Image source: The Motley Fool. Abbott Laboratories (NYSE: ABT)Q3 2019 Earnings CallOct 16, 2019, 9:00 a.m. ETContents: Prepared Remarks Questions and Answers Call Participants Prepared Remarks: OperatorGood morning, and thank you for standing by. Welcome to Abbott's Third Quarter 2019 Earnings Conference Call. [Operator Instructions]This call is being recorded by Abbott. With the exception of any participants' questions asked during the question-and-answer session, the entire call, including the question-and-answer session, is material copyrighted by Abbott. It cannot be recorded or rebroadcast without Abbott's expressed written permission.I would now like to introduce Mr. Scott Leinenweber, Vice President, Investor Relations, Licensing and Acquisitions.Scott Leinenweber -- Vice President-Investor Relations, Licensing, and AcquisitionsGood morning, and thank you for joining us. With me today are Miles White, Chairman of the Board and Chief Executive Officer; Robert Ford, President and Chief Operating Officer; and Brian Yoor, Executive Vice President, Finance and Chief Financial Officer. Miles will provide opening remarks, and Brian will discuss our performance and outlook in more detail. Following their comments, we'll take your questions.Before we get started, some statements made today may be forward-looking for purposes of the Private Securities Litigation Reform Act of 1995, including the expected financial results for 2019. Abbott cautions that these forward-looking statements are subject to the risks and uncertainties that may cause actual results to differ materially from those indicated in the forward-looking statements. Economic, competitive, governmental, technological and other factors that may affect Abbott's operations are discussed in Item 1A, risk factors, to our annual report on Securities and Exchange Commission Form 10-K for the year ended December 31, 2018. Abbott undertakes no obligation to release publicly any revisions to forward-looking statements as a result of subsequent events or developments, except as required by law. Please note that second quarter financial results and guidance provided on the call today for sales, EPS and line items of the P&L will be for continuing operations only.On today's conference call, as in the past, non-GAAP financial measures will be used to help investors understand Abbott's ongoing business performance. These non-GAAP financial measures are reconciled with the comparable GAAP financial measures in our earnings news release and regulatory filings from today, which are available on our website at abbott.com. Unless otherwise noted, our commentary on sales growth refers to organic sales growth, which is defined in our earnings news release issued earlier today.With that, I will now turn the call over to Miles.Miles D. White -- Chairman and Chief Executive OfficerOkay. Thanks, Scott. Good morning. Today we reported results of another strong quarter with ongoing earnings per share of $0.84 reflecting 12% growth on an absolute basis and even higher growth when excluding the impact of currency. Sales increased more than 7.5% on an organic basis in the quarter led by double-digit growth in Medical Devices and sequential improvements in Established Pharmaceuticals and diagnostics.We also narrowed our full year adjusted earnings per share guidance range to $3.23 to $3.25, which at current rates would reflect high-teens growth excluding the impact of currency and is at the upper end of the range we set at the beginning of the year. As we've discussed previously, following our recent strategic shaping and acquisitions, we've been completely focused on running the company we built. This focus on organic execution is delivering strong performance on a remarkably consistent basis. Over the last eight quarters, we've averaged 7.5% organic sales growth worldwide with very little variation. We've also continued to strengthen our portfolio with new products, expanded access and reimbursement coverage and generated new clinical data that further enhances the sustainability of our strong growth outlook going forward.I'm particularly pleased with the continued exceptional performance across several of our key growth platforms, including FreeStyle Libre, MitraClip and Alinity which I'll highlight as I summarize our third quarter results in more detail.And I'll start in our Medical Devices business where sales increased double digits for the second quarter in a row. In Structural Heart, we achieved 16% sales growth led by MitraClip our market leading device for the treatment of mitral regurgitation or leaking heart valve. MitraClip sales increased more than 30% in the quarter, including U.S. growth of nearly 50%. During the quarter we received U.S. FDA approval for our next generation MitraClip device and we initiated the first ever U.S. pivotal trial for the minimally invasive treatment of tricuspid regurgitation, which will evaluate the safety and efficacy of our TriClip repair system.Turning now to FreeStyle Libre, our market leading continuous glucose monitoring system that eliminates the need for routine finger sticks. We achieved sales of $0.5 billion in the quarter and continue to add significantly to our global user base, as reflected by our organic sales growth of nearly 70%. During the quarter FreeStyle Libre obtained public reimbursement coverage in Ontario and Quebec becoming the first and only sensor-based glucose monitoring system to be listed by any provincial health plan in Canada.We also continue to advance our strategy to develop integrated solutions where people with diabetes can seamlessly manage their condition across devices, including recent announcements that we're seeking to integrate Libre with the insulin delivery technologies of Sanofi and Tandem as well as the digital care platform of Omada Health. This easy-to-use, affordable device is changing the way millions of people manage their diabetes and our ongoing efforts to expand awareness adoption and excess for Libre around the world will drive tremendous growth for years to come.Turning now to diagnostics, where sales grew 6.5% in the quarter led by double-digit growth in Core Laboratory Diagnostics the