Feature article April 28, 2017:
Growth Trajectory in Sight for DIAGNOS Inc.
Applying artificial intelligence in the
diabetes market, a robust healthcare business has emerged.
ADK) (US: DGNOF) (Frankfurt: 4D4)
Share data, Capitalization, & Corporate info
(9.14M warrants, 10M options, 37M
52 Week High/Low:
$0.20 / 0.035
Current Market Capitalization:
~$18.3 million Canadian
DIAGNOS' share price is
poised for significant upside revaluation as its vision loss prevention
business targeting diabetics has, as of this
fiscal Q3 (ending December-2016), turned profitable and its revenue
growth curve is rapidly accelerating with no stop in sight.
Able to cost effectively screen millions
of diabetics; proprietary algorithms are capable of
automatic detection of pathology in retinal images and lesion
Big Pharma now converting pilot programs
to lucrative growing contracts for ADK.V (Novartis & Bayer
ADK.V now positioned to target
hospitals and clinics in USA.
Governments are now starting to see the
value in having ADK.V screen diabetic populations
in order to contain costs.
DIAGNOS Inc. (TSX-V: ADK) (US Listing: DGNOF) (Frankfurt: 4D4) is a
Canadian-based healthcare software technology company,
its 'Computer Assisted Retinal Analysis' (CARA) business applies
artificial intelligence in the diabetes market which non-invasively identify patients
at risk of vision loss. The announcement this April-2017 of new
operations in Bangladesh brings to 15 countries in total of
installations for DIAGNOS' CARA technology platform worldwide, this
number and related metrics are only just getting started with the
company in the early stages of a vertical growth trajectory.
Retinal image enhanced with DIAGNOS software, prepped
for A.I. auto-detection of pathology & lesion classification.
DIAGNOS Inc. is expanding globally as a
first-mover in this sector with proprietary disruptive technology
whose adoption is quickly gaining momentum,
doctors and specialists
strongly endorse it as large numbers are non-invasively screened that would otherwise not be
seen. ADK.V's revenue growth curve is rapidly accelerating with
topline >100% Y/Y. Swiss pharmaceutical giant Novartis has become
the Company's biggest customer, initially engaging ADK.V for a
series of pilot 'wellness' programs over the last couple years in various
countries, paying DIAGNOS to screen patients. Recently Novartis has begun converting
pilot programs into
contracts, with more on the way due to the overwhelming success in
identifying patients that could benefit from Novartis' treatment.
German pharmaceutical company Bayer has only recently engaged ADK.V
with similar intentions. DIAGNOS recently signed a contract with an
unnamed pharmaceutical company targeting the US, the world's largest
healthcare market. ADK.V has also started to sell its
solutions to governments on a cost-reduction approach, recently
signing its first government contract in Mexico. Supported by a strong growth and
recurring revenue model, and a low cost growth associated with
its artificial intelligence software, we expect shares of ADK.V to
rise several multiples higher than its current price near-term.
market cap of ~$18.3 million Canadian (recently trading at ~$0.13/share) is minuscule compared to
where it appears headed based on contracts in hand, momentum, and
potential. As the reality of the accomplishments and potential are
understood by the marketplace we anticipate the share price of ADK.V
will move nearer to 50 cents to better reflect its current inherent
value. Further below we document compelling projected
transaction and revenue numbers; Further below is document
compelling projected transaction and revenue numbers, important to
note is that the Company's fiscal Q3 (ending December-2016) showed
profitability, and the
Company is expected to experience
increasingly robust financials going forward. Patient tests per
month were ~22,000 this October, are expected to be ~26,000 for
November, and are expected to increase to between 60,000 - 70,000
patients per month in 2017. As
impressive as those increases in patient tests are, it is only just the beginning. How big will this
get? The answer is 'we just don't know', but there are numerous
indicators ADK.V is going on a massive run; experts believe
there are ~500 million diabetic individuals worldwide (source: WHO) and the Company's
adoption growth curve for its technology is very early stage. The
Company negotiates its pilots with Pharma so that upfront costs are
covered, ensuring it has a big enough commitment so that DIAGNOS
rarely needs to spend money up front on incremental business. With
four deployment options for its technology, all running at least 55%
margin per transaction, ADK.V has impressive revenue projections
based on committed contracts alone. Future projections are certain
to improve as the level of new inquiries now coming into the Company
and discussions regarding new business from big Pharma, governments,
hospitals, and clinics world-wide now are off the chart. Often there
is lag for new business from initial pilot (dipping their toe) to
commitment (full plunge into larger contract), but as DIAGNOS has
proved with Novartis and the Government of Mexico (see February 14,
2017 news entitled "DIAGNOS
announces contract extension with the Mexican government and an
update for a two-year potential national coverage program") -- it's a win-win
for everyone to be in business with DIAGNOS. Where this
is headed is truly exciting, the long-term strategy for the Company
is to eventually shift more toward standalone deployment of its technology
(which has highest margins for the Company), with others/partners
carrying the operating costs, and DIAGNOS acting as a centralized
world-wide cloud-based database/processing center (a secure
state-of-the-art facility in Montreal where its
software enhances and analyzes retinal images of patients) handling
large volumes of transactions.
