REG - Cambridge Cognition - Preliminary Results, Trading Update & Board Change
01/05/2024 07:00
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RNS Number : 7029M Cambridge Cognition Holdings PLC 01 May 2024
1 May 2024
Cambridge Cognition Holdings plc
("Cambridge Cognition", the "Company" or the "Group")
Preliminary unaudited results for the year ended 31 December 2023, trading
update and Board changes
Cambridge Cognition Holdings plc (AIM: COG), which develops and markets
digital solutions to assess brain health, is pleased to announce its
preliminary unaudited results for the year ended 31 December 2023 as well as
an update on its outlook and current trading.
Financial highlights
● Revenue up 7% to £13.5m (2022: £12.6m).
● Gross profit increased by 8%, with margin improving from 73.9% to 79.9%.
● Adjusted operating loss of £1.1m for the year (2022: £0.1m profit),
exceeding market expectations, with profitability achieved in the second half.
● Loss per share 10.1 pence (2022: 1.3 pence loss per share).
● Cash balance of £3.2m at 31 December 2023 (31 December 2022: £8.3m).
● Continued reduction in cost base post year-end.
Corporate and operational highlights
● Successful integration of two acquisitions, Clinpal and Winterlight,
diversifying our offering and realising annualised cost synergies in excess of
£1.5m.
● Launched a novel automated quality assurance product, AQUA, based on the
Winterlight technology.
● Major contract wins included two £2m+ clinical trials and one for £1m
combining CANTAB, Winterlight and AQUA.
● Contracted order book of £17.2m at 31 December 2023 providing good visibility
over future revenues (2022: £17.6m).
● Approximately 69% of our revenue in 2023 (2022: 68%) from top 10 customers,
all of whom have been long-term clients.
● Post-period end, strengthened the sales and marketing teams to drive
commercialisation.
Outlook and current trading
The Company's pipeline of opportunities for the remainder of 2024 is healthy.
The first quarter has already seen an increase in contract wins compared to
the same period last year, however, with several major contract delays, the
majority of new business is expected to occur in the second half of 2024.
Depending on the timing of these contract wins, the Company expects full year
revenues to be within the range of £13.0m to £15.0m.
With an objective to increase profitability, the Company has reduced its 2024
operating and research and development costs further, resulting in annualised
overhead savings in excess of £2m (which were in addition to the 2023 cost
synergies noted above). As a result, the Company expects to generate a full
year adjusted operating profit at least in line with or ahead of current
market expectations.
The Company's focus in 2024 continues to be commercialising our digital
solutions for Central Nervous Systems ("CNS") clinical trials. It has recently
made a step change in commercial capability with four new sales and marketing
related hires with deep experience in the clinical trials market. This has
already resulted in an increase in new lead generation and the number and
value of proposals being submitted.
As a digital health technology provider operating in the large and growing CNS
clinical trial market, with a healthy pipeline of opportunities, strengthened
commercial team and substantially reduced cost base, the Company looks forward
to delivering profitable growth in 2025 and beyond. In the meantime, it
continues to manage working capital based on its current expectations.
Management and board changes
The Company has recently broadened its Board with two additional Non-Executive
Directors, Nick Rogers and Stuart Gall, post period-end. The Company is
already benefitting from their expertise and they are making significant
contributions to support future growth.
The Company has also strengthened its commercial leadership. Alex
Livingstone-Learmonth joined Cambridge Cognition as Chief Commercial Officer
in February, bringing a wealth of sector experience, having worked in the
clinical trial technology, services and solutions industry for over 20 years.
In addition, Stephen Symonds, who joined the Company as Chief Financial
Officer in April 2022, will step down by 30 September 2024 to join an
unrelated business. Stephen has made an important contribution to the
leadership and development of the Company and will continue as CFO to support
a smooth handover while a successor is recruited. The Board wishes him well in
his future endeavours.
Matthew Stork, Chief Executive Officer of Cambridge Cognition, commented:
"With continued revenue growth in 2023, over the last five years we have
delivered a CAGR of 20% plus. The start of 2024 has seen year-on-year orders
growth and we have stepped-up our commercialisation capability and activities.
Pharma companies are investing more in CNS drug development and we anticipate
that market conditions will improve throughout 2024. With a focus on
commercial growth, tight control of costs and operating in fast-growth
markets, we believe the long-term future for Cambridge Cognition is a bright
and profitable one."
This announcement contains inside information for the purposes of Article 7 of
the Market Abuse Regulation (EU) 596/2014 as it forms part of UK domestic law
by virtue of the European Union (Withdrawal) Act 2018 ("MAR"), and is
disclosed in accordance with the Company's obligations under Article 17 of
MAR.
Enquiries:
Cambridge Cognition Holdings plc Tel: 012 2381 0700
Matthew Stork, Chief Executive Officer
Stephen Symonds, Chief Financial Officer
Panmure Gordon (UK) Limited (NOMAD and Joint Broker) Tel: 020 7886 2968
Freddy Crossley / Emma Earl (Corporate Finance)
Rupert Dearden (Corporate Broking)
Dowgate Capital Limited (Joint Broker) Tel: 020 3903 7715
David Poutney / James Serjeant
Hudson Sandler (Financial PR and IR) Tel: 020 7796 4133
Dan de Belder / Hattie Dreyfus cog@hudsonsandler.com (mailto:cog@hudsonsandler.com)
Notes to Editors
About Cambridge Cognition
Cambridge Cognition is a technology company marketing digital health products
to better understand, detect and treat conditions affecting brain health. The
Company's software products assess cognitive health in patients worldwide to
improve clinical trial outcomes, identify and stratify patients early and
improve global efficiency in pharmaceutical and healthcare industries.
For further information visit www.cambridgecognition.com
(http://www.cambridgecognition.com)
CHAIR'S INTRODUCTION
2023 was an important year for the Company with two acquisitions which have
expanded our addressable market and broadened our product portfolio. Clinpal
(the trading name for eClinicalHealth Limited) was acquired in October 2022
and Winterlight Labs Inc in January 2023. These acquisitions enable the
Company to offer customers an end-to-end solution for central nervous system
('CNS') clinical trials and enhance our competitive position. Following the
acquisitions the Company undertook a significant restructuring, which enabled
a return to profitability in the second half of the year.