rollout of Alinity in Europe and other international markets continues to drive strong growth in our core laboratory business outside the U.S. In the U.S. where we continue to outperform the market with our legacy architect system. We've made good progress, achieving regulatory approvals of immunoassay in clinical chemistry tests for Alinity and are beginning to ramp up our launch efforts in these areas. With highly differentiated instruments and a matrix rollout across multiple geographies and diagnostic testing areas over time Alinity is well positioned to be a multi-year growth platform for our Diagnostics business.In Nutrition sales increased nearly 4% in the quarter led by double-digit growth in international Adult Nutrition for the third quarter in a row. In pediatric nutrition above market growth in the U.S. and several other countries was partially offset by challenging market dynamics in Greater China which comprises a little less than 10% of our overall Nutrition sales. While consumers continue to trade up the premium brands, which is the segment where we compete we've seen volume in the market declined due to historically low birth rates. We remain focused on strengthening our portfolio and competitiveness across the various segments and purchasing channels in China and given our broad portfolio and global footprint anticipate continued strong performance across other geographies and long-term growth opportunities such as adult Nutrition.I'll wrap up with Established Pharmaceuticals or EPD, where sales increased 8% in the quarter led by strong growth in several geographies, including India, China and Brazil. Sales growth in EPD has now improved sequentially for each of the last three quarters. With leading market positions in several international growth geographies EPD is well positioned for sustained above market growth in some of the largest and fastest growing pharmaceutical markets in the world.So in summary, we're performing [Technical Issues] well across several areas of the portfolio resulting in another quarter of strong sales and earnings growth. We continue to strengthen our product portfolios and key product platforms with a steady cadence of new product approvals reimbursement coverage and clinical data. And we're well on track to deliver ongoing EPS and organic sales growth at the upper ends of the range, as we set at the beginning of the year.I'll now turn the call over to Brian to discuss our results and outlook for the year in more detail. Brain?Brian B. Yoor -- Executive Vice President, Finance and Chief Financial OfficerThanks, Miles. As Scott mentioned earlier, please note that all references to sales growth rates unless otherwise noted for on an organic basis, which is consistent with our previous guidance.Turning to our results. Sales for the third quarter increased 7.6% on an organic basis. During the quarter, we saw the U.S. dollar strengthened modestly resulting in an unfavorable impact on sales of 1.9% from exchange or 50 basis points higher than if rates held steady, since the time of our call in July. Reported sales increased 5.5% in the quarter. Regarding other aspects of the P&L, the adjusted gross margin ratio was 59.2% of sales. Adjusted R&D investment was 7% of sales and adjusted SG&A expense was 29.1% of sales.Turning to our outlook for the fourth quarter. We forecast adjusted EPS of $0.94 to $0.96 which reflects nearly 17.5% growth at the midpoint. We forecast organic sales growth of around 8% and a current rates would expect exchange to have a negative impact of somewhat above 1.5% on fourth quarter reported sales. We forecast an adjusted gross margin ratio of approximately 59.5% of sales. Adjusted R&D investment of around 7% of sales and adjusted SG&A expense approaching 27.5% of sales.Before we open the call for questions. I'll now provide a quick overview of our fourth quarter organic sales growth outlook by business. For Established Pharmaceuticals, we forecast high single-digit growth. In Nutrition, we forecast low to-mid single digit growth. In Diagnostics, we forecast mid to high single-digit growth. And in Medical Devices we forecast growth similar to the third quarter which reflects continued double-digit growth in several areas of this business.With that, we will now open the call for questions.Questions and Answers:OperatorThank you. [Operator Instructions] And our first question comes from David Lewis from Morgan Stanley. Your line is open.David Lewis -- Morgan Stanley -- AnalystGood morning. Just a couple of questions for me. Miles, just want to start off on growth. So, I mean, this time of year Investors are very focused on sustainability and you obviously said you've been averaging 7.5% for seven to eight quarters. So a couple of questions, one, guidance for the fourth quarter implies a little bit of momentum deceleration in the business anything specific to call out there? And then more specifically, as you think about 2020. What are those drivers to get you confident that you can deliver growth in that 7%, 7.5% range that you've been doing in the last couple of years? And then one quick follow-up.Miles D. White -- Chairman and Chief Executive OfficerOkay. David. Well, I'll start with what you said. We have had eight straight quarters averaging 7.5%. Going into the fourth quarter, we actually, we're going to be close to 8%. And -- then going into next year, I think where we are in the range we've given, I think we gave a range of the beginning of this last quarter of 7% to 8% somewhere in that range. And frankly, I see no change to that, right. I don't see any change to momentum at all here. If anything, we've got pretty strong momentum across the board. We've got sequential growth in a number of areas that we expected improvement in and we're seeing that EPD comes to mind.Obviously, our growth drivers Libre and MitraClip and the Alinity systems, et cetera, are all very strong Structural Heart is very strong. So -- you know that, as I said in the past many times this is sustainable and strong going forward, I see no change in momentum, no changes to progress, no change to growth rates. If anything, you could get a touch better. So and it clearly well in