CARA Platform is currently being utilized in multiple countries &
Company's retinal analysis business was incepted
in the wake of the downturn in the mining sector
a few years back, DIAGNOS was focused on data
analysis in that sector and made the decision to
springboard off its platform and expertise in
artificial intelligence to build the application
it has now in order to fill the gap between
doctors and specialists. ~Four years ago the
Company launched with zero clients, proved its
concept in 2015 and 2016, and is in 12 countries
with pharmaceutical companies today (10
countries with Novartis). DIAGNOS just became
operational with wellness programs in three new
countries (Nigeria, Kenya, and Malaysia) this
Besides Novartis and Bayer
investing increasingly more capital towards
DIAGNOS, the contacts and introductions that
have been made by pharmaceutical companies in
all those countries to date have themselves
created a flurry of new interest in DIAGNOS that
is expected to translate to additional
opportunity for the Company to expand and gain
Once DIAGNOS is in a
country it gets introduced to all the government
departments, hospitals, and clinics; DIAGNOS
develops its own contact with them. The first
major government deal with the Mexican
government was recently signed
for ADK.V to screen up to 106,000 diabetics by
year end. DIAGNOS can now rely on larger monthly
revenues. The Latin America market is one of the
largest market for this kind of automated
analysis of medical images.
vision by reducing congestion at specialists
DIAGNOS sells an
automated system to screen patients for eye diseases. Its system
takes a pictures of a person's eyes, and then uses an artificial
intelligence image-recognition algorithm to assess the patient's
risk of over 20 eye diseases. If it detects a risk, it refers the
patient to a retinal specialist doctor, who prescribes the
appropriate medication or treatment. Because the images can be sent
over the internet, the doctor can be in a different physical
location confirming the diagnostic.
The diseases targeted by the algorithm include the leading causes of
blindness among adults, such as diabetic retinopathy and
aged-muscular degeneration. According to the World Health
Organization, 347 million people have diabetes worldwide (many
experts believe that number is low and actually closer to 500M), of
that number 0.1% of people with diabetes will lose their vision
completely per year if not screened, that translates to 347,000
people per year that will go blind from a curable disease if they
are not screened. These diseases are treatable with
existing medicine but only if caught in the early stage. However,
people at risk are not getting their eyes checked regularly, and
therefore going blind unnecessarily, for the following reasons:
A). There is a shortage of retina specialist doctors. There
are just ~1,800 retina specialists in the US versus ~42 million
diabetics. Clinical guidelines suggest that every diabetic be
screened for diabetic retinopathy once a year, obviously impractical
for such a large number to be screened under traditional methods by
so few specialists. In less developed countries the ratio of
specialists to diabetic population is even worse compared to the US
and Canada. By
using an algorithm to screen patients, DIAGNOS ensures that only
those at risk see a doctor, which relieves congestion in the
healthcare system, while improving access to healthcare.
B). Seeing a doctor is expensive. Retina specialists can
charge $300 per visit, but DIAGNOS' software driven procedure
charges out at only say ~$20 per visit, and
this fee can be paid by the pharmaceutical company rather than the
C). Seeing a doctor is inconvenient. Retina specialists tend
to be located in urban areas, and therefore may be inaccessible for
rural populations. However, DIAGNOS' system could be installed in
Primary Care Facilities, or stores such as Walgreens and Wal-Mart,
which are beginning to provide low-cost healthcare services, further
improving access to basic healthcare. Theranos Inc., an American
privately held health technology company which
developed a simple blood test that could be deployed in a similar
manner, had signed a partnership agreement with Walgreens and ramped
up to ~$9 billion valuation (Theranos has since had tech issues and
pulled back, unlike Theranos tough DIAGNOS' technology has been able
to withstand rigorous vetting). Often there is also a general lack
of advertising targeting diabetics as to where they can be tested.
