Nuwellis 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.

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.

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.

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.

Alcon is one of the leading visioncare companies in the world. Following nine years as a Novartis subsidiary, it was spun off as a public company in April 2019. Alcon operates in two segments: visioncare and surgical. Visioncare comprises contact lenses, lenscare solutions, and a suite of ocular health products. With brands like Dailies, Total1, and Air Optix, Alcon controls about one fourth of the US contact lens market. Surgical comprises intraocular lenses, ophthalmic surgical equipment, and consumables used during surgeries. Its main products include Centurion, a phacoemulsification device used during cataract surgeries, and a portfolio of IOLs including PanOptix and Vivity. Alcon has one of the largest installed bases of eye surgical equipment in the world.

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.

Illumina provides tools and services to analyze genetic material with life science and clinical lab applications. The company generates over 90% of its revenue from sequencing instruments, consumables, and services. Illumina’s high-throughput technology enables whole genome sequencing in humans and other large organisms. Its lower throughput tools enable applications that require smaller data outputs, such as viral and cancer tumor screening. Illumina also sells microarrays (9% of 2024 sales) that enable lower-cost, focused genetic screening with primarily consumer and agricultural applications.

Halma consists of 45 operating businesses managed in a decentralized manner. The company, through its products, focuses on trying to make the world safer, cleaner and healthier. The group operates across three segments: safety, environmental and analysis, and medical equipment. Halma’s products include smoke detectors, healthcare equipment, door sensors, and water treatment. Most of the group’s products are niche with limited competition. Over 75% of sales are generated in the United States, Europe and United Kingdom. Halma is listed on the London Stock Exchange.

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%.

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.

Hologic manufactures proprietary products for the healthcare needs of women. The company operates in four segments: diagnostics (44% of total sales), breast health (38%), surgical (16%), and skeletal health (2%). While the company traditionally focused on breast health, the acquisition of Gen-Probe put greater emphasis on commercial diagnostics. The United States accounts for the largest portion of the firm's revenue (69%), followed by Europe (20%), Asia (8%), and other international markets (3%). Hologic is headquartered in Bedford, Massachusetts.

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.

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.

Coloplast is a leading global competitor in ostomy management and continence care. The firm designs, manufactures, and markets ostomy care systems, disposable containment devices, intermittent catheters for continence care, and devices for patients with neck stomas. Coloplast also maintains a tertiary presence in the urology and woundcare markets, where it manufactures and markets penile implants, slings for incontinence and prolapse, and wound dressings. The company derives more than 60% of sales from Europe, 24% from other developed countries, and 17% from the rest of the world.

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.

Domiciled in the US, Penumbra designs, manufactures, and markets an array of thrombectomy and embolization devices and equipment to mechanically remove blood clots. The firm sells mainly to hospitals and physicians. These minimally invasive devices are primarily used in the acute care setting for patients with stroke, pulmonary embolism, deep vein thrombosis, cranial aneurysms, and other vascular diseases.

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.

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.

CooperCompanies is one of the largest eyecare companies in the US. It operates in two segments: CooperVision and CooperSurgical. CooperVision is a pure-play contact lens business with a suite of spherical, multifocal, and toric contact lenses. The company also has one of the most comprehensive specialty lens portfolios in the world. With brands including Proclear, Biofinity, MyDay, and Clariti, Cooper controls roughly one fourth of the US contact lens market. CooperSurgical, founded in 1990, is made up of equipment related to reproductive care, fertility, and women’s care. Cooper has the broadest medical device coverage of the entire IVF cycle. It also has Paragard, the only hormone-free IUD in the US, and controls 17% of the US IUD market.

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.

Zydus Lifesciences Ltd is a specialty and generic drug manufacturing company. It is engaged in the research, development, production, marketing, and distribution of pharmaceutical products. The product portfolio of the company includes Active Pharmaceutical Ingredients (API), human formulations, animal health and veterinary, and consumer health and wellness products. Its products are marketed under brands like Amlodac, Inditel, Pivasta, and others. The company's operating segments are: Pharmaceuticals, which derives key revenue, and Consumer products. Geographically, it generates maximum revenue from the United States, followed by India, and other countries.

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.

Insulet was founded in 2000 with the goal of making continuous subcutaneous insulin infusion therapy for diabetes easier to use. The result was the Omnipod system, which consists of a small disposable insulin infusion device that can be operated through a smartphone to control dosage. Since the Omnipod was approved by the US Food and Drug Administration in 2005, approximately 500,000 insulin-dependent diabetic patients are using it worldwide.

Baxter offers a variety of medical supplies and equipment to providers. From its legacy operations, Baxter sells injectable therapies for use in care settings, including IV pumps, administrative sets, and solutions; nutritional products; and surgical sealants and hemostatic agents. Baxter expanded its portfolio of hospital-focused offerings by acquiring Hillrom in late 2021, which added basic equipment like hospital beds, operating room equipment, and patient monitoring tools to the portfolio. Baxter also sold its kidney care tools in early 2025.

Masimo Corp is a technology company. The company's segment includes healthcare and non-healthcare. The healthcare business segment is a key revenue driver, develops, manufactures, and markets a variety of noninvasive patient monitoring technologies, hospital automation and connectivity solutions, remote monitoring devices and consumer health products. Its non-healthcare segment includes consumer audio business develops, manufactures, markets sells and licenses premium and luxury audio sound products and related integration technologies.

Bruker Corp manufactures scientific instruments and diagnostic tests for customers in the life sciences, applied markets, pharmaceutical, and biotechnology industries. The company operates in segments, namely, Bruker Scientific Instruments (BSI) BioSpin, BSI CALID, BSI Nano, and Supercon Technologies (BEST). The company generates maximum revenue from the BSI CALID segment. Geographically, it derives the maximum of its revenue from United States.

Demant is a Denmark-based manufacturer and distributor of hearing solutions, such as hearing aid devices and diagnostic equipment. More than 80% of the company's sales come from North America and Europe.