Management's review
Beskrivelse af virksomhedens væsentligste aktiviteter:Who we are
Qufora is committed to building a centre of excellence to create solutions for people with bowel disorders
through innovation. Solutions that set new standards and make toilet routines as effortless and natural as
possible for users.
We do this because living with a chronic bowel disorder is hard enough without the anxiety, difficulties
and taboos complicating peoples lives. Bowel disorders take a big emotional toll on those struggling to
maintain their confidence, dignity and desire to lead fulfilling lives. That is why we focus on developing
products that are so easy and intuitive to use, people can regain their sense of control and selfconfidence.
We are proud to offer the widest range of bowel irrigation solutions available today and our
ambition is to become industry leaders by 2025.
Leading the industry by passion, innovation and collaboration
Qufora is based on its founders personal story of bowel
dysfunction; our motivation has been personal from the
start. Our aspiration for Qufora is the same today as when
we started: everyone at Qufora is striving to challenge the
status quo and pioneer the advancement of the bowel
irrigation industry to serve a range of customer segments.
At Qufora, our work is driven by four cornerstones:
Problem-solving
We believe everyone deserves the right to bowel irrigation solutions that fit seamlessly
into their lives regardless of their situation, or how active they want to be.
Product-designing
We design functional, simple and æsthetic medical aids for people with bowel
dysfunction to live their best and most fulfilled lives. We call it design that matters.
Passion-driven
Qufora is more than a business, it is a personal story. Living with a spinal cord injury,
one of our founders believed that bowel irrigation solutions could be improved.
Partner-oriented
Everything we do is centered around the experience of users and healthcare
professionals. We embrace co-creation and seek to collaborate across all levels, to be
inspired to create better solutions.
Strategy
At Qufora, we work hard every day to provide our customers with the highest quality bowel
irrigation products that help people with chronic bowel disorders live more fulfilling lives.
Our 2025 strategy: innovation leadership, partnerships with clinicians, a broader geographical
footprint and digitalisation.
Digitalisation
Innovation leadership
Broader geographical footprint
Partnerships with clinicians
We continue to execute on our innovation leadership strategy. Throughout 2022 we launched
our newest product Qufora IrriSedo Flow with success. Through dedicated and structured user
involvement we were able to incorporate enhanced functionality through design improvements,
and obtained a prestigious design award for the product in recognition of the new design
standards it set.
By listening carefully to our customers, we aim to address more user needs, helping people
to regain their sense of control and self-confidence. We aim to make our bowel solutions
accessible to all people with the need, so more people can benefit from innovative solutions
with consistent high quality and that are easy and intuitive to use.
We are dedicated to creating an ambitious pipeline of products and services that will
demonstrate our innovation leadership in the bowel management market. Because the people
with bowel problems deserve it.
We understand how important our products are to maintaining health and well-being. This we
share with the dedicated healthcare professionals (HCPs) who everyday strive to help their
patients. They are the voice and hearts of their patients, and we rely on their valuable input in
our product and service development. Our interactions with HCPs in 2022 have increased, and
we have started interacting with them more at congresses (after COVID-19 restrictions) and we
are setting up Advisory Boards in more countries, now we are active in the UK and Germany
with more to come.
Year in headlines
In 2022 sales finished at 147,0 MDKK, slightly higher than expected and 17,4 % over last year.
Gross Margin finished at 63,5 %, an improvement over 2021.
EBITDA in 2022 finished at 11,1%, which is below our target due to higher-than-expected material and transportation costs together with increased investments into sales subsidiaries.
Operating profit finished at 11,2 MDKK, which is lower than expected, also impacted from unfavorable currencies.
Our bowel care business develops well in our key markets and continence care also performed above expectations.
We outgrew the market in bowel care and had a positive development in both new patient discharge shares and market shares.
Our positive market performance is primarily driven by our newest launches of MiniGo and Flow.
Given the backdrop of challenging supply conditions, management finds the 2022 results satisfactory, and we expect the positive growth momentum to continue in 2023.
Our business areas
Bowel care
Bowel care is our core business area, addressing chronic constipation and fæcal incontinence. We design,
develop and market a wide range of solutions for bowel irrigation through our network of subsidiaries and
distributors.