Despite a widely reported slowdown in the clinical trials market in 2023,
customer activity began to improve late in the year and we expect this to
impact positively on contracted business in the second half of 2024. We remain
well positioned for sustainable profitability over the next 24 months.
Post-period end, in February 2024, we welcomed Stuart Gall and Nick Rodgers to
the Board as Non-Executive Directors. They each bring broad expertise and
experience in the healthcare and technology sectors, and further strengthen
the Board and its ability to support our growth plans, bringing additional
commercial, investor relations and financial expertise.
We have strengthened our executive leadership team and welcome the appointment
of Alex Livingstone-Learmonth as Chief Commercial Officer in early 2024. Alex
is an experienced commercial leader with vast experience leading teams selling
digital solutions into clinical trials.
Finally, I would like to thank all of our operational teams in the UK and
North America, who have continued to work with commitment to grow and develop
our business as we continue our transition to a highly profitable company.
CHIEF EXECUTIVE OFFICER'S REVIEW
Cambridge Cognition took a major step forward in 2023, through acquisitions
and internal developments, to be positioned as an end-to-end provider of CNS
clinical trial solutions. The Company now a broad range of solutions with a
focus on commercialisation. These strategic developments underline our
commitment to boost growth and profitability.
After the acquisitions in late 2022 and early 2023, we have successfully
integrated Clinpal and Winterlight and been able to realise significant
synergies that resulted in an adjusted operating profit in the second half of
2023.
We were able to deliver 7% revenue growth and we improved our gross margin to
80%. Operating expenses were higher than the previous year, as expected,
following the acquisitions, however we took steps to reduce operating costs
with the integration of the organisational structures, systems and processes,
driving cost efficiencies.
Although our new contracted orders, at £10.9m in 2023, were below those of
the prior year, we saw increasing activity and engagement with major
pharmaceutical companies and clinical research organisations ("CROs") through
the second half of 2023. There have been longer lead times to contracting and
delays to commencing studies, though as noted above, we have made a step-up to
commercial capability and activity and consequently expect an acceleration in
orders in 2024.
Our strategy is to provide researchers with precise measures of patient
symptoms and set benchmarks for accurate, patient-focused measurements in
clinical trials. Developments to our offering during 2023 included:
● Completion of the Winterlight acquisition to expand our expertise and offering
in voice-based assessments, complementing our existing gold standard, touch
screen assessments.
● Integration of the acquisitions under one operational and commercial structure
that can clearly promote our unique end-to-end offering to customers and
enable larger, multi-product orders.
● Launch of the AQUA (automated quality assurance) product for clinical trials,
the first collaboration of the Cambridge Cognition and Winterlight
technologies.
● Go-live of our RADIAL app, an enhancement of the Clinpal product including
eConsent and telemedicine, for the large Trials@Home clinical trial.
● Launch of new tasks for use on mobile devices, a key growth area for clinical
trials.
Market Overview
We continue to operate across three main business areas: pharmaceutical
clinical trials, academic research and healthcare.
Pharmaceutical clinical trials
Our digital outcomes assessment solutions, including software, configuration
(with customisation options), consulting and reporting services, accounts for
approximately 90% of revenue.
Table summarising total addressable markets and growth rates:
Market sector Market size Market growth per annum Source
Digital cognitive outcomes assessments $67m US only in 2021 30% Independent report
eCOA for CNS clinical trials £185m in 2023 16% from 2024 Independent report x CNS proportion
IT systems for CNS decentralised clinical trials £140m in 2023 15% from 2024 Calculated by Company
Patient recruitment for CNS trials £100m in 2023 10% Independent report x CNS proportion
We have three active target market opportunities: digital cognitive outcomes
assessments, automated quality assurance and electronic clinical outcomes
assessments ('eCOA'), and two passive, decentralised clinical trials and
recruitment solutions.
1. Digital Cognitive Outcomes Assessments
Approximately 500 clinical trials each year use measures of cognition(1).
Traditional assessments require clinicians to ask patients questions and score
the answers, and can be more subjective, costly and inconvenient. Our
touchscreen and voice-based cognitive assessments can be used alongside or
even instead of traditional methods. The US market for digital cognitive
assessments in clinical trials was estimated to be $67m in 2021 growing at 32%
per annum(2).
2. Quality Assurance
In later phase clinical trials for diseases such as Alzheimer's and
Parkinson's Disease, the patient consults may subsequently be reviewed for
quality assurance. Our new AQUA offering automates this process. The market
for quality assurance for clinical trials is likely to be measured within the
overall eCOA market.
3. Electronic Clinical Outcomes Assessment ('eCOA')
The clinical trials market is moving from pen and paper to electronic
solutions. eCOA systems are designed to capture patient, carer or
clinician-reported data on a patient's outcomes during a clinical trial.
Taking a proportion of the reported global market for all therapeutic areas,
the eCOA market for CNS disorders was estimated to be $250m in 2023 and
predicted to grow at 16% per annum from 2024 to 2029(3).
4. In-Clinic, Hybrid and Virtual/Decentralised Clinical Trial Systems
Pharmaceutical companies and CROs depend on various information technology
systems to effectively communicate with patients, schedule events, gather and
analyse clinical data and prepare reports. A wide range of providers offer one
or more of these systems, with some designed for in-clinic or virtual use or
both. The global market for these solutions in CNS virtual clinical trials was
estimated to be $200m per annum in 2023(4). A recent report stated that
market growth is forecast to be 15% from 2024(5).
5. Patient Recruitment
There is a market opportunity for Cambridge Cognition to provide the digital
solutions to support patient recruitment for a wide range of CNS clinical
trials. The Company has several partners and provides clinical consulting,
patient tracking systems and clinical screening solutions. The CNS clinical
trial patient recruitment market, excluding advertising, is estimated at just
over $140m with 10% annual growth(6).
Academic research
The supply of cognitive outcomes assessments for use in research by academics
via a software-as-a-service ('SaaS') solution generates valuable evidence of
the utility of our solutions as academics publish papers and give
presentations referencing our data and software. This peer generated evidence
is useful in marketing and securing new clinical trial contracts with our
pharmaceutical customers.
