Healthcare · Medtech
Procedure Volumes: the Demand Unit
Clinical procedures as medtech demand: Edwards TAVR at 74% of sales, Intuitive's 3.15M procedures, Stryker Mako volume, and revenue with no installed base.
Selborne Research · Medtech coverage: 7 guides, 6 company profiles, a primer and Excel model
Educational analysis for professional use. This guide is not investment advice or a recommendation to buy or sell any security, and it is not personalised.
On this page
- Procedures, Not Shipments, Drive Device Revenue
- Procedure Volume vs Installed Base
- Edwards: Procedure Economics With No Unit Count
- Intuitive and Stryker: Filed Volume Anchors
- Boston Scientific and Abbott: Milestones and User Counts
- Worked Example: Edwards' TAVR Concentration
- From Procedures to Valuation
- Profiles to Read Next
Procedures, Not Shipments, Drive Device Revenue
A device maker’s revenue follows clinical activity: surgeries, catheter procedures, sensor replacements. So the forecast starts with how many procedures ran and the pull-through: what each procedure brought in from the company’s own consumables or implants.
Disclosure is uneven. Intuitive Surgical (ISRG) files robots and procedures, Stryker (SYK) a cumulative count of procedures on its Mako knee and hip robot, Edwards Lifesciences (EW) only product revenue. The procedure is the demand unit either way.
Procedure Volume vs Installed Base
| Concept | What it measures | Example (FY2025) |
|---|---|---|
| Installed base (stock) | Platforms or users in the field | ISRG 11,106 da Vinci robots; Abbott >8M users of its Libre glucose monitor |
| Procedure volume (flow) | Clinical events in the period | ISRG ~3.15M da Vinci procedures, +18% |
| Cumulative procedures | Lifetime use of a platform | SYK >2.0M Mako procedures |
| Revenue without a count | Procedure-linked sales only | EW TAVR heart valves $4.5B, 74% of sales |
The installed-base guide covers the stock; this guide covers the flow.
Edwards: Procedure Economics With No Unit Count
Edwards files no implant count, centre count or procedure total, so demand shows up in product revenue. Its three product lines are all heart-valve therapies. TAVR (transcatheter aortic valve replacement) is a valve delivered by catheter rather than open surgery. TMTT covers catheter treatments for the mitral and tricuspid valves.
| EW line (FY2025) | Revenue | Growth at constant currency (CC) | Share of $6,067.6M sales |
|---|---|---|---|
| TAVR | $4,487.7M | +8.6% | 74% |
| TMTT | $550.6M | +53.1% | 9% |
| Surgical Structural Heart | $1,029.3M | +4.3% | 17% |
| Group | $6,067.6M | +10.7% | 100% |
TAVR is 74% of sales, so Edwards’ growth rides on one therapy.
With no equivalent of Intuitive’s 11,106 robots, an Edwards forecast starts with TAVR sales growth as the stand-in for procedure growth, then TMTT scaling from 9% of sales. TAVR grew more slowly than the group; TMTT’s 53.1% made up the difference.
Intuitive and Stryker: Filed Volume Anchors
Intuitive shows the whole chain. Its revenue link is instruments and accessories (I&A), the single-use tools each operation consumes. Its filed pull-through, $1,810, is I&A revenue per da Vinci procedure.
| Company | Volume metric | FY2025 | Revenue link |
|---|---|---|---|
| ISRG | da Vinci procedures | ~3.15M (+18%) | $1,810 of I&A per da Vinci procedure; all I&A $6,018.9M |
| ISRG | Procedures on Ion, its lung-biopsy robot | ~144,100 (+51%) | Instruments sit in I&A but outside the $1,810 |
| SYK | Cumulative Mako procedures | >2.0M | Orthopaedic implants fitted with Mako; the 10.3% organic growth is for Stryker’s whole group |
For Intuitive, 3.15M × $1,810 ≈ $5.7B, the da Vinci part of I&A. Most of the other $0.3B is instruments for Ion procedures, which the $1,810 leaves out. That is also why dividing all I&A by da Vinci procedures gives a higher figure, about $1,910. Stryker shows adoption but files neither its recurring share nor its Mako robot count.
Boston Scientific and Abbott: Milestones and User Counts
Boston Scientific’s >600,000 patients treated with WATCHMAN, a heart implant that lowers stroke risk, is a running total since launch. Boston Scientific files no yearly procedure count, so there is no growth rate to work out.
Abbott’s >8M Libre users are active users. Diabetes Care revenue was $7,998M in FY2025, up 16.3% organic (17.5% reported). More users means more sensor reorders, but there is no “procedures per user” line.
