Boston Scientific at TD Cowen Conference: Strategic Growth Insights

On Tuesday, 04 March 2025, Boston Scientific (NYSE: BSX) presented at the TD Cowen 45th Annual Healthcare Conference. The company outlined its robust growth strategy and shared insights on its performance. While highlighting its consistent outperformance and strategic initiatives, Boston Scientific also addressed challenges such as pricing pressures in China.

Key Takeaways

• Boston Scientific aims for a 10% to 12% growth rate, leveraging R&D, venture capital, and strategic M&A.
• The company targets a 30% operating margin, driven by gross margin improvements and SG&A leverage.
• Successful growth strategy includes expansion into larger markets and increasing market growth rates.
• Significant growth expected from Farapulse in the AFib ablation market and concomitant use of Watchman.
• Strong presence in China with over 2,000 employees, despite volume-based pricing challenges.

Financial Results

• 2023 organic growth reached 16%, with a target of 10% to 12% for 2025.
• Adjusted operating margin last year was 27%, with a 70 basis point increase.
• Expected margin increase this year is 50 to 75 basis points, aiming for a long-term goal of 30%.
• Gross margin decreased from 72.4% in 2019 to 70.3% last year.
• Axonics revenue exceeded $400 million, growing at strong double digits.

Operational Updates

• Leadership in seven verticals with 47 acquisitions over the last decade.
• Five business units are approaching $3 billion in revenue.
• Key acquisitions include Sonavi, Apollo, Axonics, Relivant, and Silk Road.
• Farapulse launch in Japan is on target, with U.S. penetration expected to reach 60% this year.
• Enrollment completed in the Avant Garde trial.

Future Outlook

• Continuing the current playbook with internal R&D, venture capital, and M&A.
• Focus on expanding into larger total addressable markets and increasing market growth rates.
• Drive margin expansion through gross margin improvements and SG&A leverage.
• Capitalize on growth opportunities in Farapulse, Watchman, urology, and endoscopy.
• Maintain a strong growth trajectory in the China market.
• Pursue label expansion for Farapulse to include persistent atrial fibrillation.

Q&A Highlights

• Discussion on sustaining high growth rates despite approaching $20 billion in revenue.
• Strategy for navigating volume-based pricing in China.
• Updates on Farapulse launch and potential in the AFib ablation market.
• Concomitant use of Watchman with AFib ablation explored.
• Overview of growth drivers and margin expansion in urology and endoscopy.

Boston Scientific’s strategic insights and financial performance were detailed in the conference call. Readers are encouraged to refer to the full transcript for a complete understanding.

Full transcript - TD Cowen 45th Annual Healthcare Conference:

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Good morning. I’m Josh Jennings from the TD Cowen Medical Devices Research Team and joined by Brian Kennedy and Eric Anderson. And we’re excited to kick off day two of the forty fifth annual TD Cowen Healthcare Conference and thrilled to have executives from the Boston Scientific Management team joining us and spending time with us this week.

Thank you, gentlemen, for this fireside chat.

Dan Brennan, Chief Financial Officer, Boston Scientific: Great to be here.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Let me do quick introductions. We have from your left to right, most of you are familiar with Dan Brennan, Chief Financial Officer Doctor. Ken Stein, Chief Medical Officer and Art Butcher, Executive Vice President, MedSurg and APAC. Gentlemen, you guys have had a ten plus year track record of outperformance. If you just think of the overall CAGR and accelerating top line revenue growth and that has been driven by improvement in the WAMGR and the playbook that you guys have run has been extremely effective and emulated by other large cap medical device companies in the industry.

But I wanted to just maybe first start on is I say we talked a little bit about this last night at dinner, but just as you guys are approaching 20,000,000,000 in revenue, it gets a little bit tougher to grow at the pace that you’re currently growing. But you did announce earlier this year in a presentation that the WAMGR would increase again in 2026, get to 9%. You guys have consistently outpaced your markets. And so I think there’s some concerns about the sustainability of high single digit to low double digit organic revenue growth. But I think are you last night kind of helped break it down a little bit, but maybe just talk about, does the playbook change?

Do you have to take bigger swings on M and A or on the R and D investment front and for internal projects? Or does it stay in the course and just executing what’s been so successful over the past ten plus years?

Dan Brennan, Chief Financial Officer, Boston Scientific: Sure. Thanks, Josh. To you and TD Confidential, pleasure to be here on behalf of Ken and Hart. So you bring up the ten year track record. We’re proud of that.