Our products are easy and intuitive to use, providing individuals that are prescribed bowel irrigation with
the means to regain their sense of control and self-confidence. By designing innovative solutions, we keep
challenging ourselves, so people get better and better products to live the life they want. Solutions that
set new standards and make toilet routines as effortless and natural as possible for users.
Continence care
Our continence care business area represents our legacy products. We design, import, and distribute a
wide range of easy-to-use and reliable urinary collection bags, valves and accessories, under the Qufora
brand. We provide one-shop customer solutions taking full control of regulatory requirements and supply
chain management. Expected development, including special assumptions and uncertain factors
First quarter of 2022 ended according to budget. Expectations for the entire year are sales growth between 15-20% over 2021. Disruptions to the global supply chains remains to be a cause of uncertainty. Increasing inflation and interests rates are also matters of concern to management.
Recognised for growth: six-time Børsen Gazelle award recipient
Gazelle companies are known for their innovative thinking, ability to adapt
and grow fast doubling up on growth. At Qufora, we take immense pride
in being recognised amongst these exceptional organisations, having been
awarded the Børsen Gazelle six times during the past decade. It is managements assessment that well-functioning logistic and quality assurance systems has been established as well as an extensive distribution network ensuring a platform for the launch of new products in existing and new markets.
Børsen Gazelle is a Danish Business award that is presented to companies that have achieved continuous
growth in revenue or gross profit for the last four financial years, and which has in total, more than
doubled the revenue or the gross profit in the period.
Management expects an improvement in EBITDA beyond the increase in sales due to higher sales of high margin products.
Raising awareness about the impact of bowel problems
Bowel problems are common, and they can affect anyone, regardless of their age, gender, or lifestyle.
Living with an invisible illness can be frustrating and cause discomfort and inconvenience.
The impact of bowel problems Research and development activities
Fæcal Incontinence During 2021 the Group has, as in previous years, been focused on development projects. These activities have influenced both the P&L and Balance Sheet for 2021. We expect these projects to have a positive effect on the results in the coming years.
The Group have developed a considerable portfolio of intangible assets, primarily trademarks and patents to secure these investments.
1 in 10 are affected
A largely hidden problem, many
patients feel too embarrassed or
ashamed to admit their symptoms to
HCPs and even family and friends2
Chronic Constipation
Worldwide, it is estimated to affect 14%
of adults
Almost 77,000 people were admitted to
hospital for it4
in the UK between 2018-19
Neurogenic bowel dysfunction
Spinal cord injury
Up to 95% of people with spinal cord injury
(SCI) report constipation and 75% have
experienced episodes of fæcal incontinence
Patients with an SCI report that bowel
dysfunction is the most important problem
among a wide variety of other
consequences.
Multiple Sclerosis
Between 35-54% of people with multiple sclerosis
(MS) suffer with chronic constipation6 and 29-51%
suffer with fæcal incontinence
Patients with MS rate bowel dysfunction as
the third most disabling symptom, after
motor disorder and fatigue
Although not usually life threatening, bowel problems can significantly impact quality of life. People
with bowel dysfunction can become isolated to varying degrees because the impact can be so allencompassing
- hygiene, loss of self-esteem, absence in the workplace, limited physical activity,
social isolation, among other issues.
While early-stage treatments in the pathway to effective bowel management, such as diet, exercise
training in defæcation dynamics techniques and medication manage symptoms for many studies
indicate that not only is there a knowledge gap about bowel irrigation as a treatment9 but also that the
length of time from onset of symptoms to starting irrigation can be very long, for example 10
years plus.
What are the underlying reasons for this? There are multiple contributing factors, which can include the
social taboos that surround it. Individuals with bowel issues may experience feelings of shame or fear
that prevent them from openly discussing their symptoms, not only with their doctor, but also with their
loved ones. Individuals may therefore not know where to go for help when they first experience bowel
problems, possibly resulting in long, complicated journeys to a specialist service. There can also be a
belief that there are limited treatment options available, with lifestyle changes or using over-the-counter
therapies as the only solutions, and treatments such as bowel irrigation a last resort treatment option.
What can be done to promote awareness of bowel problems as a common condition and encourage
individuals to seek appropriate healthcare for their symptoms? We believe that by challenging the
stigma around bowel problems, raising awareness about the symptoms and demystifying bowel
irrigation as a treatment option, we can make a positive impact.
