• The operator of two medical clinics in Singapore – Singapore Institute of Advanced Medicine (SAM Holdings) is among the first in the nation to install the ProBeam Proton Therapy Solution, an advanced technology used to treat cancer.
• SAM Holdings made its debut on the SGX Catalist today. With an established market capitalisation of S$23.2 million, the company aims to create a comprehensive one-stop ambulatory cancer centre through its team of industry professionals and experts to seek solutions for and improve the quality of cancer patients’ lives.
• SAM Holdings expects to see an increase in patients seeking treatments for theranostics services from a rising demand for a new strategy for the medical treatment, a wider variety of cancers that may be treated using radioisotopes and a surge in investments in biological research.
• SAM Holdings' placement Shares under the Invitation were fully subscribed for, with the Public Offer Shares approximately 1.4 times subscribed, with gross proceeds of approximately S$26.2 million raised through the Invitation, the stock is now listed for trading on Catalist with code 9G2.

Singapore Institute of Advanced Medicine Holdings (SAM Holdings) is a healthcare services provider that uses advanced technology for early and accurate diagnosis, offering treatments for a wide range of health conditions such as cancer as well as neurodegenerative and cardiovascular diseases. With cancer as the leading cause of death in Singapore, the demand for specialised healthcare services is also seen to be on the rise as the World Health Organization estimates global cancer cases to exceed 35 million new cases in 2050, a 77% jump from the estimated 20 million cases in 2022.

Its two medical clinics in Lucky Plaza and Biopolis Drive offer advanced technology, including radiotherapy services, nuclear medicine, diagnostic imaging and theragnostic services. The company aims to create a comprehensive one-stop ambulatory cancer centre through its team of industry professionals and experts to seek solutions for and improve the quality of cancer patients’ lives.

SAM Holdings' placement Shares under the Invitation were fully subscribed for, with the Public Offer Shares approximately 1.4 times subscribed, with gross proceeds of approximately S$26.2 million raised through the Invitation, the stock is now listed for trading on Catalist with code 9G2. For more details click here.

Overview and Trends in the Healthcare Industry

The wider global healthcare sector faced a slew of of challenges in 2023 – high interest rates, post-Covid inventory reductions and tighter budgets – with the exception of anti-obesity medications. Global healthcare stocks have lagged broader indices, reflecting what some call a “Covid-induced hangover,” or being faced with difficult year over year comparisons due to a high base revenue from 2022. As the company states under “Risk Factors,” these challenges affecting the healthcare industry have also resonated with SAM Holdings, including the technological and pharmaceutical improvements that reduce the demand for its services as well as an inflationary macroeconomic environment.

Meanwhile in Singapore, Healthcare stocks recorded a net institutional inflow of S$30.5 million in 2023. The iEdge SG All Healthcare Index, which tracks the performance of the listed healthcare segment in Singapore, generated a 5.7% gain in total returns terms in 2023, outpacing that of the benchmark Straits Times Index, which saw a 4.7% increase for the year.

Business Segments

The Group is primarily engaged in the following key business segments:

• Medical Diagnostics and Treatments: Medical diagnostics and treatments which cover:
  • Cancer-related diagnostics and theranostics treatments
  • General diagnostics and health screening
  • Aesthetic services
• Radiation Therapy and Medical Oncology Services: Radiation therapy and medical oncology services which cover:
  • Proton beam therapy: A technologically advanced method to deliver radiation treatment, using proton beams to precisely target cancerous tumours. It focuses beams of protons instead of photons on the cancer. The proton beam therapy machine produces a fine beam of proton particles accelerated to 75% of the speed of light that is directed to the tumour.

  • Photon radiation therapy: Photon beam therapy involves photon beams which are the same type of radiation that is used during an X-ray, but at a much higher intensity. Photon beams are able to travel deep into the body to the location of the tumour and, through a series of interactions inside the body, break the DNA inside the cancer cell, rendering it unable to repair or copy itself, which eventually kills the cancer cell.

  • Medical oncology: Medical oncology is a medical speciality that focuses on the management of cancer from diagnosis to palliative care. A medical oncologist’s expertise is treating cancer using systemic or medication-based therapy.

Industry Trends & Prospects (Refer to page 194-195 of Offer Document)

• Wellness department expecting to see increase in patients purchasing health screening from (a) influx of overseas visitors to Singapore and medical tourism, (b) increase in marketing activities by company
• An increase is expected in the company’s diagnostic imaging services, such as MRI services in AMI and AHP, and PET-CT scanning services in AMI, largely due to pent-up demand from medical tourism from previous years
• An increase is expected in patients seeking treatments for theranostics services mainly due to: (a) increasing demand for a new strategy for the treatment of disease and other chronic illness; (b) a wider variety of cancers that may be treated using radioisotopes; and (c) a surge in investments in biological research
• Its radiotherapy services are expecting an increase in patients since the company has treated its first patient using the Varian Halcyon system in December 2021 as photon radiation therapy will be fully operational for the whole FY2024
• The Group has been receiving enquiries regarding its services, particularly the proton beam therapy services which commenced providing recently in June 2023. The company is collaborating with medical concierge service providers to facilitate the referral of patients living overseas who wish to use the company’s services