But that’s kind of the rearview mirror, and we like to look through the windshield. And so when you look back a quick second and you go to 2023, we grew 12% as a company. Organically, last year, we grew 16%. Kind of what do you do for non core back to your geese? Can you keep this growth up?

We think 10% to 12% is a really strong statement for that in 2025. A lot of scarcity value versus our peer set there with again double digit growth off of the 2016 comp. I don’t think the playbook changes. The playbook has been very successful. So our strategy for those that have followed the story for a while is category leadership.

We have seven verticals we support. We want to be as deep in each of those, serve our physician customers as best we can with the broadest set of products. That’s worked well for us. We do it with internal R and D. We do it with a very savvy venture capital portfolio that has almost 50 companies in it as we sit today.

And we do it with smart M and A, both that comes from the VC portfolio as well as opportunistic M and A across the entire portfolio that we serve, most recently as of yesterday with our acquisition of Sonavi for the hypertension space. So we’re excited by what we’ve accomplished, but I think really excited for ’25 and then the rest of the decade. We want to continue to do this for the rest of the rest of this decade. And there’s, interesting slide in a presentation we did in January. I think that really summarizes it well.

It’s the last slide in the presentation, and it shows all the different areas that we wanna get into, to get back to your comment on the WAMBRA, and also TAM, our total addressable market. So the goal is keep the WAMGR high, try and increase the WAMGR, and also increase the TAM. To your point, yes, we need to fish in bigger TAMs now. Right? That doesn’t necessarily mean bigger acquisitions.

We had an acquisition yesterday. Right? As you saw, it’s a very reasonable tuck in size. We’ve done 47 acquisitions over the last decade. They’ve all been tuck ins.

And so that looks like what we’ve done, that same playbook. And that’s a TAM, you know, north of a billion dollars that we’re excited about, overtime. And I’d look for much much more of the same. No reason to change. Plenty of growth in the verticals that we we support today.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Excellent. And then one of the perspectives I gained last night, which seems obvious and we thought about a little bit in the past, but it was just looking at all the different business units and the size of each business units. Some of them are just approaching $3,000,000,000 not to $20,000,000,000 and so continuing that that M and A tuck in playbook, can can, you know, bear a lot of fruit in terms of accelerating revenue growth in each unit. But maybe Art, you can expand on that.

Art Butcher, Executive Vice President, MedSurg and APAC, Boston Scientific: Yeah. Sure. When you think about Boston Scientific as a as a company that’s approaching $20,000,000,000 I think your question, is one that we get a lot, which is doesn’t the law of large numbers make it harder and harder to continue to run your playbook? And we actually don’t think so. And part of what the conversation we had last night was when you look at the seven verticals that Dan described, five of those business units are approaching about $3,000,000,000 this year, and and all of them should cross into that territory next year.

So and think of each of those as, its own actual, company or or or or or business that we’re trying to accelerate the growth of. And then it becomes much more morsel sized as you think about it because, we’re doing acquisitions and doing r and d across all of those verticals. And so five approaching, 3,000,000,000 would be urology, endoscopy, PI, EP, and cardiology. And, across each of those, we’ve made acquisitions that will support accelerating their growth in the last twelve months, in some cases, multiple. So across med surg, you know, in endo, we bought Apollo, Axonics in urology, Relivant, in neuromodulation, Silk Road in PI, and and so on and so on.

So when you break it down, we believe that playbook, can continue to be actionable.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Thanks for that. And Dan, just to take advantage of your expertise as a CFO for Boston’s margin trajectory and historical strong performance, wanted to just touch on the margin expansion pathway. I mean, I think you played this out nicely, so sorry to ask you to review it. But gross margin expansion from here, I mean, I think you and your team have an intense focus to get back to pre pandemic margins and that sounds like it’s achievable, increasing R and D, getting SG and A leverage. But maybe just talk about how this operating leverage story is part of you’ve said before that it’s part of the DNA of the company, maybe how that how you instilled that and then and then how we think should think about margins as we move through these next couple of years?

Yes.

Dan Brennan, Chief Financial Officer, Boston Scientific: I would reiterate that it is part of the DNA of the company. And, it’s been a great, global team’s done a wonderful job over the last decade of, taking what used to be kind of 18% adjusted operating margin and closing last year at 27% with 70 basis points alone in last year. And then this year another 50 to 75 basis points. So we look at it and, as I mentioned on the revenue growth, we believe there’s some scarcity value on, there versus our peer set and double digit at that 10 to 12 is exciting. But then you also need to be differentiated margin expansion.