Healthcare
Cambridge Cognition has two FDA and EU approved medical devices to aid in the
triage and diagnosis of patients with cognitive impairment, one for primary
care practitioners and one for secondary care specialists. The products are
supplied to health centres in the UK direct and in the US via a distributor.
Demand is currently limited as there is minimal reimbursement, although it
could grow rapidly with more interest in using digital cognitive biomarkers
for healthcare, as there are new drugs to treat Alzheimer's disease. For
that reason, we are in discussions with several potential partner companies to
extend distribution.
Innovation and Product Review
There was considerable innovation in 2023 across the Company's expanded range,
with combined offerings, product improvements and new products.
The Company launched two new products: AQUA, that leveraged the capabilities
acquired with Winterlight; and RADIAL, a new decentralised clinical trial app
for the Clinpal platform specifically for the IMI-funded Trials@Home project,
a 600 patient European clinical trial. In 2024 we will prioritise
incremental developments and system maintenance as we step-down investment in
new product development and focus on commercialisation of the portfolio.
Cognitive assessments
The Company has three types of cognitive assessments, screen-based, verbal and
short daily tasks on mobile phones, that make up the widest range of
assessments available on the market, so that clients can select those that
most suit their clinical trial requirements. Our leading scientists also make
recommendations dependent on the research objectives and patient population.
A particular success in 2023 was a sizeable contract win for a Phase IIb
clinical trial for Alzheimer's disease, utilising both CANTAB™ and
Winterlight assessments, which went live with the first patients in March
2024. The Company's assessments were selected because they can identify
smaller changes in the effect of a drug and, as a result, a smaller population
can be enrolled compared to traditional assessments.
CANTAB™ cognitive assessments
Cambridge Cognition's core product, CANTAB™, constitutes most of the
Company's revenues. It comprises 15 main tasks that cover all of the cognitive
domains typically measured in a clinical trial. The number of publications on
CANTAB™ trials is now over 3,250.
CANTAB™ assessments are available on Apple iPads™, through a web browser
and mobile phones. The project to enable and validate screen resizing for our
tasks on mobile screens continued through 2023, and concluded in early 2024,
with the addition of two further frequently used tasks in the mobile format.
We have also developed an R&D version of our CANTAB™ App that can be
used flexibly with individuals to test variants of assessments.
Daily cognitive assessments
The Company markets several short mobile phone assessments that can be done
daily, or multiple times each day. The Company currently has three assessments
and progressed two further assessments in 2023 to be ready for validation and
sale.
Voice-based cognitive assessments
In 2023, the Company expanded its range of voice-based cognitive assessments
with the acquisition of Winterlight. The full portfolio now includes 11 verbal
assessments which are mostly automated versions with unique features of
well-known assessments used by psychologists or neurologists to assess
patients, such as asking someone to describe a picture or to memorise pairs of
words. Many are multilingual, which is essential for international clinical
trials. The Winterlight solution was also used to develop AQUA.
AQUA, Automated quality assurance
The AQUA opportunity was part of the rationale for acquiring Winterlight.
Product development was completed post-acquisition and the product was
launched in Q4 2023. It uses the Winterlight transcription engine and
provides a report on the quality of clinical consults for clinical trials.
In 2022, we commissioned independent market research that estimated the
potential market opportunity for the solution could reach £16m per annum
within five years of being launched(7).
Research Collaborations
As well as providing a SaaS product for academics, the Company actively
collaborates with academic organisations and pharmaceutical company consortia
to gather data to validate and promote solutions and broaden the user base for
our products. Some of these are grant-funded, providing additional income for
the Company.
During 2023, in addition to the Trials@Home trial, there were notable
achievements with several high profile collaborations, including:
● Publication by the IdeaFAST Consortium of the multi-device pilot, showing
Cambridge Cognition's fatigue assessments were effective, usable and sensitive
in the pilot, and appropriate for use in clinical trials by pharma clients.
● Announcement of the inclusion of the Company's solutions in the EU & UK
funded AD-RIDDLE project that aims to pair real world solutions for
Alzheimer's Disease detection with targeted interventions.
● Selection of our assessment by the Michael J Fox foundation for use in their
Parkinson's Disease PPMI study.
Clinical Trial Solutions
The Company's clinical trial solutions, eCOA and decentralised clinical trial
product, saw major progress in 2023:
● The combined product offering has enabled the Company to bid for major eCOA
tenders.
● The Clinpal solution was developed further, with a new app, eConsent and
Telehealth modules, and launched as the RADIAL solution.
● A third regional data centre was opened, enabling the Company to provide
services within the US, EU and Asian blocks meeting local patient privacy and
data transfer requirements.
Combined product offering
An early objective of the acquisition of Clinpal and Winterlight was to put
together a combined offering with seamless functionality within a single
front-end user interface. This was done in early 2023, enabling sales of the
combined solution in the second half of the year.
Operational Review
We operate to high regulatory standards, supporting Good Clinical Practice for
clinical trials so that clients can use the data collected for new drug
applications and label claims. We continue to deliver outstanding services to
clients, supported by a customer satisfaction net promotor score of 66 in
2023, which is 32 above the average(8).
Over the course of the year, the Company made considerable improvements in
internal operations, introducing new cloud-based systems for operational
management, people management, quality assurance and learning and training
record-keeping. We completed 21 client and certification audits, including
recertification during the year for ISO9001 and ISO 14001 and we maintained
ISO 27001.
In 2023, the three companies were restructured into one single organisation to
provide a seamless service to customers. In completing this, costs were
reduced whilst maintaining the same high level of client delivery and a strong
customer focus.
Business Model
The Company's business model centres around the provision of easy-to-use
applications to measure patients in clinical trial site settings or at home.
The primary advantage for clients is that the Company gathers reliable, novel
data that can demonstrate the efficacy or safety of a therapeutic agent and,
moreover, may do so with more reliability and accuracy than alternatives, and
measuring a smaller effect size or specific elements.
The key components of the business model are:
● Fully serviced solution, such that a preconfigured application is provided for
patients or clinicians on a device and training is provided as required to
client project managers and site staff.
● Scientific consultancy, using a data-based approach to recommend outcome
assessments for clinical trials, leveraging our existing publications and
expert scientists.
● Provider of data and final reports that can be used to guide pharmaceutical
company decision-making during the clinical phase of drug development or used
for a data package for a new drug.