As the internet often is the go-to source of information for people looking to understand their bowel
symptoms, we strive to leverage our digital presence to help raise awareness about bowel disorders
through informative and engaging content. Our goal is to contribute to the wider efforts to break down
taboos surrounding bowel dysfunction and increase awareness of the symptoms and their impact on
everyday life. By doing so, we aim to encourage people to seek medical advice if they experience the
effects of bowel dysfunction on their overall well-being.
In addition to providing educational content, tips, and tricks to help users of products to stay motivated
in maintaining their prescribed bowel irrigation regime, we share personal stories of how individuals
using bowel irrigation solutions can live their best and most fulfilled life.
Maybe one day taboos surrounding bowel problems can effectively be put aside.
Market description
Current market value of bowel irrigation
In 2022 our biggest market, the UK grew 10% in volume*. With Qufora growing 17% we significantly
outgrow the market and continue to be the main growth driver of the bowel irrigation market.
Our strategy to spread and grow our European footprint is well underway with good growth in all
markets, and our plan to enter the French market in 2024 is still pursued.
Performance
2022 Highlights
Expected development, including special assumptions and uncertain factors
The first quarter of 2023 ended above budget and expectations, and as a result, the following
three quarters are anticipated to be in line with the budget for FY2023. Fluctuating currencies
and high material costs continue to be causes of uncertainty and matters of concern for
management. Changing settlements to other currencies than Dollars is our mitigation that will
have effect from second quarter of 2023.
It is managements assessment that well-functioning logistics and quality assurance systems have
been established as well as an extensive distribution network ensuring a platform for the launch
of new products in existing and new markets.
The revenue for the year 2023 is expected to increase with at least 21% for both the group and
the parent company.
Highlights - key figures
Turnover
Turnover was 147 MDKK in 2022 growing with
17,4% mainly driven by bowel care in our key
markets.
Turnover in 2023 is expected to increase
with 21%.
EBITDA
EBITDA amounted to 16,3 MDKK in 2022,
equal to 11,1% driven by turnover increase.
EBITDA is expected to increase to 32,2 MDKK
in 2023, equaling 18,1%.
ROE
ROE ended at 15,2% in 2022 and is expected to
return to a higher level in 2023.
Clinical partnerships
Bowel irrigation has actually been practiced for many hundreds of years, yet in terms of
medical devices and clinical research, it can still be considered to be in its early stages.
It has been established as a proven therapy for patients with fæcal incontinence and chronic
constipation especially since the first randomised controlled trial in 2006 Transanal Irrigation
(TAI) in Neurogenic patients1, and at the outset, treatment and products for bowel irrigation were
predominantly focused on addressing neurogenic bowel dysfunction (NBD).
Quforas introduction of the cone segment in our first product over a decade ago revolutionised the
category of bowel care by broadening it as a treatment to new patient groups within the area of
functional and surgical bowel disorders. This is more widespread and encompasses a diverse range of
conditions that affect how bowel function works, such as obstetric trauma and low anterior resection
syndrome (LARS), among others.
Bowel irrigation is receiving increasing attention as a treatment option in patients with bowel
dysfunction across varied patient groups of NBD, LARS and people with fæcal incontinence and
chronic constipation2. Ongoing clinical research through clinical trials and observational studies
continue to explore a wide range of clinically relevant themes. This important work has the potential
to significantly improve the daily lives of thousands of people suffering from bowel dysfunction and
enhance the daily practice the healthcare professionals treating patients with bowel management
issues.
Qufora is committed to leading the industry by supporting important clinical research studies that
reveal the efficacy of bowel irrigation. We do this through close collaboration with PhD candidates and
specialists in the field. The recently-published PERSPECTIVE study3, an observational study sponsored
by Qufora, examines the impact of functional bowel disorders on quality of life, work productivity, and
healthcare utilisation.
The findings offer a snapshot of irrigation use and perceived effectiveness for a mixed population
of people across primary and secondary care. Such new insights can impact clinical practice by
reassurance that treatment strategies are effective and strengthening the treatment pathway by
exploring bowel irrigation as a treatment option earlier on.