It’s not just top line. It’s margin expansion, as well. So, at 27.5 to 27.75 at the end of this year at the 50 to 75, that sets us up really well for the the rest of the decade. We’ve talked about 30% as our long term goal. When you’re at that level, 30% seems really achievable, and so and we believe that is.

So what I what I like a lot about 2025 is the equation of how how there’s no perfect equation of how to increase margin, but a great one is gross margin goes north, SG and A goes south and R and D might tick up a little bit. You spend a little bit more on R and D to grow and fuel the top line for the future. That’s what you should see this year in that 50 to 75 basis points. You mentioned gross margin. We were 72.4% gross margin in 2019, we closed last year at 70.3%.

So we have a couple hundred basis points to get there. The team is maniacally focused on getting there over time as part of the margin expansion journey to get to that 30% SG and A when you grow in the top line at 10% to 12% to 16% last year, the 12% the year before, you get natural leverage points throughout the SG and A cycle. And then R and D, as I said, probably realistic to see us tick up a few basis points this year as we look to continue to fuel that top line. So I really like the equation for 2025, how it’s set up.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Excellent. And one of the prime and recent examples of the success of your growth strategy and increasing the WAM accelerating the organic revenue growth trajectory has been the Farepulse acquisition. And Doctor. Stein was wanted to I mean, I think this isn’t the right place to start, but I was impressed with the opportunity in APAC as others are as well. And just billion plus dollar opportunities in Japan and China, it sounds like the launch in Japan is going gangbusters, but maybe just share a little bit more intel there.

And I think you may have said last night or maybe are two, maybe both of you can answer this question, but that Japan could reach penetrations of The U. S. By mid year twenty twenty five, which is a nice trajectory. But, I’ll hand it over to you to talk about Japan and very close in Japan and China.

Ken Stein, Chief Medical Officer, Boston Scientific: Yeah. No. Thanks, Josh. And and, yes, you’re right. So Japan and China are two of the largest electrophysiology procedure markets in the world.

I I think, you know, China, just based on the size of the population, Japan, again, just very high-tech, very skilled set of physicians. We we start from a relative position of strength in Japan even pre the launch of Farakuls. It it it it was where we reached our high watermark in terms of use of the rhythmia mapping system. We had already launched our, PolarX cryoablation system there very successfully. And we are, again, pleased and really right on target with where we thought we would be with the launch of Therapulse.

And, again, just based on the experience there with Rythmia now, our our new OPAL system, again, expect to do very well there in terms of MAP cases as as well as Farapulse cases. China is gonna be a little bit slower out of the gate, and that really more than anything else just relates to complexities of contracting in China. In China, you need to both first get provincial tenders, and then you need to go through a second process to get listed at each individual hospital. But again, we we are very pleased with with the the rate of progress Farapulse there as as we’ve been pleased with it everywhere else in the world.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Excellent. And and, you know, interrupt the the Farapulse questions with the questions on China and Boston’s success there. I mean, many of your large cabinet device peers have faced some turbulence, there’s volume based pricing. You guys aren’t immune to that, but somehow your China business continues to grow well into the double digits. And maybe just talk about from a at a high level why Boston has been effective in navigating some of the turbulence in the China devices market and any changes to the strategy going forward?

Art Butcher, Executive Vice President, MedSurg and APAC, Boston Scientific: Sure. Thanks, Josh. And and for those who don’t know, VBP or volume based pricing is a headwind that’s facing the China market right now for med device companies and pharmaceuticals. And what it equates to is, the the China, health care system is a single payer system, and the government, does pretty radical reductions of price in certain categories, each year. And depending on your business model, that can be, catastrophic or survivable and or you can thrive there.

And so our our motto in China is survive, and thrive. And the reason that I think we’ve been able to post differentiated results in China, is multifold multifold. We always are committed to playing. We are committed for the long term, so there’s never a question of we’re not gonna we’re not gonna play. We really try and make a study of the full playing field, And we’re able to do that because of the breadth of our portfolio, and the strong differentiated technologies that we have in pockets throughout that portfolio.