● Consultancy services that require a bespoke solution. These services can
contribute additional revenue streams and strengthen client relationships.
● SaaS solution provided to academics, so that they configure and manage trials
themselves at accessible prices.
● Maximising value of non-core solutions, such as the spin-out of Monument
Therapeutics to develop and commercialise drug and digital diagnostic
therapeutics for CNS disorders.
Advantages of the business model include:
● Highly configurable system with no software development required for standard
cognitive assessment and eCOA studies, enabling a rapid service delivery and
higher margins.
● Scientific rigour and verification ensures a high level of accuracy,
reliability and validity, providing confidence in the data results.
● Diversified offering, with functional assessments, eCOA and quality assurance,
reducing dependency on a single market and broadening our customer base.
● Long-term relationships with many existing clients and customer advocates
brings business from existing and new clients, supported by exceptional
customer service and multiple senior scientist contacts.
The business model is expected to provide returns on the investments made over
time through:
● Market leading position with a range of proprietary products widely validated
both academically and commercially, led by CANTAB™ and supported by emerging
voice technologies and a differentiated eCOA offering.
● Significant addressable and growing market.
● Diverse, blue-chip customer base that includes many of the world's leading
pharmaceutical companies.
● Fully integrated acquisitions with synergies realised and positioned to
capitalise on market opportunities.
● Experienced leadership team strengthened by new Non-Executives Directors and
the recently formed Scientific Advisory Board.
Acquisition Performance
Having acquired Clinpal and Winterlight, our primary goals in 2023 were to
integrate the three organisations into one operational structure and to
promote multi-product, end-to-end solutions. We are pleased to have achieved
this, with cost synergies realised above our original expectations.
Following the acquisition of Winterlight, the combined team continued the
development and production of AQUA, which helped to secure a significant
contract with a new customer. The Clinpal team focused on the launch of
RADIAL, which went live in July 2023, and we leveraged the Clinpal platform to
enhance our eCOA offering, an area for growth in 2024.
Commercially, the acquisitions performed in line with the rest of the
business. We remain confident there is significant potential in the medium
term, as we are able to offer a broader range of solutions to support larger
contract opportunities.
Monument Therapeutics ('Monument')
Cambridge Cognition spun out Monument in 2021 to combine the Company's digital
biomarkers with novel drugs and provide targeted precision therapeutics.
Cambridge Cognition had been incubating Monument since 2018, with early-stage
research supported by two Innovate UK grants. Monument is now a novel drug
development company with a pipeline of promising drug development programmes,
with the most advanced being for cognitive impairment in schizophrenia.
Over 2023, Monument made positive progress in clinical trials, demonstrating
stability and activity of the compounds and validity of the digital
biomarkers. As a result, the fair value of Monument has been increased to
£156k, although significantly discounted to reflect the level of risk in
early stage companies and the inherent risk of future fundraising by
Monument.
Subsequent to the period-end, Monument announced a fundraising of £1.0m and a
grant of £0.5m that will enable to the initiation of clinical trials for the
digital assessment and drug combination for schizophrenia. The fundraising
valued Monument at approximately £7m with Cambridge Cognition holding 25%
post raise. This, together with the license agreement that includes
royalties on future sales by Monument may generate considerable financial
benefit for Cambridge Cognition if Monument is successful.
Growth Strategy
Our overarching goal as we entered 2023 was to continue to grow revenue and
move to sustainable profitability. Good progress was made, with revenue growth
of 7% in 2023 and profitability achieved in the second half of the year. Our
strategy was to complete development and commercialise our unique set of well
protected, high value and validated solutions. We continue to monitor the
healthcare market with the readiness to promote our medical devices as and
when increased demand resurfaces.
Our progress for 2023 and the non-financial strategic objectives for 2024 are
set out below:
Area of focus Progress in 2023 Objectives in 2024
Driving sales of existing products and winning a greater volume of clinical Multiple major contracts won including a combined project that incorporated Target well-funded companies with active programs through an extensive science
trial work for our broader portfolio, including combined offerings CANTAB™, Voice and AQUA led pre-sales process to demonstrate unique technology solutions
Establishing partnerships in the sector, such as with major pharmaceutical Agreed a co-promotion with Actigraph (announced early 2024) and progressed Progress existing and seek partnerships with global pharmaceutical and CRO
companies, CROs and suppliers discussions with a with major pharmaceutical company and CRO companies
Investing in innovation to maintain our brand position and complete the Launch of AQUA, integration with eCOA product offering, and launch of RADIAL Analyse new data and present advantages of our solutions and form a scientific
development of our offering app advisory board to support our growth
Realising synergies from acquisitions, driving efficiencies in the business, Integrated the three businesses to one operational structure with a single Leverage operational systems for further cost-reduction and implement internal
and ensuring continued customer focus go-to-market strategy and introduced multiple cloud-based systems for AI large language models ('LLM') solutions to gain productivity advances
operational efficiencies
Focusing on our people and ensuring Cambridge Cognition is a great place to Integrated the Clinpal and Winterlight teams with Cambridge Cognition Develop career pathways and competency led career journeys
work
External factors: Economic, Technical, Regulatory Environment
External factors have and continue to impact our market and operations,
presenting opportunities and also challenges for the Company.
Inflation and high interest rates affected the Company in 2023 with rising
costs, though these were mitigated through cost-saving measures and margins
have improved. At the same time, we have taken advantage of considerable
advances in cloud-based solutions to enable operational efficiencies in 2024.
The global macro-economic environment, which affected our market, has improved
recently. There was cost-cutting across major pharmaceutical companies and a
drop-off in investment in biotech companies. We have seen the impact of these
on the demand for more experimental assessments. There has been continued
demand for eCOA solutions. We are now seeing an increase in investment in
the CNS sector by major pharmaceutical companies and expect the market will
normalise late in 2024 or in 2025. That is aligned with the independent market
reports that indicate eCOA market growth of 16% from 2024 to 2029.
Cambridge Cognition is at the forefront of advances in AI present
opportunities. The Company provides solutions that involve complex machine
learning models that are trained on clinical data sources. In addition,
there was a new programme of work in 2023 to identify operational processes
that could be improved by leveraging LLMs and this is continuing in 2024.