Additionally, specialists in some countries are caped by quotas.
Retinopathy is a Treatable Disease
Early detection and treatment
can prevent 85% to 95% of blindness
The patient may experience no symptoms until the condition is
People who are unscreened are more likely to:
- Present in the ER.
- Become blind.
- Have other complications.
People who are screened tend to take better care of their diabetes.
The Solution: Early screening using artificial intelligence
DIAGNOS' Computer Assisted Retinal Analysis (CARA) Platform -
DIAGNOS already has FDA approval as a medical device. The DIAGNOS solution fills the gap between the doctors and the
specialist. Making the general practitioner able to manage vision
lost for all diabetic patients by having access to this technology.
Canadian Medical Devices Conformity Assessment
- Class 2 Medical Device
- Class 2 Medical Device
DIAGNOS' test is painless and quick, generally
taking 2 - 3 minutes maximum, its one flash, the company takes the
original image and enhances it to make it easier to read and then
the algorithms do the interpretation.
Having artificial intelligence in the loop to
take care of a very demanding interpretation task that requires a
high degree of proficiency, consistency, and accuracy 24/7 is a
great benefit to specialists. DIAGNOS' software can operate at the
same high level all day long, where as traditional methods rely upon
alertness of humans.
Automatic Detection and Triage
DIAGNOS' algorithms are capable of:
• Automatic detection of pathology in retinal photographs.
• Lesion classification.
• Pre-triaging patients in order of severity.
Figure 5 (above)
Automated triage can help reduce healthcare labor requirements
while increasing patient access to quality care and reducing
DIAGNOS ends its patient screening session by returning
to the patient a copy of the image of their own eye, either by
email, or smart phone, or a printed copy. That way they can see
inside their own eyes, it makes an impression on the client to be
more conscientious of their health. From the patient's perspective
screening gives a visual representation of how well someone is
managing their diabetes, leading to increased awareness, and
increased compliance with diabetes management.
Because people are not being screened regularly, they are losing
their vision unnecessarily. This is also a problem for
pharmaceutical companies, since they are missing out on drug sales.
It is estimated that only 30% of people at risk have their eyes
checked on an annual basis. Increasing that rate to 90% would triple
the drug sales, while reducing the number of individuals who go
blind by 85%. This creates a win-win situation for patients and drug
companies. The pharmaceutical companies pay DIAGNOS to screen
people, but make their money back through higher sales of their
• Convenient non-invasive test.
• Trip to specialist only if necessary.
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Diabetologist/ GP / Endo
• Higher patient compliance.
• Additional pertinent patient information.
DIAGNOS is aiming to target
hospitals and clinics. Putting a camera in a
clinic with say 12 doctors operating out of it
makes sense; it would allow the doctors to get
results on the spot and provide a higher level
of care for their patients.
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• Increased focus on treatable cases.
• Increased revenue.
DIAGNOS does not compete
with specialist as the Company's algos do not
diagnose, they flag patients most at risk with
indicators to see the specialist.
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• Increased drug sales volume.
Novartis' main Dibetic
Retinopathy drug is Lucentis, Bayer's is EYLEA,
specialists inject the drug into the eye. The
relationship DIAGNOS has had with Pharma has
been developing over the last 2 - 3 years but
has only now begun to bloom.
[Note: In Canada the drug
companies charge ~C$1,800 for a dose, and once a
patient gets under the drug its 4 to 7 times per
year and treatment averages for ~4 years.]
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• Increased patient compliance.
• Decreased health plan expenditure.
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• Significant cost avoidance mid/long term.
• Positive political optics.
The old saying "A stitch in
time saves nine" rings true. The cost of
managing diabetic populations that have not been
getting screened properly is exploding. In the
case of Mexico, for example, ~7 years ago
diabetics took up ~6% of the country's medical
budget, now it is ~27% of their medical budget.