So what we’ve been able to do is when one of our, product categories is hit hard with a volume based purchasing tender and we play, we aim to be in the selected set, and that gives us expanded hospital access. So we may gain access to an additional thousand hospitals by, by playing and winning in a specific tender, and that gives us the ability to also pull through unaffected categories across our broad portfolio. So that’s the key. It’s the breadth of the portfolio. It’s the vision to stay to to win and survive and thrive, and then leveraging the access and the wins that we get in different parts of the portfolio to pull through the rest of the portfolio.

And then the last piece is if you wanna survive and thrive for the long term, you have to continue to bring highly differentiated technologies so that that strategy continues to work. And we’ve been doing that through our internal, r and d and, m and a combination. And and then one more tiny layer is we’re also participating in the ecosystem the innovation ecosystem in China. So it’s multifaceted strategy, but it has allowed us to deliver strong double digit growth year after year after year in China. Our business is over a billion dollars today.

We have over 2,000 people, employees in China, and we’re committed to keep winning there for the long term.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Excellent. Doctor Stein, I think maybe just remind us of penetration assumptions for just PFA into AFib ablation cases in The United States and for 2025. I believe exiting 2024 is about 40% and maybe we’re gonna get closer to 60% in 2025.

Ken Stein, Chief Medical Officer, Boston Scientific: Closer to 60 this year moving up to 80. And, I think eventually when you look at the AFib market, there’s going to be a time when no one uses any other technology. PFA in general and Therapulse in particular, and again, you all might get very tired of hearing me say this, but all PFA is not created equal, and you really do need to look at each of these systems individually on their own merits. But

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: when

Ken Stein, Chief Medical Officer, Boston Scientific: you look at Faraway, the advantages that it brings to physicians and patients in terms of safety, in terms of speed, in terms of the simplicity of use, and now in terms of accumulating data that actually show you actually get better efficacy when ablating atrial fibrillation. You know, it’s just hard to understand why you’d ever wanna have any other technology. And I, again, you know, we have been pleasantly surprised at the pace at which it has penetrated. It’s certainly penetrated ahead of what we had laid out in our last Investors Day. And again, I just think it gets to both the quality of our launch, our ability to launch completely unconstrained by supply and the quality of the clinical data that we’re providing to support VERIPULS.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Excellent. I think we had a physician expert panel yesterday and three of the panelists are already at 95% to one hundred percent for all their AFib ablation cases using primarily VERIPULSE. I think in our we’ve struggled to find EP consultants, electrophysiology consultants that aren’t using PFA technologies in at least eighty percent of the case. But we’re selection bias or sampling these high volume academic center clinicians. And the majority of AFib ablation cases are done out in smaller hospitals, maybe community hospitals, and may even see some transition sooner rather than later into ASCs.

But my question is really, maybe just talk about the launch. I know that in the very, very early days, you guys were targeting those high volume academic centers and other high volume centers. And now as you move into the smaller hospitals or as you have been, I mean, my understanding is that that is where single shot approaches have gained the most attraction. And so Feripulse seems to be a very attractive option for that bucket of potential customers as well. But maybe help us think through that and and and Fair Pulse’s success in in both those buckets to date and how you think about success in in that, the bigger bucket of smaller non academic center hospitals.

Ken Stein, Chief Medical Officer, Boston Scientific: Yeah. Absolutely. Although, again, I I you know, our our initial launch strategy,

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: right,

Ken Stein, Chief Medical Officer, Boston Scientific: which again gets back to being able to launch on unconstrained by supply. And that was really a critical part of our decision to move on Farapulse when we did. And, you know, just we cannot give enough kudos to our operations team for for the way they manage this launch. We are at the institutions already that do the the a good majority of the AF ablation procedures. And where we are now is both going broader to those institutions that have not yet contracted with a generator, but also going deeper.

Right? And, you know, even the institutions, the the very high volume, large academic centers that may have started with two or three Farapulse generators are now coming back and saying, you know, they’re they’re they’re they’re getting pressure from their physicians. We we need to buy even another generator. The other thing that we’re seeing, and this gets back to your question around single shot, is this is not only a single shot technology. Our initial labeling was as a single shot device, in other words, doing what’s called pulmonary vein isolation only for treatment of paroxysmal atrial fibrillation.

We are already seeing a very large amount of off label use going beyond just pulmonary vein ablation. And the Faraway catheter is just exquisitely beautifully designed for doing a procedure called posterior wall ablation in addition to pulmonary vein isolation. And we’re seeing folks do that for paroxysmal atrial fibrillation. The greater use case for that is in what’s called persistent atrial fibrillation, which is, you know, at least as large a potential market as is paroxysmal atrial fibrillation. We presented our IDE data on ablation of persistent atrial fibrillation with FaroWave using that approach of pulmonary vein plus posterior wall ablation.