The regulatory environment continues to be encouraging, with the FDA and the
EMA setting out clear guidance and discussion documents for new approaches for
digital biomarkers, decentralised trials and the use of real-world evidence
for clinical trials. A major shift that could support further use of our
solutions is the FDA's focus on the importance of patient meaningfulness of
outcome measures, such that they are starting to require evidence that
translates to an impact on a patient's life. Our measurements are inherently
meaningful, for example memory, speech and language are necessary for normal
day-to-day functioning.
Longer-term Outlook
The Company has grown consistently over the last five years with a revenue
CAGR of over 20%. Despite a challenging global economic environment in 2023,
we have grown revenue whilst managing our cost base accordingly.
We operate in a large market that is forecast to grow at 16% per annum over
the next five years. We have been further encouraged by the recent M&A
activity in the CNS sector, with over $30bn being invested by major pharma
recently. We are confident that the investment in neurological research will
result in more opportunities for Cambridge Cognition in the future as the
adoption of digital clinical trial solutions increases and, in time, becomes
the industry measurement standard.
With the products in our portfolio, both developed and acquired, we have a
fully-developed end-to-end solution for clinical trials that we are actively
commercialising. Post-period end, we invested in our team with key
appointments to drive greater lead generation, increase the quality and
conversion of opportunities, and to promote Cambridge Cognition as a leader in
CNS clinical trials solutions.
The longer-term growth outlook remains exciting for Cambridge Cognition, with
a strong addressable market and a well-positioned portfolio of products.
Following our refreshed focus on commercial execution, we have seen levels of
engagement from our customers that will enable us to win more consistent and
sizeable contracts and grow profitability in the coming years. I look forward
to updating you on our progress during the year.
References:
1. Citeline TrialTrove, April 2024.
2. Astute Analytica (2021) US Cognitive Assessment Market.
3. Markets & Markets (2024), eCOA Solutions Size And Global Industry Forecast
2029
4. Estimate from Global Data, April 2023, and Assessing the Financial Value of
Decentralised Clinical Trials, Therapeutic Innovation & Regulatory
Sciences, 57, 209-19, 2023.
5. Global Market Estimates (2024), Decentralized Clinical Trial (DCT) Platforms
Market.
6. Grandview Research (2022), Clinical Trial Patient Recruitment Market; Adjusted
by CNS studies as a proportion of all.
7. Extrapolated from independent market research report commissioned by Cambridge
Cognition.
8. Retently (2024), Data of average customer satisfaction for healthcare.
CHIEF FINANCIAL OFFICER'S REVIEW
Overview
The Company saw revenue growth of 7% in 2023 and returned to profitability in
the second half of the year following growth in the contracted book in the
first half and from realising cost benefits associated with the integration of
Clinpal and Winterlight. The Company ended the year with cash of £3.2m.
This review includes a comparison of the financial KPIs used to measure
progress over the year:
KPI 2023 2022 Movement Movement
Revenue £13.5m £12.6m £0.9m 7%
Gross margin 79.9% 73.9% 600bps 8%
Adjusted operating (loss)/profit £(1.1)m £0.1m £(1.2)m -%
Investment in R&D £3.8m £2.3m £1.5m 168%
Sales orders £10.9m £13.1m £(1.2)m (9)%
Contracted order book £17.2m £17.6m £(0.4)m (2)%
Cash £3.2m £8.3m £(5.1)m (61)%
After a tax charge of £0.1m (2022: £0.2m tax credit), the post-tax loss for
the year was £3.5m (2022: £0.4m) which equates to a loss per share of 10.1
pence (2022: 1.3 pence loss per share).
Adjusted operating (loss)/profit
We have presented a non-GAAP measure of adjusted operating loss to enable year
on year comparison of ongoing operational results, which excludes
non-recurring items associated with acquisitions and restructuring, non-cash
charges associated with acquisitions and share-based payment charges as
follows:
2023 2022
£m £m
Operating loss (3.3) (0.6)
Amortisation of acquired intangibles 0.5 -
Share-based payment charges 0.2 0.2
Non-recurring items 1.5 0.5
Adjusted operating (loss)/profit (1.1) 0.1
Non-recurring items include costs associated with acquisitions and integration
of £1.3m (2022: £0.5m) as well as restructuring costs of £0.2m (2022:
£nil).
Revenues and gross profit
Revenue grew by 7% to £13.5m compared to £12.6m in 2022 in difficult market
conditions with a good conversion from the contracted order book. A large
proportion of our contracts are for clinical trials, which usually commence
three to six months after the signing of the contract and can run for several
months or up to five years. As a result, the Company recognised more than half
of the revenue in 2023 from orders won in previous years, with the remaining
balance from in-year contract wins.
We anticipate the £17.2m contracted order book at 31 December 2023 will
generate at least £8.0m of revenue to be recognised in 2024, subject to
customer schedules and start dates, with the balance to be recognised in
subsequent years.
Recognised revenue split by type was as follows:
2023 2022 Movement Movement
£m £m £m %
Software 6.5 5.0 1.5 30%
Services 6.4 6.5 (0.1) (2)%
Total Software & Services 12.9 11.5 1.4 12%
Hardware 0.6 1.1 (0.5) (45)%
Total Revenue 13.5 12.6 0.9 7%
As expected, software revenue continued to grow in 2023 and increased by 30%,
reflecting the usage of assessments from large contracts signed in previous
years. Services revenue decreased marginally in 2023 and is reflective of the
data and study management services being provided evenly over the term of the
contracts following go-live. Hardware, which is procured from third parties,
decreased in the year due to the prior year including a contract with an
unusually high hardware element.
Gross profit was £10.8m (79.9% margin) compared with £9.3m (73.9% margin) in
2022. The improvement in margin was due to higher third-party costs on three
large, one-off contracts delivered in 2022 (won in 2021) as well as a lower
number of new study starts in 2023 (where a large proportion of third-party
costs are incurred).
Expenditure
In the first half of 2023, we completed the operational integration of Clinpal
and Winterlight, resulting in a single organisational structure and a
commercial team with a single go to market strategy. This resulted in the
realisation of more than £1.5m of cost synergies that we had not anticipated
from the acquisitions and the Company returning to profitability in the second
half of 2023, ahead of expectations.