Our strong partnerships with healthcare professionals have led to the adoption of co-created
educational tools in clinical practice, such as the Decision Guide, a practical tool to aid the decisionmaking
approach. A consensus-review by a working group of experts in the field4,5 resulted in a
framework for a standardised approach to support the healthcare professional in their decision making
for each individual patient when initiating bowel irrigation and helping to optimise patient outcomes.
A part of Quforas clinical agenda is powered in the UK by a team of healthcare professionals
with extensive practice-based experience in bowel management and recognised for their
contributions in the field.
Qufora drives the clinical agenda through various activities such as sponsorship of clinical
research, post-market surveillance, co-creation of educational tools, educational training for
healthcare professionals and especially for whom bowel care is a minor part of their role
supporting with patient education and tools.
By working in these different spheres, at Qufora we strive to empower healthcare professionals
with the knowledge, tools and support to address more patient needs and achieve successful
patient outcomes.
Collaboration a crucial role in successful bowel management
Everything we do is centered around the experience of the users of our products and the healthcare
professionals that prescribe bowel irrigation. Effective bowel management requires that users adhere to their
prescribed irrigation regime over time. To facilitate this, users benefit from a whole range of collaborative
relationships around them. Most importantly, the close follow-up between the healthcare professional and
the patient to closely monitor treatment and outcomes, with adjustments to the regime introduced when
needed.
How we support and collaborate with users and healthcare professionals
Myqufora
Myqufora has been developed in collaboration with healthcare professionals and users. It is
a platform that supports both healthcare professionals and users with information, help and
advice. We offer guides, help videos, FAQs and tips, as well as chat- and e-mail support.
Qufora Club
Our Qufora Club is aimed towards healthcare professionals who are interested in the latest
research, information and news on the bowel and bowel management.
Qufora Direct
Qufora Direct is an ordering support function. Through Qufora Direct, healthcare professionals
can easily order bowel irrigation solutions we handle prescription requests, delivery directly
to the user as well as follow-ups with the user to ensure they have everything they need.
Qufora Development Board
We involve healthcare professionals who are close to their patients and function as advocates
for users in developing new products. We aim to transform their knowledge and clinical
experience into innovative solutions. The boards meet several times per year and discuss
everything from needs and prototypes, to evidence and clinical practice.
Qufora Advisory Board
With a group of international doctors, we constantly strive to improve the standard of care for
people with bowel dysfunction. In order to pursue to drive the clinical agenda for bowel
management, we engage in relevant evidence discussions, product requirements, patient
outcomes and performance measurements.
Additionally, an important source of support is also provided by family members and close friends. Dealing
with symptoms, the impact of the underlying condition on daily life, getting to grips with irrigation - many
aspects can feel overwhelming. But speaking about a hidden condition and symptoms such as chronic
constipation or fæcal incontinence is not easy, even with close family and friends. Finding someone who
completely understands what an individual is going through can sometimes feel impossible. Meet the
Qufora Twins!
Qufora Twins Story: the power of openness and support
Laura and Chlø both suffer from Ehlers-Danlos syndrome (EDS), a rare connective
tissue disorder. As a result, they experience slow transit constipation and have a pocket
which has formed in their bowel called a rectocele. To manage their bowel symptoms,
they both use a Qufora bowel irrigation product and this is where their story began.
Laura discovered Chløs Instagram posts to her 11+ thousand followers about the
challenges of living with EDS. Laura could not believe she had found someone with the
same condition as her and who uses the same medical device to allow her to go to the
toilet. Quickly bonding over shared symptoms and experiences, and their Qufora product,
they developed a supportive relationship. Eventually, they called themselves the Qufora
Twins because they never imagined there was someone else who is just like them.
Having bowel dysfunction is their normal, and asking each other how are your bowels
today? is just like asking someone how are you today? Their positivity and openness
about bowel dysfunction is admirable and their story shows how talking about bowels
can be a natural and even light-hearted conversation. Their open and supportive
relationship is their take on breaking down the taboo.
User-driven innovation is in our DNA
At Qufora, we adopt a dialogue-based approach to innovation, grounded in our strong and constructive
collaborations with the both the users of our products and the healthcare professionals who prescribe
bowel irrigation.