the fourth quarter. So it's pretty strong and the earnings flows with it and we're not going to make any guidance forecast or anything, but I think directionally here all fundamentals are strong for us.David Lewis -- Morgan Stanley -- AnalystOkay. Very helpful. And then just one quick product question Miles. Just there has been Libre 2, obviously an important driver for next year. I just want to get your commentary the longer this product has not been approved it's led to kind of concern about the product, the regulatory time line. Your view, your Tandem partnership yesterday suggests to us that you're still confident in Libre 2 iCGM. Are you still confident in Libre 2 iCGM? And how are you thinking about the timing of potential for that product? Thanks so much.Miles D. White -- Chairman and Chief Executive OfficerI'd say, I going to comment myself and then I'm going to hand it to Robert Ford here to comment as well. But first, are we confident? Absolutely. The product is performing wonderfully -- the growth is strong, the expansion is strong. There is a lot to be pretty encouraged about. And while I recognize a lot of people, including us are feeling in patients -- in patients doesn't translate the concern. We're all inpatient and we'd all like everything yesterday. But it's not quite working out as yesterday. And Robert can comment on that here, but there is nothing but good here looking forward with Libre. And we anticipate a lot of expansion with this product including with some of these partnerships that we've announced and working with the interoperability with various partners for what I think will be the future of glucose monitoring and diabetes management. I think all of this is not just on plan, but spectacular particularly for diabetes patients and I have nothing, but confidence in it.So let me turn it over to Robert to expand on that.Robert B. Ford -- President and Chief Operating OfficerYeah, David, let's admittedly it's taking longer than we had expected. We obviously misjudged that we're currently working through a handful of open items with the agency and what I can tell you on -- I've got the same confidence level that Miles does, I'm confident in the data, I'm confident in the product, right. In the meantime, if you look at Libre in Q3, we had an exceptional Q3, sales of just under $0.5 billion, that puts us on a $2 billion run rate here with growth rate over 70%. Our international business grew 50% and that's -- that's on a large base. And in the U.S. sales sales nearly tripled. So, and it's triple because we're adding new patients at a strong and steady rate. And it's a high rate. And you could see that progression in our total Rxs. So -- and one of the challenges we've had over -- like the nine months here has really been about how to pulse our demand generation activities with aligning to our supply and we talked a little bit about kind of some of those supply constraints.So we've now released in the third quarter toward the end of the third quarter, our next tranche of manufacturing capacity on plan, on schedule. And I can tell you, the commercial team right now is really feeling excited about not being able to have that constraint over and really start to intensify the commercial efforts, whether that advertising, whether that sampling, et cetera, both in the U.S. and international. I think that's, that gives us a lot of excitement as we exit the year going into next year.The value proposition is still continues to be very strong to patients and physicians and to payers and as Miles mentioned in his opening comments, we achieved reimbursement in Canada public reimbursement the only sensor, system reimbursed in Canada. And it's important because it's one of the top five largest glucose monitoring markets in the world and similar to what we saw in some of these large markets when we obtained national reimburse when we see a pretty accelerated kind of explosive growth we saw that in Germany, we saw that in France and UK. So we expect to see that same trajectory in Canada, and early indications suggest that kind of same curve. So that will be also exciting for the team as we move into Q4.And as Miles has also said, we're pleased with the partnership strategy that we've adopted. We've gone through it at a very intentional phased approach first with Bigfoot, as you know. We then moved into announcing our agreements with insulin manufacturers, like Novo and Sanofi, that connect Libre to their pen systems. And the next phase here, we'll start to move into insulin pumps and that was the agreement that we announced yesterday with tenant to co-develop an integrated system because we know this is an important segment also connecting to pumps and we're now at a phase where we feel that we can start to kind of roll that out as we thought about our partnership strategy. So I think momentum here on Libre is exceptional, it is very strong as we go into Q4, I think we've got a lot of stuff going right, firing all cylinders, whether it's commercial, whether it's commercial, whether it's operation, whether it's our R&D program. So I'm very confident on the sustainability of Libre and Libre going forward.David Lewis -- Morgan Stanley -- AnalystGreat. Thanks so much.OperatorThank you. Our next question comes from Larry Biegelsen from Wells Fargo. Your line is open.Larry Biegelsen -- Wells Fargo -- AnalystGood morning. Thanks for taking the question. So two for me, one on capital allocation, one on MitraClip. Let me start Miles with the capital allocation. Now that you have more financial flexibility. How are you thinking about capital allocation in the importance of reloading the pipeline? I think on the Q2 call, you seem to de-prioritize buybacks, but yesterday you announced a $3 billion share repurchase authorization. So has your view changed? And I just had one follow-up on MitraClip.Miles D. White -- Chairman and Chief Executive OfficerWell, I'd say, look, we've come through a period where we paid down a lot of debt. And I think we find ourselves in a good capital balance. I think where we've got -- gotten to the place where our net debt to EBITDA ratio is well ahead of what we targeted probably a year earlier than