Operating expenses have been presented by function for 2023 according to the
following definitions:
Category Description 2023 2022
£m £m
Research and development expense New product development including software research and development and 3.8 2.3
scientific support
Sales and marketing expense Commercial, marketing and pre-sales scientific support 3.0 2.5
Administrative expenses Corporate management, product and platform maintenance, finance, legal, HR, 6.1 4.8
quality and IT
Non-recurring items Acquisition, integration and restructuring 1.5 0.5
Total operating expense 14.4 10.1
Total operating expense increased to £14.4m (2022: £10.1m), driven primarily
by additional costs from the acquired businesses, the non-recurring items
directly related to the acquisition and integration and amortisation of
acquired intangible assets (included in Research and development expense:
£0.5m, Sales and marketing expense: £0.1m).
In recent years, we have maintained a high level of expense on research and
development to complete the development of key products. This expenditure
increased in 2023 from £2.3m to £3.8m following the acquisition of Clinpal
and Winterlight. During 2023, we continued to invest in developing the
portfolio through the launch of new tasks for mobile devices, the development
of AQUA, integration of Winterlight voice tasks to the Connect platform and
the completion of our multi-region server programme to ensure more secure data
protection for our customers. Going forward we expect research and
development expenditure to reduce as we focus on maximising the commercial
opportunities from our current product portfolio.
Sales and marketing expense increased from £2.5m in 2022 to £3.0m for the
current year, as we made selective hires to the team in order to strengthen
our position in key regions.
Administrative expense increased from £4.8m in 2022 to £6.1m due primarily
to the higher initial costs associated with the larger group following the
Clinpal and Winterlight acquisitions. Following the integration and
efficiency measures that we have implemented over the last 12 months we expect
this to reduce in 2024.
Taxation
The tax charge for the year includes tax charges for foreign entities of
£0.2m, including adjustments to prior period provisions, offset by R&D
Credits of £0.1m.
Cash and capital expenditure
As of 31 December 2023, cash was £3.2m (31 December 2022: £8.3m), with the
cash outflow from operating activities during the year was £5.0m (2022:
inflow £1.7m), reflecting the lower sales order levels as well as the higher
operating expense following the acquisitions. During the year, £3.0m of cash
was paid to acquire Winterlight. In September 2023, the Company secured a
fully drawn £2.9m term loan to provide working capital and enable investment
in product development and solution integration during 2023. The loan has been
fully drawn down with a term of 36 months and is repayable, with interest, in
30 monthly instalments following an initial six-month interest only period.
Capital expenditure was £0.1m, primarily related to IT hardware and office
equipment. We have not capitalised any development expenditure in the year as
the criteria has not been met for new product development, primarily due to
the timing between the costs to develop being incurred and the clinical
validation needed to make the product available to market.
Balance sheet
The Company held an investment of 28% in Monument Therapeutics Limited
('Monument') at 31 December 2023, the digital phenotyping drug development
business that was spun out in 2021. The fair value of the investment in
Monument has been increased from £49k to £156k and reflects a
non-controlling interest in an unquoted investment whilst recognising that
there are significant risks associated with early-stage biotechnology
companies, including future fund raising. Monument has continued to make
positive progress during the year, including the grant of a US patent
supporting MT1988 program for Schizophrenia, and remains on track with our
expectations.
Subsequent to the year end, Monument secured further investment of £1.0m
valuing Monument at approximately £7m and reducing the Company's holding to
25%. Monument also secured a further £0.5m of grant funding, which together
with the investment will enable it to continue its development programmes.
Goodwill and other intangible assets increased to £7.7m (2022: £1.4m). This
reflects assets arising from the acquisition of Winterlight in January 2023.
Trade and other receivables decreased to £2.4m (2022: £4.7m) due to the
timing of customer invoicing and the release of prepayments associated with
contract delivery.
Deferred income on contracts with customers decreased to £7.7m (2022:
£12.3m) due to the lower level of invoicing on contracts in 2023 relative to
revenue recognised. Deferred revenue balances primarily arise early in a
contract as software licenses are typically invoiced at signing of the
contract.
Financial outlook
Cambridge Cognition ended 2023 with £3.2m cash and a healthy pipeline,
although the Company has continued to experience longer lead times for
contracting and impacting on invoicing levels. With the current expectations
on conversion of opportunities in the pipeline, revenue is expected to be in
the range of £13.0m to £15.0m for 2024, although the Company continues to
engage in discussions with strategic partners that could deliver revenue above
this level. The Company expects to recognise £9m of revenue in 2024 from
the contracted order book, including revenue recognised in the first quarter.
The cost base continues to be managed relative to the revenue growth prospects
and the Company has structured its operations to achieve profitability and
provide a stable base for future growth. We anticipate that operating expenses
and particularly research and development expense will reduce in 2024 as we
focus on the commercial execution of our existing product portfolio leading to
profitability for the full year. In the meantime, we continue to manage
working capital based on our current expectations and the reduced cost base.
The Company aims to deliver continued revenue growth at above market levels
into 2025 and beyond with a cost base that will provide significant
operational leverage and strong potential for future earnings growth.
CONSOLIDATED STATEMENT OF COMPREHENSIVE INCOME
(Unaudited) (Audited)
Year to Year to
31 December 31 December 2022
2023
Notes £'000 £'000
Revenue 3 13,515 12,613
Cost of sales (2,717) (3,291)
Gross profit 10,798 9,322
Research and development expense (3,847) (2,285)
Sales and marketing expense (2,983) (2,528)
Administrative expense (6,139) (4,803)
Non-recurring items (1,456) (479)
Total operating expense (14,425) (10,095)
Other operating income 322 156
Operating loss (3,305) (617)
Adjusted operating (loss)/profit (1,128) 68
Adjusting items(1) (2,177) (685)
Operating loss (3,305) (617)
Interest receivable 16 9
Finance costs (168) (16)
Loss before tax (3,457) (624)
Tax (expense)/credit (51) 215
Loss for the year (3,508) (409)
Other comprehensive loss
Items that may subsequently be reclassified to profit or loss:
Exchange differences on translation of foreign operations (210) (302)
Fair value movements in equity investments 107 -
Total comprehensive loss for the year (3,611) (711)
Loss per share (pence)
Basic 4 (10.1) (1.3)
Diluted 4 (10.1) (1.3)
All items of income are attributable to the equity holders in the Parent.