Prospects, Business Strategy and Future Plans (Refer to page 191-197 of Offer Document)

• Acquisitions of new equipment and facilities in advanced medical and healthcare technologies
• Upgrading of the IT and POS systems and other facilities in its medical clinics, expansion of its medical and healthcare professional team, and expansion of the services offered by the Group
• Pursuing growth through acquisitions, joint ventures and/or strategic alliances:
  • Identified potential targets but not entered any definitive agreements, have commenced preliminary discussions with some of the targets on a preliminary basis for the purpose of enhancing the core business of the company.
  • Entered into an agreement with a radiation oncology clinic involving an arrangement for the referral of patients for consultation and/or treatment at its clinic at Biopolis Drive, and a services agreement with Raffles Hospital Pte Ltd under which medical professionals may be sent as visiting consultants to each other’s clinics to provide services to patients in accordance with an agreed upon scope of services and fees.

Competitive Strengths (Refer to page 171 of Offer Document)

• The first to install the Varian ProBeam Compact in Singapore
  • The Varian ProBeam Compact is capable of emitting pencil beam proton therapy to deliver precision proton beam therapy to treat cancer patients, placing the company at the forefront of medical technology in the field of radiation therapy for cancer treatment in Singapore
• Long-standing relationships with global companies in advanced medical and healthcare technology which are its suppliers, and private and public institutions
• List of suppliers include Philips Singapore, GE Healthcare, Varian Medical Systems and Siemens Healthineers
• Strong focus on the use of industry-leading and advanced technologies in the provision of healthcare services
  • The first in Singapore to bring in the Varian Halcyon system to provide radiotherapy treatment for cancer patients. Although the Varian Halcyon system uses the traditional photon radiation therapy, the improved technology allows radiation to be delivered in modulated (or varying) intensities with the aid of guided cone-beam CT images at high speeds, thus reducing impact on surrounding healthy tissues

Risk Factors (Refer to page 40-57 of Offer Document)

• SAM Holdings have incurred net loss after tax and are in a negative working capital and largely negative operating cash flow position for the Period Under Review
• Its business is operating in a highly-regulated industry that is subject to various laws, regulations and guidelines
• The Group has just started to offer proton beam therapy in Singapore as a form of cancer treatment in Singapore
• The company may lose its competitiveness if they are unable to keep abreast with the latest technology by acquiring new or upgrading its equipment and facilities
• The company is dependent on its ability to attract and retain suitable and qualified healthcare professionals

Financials (Refer to page 90 of Offer Document)

• The company generated increasing revenue from continuing operations of S$12.9 million in FY2021, S$13.8 million in FY2022, and S$16.2 million in FY2023 – mainly due to the increase in patients for the medical diagnostics and treatments segments of its business
• Loss after tax also rose from S$9.4 million in FY2021, S$14.5 million in FY2022 and $S19.0 million in FY2023, mainly due to the increase in operating expenses arising mainly from the increase in employee compensation as the Group increased its headcount during the Period Under Review in preparation for the commencement of photon radiation therapy services and proton beam therapy services
• Total assets rose from S$172.1 million in FY2021 to S$174.4 million in FY2022 and fell to S$159.5 million in FY2023. Meanwhile, total liabilities rose from S$112.9 million in FY2021 to S$120.3 million in FY2022, then fell to S$114.6 million in FY2023 – mainly due to the proceeds from issuance of the Pre-IPO Convertible Loans. In FY2023, the decrease in total assets was mainly due to the disposal of the investment properties and the decrease in total liabilities was mainly due to the repayment of bank borrowings and other payables
• The company currently does not have a fixed dividend policy

Valuation (Refer to page 34, 197 of Offer Document)

• According to the offer document, SAM Holdings reported loss per share (LPS) of -2.12 cents for FY2023, based on pre-invitation share capital, or -1.88 cents, based on post-invitation share capital.
• Based on the valuation report in the commissioned by the Group, which has adopted the income approach as the basis of the valuation, the market value of 100.00% equity interest as at 30 June 2023 is in the region between S$222.72 million and S$269.63 million.
• Net Asset Value (NAV) per share as of 30 June 2023, based on pre-invitation share capital, is 5.03 Singapore cents.

IPO Details (Highlights from Offer Document)

• Issue Price at S$0.23
• Total of 114 million invitation shares comprising:
• Public offer: 4.415 million shares
• Placement: 109.585 million shares
• IPO Market Capitalisation S$23.18 million
• Use of IPO net proceeds of S$21.72 million:
  • S$15 million – repayment of bank borrowings
  • S$6.5 million – working capital purposes
  • S$0.2 million – acquisition of new equipment and facilities and upgrading of systems

Did you know?

Data from the World Health Organization’s International Agency for Research on Cancer (IARC) show there is a growing burden of cancer – with an estimated 20 million new cancer cases for the year of 2022 and 9.7 million deaths worldwide. About 1 in 5 people develop cancer in their lifetime, approximately 1 in 9 men and 1 in 12 women die from the disease, the IARC said. The three major cancer types in 2022 were lung, breast and colorectal cancers. The new estimates available on IARC’s Global Cancer Observatory show that 10 types of cancer collectively comprised around two-thirds of new cases and deaths globally in 2022. Data covers 185 countries and 36 cancers.

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