we expected and that was with an aggressive paydowns strategy, et cetera. Our business is performing strong. Our cash flows are strong. Can we still continue to pay down debt? We can. Can we refinanced debt? We can. Can we do things that are prudent, good balance sheet management? Yes.And we're also generating cash. We are generating sufficient cash, more than sufficient cash to invest in a lot of manufacturing expansion for all the new products we've talked about. Robert just mentioned, one of the biggest and that's fully funded and obviously coming online and good. So you say, alright, well, then about the dividend. Why we raised the dividend 14% last December, and we have a targeted range where we like to keep that dividend as a percent of our EPS, et cetera.So as we go across all the things you can do with your cash returning cash to shareholders is also positive thing to do, if the conditions are right and if the return is good, et cetera. And we want to be prepared to have that flexibility on the table as well. We have not gone significant share repurchase as you know for several years. While we focused on the pay down of debt, but now we wanted to add back the flexibility to do that as well. So I'd say in general we find ourselves in a strong cash position, strong performance position, good strong balance sheet position we can continue to pay down some debt, but we've got the flexibility to do just about whatever makes sense for us on a return basis or return to shareholder basis.We don't have any active M&A on the radar screen to the extent that we track or follow anything. I'd say it's your typical bolt-ons and tuck-ins and so forth that are additions to already strong businesses. We're pretty happy with our pipeline. We're pretty happy with our R&D pipeline. So our standards are pretty high right now about what's attractive and what may not be. But I'm not forecasting anything significant at all in the M&A area. So obviously we want to keep our options open here with how we manage cash for our shareholder.Larry Biegelsen -- Wells Fargo -- AnalystVery helpful. And then on MitraClip. You have -- U.S. reimbursement goes up in October. You hopefully will have coverage for the functional MR indication next spring. So you're thinking about 2020 is an inflection year for MitraClip and in Europe, it looks like sales improved growth, improved this quarter. And how are you feeling about MitraClip outside the U.S? Thanks for taking the question.Miles D. White -- Chairman and Chief Executive OfficerLarry, I'm going to toss that one to Robert Ford.Robert B. Ford -- President and Chief Operating OfficerHi, Larry. Thanks for the question. So you know, we filed our MitraClip NCD it was kind of opened in August. So that timeline there is usually takes about nine months, I mean that's a statutory maximum as we'll say, when we did FMR in MitraClip that's take about seven months. So I think we'll be in the December, January time frame -- kind of -- trying to kind of get exactly what quarter that's going to land in. But in the meantime, you see kind of our growth rate. The reimbursement is going to be important, but our Structural Heart was up mid-teens. And the big driver of that was MitraClip up 30%, up 50% in the U.S.So reimbursement is going to be important, there definitely be an inflection point, when we get it, but as I said in the previous call, that is a component, it's a building block here that we're focusing on. So, opening new centers is another kind of key building block. We have about 400 today, and I don't want to get to about 550 over time. And we've been supporting that with investments, investments in our sales force, our clinical specialists, our therapy development specialists so that we can not only train the centers, train the implanters to keep up with that demand that we see, but also to support the demand generation through the development of these patient referral network.So that investment is ongoing on target, on plan in terms of how we're ramping up the field team and as Miles said in his opening comments, we continue to invest also in the innovation side, on the product development side. So in July, we obtained approval for our fourth generation MitraClip which has independent graspers, more sizes, et cetera that space goods more options to the physician. So I think that, MitraClip here is and it's really early innings Alere, I think this is a multi-year, multi-billion dollar growth opportunity that we've got. And it is going to continue to ramp over time and we're making the investments to make sure we are going to lead in that. So as I looked --Larry Biegelsen -- Wells Fargo -- AnalystThank you very much.Robert B. Ford -- President and Chief Operating Officer2020 I think we've got the right momentum. And once we have NCD coverage, yes, I think there'll be an inflection to growth.Larry Biegelsen -- Wells Fargo -- AnalystThank you very much.OperatorThank you. Our next question comes from Bob Hopkins from Bank of America. Your line is open.Bob Hopkins -- Bank of America -- AnalystHi, thanks and good morning. Just two quick product related questions first a follow-up on the Libre 2 commentary just to kind of set expectations. Just curious, is there been any new data request from the agency and is approval of Libre 2 in the U.S. you think possible next couple of months or credit take a little longer?Miles D. White -- Chairman and Chief Executive OfficerListen, we've -- what I'll say is that, probably, we've obviously misjudged that. So I'm not going to sit here and try and pinpoint the exact timeline of the approval. As I said, also we're actively working through a handful of open items with the agency and that's where we're at.Bob Hopkins -- Bank of America -- AnalystOkay. Fair enough. And then I also want to ask on pediatric nutritionals in China. And it's just curious if you could elaborate a little bit more on the slowdown there. And then just wonder if you could comment on China, more broadly and your confidence in growth continuing in China. So just comment on pediatric nutritionals in China, please.Miles D. White -- Chairman and Chief Executive OfficerSure. Let me start off with the -- with