We presented that data at the AFib Symposium here in Boston A Couple Months ago, met all our endpoints, couldn’t be happier with the results, have already submitted to FDA for that label expansion, Expect to get it, second half of this year. We will have more data from that trial to be announced at an upcoming meeting within the next few months. We are also have completed enrollment in trial called Avant Garde, which extends ablation now using FAROWAVE to first line therapy for new onset of persistent atrial fibrillation. And we expect to begin enrollment very shortly in a trial called REMATCH where we look at using the FAROWAVE system for redo cases. And those patients who who failed their first ablation temp with with whatever technology was was used for the first.

And and the reason I’m going this deep into that is so that that gets well beyond single shot. And and, really, you know, we find that people can do anything that they could have done with radio frequency technology. And we hope to be able to prove not just do it faster, but do it safer and do it better.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Understood. But, Greg, if I’m wrong, and I apologize for didn’t mean to imply that FERPA plus was a single shot solution, but it can serve that role. And my understanding is that the cryo balloon had significant traction in that non academic center bucket because of the procedural efficiencies and just in straightforward paroxysmal cases. But, that’s a big opportunity for Fair Pulse. We just haven’t been able to track it very well on our side.

Ken Stein, Chief Medical Officer, Boston Scientific: No. No. I’m with that. And I’m I’m not there was no need to apologize. I wasn’t, I was I was only mildly offended.

The, I think the point I’m trying to make is I think there were a lot of people when we were approaching the launch that looked at this as another single shot technology, and that was gonna appeal most to the folks that you’re talking about. And and that has not been our experience. We we have pulled just as much, you know, from from from these very high volume folks like like some of the folks you were you had on your panel yesterday. Right? And and so it it has been as attractive to the artisans who are doing point by point RF ablation as it’s been attractive to the single shot folks who would have dropped in cryo.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Excellent. I wanted to just touch on the concomitant LAO WATCHMAN plus atrial fibrillation indication. It’s now reimbursed, and we have the option trial data. I think, Dan, when you put on your CMO hat last night, you shared some good insights just in terms of, it’s a double positive in terms of, you know, you’re getting AFib ablation cases that are high risk of stroke and WATCHMANs are being done concomitantly. But you’re also having WATCHMAN candidates that are getting AFib ablation that maybe not wouldn’t have in a concomitant procedure as well.

But maybe expand on that, Dan, and then maybe Doctor. Sine, you can as well just in terms of what you’re seeing on the concomitant. I think you described on the fourth quarter, it was a little bit of a tailwind, but that should get stronger over the course of this year.

Dan Brennan, Chief Financial Officer, Boston Scientific: It’s rare that I play the CMO. I’m going to turn that over to the real CMO, Doctor. Stein.

Ken Stein, Chief Medical Officer, Boston Scientific: Dan’s allowed to put on the CMO hat. I am prohibited from putting on a CFO hat.

Dan Brennan, Chief Financial Officer, Boston Scientific: One way street.

Ken Stein, Chief Medical Officer, Boston Scientific: Yeah. Again, just come back. So, you know, we we were absolutely thrilled with the results of the OPTIONS study for the again, for the folks who may not be intimately familiar with it. Right? This was a trial that compared the Watchman device for stroke prevention after atrial fibrillation ablation and was the first head to head comparison that we’ve had of the Watchman device against the newest generation of blood thinners, the so called novel oral anticoagulants.

Clearly, a safety advantage in this trial, less clinically important bleeding with the Watchman device compared to these drugs, but also clearly as effective, in fact numerically better than the drugs at at preventing stroke. Another really important finding from that trial is that there was no additive safety impact to adding the WATCHMAN implant to an ablation as a concomitant, in other words, as a procedure being done at at one setting. And and there are huge advantages from a patient standpoint, huge advantages from a physician standpoint, and huge advantages from a hospital health care system standpoint to getting that all done at one setting as opposed to having to bring patients back from multiple procedures. And sometimes it is better to be lucky than to be good. A month before we released that option trial data, we had CMS create a new DRG category to reimburse the the concomitant procedure in a way that really makes it financially quite attractive for hospitals.

So we’ve already seen a large tick up in use of the concomitant procedure. And and and one of the things that I think honestly did surprise us a little bit is we’ve seen that pull through both types of procedures. So we see patients who might not have otherwise gotten a WATCHMAN device now getting in and having it done at the same time. But I’m I’m already there. I’ve already done three quarters of the procedure in getting into the left atrium.