Our innovation process is firmly anchored in insights gained from prioritising dialogue and collaboration at
all stages of product development. From the earliest ideation phase to the first focus group meetings and
prototype design, and through to advanced usability testing and all the way to the final adjustments, we
integrate the input gathered from these dialogues into every aspect of our product development. Talking
with people who face bowel problems and their associated challenges is key to user-driven innovation
and, ultimately, great products. After all, the essence of product design is design for humans.
Therefore, one of our most valuable objectives during product development is getting the feedback
from users and healthcare professionals. We believe that by attentive listening to our customers, we
can develop solutions that are tailored to the everyday life of our users. Consequently, the R&D and
commercial teams working with product development spend much of their working day focused on user
needs.
Bowel-related issues remain highly stigmatised, which underscores the importance of creating products
that can fit in as a natural part of the users everyday life, occupying as little space physically and mentally
as possible. Thus, in addition to prioritising the physical needs of users, we also place their emotional
needs and coping strategies at the core of our product design process. A product of this philosophy
is Qufora IrriSedo Flow, where user-driven insights resulted in an innovative approach to water flow
management giving the user intuitive control over the flow of water.
Ultimately, there is also a socio-economic dimension to medical device design. If our products are inviting
and intuitive to use, facilitating user compliance with the prescribed irrigation regime, it can have a
positive impact on society. Conversely, if the product is not utilised, or only sporadically, and perhaps
individuals instead are socially isolated, it creates a challenge not only for the individual but also for
society as a whole.
Qufora IrriSedo Flow Imagine the possibilities
When we design products at Qufora, we design for a person, not a function. Like all other devices and
objects we surround ourselves with on a day-to-day basis, they do not only solve a certain technical and
functional purpose, they are a part of the life of the user. Thats why design matters also for medical
devices.
in 2022 Qufora took the standards of high volume bowel irrigation design to a new level.
Design and innovation come together to enhance product function
Water flow management reimagined
Qufora IrriSedo Flow offers an innovative approach to water flow management throughout the user
experience. It provides choices for water bag positioning to suit the bathroom set-up, as well as the
ability to regulate water flow to suit individual preferences. In addition, it features our most advanced
cone design yet. The flow cone is designed for comfort and efficiency, with five outlets giving a
multidirectional water flow.
Imagine the possibilities for personalisation
Bowel problems can vary greatly between individuals, just as adjusting to a newly-prescribed medical
device as part of everyday life also differs from person to person.
In order to address the needs for customisation and
discretion in a new way, we looked to trends within
using accessories to change the appearance of
everyday items.
Collaborating with a designer specialised in
creating æsthetic design solutions, we were
inspired by a combination of Danish minimalism
and Japanese origami folding techniques. We were
particularly interested in how these techniques
were used within home designs to create threedimensional
shapes, and in fashion, how pleated
fabrics can adapt to the bodys movements in an elegant way.
With these influences in mind, the water bag accessory allows the user the option to add an æsthetic and individual touch to Flow, by changing the water bags appearance and feel.
Problem-solving
We offer a broad range of solutions for bowel irrigation to overcome chronic constipation and fæcal
incontinence.
Many people can benefit from solutions that are easy and intuitive to use, and that can help them regain
their sense of control and self-confidence. The Qufora range of bowel irrigation products are intended
to assist a wide range of patients in the management of chronic constipation, fæcal incontinence,
neurogenic bowel dysfunction and low anterior resection syndrome (LARS).
Promoting human health
We have a holistic approach to forming a healthier, more innovative, and sustainable future for everyone.
In todays world, the importance of sustainability cannot be overstated, as it represents a crucial
pathway to securing a better future for generations to come while achieving sustainable development.
Encompassing wider social, environmental, and economic concerns that affect the well-being of the
planet and all its inhabitants, it has gained immense importance and urgency in recent times, compelling
organisations to prioritise sustainable practices and embed them into their core values and operations.
Sustainability is a highly contextual concept that varies from one company to another. Every
organisation faces its distinct combination of environmental, social, and economic circumstances,
and thus, companies must have their own interpretation of sustainability there is no one-size-fits all
approach. At Qufora, we have dedicated significant time on defining our sustainability mindset based
on our own specific circumstances, challenges, and opportunities. Although we have made progress in
areas where we can have the most immediate impact; design thinking in material choices and packaging
for our two most recent product launches, we know that there is a long way to go to achieving our
sustainability aspirations.