The above results relate to continuing operations.
1. Adjusting items comprise amortisation of acquisition related
intangible assets of £561,000 (2022: £32,000), non-recurring items of
£1,456,000 (2022: £479,000) and share-based payments of £160,000 (2022:
£174,000).
CONSOLIDATED STATEMENT OF FINANCIAL POSITION
(Unaudited) (Audited)
At 31 December 2023 At 31 December 2022
Notes £'000 £'000
Assets
Non-current assets
Goodwill 3,653 482
Other intangible assets 4,089 939
Property, plant and equipment 133 188
Investments 156 49
Trade and other receivables 20 -
Total non-current assets 8,051 1,658
Current assets
Inventories 187 216
Trade and other receivables 2,417 4,680
Current tax receivable 351 231
Cash and cash equivalents 5 3,222 8,322
Total current assets 6,177 13,449
Total assets 14,228 15,107
Liabilities
Current liabilities
Trade and other payables 2,603 2,718
Deferred income on contracts with customers 3 7,699 12,294
Loans and borrowings 566 -
Current tax payable 99 -
Total current liabilities 10,967 15,012
Non-current liabilities
Loans and borrowings 1,978 -
Total non-current liabilities 1,978 -
Total liabilities 12,945 15,012
Equity
Share capital 350 312
Share premium 15,169 11,151
Other reserves 5,613 5,823
Own shares (71) (71)
Retained earnings (19,778) (17,120)
Total equity 1,283 95
Total liabilities and equity 14,228 15,107
CONSOLIDATED STATEMENT OF CHANGES IN EQUITY
Share capital Share premium Other reserves Own shares Retained earnings
Total
£'000 £'000 £'000 £'000 £'000 £'000
At 1 January 2022 312 11,151 6,125 (78) (16,878) 632
Loss for year - - - - (409) (409)
Other comprehensive loss
Exchange differences on translation of foreign operations - - (302) - - (302)
Total comprehensive loss for the year - - (302) - (409) (711)
Transactions with owners
Transfer of own shares - - - 7 (7) -
Credit to equity for share-based payments - - - - 174 174
Transactions with owners - - - 7 167 174
At 31 December 2022 (audited) 312 11,151 5,823 (71) (17,120) 95
Loss for the year - - - - (3,508) (3,508)
Other comprehensive loss
Exchange differences on translation of foreign operations - - (210) - - (210)
Fair value movements in equity investments - - - - 107 107
Total comprehensive loss for the year - - (210) - (3,401) (3,611)
Transactions with owners
Issue of new shares in relation to business combinations 34 3,966 - - - 4,000
Issue of new shares in relation to exercise of employee share options 4 52 - - - 56
Credit to equity for share-based payments - - - - 160 160
Deferred contingent consideration movements - - - - 309 309
Issue of warrants - - - - 274 274
Transactions with owners 38 4,018 - - 743 4,799
At 31 December 2023 (unaudited) 350 15,169 5,613 (71) (19,778) 1,283
CONSOLIDATED STATEMENT OF CASH FLOWS
(Unaudited) (Audited)
Year to Year to
31 December 2023 31 December 2022
Notes £'000 £'000
Net cash flows (used in)/generated from operating activities 5 (4,967) 1,668
Investing activities
Acquisition of subsidiary, net of cash acquired (3,002) -
Interest received 16 9
Purchase of property, plant and equipment (33) (189)
Net cash flow used in investing activities (3,019) (180)
Financing activities
Proceeds from borrowings, net of fees incurred 3,054 -
Proceeds from exercise of share options 56 1
Repayment of borrowings (116) (133)
Interest payments (109) -
Net cash flows generated from/(used in) financing activities 2,885 (132)
Net (decrease)/increase in cash and cash equivalents (5,101) 1,356
Cash and cash equivalents at start of year 8,322 6,810
Exchange differences on cash and cash equivalents 1 156
Cash and cash equivalents at end of year 5 3,222 8,322
NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS
1. General information
Cambridge Cognition Holdings plc ('the Company') and its subsidiaries
(together, 'the Group') develops and markets digital solutions to assess brain
health.
The Company is a public limited company which is listed on the AIM market of
the London Stock Exchange (symbol: COG) and is incorporated and domiciled in
the UK. The address of its registered office is Tunbridge Court, Tunbridge
Lane, Bottisham, Cambridge, CB25 9TU.
2. Basis of preparation
The preliminary financial information for the year ended 31 December 2023 is
unaudited. As such, the unaudited preliminary financial information presented
does not represent statutory financial statements within the meaning of
section 435 of the Companies Act 2006.
The statutory financial statements for the year ended 31 December 2022, upon
which the auditors issued an unqualified opinion, have been delivered to the
Registrar of Companies and did not contain statements under section 498(2) or
(3) of the Companies Act 2006.
The accounting policies adopted are consistent with those followed in the
preparation of the consolidated financial statements for the year ended 31
December 2022 The accounts are presented in Pounds Sterling ('£'), and to the
nearest £1,000.
The consolidated financial statements incorporate the results of the Company
and of its subsidiaries. All intra-group transactions, balances, income and
expenses are eliminated in full on consolidation. All of the Group's
subsidiaries are wholly owned.
The Group has made the following changes to the presentation of the
Consolidated Statement of Comprehensive Income and Consolidated Statement of
Financial Position, which have resulted in restatements of prior period
balances:
● Consolidated Statement of Comprehensive Income: the Group previously combined
Research and development expense, Sales and marketing expense and
Administrative expense (excluding non-recurring items) into Administrative
expense (excluding non-recurring items). These have been separately presented
in 2023 to better represent the nature of the expenditure. The overall
operating loss for 2022 remains unchanged.
● Consolidated Statement of Financial Position: the Group previously combined
Goodwill and Other intangible assets within Intangible assets. These have been
separately presented in 2023 due to their materiality. The overall total and
net asset balance for 2022 remain unchanged.
● Consolidated Statement of Financial Position: the Group previously combined
Trade and other payables and Deferred income from contracts with customers
within Trade and other payables. These have been separately presented in 2023
due to their materiality. The total liability and net asset balances for 2022
remain unchanged.