If I’ve done the ablation, I may as well just close the appendage now based on the results of option. But we’re also seeing the opposite. We’re seeing patients who were referred in for a WATCHMAN procedure now having a conversation with their physicians. You know, it’s it’s worth a try at doing the ablation. BaraPulse, again, so safe, so simple, so effective.

Let’s just give you a shot at restoring it a normal rhythm at the same time. So it’s it’s really helping both franchises, helping us with Watchmen, but also helping us with Farapulse.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Excellent. I wanted to take advantage of having Art here with us today and ask one more question on MedSurg. But there are high growth businesses within under your leadership. They are margin accretive to the overall corporate margin performance. Maybe just talk about, you know, the growth drivers in urology and endoscopy and how that margin expansion for MedSurg is shaping up.

Art Butcher, Executive Vice President, MedSurg and APAC, Boston Scientific: Sure. Great. Thanks, Josh. So our urology and endoscopy businesses are both very strong category leadership businesses. They’re with the acquisition of Axonics, they’re roughly, the same size.

So they’re they’re both, aiming, as I said, at 3,000,000,000. And they are operating margin accretive, to our overall, Boston Scientific business model. And we don’t talk a ton about them, especially because we’re extremely fortunate right now to have superstars like Parapulse, Watchmen, Agent, that are getting a lot of attention. But urology and endoscopy are very much worth understanding and taking a close look at. The urology business is a perfect example of how to build a category leadership business.

That was, I joined that business twenty eight years ago, as a sales rep, and it was just a kidney stone management business. Balloons, baskets, stents, and wires. It was a strong category leadership business in that space. But since Mike Mahoney joined us as CEO, he really, and this is important, diversified the company to say we’re not just going to focus our biggest investments in cardiology. We love cardiology and EP, but we’re also gonna sprinkle these investments into the other divisions.

So you have seven or eight pistons pumping, in the Boston Scientific engine, instead of one or two. And that is critical when you think about the the longer term, ability for us to continue to grow. So let’s take urology. Over the past five or six years, we added the Luminess laser franchise, which is the world leader in homium lasers for urology. We added, the Resume technology, which is a really nice solution for BPH and has been growing strong double digits, especially internationally.

We’ve also just added Axonics, which we couldn’t be more excited about, Axonics, franchise. There’s a lot of things that we can do to extend the growth and even accelerate the growth, of that technology, and that was over 400, over $400,000,000 in revenue last year, growing strong double digits. And I think in our hands, we can extend that with adding our global footprint, our global distribution footprint. We can also make it more efficient because think about the technology. It’s, implantable pulse generators plus leads.

We do a lot of implantable pulse generators plus leads, so we can make, we can take a lot of cost over time, out of that, out of that franchise as well. We added SpaceOAR, which gets us into urologic oncology. Right? So if you look at the overall portfolio now, you’ve got a plus we added AMS, which got us into erectile restoration, bale incontinence. So you think of the urologist and every single procedure that he or she does, we now have not every single because there’s still room to, to keep extending the strategy, but the majority of those procedures, we now have highly differentiated market leading technology that are largely penetrated with lots of running room to grow.

So definitely worth looking at and understanding that if you’re thinking about, okay, how does Boston continue to grow as you get past 20,000,000,000? There’s a lot there. I won’t go as deep. I know we’re tight on time for endoscopy, but it’s a similar story. There are 10 categories in gastroenterology in which we play, and we are the market leader across that, that spectrum.

And in both of these divisions, what we liked, is approach hospital systems with a broad based contract that, pulls through some of the more, say, commoditized older parts of the portfolio, tie it to the strong, highly differentiated newer parts of the technology, so that you have, as Dan described it, a business that deliver clockwork in terms of predictable, strong results. So there’s a lot to love in med surg, and I’ll leave it there.

Josh Jennings, Analyst, TD Cowen Medical Devices Research Team: Appreciate that, Art. And, Dan, doctor Stein, Art, thank you so much for for joining us. Sorry I didn’t, a lot more ground to cover. Didn’t use the time as effectively as I hoped, but thank you for putting up with all our questions and giving us such strong answers. Have a great rest of the day.

Art Butcher, Executive Vice President, MedSurg and APAC, Boston Scientific: Thanks, Art. Pleasure. Thank you.

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