the nutritional question here, then. So you saw our Nutrition business was just under 4% we had really good growth in the U.S. in pediatrics up 4% double-digit growth in international adult for the second quarter in a row. So our challenge here really was the international pediatric performance, which was really driven by Greater China. And I would say there were some challenging market dynamics here. As Miles mentioned, we're seeing the consumer trade up into the premium brand segment, but the volume has been declining, partly because of these low birth rate. So this is led to what I would say a much more competitive environment, competitive in terms of pricing, competitive in terms of promotional activities.And this is now got our full attention, a full attention from the management team here. And our key thing is really focusing and you know the market dynamics of the market dynamics, but we've got to really focus on improving our competitive fitness, our competitive position here in the pediatric segment we're launching a series of new strategies here in the coming weeks regarding our media campaigns, strengthening our consumer relationship platforms. We've got some plans to launch some new products over the next several quarters. So I'd say that the key focus of us right now in Nutrition really has been at this point here to focus on improving our competitive fitness in China.Robert B. Ford -- President and Chief Operating OfficerAnd I'll follow up on the rest of the -- other businesses in China, I'll give you a little bit of context. I think, you know I'll speak as a CEO, we are the multinational CEOs of the world are we? If we do business in China, are we nervous about trade, are we nervous about China, are we nervous about all this. I think you can't help but we nervous about it, but I'll tell you what's interesting, while it's affecting some segments of the U.S. economy and U.S. businesses pretty directly, it doesn't seem to be affecting us or our business. The nutrition challenge we have is completely separate from any kind of trade or economic or autonomy issues, other than birth rates.And on -- the performance in our device businesses, our Diagnostics businesses and so forth are double-digits and strong. You know there is all kinds of ways that people can hypothesized that maybe the Chinese government would intervene and make things more difficult and so forth for U.S. multinationals. But in our business we actually don't see that and you know the product approvals are coming in a timely manner, the China FDA is doing everything that they're supposed to do -- and for our products. We haven't seen any of that kind of friction at all and the demand for our products in the performance of our businesses in China has been strong other than the challenge we've got with a pediatric nutrition all our other businesses are doing well. Showing no signs of any kinds of issues. So while I know that there are industries and segments that are tied to whether it's automobiles, oil, big industries, et cetera that may have challenges particularly agriculture we're not seeing that. And our China business is good.Bob Hopkins -- Bank of America -- AnalystThank you very much. Helpful.OperatorThank you. Our next question comes from Vijay Kumar from Evercore ISI. Your line is open.Vijay Kumar -- Evercore ISI -- AnalystThanks for taking my question guys. Two from me. Maybe Miles starting off with that last question at the macro, China. I know there are a number of moving parts, China 4/7 on the drug side, some questions from maybe a CapEx slowdown, Diagnostics slowdown. Just to be clear, what is your exposure either on the drug or Diagnostics side to China, I maybe broadly comment on emerging markets in general it looks like some of those markets are slowing down and how is Abbott position to handle some of the macro slowdown, if you will?Miles D. White -- Chairman and Chief Executive OfficerWe're looking at each other trying to figure out who answers what part of that question. I'd say this underlying growth in emerging markets is still good, has it slowed some. Yeah, it has slowed some. But it's still good, it's a relative thing. So the underlying growth we see in India, Latin America, China, et cetera. It's all good, you can say there is the occasional Argentina. Okay. That's not good. Argentina is its own thing. But there are -- the advancement of the healthcare systems advancement in demand for health products Pharmaceuticals, et cetera strong. China in particular for us, for our pharmaceutical business strong, we're doing well. I don't think we have a lot of exposure. I'll let Robert expand on that in a minute. But overall, I think the conditions for us in those markets remain strong as we've said many, many times single most difficult thing we deal with this the volatile currency if it's volatile and sometimes it is, sometimes it isn't.And right now, currency isn't exactly working in our favor in those markets. So, while we grow at a pretty healthy rate on an underlying basis. And typically, faster than the market -- the currency races some of that. Robert?Robert B. Ford -- President and Chief Operating OfficerYeah, I'll just, Vijay, on the generic pharma in China, I think you're referring to the four plus -- four plus seven tendering process there. We haven't seen an impact and we don't anticipate a significant impact going forward. We have a fairly kind of concentrated portfolio here at products just about 15 products, most of these products are more specialized kind of segments in areas where there is kind of difficult to manufacturer. So on the generic side of the pharma business we're less susceptible to this. Obviously, we're going to monitor we're part of this process, we understand how the tendering process is going to work. But if I think about kind of bigger impact we have less of an impact to given the portfolio of products we have in China.Vijay Kumar -- Evercore ISI -- AnalystYeah. That's helpful guys. And just one quick one on that guidance maybe for Brian. Brian, it looks like the Q4 guidance is implying really strong margin expansion 200 basis points plus. Just given some of the comments on FX maybe clarify