Helen Giza: Yes. Thanks, Lisa. I will try my best there, but I can also follow up with Frank afterwards. So the RAS inhibitors have been available for they’ve only been used in about 50% of the eligible people despite the low price and wide availability. As we think about the — you talk about this 15 years of ESRD population growth. I think would speak to that as where we’ve seen an improvement in mortality and the average life on dialysis has extended. Now I think that is — flattening off in recent years and kind of we have COVID effect there in those years, too. But I think the improvement in mortality in average life on dialysis has obviously been a benefit in that patient population growth. In terms of your kind of question on delay in progression, I think really what’s behind your question is, are we going to see a change in kind of mix here as we think about kind of an extended funnel on CKD and the cardiovascular benefits, which may delay kind of ultimately a larger pool coming into dialysis because they have the cardiovascular benefits.
If they have that, we could potentially see an age shift where you have younger, healthier patients who could be kind of working or on commercial insurance coming into the ESRD population. And of course, what we see today is, I get my numbers right here, the average commercial patient is on insurance for about 30 months — or less than 30 months, sorry, I should say that, less than 30 months. So if we get more commercial patients in and then we have that 30 months before they go on to Medicare, that — we could see that age shift happen in that population. But I think that’s something only time is going to tell on what happens to that mix. I mean, you’re absolutely right that the average age of new starts now is over 65, and we already see that phenomena.
So I think what we’ll be looking at is to see what happens in the CKD population and the , particularly in stages 3 to 5. And then what happens in that the commercial plans were kind of whether already on less than 30 months coverage. I think obviously — we, obviously, have significant growth in MA the last 2 years. That becomes more important as well in the age above 65 in the future.
Lisa Clive: Okay. Just one quick follow-up. On the patients, obviously, the MSP period is 33 months. But my understanding is actually a lot of your patients drop off after sort of 18 months, if they’re on COBRA because it gets a lot more expensive at that point. Is that a fair statement?
Helen Giza: Yes, I think that’s fair. I think, on average, it’s more like 18 to 24 months.
Operator: The next question comes from the line of Richard Felton with Goldman Sachs.
Richard Felton: My first one is on the guidance, EBIT growth. Like given the first 9 months has been very strong, the upgraded guidance implies quite a sharp deceleration in Q4. So my question is, is that all comps related? Or is there anything else you’re seeing in the momentum of your business that’s keeping you a little bit more cautious on Q4? That’s my first question. And then my second one is on Care Enablement. So look, it’s another quarter where margin’s quite a long way below your target. Can you maybe provide a bit of color on how much the margin was impacted by transactional FX in the quarter? And then maybe a bit of an update on what you’re doing to drive better performance and better margin in that part of the business within the new organizational framework?
Helen Giza: Thanks for your question, Richard. Yes, and I think the flavor of the day from many of the analysts has been we seem to be predicting a sharp decline in Q4. And I think the high-level answer, it is one of comps. There is nothing fundamentally happening or shifting in the business in Q4 from an operational perspective. But I do think it’s probably worth unpacking that for the wider audience as well. So Q4, year-over-year, over ’23 to ’22. In Q4 of last year, with our performance, we had some significant favorability from our bonus plans, if you will, the compensation-related short-term bonus. That was around EUR 30 million last year. And obviously, we’re on track this year. We did have some NCP deconsolidation gains in Q4 of last year of around EUR 40 million.
And then this year, we also have the foreign exchange impact in CE that we didn’t have last year. So that perhaps answers your second question. That number was around EUR 22 million, or projected to be around EUR 22 million. So that’s the CE transaction piece. As I think about kind of what we’ve seen in Q3 and what our implied guidance assumes for Q4, a couple of things there. And again, some of the more Q3 to Q4 improvement that we saw in Q3 that maybe don’t happen in Q4. We do have some favorable phasing in corporate. In the quarter, we would — you saw a very low corporate number that is kind of timing and phasing that we are expecting to come back in Q4. As I mentioned, we had the CKCC true-up of 3 quarters included in Q3 that wouldn’t be expected to repeat in Q4, and that’s around EUR 25 million or so.
We have ongoing exchange plans in CE. And then in Q4, we are expecting lower contribution from equity investments in our JV. So I think it’s — none of this is operational. It’s either phasing or kind of onetime that we’ve already called out and spoke to as watching in our headwinds in the business.
Operator: The next question comes from the line of Veronika Dubajova with…
Veronika Dubajova: I will keep it to two, please. One, I just want to follow up on Richard’s question on the fourth quarter is. I mean, I appreciate the year-on-year comparison looks very difficult. But also looking just at the absolute level. I mean normally, fourth quarter is the strongest quarter that you guys tend to have from an absolute EBIT perspective. And it’s looking far from it this year, Helen. Is there something that’s changed in the seasonality of the business or something that’s been pulled forward into the other 3 quarters of the year? Just trying to understand that. And then my second question is on same market treatment growth, and obviously, I appreciate we’re still annualizing the mortality impacts from COVID. But just curious on how you’re thinking about the fourth quarter and whether you think we’re going to be in positive territory? And whether you’re still comfortable with an assumption that is greater than 1% for 2024?
Helen Giza: Yes. Thanks, Veronika. Look, there’s nothing fundamental changing in Q4. I think we’ve got — you’re right, it’s always our strongest quarter. I think this really is one of phasing of expenses, I think, as I mentioned earlier, the lower contribution from the equity investment and the ongoing kind of transaction FX effects that we’re seeing in CE kind of the quarter was buoyed up a little bit on the true-up of the CKCC which came in with 3 quarters. So I’m not looking at anything in Q4 with a level of concern that says there’s something drastically bad or different happening in either seasonality or the underlying performance. Look, I think some of this will depend on where in the guidance range you’re expecting us to come in.