Fact is, there is not enough
money and it is endangering the quality of
patient care. Health Services is the
largest ministry in Mexico, they take care of
DIAGNOS has spreadsheets
with analysts in the US, at Medicaid and
Medicare, that show the savings simply from
preventing diabetics going blind, forget
everything else that DIAGNOS can help combat,
the Company can save in the state of Florida
alone over $6 billion over the next 20 years
(Note: DIAGNOS is in proposal stage with Florida
at the moment). It is expected that in 2018
Medicaid and Medicare will be establishing new
guidelines for screening and are expected to be
spending substantial amounts on screening
programs. Government involvement with DIAGNOS
is the big prize for shareholders; when key news
is announced, we anticipate it will act as a
major catalyst that will supplant all current
projections and cause a dramatic upside
revaluation in share price, well above what is
being discussed here today.
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Additional value propositions
stem from interaction with a largely uneducated market; retina screening can be used as an opportunity to educate,
important since less than 10% of people diagnosed with diabetes are
given diabetes self-management training.
Medical Software Has the Mechanics of a Great Business
When mature, DIAGNOS promises to provide investors with a steady
stream of recurring revenues, with minimal maintenance capex
requirements, three hallmarks of a robust business. The revenues are
recurring since people must have their eyes checked annually. Those
at risk, such as diabetics and seniors, are stuck with their
condition for the rest of their lives, which means decades of repeat
sales for DIAGNOS. The sales are reliable because healthcare
providers rarely change application software once it becomes
ingrained in the system, due to high switching costs. Another
strength of DIAGNOS' business model it is scalable and a low
marginal cost of growth, a feature common to other application
software companies. Since the software is developed upfront, the
marginal cost of growth is miniscule, allowing the additional
revenue to fall to the bottom line.
Sunny Macro Supports DIAGNOS
A number of macro tailwinds support the technology's adoption. The
diabetic population is growing at 10% to 12% per year. The
population of seniors and diabetics, two demographics at risk of
blindness-causing eye diseases, continue to grow. These two
demographics also vote, which incentivizes politicians to see the
technology adopted. Companies such as Walgreens and Wal-Mart are looking to offer
low-cost healthcare services in their stores, which could be the
perfect location for a DIAGNOS' system.
With the number of seniors in the world expected to hit one billion
by the end of the decade, charging each $10 to scan the eyes of
every senior means the market will be worth $10 billion per year.
DIAGNOS generated annualized sales of less than $1 million last
year, meaning less than 0.01% of the market has been penetrated. But
the company is growing sales at 300% per year, and the rate of test
per month is increasing, as shown in the table below.
Company growth on a test basis
Table 1. (Below) Patient tests month over
month. Source: Company disclosures.
Note the recent dramatic increases in patient
tests month over month; it took a while but all those Pharma pilots
are now converting to contracts
and growing fast. Patient tests per month were ~22,000 this October,
are expected to be ~26,000 for November, and are expected to
increase to between 60,000 - 70,000 patients per month in 2017.
Company growth this fiscal year
Table 2. (Below) Revenue 2017 fiscal year. Source: Company disclosures.
The quarterly sales growth rate has increased
from the past three quarters. Furthermore, DIAGNOS recently signed a
contract with an unnamed pharmaceutical company targeting the US,
the world's largest healthcare market. The company also signed its
first government contract in Mexico and is looking at Latin America
as a large potential market. This suggests the company's sales could be
hitting an inflection point, which could see its
congestion-relieving software gain the critical mass to be globally
[*FYI: CARDS stands for 'Computer Aided
Resources Detection System', CARDS revenue comes from the remnants
of DIAGNOS' mining data analysis business which it is phasing out.]
growth year over year including 2018 forecast
Table 3. (Below) Revenue 2015 - 2018. Source: Company disclosures.
DIAGNOS' fiscal year end is in March.
DIAGNOS believes it will hit at least $6.6M in CARA revenue for next
year, that is a conservative low figure, as depending on what it
does in this Q4 the revenues for
next year could very easily
become $10M or $12M. The growth curve is NOT going to
stop as the diabetic population keeps growing and DIAGNOS is so
effective at early screening it is quickly now developing a
reputation as the best option out there.
NOTE: Right now Bayer
is going to be doing a pilot in Canada with DIAGNOS starting in
January 2017, they are going to pay DIAGNOS to screen a small
population of diabetics to see if what has been observed in other
parts of the world are occurring in Canada too. DIAGNOS is confident
the results are going to be the same. DIAGNOS currently has a
program running with Bayer in Columbia right now. What happens with
Bayer is not reflected in the financial projections, however if what
occurred with Novatris' pilots is any indication of what to expect then 2018
projections will have yet another revision upwards.