the FX -- ahead to Q4 in the margin side? And in general, when you look at 2020, what kind of headwinds that we're looking at from an FX perspective. Thank you, guys.Brian B. Yoor -- Executive Vice President, Finance and Chief Financial OfficerYes. From a top line next year, I'm not prepared to talk about next year. But I think there would be natural some flow-through on the top line next year, Vijay. Perhaps, Scott can [Indecipherable] back to you on that. Then let me circle back. If you look at Q3 you saw we had gross margins of 59.2%. You are absolutely correct. Foreign exchange has an impact on us of about 50 basis points, otherwise you be at 59.7%. So, I feel good about where we're guiding Q4. Q4 tends to be that quarter, we get a little bit more natural leverage as well. And you'll see that play out through the bottom line, pretty consistent with how we thought about this at the beginning of the year.As you know, I mean, gross margin improvement is just part of our DNA. It's part of what we do and how we think about in addition to cash flow and it's something we're going to continue to improve upon across all of our businesses. And I think you could expect that to continue in the next year. That's how we get the double-digit growth than we usually start with and continue to invest back into our SG&A and R&D for our growth.Vijay Kumar -- Evercore ISI -- AnalystThanks guys.OperatorThank you. Our next question comes from Robbie Marcus from JP Morgan. Your line is open.Robbie Marcus -- JP Morgan -- AnalystGreat. Thanks for taking my question. Miles, I was hoping you could touch on the Diagnostics business. This is one you've called out for many quarters now is a durable multi-year growth driver for the company. We saw fantastic growth in Core Lab this quarter even without really benefit from Alinity hitting U.S. Maybe you could just update us on the status of where you are in Europe in terms of rollout. What you're seeing in terms of competition, because we're seeing some negative results from competitors. And then the latest and thoughts on the U.S. launch and how we think that uptick there?Miles D. White -- Chairman and Chief Executive OfficerOkay. Thanks, Rob. I'm going to have Robert do that.Robert B. Ford -- President and Chief Operating OfficerSo, Robbie, we've talked about how this is a multiyear opportunity and we've been executing on this very, very focused year. If you think about the core labs and the rollout of the Alinity program, it's doing very well and you can see that -- you can see that in our top line. The rollout has been particularly strong in Europe we're winning over 50% of the businesses where we targeted an entrenched competitor. And if you think about kind of the renewal process we're retaining nearly all of our current business that comes up for contract.So we placed over 3,700 instruments and when we give out that number, we're talking about instruments that are actually placed in the market, placed in the account, running test and generating revenue. So that's gone very well. In the quarter that you saw that we also got an approval in the U.S. for the Alinity blood and plasma screening. So this fourth quarter here, the team's already kind of rolling out that commercial launch. We had a lot of success in rolling out the blood plasma systems in Europe and in Asia last year or so. It's great to see that a little bit ahead of schedule here in the U.S. and the teams are jump in on the opportunity.As it relates to the immunoassay side, a lot of our focus here is really kind of ramping up on the R&D side, ramping up the menu and the assay menu. I'd say that assay completion rate of what we need to be kind of fully competitive in Europe is getting close to that 100% mark that we need. And in the U.S., it's a little bit behind, but a lot of our focus here is to get those systems those assays approved and in place and we'll start to see that kind of play effect in our growth rate in the U.S. as we move into next year.So I think internationally, we're doing really well U.S., we've got the opportunity here as the assays come on board to be able to accelerate our growth rate. So I'm really pleased with the momentum that the team has done here. Of course, we can, we feel that we can always do better and that's what we're going to keep on pushing too.Robbie Marcus -- JP Morgan -- AnalystGreat. Thanks. And maybe just one quick follow-up in neuromodulation numbers came in a little softer than the Street was looking for. I'm assuming a big chunk of that was in the spinal cord stim market. Maybe you could just update us as to what exactly you're seeing on the ground with Abbott and what do you think is driving that deceleration in the market here in the U.S. Thanks.Miles D. White -- Chairman and Chief Executive OfficerYeah, sure. So obviously still work in progress here. It's a little bit longer than we had initially hope when we talked about it over the last couple of quarters. We talked about the sales force hiring, the sales force productivity and it's a very specific selling process here in devices and if you're a new rep, it takes some time to kind of understand it. So that's been going -- that's been progressing well, we've had some stabilization in the sales force and some of the monthly KPIs that we track them on their improving. But we've also seen as you pointed out a little bit of a market decline, especially in the first half of this year and it follows a couple of years of double-digit growth rate.So lot of our focus here has got to be on sales force execution and productivity. The approval of Proclaim XR this quarter I think really provides a nice addition to the portfolio and provide the sales force with the new technology to promote. And early signs of the launch, it's only been a couple of weeks. But early signs are positive. We tend to look at our trials and our trials across the U.S. in spinal as our leading indicator. And I'd say early signs are positive, but there is more monitoring there for us to be aware of.On the market side, there's really no third-party data source here like we have in stents or pacemakers, et cetera. So it's difficult to peg the growth rate here. We usually have