We are advancing on the path towards a more sustainable future for Qufora, but in doing so,
must not compromise on safety and quality in the process. That is why we think holistically
about our impact on people and planet. For instance, Quforas design benefits the users health,
making sure toilet routines are as natural and effortless as possible. Thereby, our products will
contribute to less use of resources, for example, in the healthcare system.
Lena Ehmsen Lachenmeier, CEO
We meticulously design our products to connect with people, seamlessly integrating into their everyday
lives in a practical and emotional manner. Furthermore, we aim for our solutions to instil confidence and
dignity whilst empowering individuals to lead fulfilling lives and make positive contributions to society and
environment. That is the change for people we want to make, and it encompasses the four Sustainable
Development Goals that we have selected as integrated parts of our business.
Progressing towards sustainability:
our ongoing efforts to reduce and rethink packaging
Packaging plays a vital role in protecting bowel irrigation products during transportation, as well as
when in the users home, serving as a storage box and an aid to the hygienic disposal of the single-use
insertion device.
Consequently, packaging is an important area to address. The medical device industry often relies on
the individual packing of the various components that make up a product in plastic to comply with
quality regulations, and to meet user expectations and historical preferences. A willingness to think
creatively, to apply innovative techniques, and to remain resolute can make all the difference in moving
towards a transformation.
Building on the progress we made with MiniGo packaging,
a new level was reached in packaging efforts with Qufora
IrriSedo Flow. The amount of plastic was reduced compared
to our comparable cone product by replacing individual
plastic bags with paper sleeve wrapping. The opportunities
provided by a paper-based inner packaging was maximised
through collaboration with design experts to create a
complete packaging experience.
Inspired by traditional Japanese gift-wrapping techniques,
the unboxing experience is welcoming and practical
features inside the box aid a quick and organised start to
irrigation. Furthermore, with this redesigned approach,
the protection of products inside the box is optimised,
while reducing unused space and contributing to a greater
transportation efficiency.
Our Sustainable Development Goals
The United Nations Sustainable Development Goals were formulated in 2015 as blueprint to achieve a
better and more sustainable future for all. At Qufora we have selected four goals as integrated parts of
our business.
Good health and well-being is at the heart of what we do. We focus on both the
physical and emotional challenges that bowel-related issues can have on human
health, through innovation and through increasing awareness to contribute to
breaking down taboos around bowel dysfunction.
Reduced inequalities. Ultimately, our goal is to provide bowel irrigation solutions
that promote equal opportunities in daily life, without individuals being limited
in their freedom due to challenges as a result of bowel dysfunction. At our
workplace we make space for employees with different challenges and we firmly
believe that all our differences bring unique perspectives and valuable attributes
to foster an innovative working environment.
Responsible consumption and production are constant focus points in our
product and packaging design for the most efficient use of materials and
resources. We are committed to adopting a circular mindset, and we recognise
that achieving this is a long-term journey that requires continuous improvement.
Nonetheless, we remain dedicated to reducing our environmental impact
without compromising product quality, safety or usability
Partnerships for the goals. Collaboration is deeply implemented in our business
strategy; such as with our strategic partners within manufacturing and through
collaboration with healthcare professionals to support for example PhD clinical
research, and education within the bowel area.
Design that matters
Qufora IrriSedo Flow features our most advanced cone design yet, that reduces materials compared
to our comparative cone by 10%, while also enhancing functionality with a multidirectional water flow.
To further enhance user experience, the flow cone includes features to provide a comfortable user
experience.
With the flow cone, a reduction in materials was achieved, while at the same time achieving a more
advanced cone design with a more innovative cone design a multidirectional water flow through a
new water outlet design and comfort through features providing comfort.
Risk management
Examples of risks:
Disruption of supply chain
External factors
Compliance issues
Quality and safety issues
Dependencies on the UK
Limited access to HCPs
Risk mitigations:
Increase number of sub-suppliers
Increase stock levels and cash reserves
High quality QMS processes
Strong QA and RA expertise
Invest in further market rollouts
Digital solutions for patients and HCPs
Knowledge resources
At Qufora we take pride in being a passionate and open-minded company that embraces
partnerships and co-creation at all levels. We have a dialogue-based approach, and we value
our strong and constructive collaborations with users, healthcare professionals and all
partners who inspire us and share our mission.
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