The Directors have adopted a going concern basis of accounting and, in doing
so, have considered the cash requirement of the Group through to the period
ended 30 June 2025. The Directors expect that the Group will remain cash
positive throughout the going concern period, with a net cash outflow for 2024
and a net cash inflow thereafter. The Directors have considered mitigating
actions that could be taken in the event of downside scenarios and will take
action to manage working capital. Delays to orders that reduce cash below
the downside case are likely to require the need to raise additional funds for
working capital. The preliminary unaudited results for the year ended 31
December 2023 have been prepared on the going concern basis of accounting.
3. Revenue
An analysis of the Group's revenue for each major product and service category
is as follows:
(Unaudited) (Audited)
2023 2022
£'000 £'000
Software 6,532 5,027
Services 6,364 6,528
Hardware 619 1,058
13,515 12,613
Costs cannot be directly attributed to the products and services above so
profit measures are not presented.
Geographical information
The revenue from external customers by geographical location is detailed
below:
(Unaudited) (Audited)
2023 2022
£'000 £'000
United Kingdom 1,010 1,088
United States of America 9,368 7,422
European Union 2,505 3,195
Rest of World 632 908
13,515 12,613
Non-current assets held in the United Kingdom amounted to £4.7 million (2022:
£1.7 million). Non-current assets held in all foreign countries amounted to
£3.3 million (2022: £nil). Material non-current assets are held in Canada
amounting to £3.1 million (2022: £nil). No other country holds material
non-current assets.
Information about major customers
One customer accounted for more than 10% of reported revenue in 2023,
amounting to 18% of the total (2022: three customers amounting to 34%).
Revenue from contracts with customers
All revenue in 2023 and 2022 comes from contracts with customers.
Timing of revenue recognition
Some software and services are recognised over a period of time, and some at a
point in time. The split of revenue in line with these factors is as follows:
(Unaudited) (Audited)
2023 2022
£'000 £'000
Software - delivered over a period of time 6,440 4,535
Software - delivered at a point in time 92 492
Services - delivered over a period of time 5,492 5,173
Services - delivered at a point in time 872 1,355
Hardware - recognised at a point in time 619 1,058
13,515 12,613
Of the £12.3 million Deferred income from contracts with customers at 31
December 2022, £9.1 million was recognised as revenue in 2023. Of the £8.8
million Deferred income from contracts with customers at 31 December 2021,
£6.0 million was recognised as revenue in 2022.
Payment terms can vary from customer to customer and are subject to
negotiation. Normally, software will be invoiced at the point of initial sale
and services invoiced as delivered. This creates a deferred income balance in
respect of software which will be reduced as the software is used.
Contract balances
Contract balances are as follows:
(Unaudited) (Audited)
2023 2022
£'000 £'000
Trade receivables 1,039 2,073
Accrued income on contracts with customers 211 206
Deferred income on contracts with customers 7,699 12,294
Trade receivables decreased due to improved cash collection, and significant
deals with large up-front billing closing in November and December 2022.
Accrued income on contracts with customers did not materially change.
Deferred income on contracts with customers decreased as revenue was
recognised in excess of new sales invoicing.
Deferred commissions
Deferred commissions are presented as part of Trade and other receivables. The
Group does not consider any of these amounts impaired. The movement of this
account specifically is as follows:
(Unaudited) (Audited)
2023 2022
£'000 £'000
At 1 January 706 728
Recognised in Consolidated Statement of Comprehensive Income (385) (332)
Net addition from sales in year 71 283
Exchange adjustments (10) 27
At 31 December 382 706
4. Earnings per share
The calculation of basic and diluted earnings per share ('EPS') is based on
the following data:
Earnings
(Unaudited) 2023 (Audited) 2022
£'000 £'000
Earnings for the purposes of basic and diluted EPS per share being net loss (3,508) (409)
attributable to owners of the Company
Weighted average number of ordinary shares:
(Unaudited) (Audited)
2023 2022
'000 '000
For the purposes of basic EPS 34,586 31,170
For the purposes of diluted EPS 34,586 31,170
The diluted loss per share is considered to be the same as the basic loss per
share. Potential dilutive shares are not treated as dilutive where they
would result in a loss per share.
(Unaudited) 2023 (Audited) 2022
pence pence
Basic EPS (10.1) (1.3)
Diluted EPS (10.1) (1.3)
5. Notes to the cash flow statement
(Unaudited) (Audited)
2023 2022
£'000 £'000
Loss before tax (3,457) (624)
Adjustments for:
Depreciation of property, plant and equipment 97 57
Impairment of property, plant and equipment 3 -
Amortisation of intangible assets 568 37
Share-based payments charge 160 174
Finance costs 168 -
Acquisition related expenses deferred amounts 318 6
Interest receivable (16) (9)
Research and Development expenditure tax credit (73) -
Operating cash flows before movements in working capital (2,232) (359)
Decrease/(increase) in inventories 29 (88)
Decrease in trade and other receivables 2,235 1,012
Decrease in trade and other payables (445) (1,718)
(Decrease)/increase in deferred income on contracts with customers (4,667) 2,630
Cash (used in)/generated from operations (5,080) 1,477
Taxation credit received less tax paid 113 191
Net cash (used in)/generated from operating activities (4,967) 1,668
Reconciliation of liabilities arising from financing activities
(Unaudited) (Audited)
2023 2022
£'000 £'000
Net Debt at 1 January - -
Debt acquired in business combination - 133
Term loan draw down 3,054 -
Repayment of borrowings (116) (133)
Interest expense 147 -
Interest paid (88) -
Offsetting
- Transaction costs (175) -
- Warrant costs (274) -
Exchange adjustments (4) -
Net Debt at 31 December 2,544 -
Cash and cash equivalents
(Unaudited) (Audited)
2023 2022
£'000 £'000
Cash and cash equivalents 3,222 8,322
Cash and cash equivalents comprise cash and short-term bank deposits with an
original maturity of three months or less. The carrying amount of these assets
is approximately equal to their fair value.
6. Annual Report and Annual General Meeting
The Company announces its intention to hold its Annual General Meeting ('AGM')
on 27 June 2024. Details of the AGM will be communicated to shareholders via
the Company's website and a Regulatory Information Service as soon as they are
finalised. This notice will also include the date on which the notice of AGM
and the Annual Report will be posted to shareholders.
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