to wait until everybody reports and we can kind of look at and added up and kind of see where it's at. So yeah, I would anticipate here Q3 to be similar in terms of market growth rate as the first half of this year, which is in that low-to-mid single digit decline here.Robbie Marcus -- JP Morgan -- AnalystAppreciate it.OperatorThank you. Our next question comes from Rick Wise from Stifel. Your line is open.Rick Wise -- Stifel -- AnalystGood morning, everybody. Miles, I'm always embrace to ask questions about the EPD business because, I would feel like I don't really understand it, but, and you said enough to see that you actually ex-currency had another solid quarter in many of the emerging markets that you're targeting. Maybe just help us understand some of your high level thoughts there the outlook is it going as you would have expected growth has slowed a little bit relative to the last few years. But again, it seems like on track and sustainably on track. Is that the right way to think about it?Miles D. White -- Chairman and Chief Executive OfficerYeah, I -- we can't say, I'm never quite as satisfied as it like to be, that's for sure. What we've learned a couple of things I think -- of the seven or eight years, we've now been fundamentally focused on emerging markets and they're growing economies and so forth. I'd say, if anything was underestimated, it was the degree of volatility of currency, which is also heavily driven by the strength of the U.S. dollar, while we can't predict those things. So this business is 100% in emerging markets that's always a bit of a challenge.Now that said, the underlying growth in those markets has been steadily strong and it's interesting one indicator of the attractiveness of those markets is -- let's just say the multiples and prices and so forth that anybody who owns a pharmaceutical business in those markets. Thanks to the company is worth. And it was a track was for a long time. Probably some of the highest multiples in the world in any business -- you now I'd say for businesses that make money.They are other attractive, the markets are attractive and the attractive parts of branded generic pharmaceutical worldwide, they are the most profitable -- they're are very profitable markets for good branded products as compared to Europe or the U.S. or something like that, if you're in that business. So we targeted this business for a reason there is underlying real growth brands matter, quality matters, breadth matters and it's got all the fundamentals that we think are stable, durable, attractive, et cetera. And frankly all those kind of economies have progressed. As we would like, maybe not as stable and maybe not as strongly in some cases, but the growth there is still strong.Our own challenge is the R&D investments to continue to expand product lines and product depth into the markets we keep our R&D somewhat decentralized by region, India has its own, Latin America has its own, et cetera. We're always looking for greater and greater productivity and greater and greater launch activity out of our teams. Every now and then we're going to run into an Argentina, a Venezuela or a tax issue in a Country like we did in India, a couple of years ago, et cetera, that are going to put a dent in the growth rate for a given year, and we've seen that. But the underlying fundamentals are quite strong, quite good and we keep plugging away at all the fundamentals that we know how to manage.And as you can tell this last year, we've had steady sequential improvement in our performance excluding exchange and they are up at 8%, I think that's pretty good. That means that we -- know how to take the corrective actions to get stronger, to get better, to drive the business better and I think the fact that the managers of pharmaceutical business are up to an 8% [Phonetic] growth rate and looking forward to even improvement. And that -- I think that's pretty strong. So yeah, we like the business.Rick Wise -- Stifel -- AnalystGreat. And if I could follow up just on two quick things. At TCT, we saw some very solid Portico data. I assume we're still on track for a mid 2020 U.S. launch any updates there would be great on Portico. And last, just -- the U.S. Vascular business still seems pressured, not really improving. What are the issues? What are you doing? I know you're still focused on execution is a competition, is it -- it's how do you turn that portion of the business around? Thank you.Robert B. Ford -- President and Chief Operating OfficerYeah Rick, this is our Robert here. So on your Portico question. Yeah, we submitted end of Q3, so we expect a kind of a mid-year approval here and launch and we're getting ready for that. On your question on vascular as we previously mentioned, there are a couple -- what I would call non-commercial items that impact the growth rate here, these are third-party royalties, third-party manufacturing agreements that we put in place is part of the St. Jude divestiture -- some of the assets.So those -- as those ramp down as those manufacturing agreements ramped down as those royalties ramped down, they obviously impact the growth rate and we've allocated those agreements into the U.S. line even though their global -- their global agreement. So here if you, if you remove those items that are naturally going down as we transition to manufacture over to the new -- to the new owners of those businesses and as the royalties ramped down you remove that out our vascular business was flat and the dynamic there was really a little bit of pricing that we've seen on the stent side we've continue to grow share in the U.S. actually and maintain our leadership position in the international markets.And that price pressure was then offset by double-digit growth in our Endo and in peripheral business and in our imaging and diagnostic business and that's part of our strategy, which is, we know that there will be some pricing pressure on the DS side, and we know we need to make our investments to maintain our competitive position there, but we also know that we over investing in our Endo and our imaging strategy. So that, those businesses can get large enough and that those double digits when