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Qualitative Points that Support DIAGNOS' Business
While DIAGNOS has a disruptive healthcare technology that looks
poised to become a robust business, valuing the Company at such an early stage of adoption
for its technology and business model is challenging, especially
with the Company only this fiscal Q3 (ending December-2016)
demonstrating a turn to profitability. An analysis
of qualitative factors provides further support that the shares are
due for significant upward revaluation:
1. FDA approval and
growing sales to Pharmaceutical imply the
technology is effective.
The fact that the FDA has approved the
product, and Novartis + Bayer are paying to
use it (and are upping their capital
investments), confirms that it works.
2. Smart money investors already own a
large block of
Management and friendly shareholders
(including Dundee: ~18%, Renauld Family: ~8%, Investment partners
NJ: ~8%) own
more than 40% of the outstanding shares.
3. No competitors have contracts with
pharmaceutical companies and governments.
While some other companies are developing
similar software systems, DIAGNOS is the
first-to-market and the only one to have a
contract with a major pharmaceutical
companies and government. The presence of
competitors can actually help the adoption
of the technology, as other firms will share
the cost of developing the market. Since
buyers would compare systems anyways,
competitors could prove to be advantageous
Note: Competitors have
not managed to do what DIAGNOS can do. For
example in the US only one other competitor
has FDA approval on part of their platform,
but they don't have any algorithms to
automatically detect the lesions on the retinas
(that artificial intelligence is the
4. First solution for government cost
control over diabetes.
By providing an economic model that
demonstrates clearly the saving of wellness
program or prevention programs, to insure
patients don’t go blind and carry the
expensive treatment that follows. DIAGNOS
has put together the first economic model to
help governments curve the cost burden of
In contrast to some other names in the
healthcare sector, DIAGNOS' management has been more interested in
running the business than promoting the stock. With the Company's
turn to profitability closing out 2016 and a ramp-up of patient tests
on tap, more attention is headed the Company's way, and we expect
management will dedicate more resources on responsibly relaying its story
to potential investors.
As the company continues to penetrate the >$10Billion dollar market
and revenue explodes to the upside, the company will undoubtedly attract
attention from the Pharma companies that sell into that market.
could be a great tuck-in acquisition for large Pharma companies
already selling into the market. Earlier this year, Welch Allyn, an
American medical device maker, bought a competitor to DIAGNOS for an
undisclosed sum. The acquired company, called Hubble Telemedical,
was developing a similar software, but Hubble was a few years behind DIAGNOS (the clear advantage ADK.V has over competition is its
proprietary artificial intelligence algorithms).
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Eyes tell volumes about
cardio vascular health.
DIAGNOS' R&D team is focused on innovation and
evolving the platform.
DIAGNOS is working at a new application that
will evaluate the risk of cardiovascular issues using the same
images as for the retina evaluation.
Future - Cardiovascular: DIAGNOS is working at a new application that will evaluate the risk
of cardiovascular issues using the same images as for the retina
evaluation. The company is focusing on using its technology to help
general doctors in the world by providing real technology tools
based on its artificial intelligence platform. Cardiovascular issues
are affecting most of the population worldwide. The total market
size is $187B in drugs and services.
[FYI: Already 10% of the
market for DIAGNOS that is screened now are
people that are at risk of being diabetic mainly
because they have high blood pressure. If you
have high blood pressure and are 60 years old
and over, then you are at risk of developing
Valuation Points to $1.00/share
The combination of variables we could input
on assumptions are infinitesimal in projections, however simply
extrapolating conservatively off of contracts in hand, continuation
of current growth penetration rates Y/Y, rate of
conversions, the fact revenues are expected to conservatively hit an
annualized rate of $6.8 million next year, and assuming a continuation of straight-line adoption (it
actually appears that ADK.V is way early in the adoption curve and
the curve is more likely to be
parabolic or hyperbolic), we project the following minimums:
Year-end Mar. 31:
Share of market:
Revenue for ADK:
Net Profit :
Value Share Target Price (minimum):
Parabolic/hyperbolic adoption (as is more likely the
case) will yield significantly higher numbers. With a disruptive technology targeting a
>$10 billion+ market, a robust business model, and attractive macro
and qualitative factors, ADK.V is a hidden gem at its current
trading price. Based on forward
discounting metrics a share price closer to 50 cents Canadian in the
near-term for ADK.V is appropriate.
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Below is expanded
insight on DIAGNOS Inc. and its technology.