Worked Example: Edwards’ TAVR Concentration
| Step | Calculation | Result |
|---|---|---|
| TAVR share | $4.5B ÷ $6.1B | 74% |
| Non-TAVR revenue | $6.1B − $4.5B | ~$1.6B (~26%) |
| TAVR growth contribution (approx.) | 74% × 8.6% | ~6.4 pp of group CC |
| Group CC growth | From the earnings release | 10.7% |
TAVR supplied roughly 6.4 of the 10.7 points of group growth. Each point of TAVR growth lost costs the group about three-quarters of a point, far more than any one product line moves a diversified group such as Medtronic (4.9% organic on $33.5B). A growth screen for Edwards uses the 10.7% group CC rate, which already includes TMTT’s faster growth.
From Procedures to Valuation
Faster procedure growth raises organic growth, which lowers the growth-adjusted ratio (P/E divided by growth) at a fixed headline P/E. Bain’s medtech work puts the link at roughly two turns of forward EV multiple per 100 bps of revenue growth (14 Jan 2024, companies above $3B revenue).
Before comparing device makers on multiples:
- Check whether the filing gives annual procedures, cumulative procedures or revenue only.
- Strip acquisitions from reported growth.
- Compare companies on growth-adjusted ratios.
Profiles to Read Next
Edwards Lifesciences for the TAVR and TMTT mix, and Stryker for Mako adoption on $25.1B of sales.
A franchise DCF charges reinvestment for every point of growth, fades that growth year by year, and asks how many years of it a price pays for.
- 15 sections, installed base and pull-through to a franchise DCF, the runway a price implies and growth-adjusted P/E
- 44 pages
- a razor-blade franchise and a diversified grower
- 2 worked archetypes
- large-cap device makers on filed organic growth, margins and free cash flow
- 6-company screen
The Excel model is the primer's franchise DCF live across 11 sheets: a razor-blade franchise and a diversified grower valued over 20 years on funded free cash flow, with growth held for a runway and then faded to terminal, an operating margin path and a WACC built from the cost of equity and after-tax debt; a runway table showing how many years of growth the illustrative price pays for; a valuation summary; the installed-base build; P/E implied by the DCF value and by the price, each growth-adjusted; organic-versus-reported checks; and a sensitivity grid. Change organic growth, the runway, ROIC or the WACC and the value moves.
See what's in the Medtech Sector Primer →£25 PDF · £59 with the Excel model · £159 for all three Healthcare industries
Frequently Asked Questions
- Why are procedure volumes the demand unit in medtech?
- Consumable and implant revenue scales with how often clinicians use the products. ISRG filed ~3.15M da Vinci procedures (+18%) and $1,810 of I&A revenue per da Vinci procedure. Edwards books TAVR revenue of $4.5B (+8.6% CC) without disclosing a global procedure count, but that revenue is still driven by procedures.
- What is TAVR concentration at Edwards Lifesciences?
- TAVR was 74% of FY2025 net sales ($4.5B of $6.1B total), growing +8.6% constant currency. TMTT (catheter treatments for the mitral and tricuspid valves) was 9% and Surgical Structural Heart 17%. Edwards' revenue therefore turns largely on adoption of transcatheter aortic valve replacement.
- How do procedure volumes differ from installed-base counts?
- Installed base is a stock (systems placed, Libre users). Procedure volume is a flow (surgeries per year). SYK files >2.0M cumulative Mako procedures and no system count in its 10-K. ISRG files both: 11,106 systems and ~3.15M annual procedures. EW files neither count, only TAVR revenue.
- How do procedure trends affect medtech valuation?
- Procedure growth feeds organic revenue growth, the denominator in growth-adjusted P/E (P/E divided by growth). At the same growth-adjusted ratio, faster procedure growth supports a higher headline P/E. Strip acquisitions from growth first, and do not read a long growth runway into a single cumulative procedure milestone.
Read next
Installed Base and Pull-Through
Systems, users, and procedures as the medtech demand engine: filed installed-base KPIs for ISRG and ABT Libre, SYK Mako cumulative procedures, and the pull-through arithmetic.
Growth-Adjusted P/E for Devices
Forward P/E divided by organic growth: why one headline multiple means different things at 6% and 12% growth, and which growth figure to divide by.
Organic vs Reported Growth in Medtech
Strip M&A before comparing medtech growth: BSX Urology +4.7% organic vs +23.1% reported, FY2025 organic growth for six peers, and why multiples follow organic growth.
See it applied
These company profiles apply the concepts from this guide to real public companies.