can really return Vascular to a healthy growth rate.Rick Wise -- Stifel -- AnalystThanks, Robert.Scott Leinenweber -- Vice President-Investor Relations, Licensing, and AcquisitionsOperator, we'll take one more question.OperatorThank you. And our last question comes from Matt Taylor from UBS. Your line is open.Matt Taylor -- UBS -- AnalystHi, good morning. Thanks for taking the question. I was hoping that you might just expand a little bit on the Libre in dynamics given the continued strength that you've seen outside the U.S. Could you comment on anything like installed base mix of Type 1 versus Type 2 our payers -- are getting involved they see value there. Anything like that, that could help us understand the sustainability of the growth especially outside the U.S., where you continue to have a larger and larger base?Miles D. White -- Chairman and Chief Executive OfficerYeah. So let's talk about that base. I mean the one way to describe it here, that it's a very large and it's growing. We focus a lot on the sales side. But if you look at the user base, where we're at the 1.5 million close to 1.6 million users at the end of this quarter. As we talked a little bit -- there was a little bit of constraint on that user base given our manufacturing capacity. So as we've now unleashed it, I think we've got the potential here to kind of grow that user base even faster.One of the things that is important here that we've seen as payers and contract start to look at this is that they're very convinced on the outcomes of using sensor-based technology, there's a lot of clinical data that proves that. We actually have RCT trials that show that Libre reduces hypo, reduces time out of range, reduces the time that patients are in hypoglycemia. And we backed that up with some fairly large real world evidence trials showing that and competitors also have that too.So, the value proposition here is how do you get that outcome at a cost that makes sense for the payer, where they can actually expand the use of the product in the technology into a much larger user base versus kind of niche it to kind of very small segments and that's been the value proposition that we've adopted and as I said in the beginning of the call that value proposition is not only very impact, but it is growing and we see that we see that in the negotiations we've had with Canadian reimbursement authorities. We see that expansion of the technology beyond just Type 1 or insulin users in other markets, we start seeing it expand into Type 2.So we think the value proposition here is very strong and it's a real an opportunity to provide the benefits of the outcomes that are proven at a cost profile that makes sense for the payer. So and it's ultimately about having the impact on outcomes for patients and we're seeing that through our trials and through our real world evidence. If you think about the composition of the patients we're looking at 50-50 what we're getting a lot of Type 1s and insulin users, but we're also getting a lot of Type 2s, Type 2s that are on single injections or Type 2s are on oral medication. There are different utilization rates, but we're getting all those patients.Matt Taylor -- UBS -- AnalystOne quick follow up. Are you now completely unconstrained on manufacturing?Miles D. White -- Chairman and Chief Executive OfficerYes.Matt Taylor -- UBS -- AnalystOkay. Great. Thanks a lot. Thanks for the color.Miles D. White -- Chairman and Chief Executive OfficerOkay. I'm going to wrap up, where we started. We had a strong quarter, exceptionally strong quarter. Our momentum continues, we've got some great growth drivers in Libre, MitraClip, the Alinity platforms other businesses, they're all growing, many of them double digits and across the board. So the balance of that performance across all businesses and across all geographies is heartening. It is sustainable. We -- our top line growth rate was 7.6% this quarter. We think it will be close to 8% in the fourth quarter and as we look into 2020. I see no reason to change any expectations about the strength of our top line sales growth rate, which is I think all of you know for a fairly large company unusual to find the other people that are able to do this for tech companies.And so we got some great strength here, owing to the strength of our pipeline, our new product launches. The improvements to access and/or reimbursement and further capabilities of those products. So we've got a good sustainable road ahead of us, obviously there are surprises or things that don't meet our expectations from time-to-time or the speed with which we want to accomplish things. But overall, I think this is good evidence to you all -- a good performance super performance really and sustainably, so. So we look at 2020 with great optimism and great expectations in spite of a lot of the uncertainties in the world and in the economies around the world. We're feeling pretty strong and pretty bullish about where we sit.So with that, we'll see in 90 days.Scott Leinenweber -- Vice President-Investor Relations, Licensing, and AcquisitionsThank you, operator, and thank you for all of your questions. This now concludes Abbott's conference call. A webcast replay of this call will be available after 11:00 a.m. Central time today on Abbott Investor Relations website at abbottinvestor.com. Thank you for joining us today.Operator[Operator Closing Remarks]Duration: 50 minutesCall participants:Scott Leinenweber -- Vice President-Investor Relations, Licensing, and AcquisitionsMiles D. White -- Chairman and Chief Executive OfficerBrian B. Yoor -- Executive Vice President, Finance and Chief Financial OfficerRobert B. Ford -- President and Chief Operating OfficerDavid Lewis -- Morgan Stanley -- AnalystLarry Biegelsen -- Wells Fargo -- AnalystBob Hopkins -- Bank of America -- AnalystVijay Kumar -- Evercore ISI -- AnalystRobbie Marcus -- JP Morgan -- AnalystRick Wise -- Stifel -- AnalystMatt Taylor -- UBS -- Analyst More ABT analysis All earnings call transcripts 10 stocks we like better than Abbott LaboratoriesWhen investing geniuses David and Tom Gardner have a stock tip, it can pay to listen. 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