medical device firms. It also offers ancillary services, including bioanalytical laboratory services and imaging capabilities. The company was founded over 30 years ago and has more than 5,400 employees across 40 countries. Medpace is headquartered in Cincinnati, Ohio, and its operations are primarily based in the US, with additional presence in Europe, Asia, South America, Africa, and Australia. Cinven, a global private equity firm, acquired Medpace for $915 million in 2014 and exited its investment in 2018.

Smith & Nephew designs, manufactures, and markets orthopedic devices, sports medicine and arthroscopic technologies, and wound care solutions. Roughly 41% of the UK-based firm's revenue comes from orthopedic products, and another 30% is sports medicine and ENT. The remaining 29% of revenue is from the advanced wound therapy segment. Over half of Smith & Nephew's total revenue comes from the United States, just over 30% is from other developed markets, and emerging markets account for the remainder.

Olympus is a medical-device maker with a leading position in the endoscope market and a diversified global revenue stream. Originally founded in 1919 in Japan as a microscope and camera maker, Olympus has gradually pivoted into endoscopic and therapeutic solutions. As of March 2025, more than 60% of its revenue comes from endoscopic solutions. In addition, North America is the biggest revenue contributor by region, accounting for 38% of its total revenue.

Pro Medicus is a healthcare IT company specializing in radiology imaging software. Its main product, Visage 7, is a clinical desktop application that radiologists use to view, enhance, and manipulate images from any device and make a diagnosis. Its main customers are US private academic hospitals. In fiscal 2025, Pro Medicus earned 90% of revenue in North America, 8% from Australia, and the remaining 2% in Europe.

Align Technology is the leading manufacturer of clear aligners. Invisalign, its main product, was approved by the Food and Drug Administration in 1998 and has since dominated, controlling over 90% of the market. Invisalign can treat roughly 90% of all malocclusion cases (misaligned teeth), and there are over 230,000 Invisalign-trained dentists and orthodontists. In 2022, Invisalign treated over 2 million cases, or roughly 10% of all orthodontic cases for the year, and it has treated over 14 million patients since its launch. Align also sells intraoral scanners under the brand iTero, which captures digital impressions of patients’ teeth and illustrates treatment plans. Over 85% of Invisalign cases are submitted by digital scans, and iTero scans make up over half of these scans.

Fresenius Medical Care is the largest dialysis company in the world, treating about 300,000 patients from nearly 3,700 clinics worldwide as of December 2024. In addition to providing dialysis services, the firm is a leading supplier of dialysis products, including machines, dialyzers, and concentrates. Fresenius accounts for about 35% of the global dialysis products market, creating the world's only fully integrated dialysis business. Services account for about three-fourths of sales, while the balance is generated from medical technology products that enable dialysis treatments.

Revvity is a global life sciences and diagnostics company formed in 2023 following the rebranding of PerkinElmer. The company operates in two segments: life sciences, which provides reagents and instruments for biopharma and academic research, and signals software, and diagnostics, which offers tools in immunodiagnostics and newborn and reproductive health. Revvity’s products and services are sold worldwide, with major markets in the US, Europe, and China.

Globus Medical Inc is a medical device company that develops and provides healthcare products and solutions to hospitals, physicians, and surgical centers. The firm's products are organized into two categories: musculoskeletal solutions, which include medical devices and instruments used mostly for spinal and orthopedic procedures, and enabling technologies, which include computer systems developed for enhancing surgical capabilities. The vast majority of the company's revenue is generated from musculoskeletal solutions products, and more than half of the revenue is earned in the United States. It also has its presence internationally.

Icon is a global late-stage contract research organization that provides drug development and clinical trial services to pharmaceutical, biotechnology, and medical-device firms. While the vast majority of its revenue comes from clinical research, Icon also offers ancillary services such as laboratory and imaging capabilities. The company is headquartered in Ireland.