Macroeconomic conditions¹

Global economic growth (excluding the euro area) remained resilient in 2025, with an estimated growth rate of 3.5%. The United States and China continued to be primary drivers, though the United States saw a cooling of labor demand toward year-end, while China’s manufacturing sector remained a pillar of its economy despite a slowing property market. In contrast to the previous year, the euro area saw improved performance with an annual growth rate of 1.4%, bolstered by strong domestic demand. The outlook for 2026 suggests a slight moderation to 3.3% globally especially as trade policy shifts and fiscal adjustments take effect.

In 2025, world trade growth slowed significantly to 2.8%, down from the more robust levels seen in 2024. This deceleration was primarily due to the unwinding of what are known as front-loading activities, where firms accelerated imports in late 2024 to avoid anticipated U.S. tariffs, and the actual imposition of new trade barriers. Private consumption in the euro area remained a cornerstone of growth, rising by an average of 1.3% over the year, supported by record-low unemployment (6.4%) and rising real incomes. However, manufacturing remained the weak link in the global economy, struggling under the weight of higher energy costs and increased international competition, particularly in the automotive and chemical sectors.

Global inflation continued its gradual normalization in 2025, with the euro area inflation averaging 2.1%. While energy and food prices stabilized, the services sector remained a source of what is known as sticky inflation, hovering around 3.5% due to persistent wage pressures. Wage growth began to cool in late 2025, with compensation per employee slowing to roughly 4.0%, a trend expected to lead to further disinflation in 2026. Core inflation (excluding energy and food) proved more stubborn, ending the year at approximately 2.4%.

Global financing conditions were characterized by a fragile stability in 2025. After a series of rate cuts earlier in the year, the ECB maintained steady interest rates in the fourth quarter as inflation neared its 2% target. Business investment saw a modest recovery, growing by 2.4%, as firms increasingly directed capital toward digital transformation and artificial intelligence (AI) integration to offset high labor costs. However, lending conditions for small and medium-sized enterprises (SMEs) remained slightly tighter than for large corporations. Geopolitical risks in the Middle East and shifting U.S. trade policies continued to create volatility in bond markets and kept risk premiums elevated for much of the year.

Healthcare industry

The healthcare sector is one of the world’s largest industries and we are convinced that it demonstrates excellent growth opportunities.

The main growth factors are:

• rising medical needs deriving from aging populations,

• the growing number of chronically ill and multimorbid patients,

• stronger demand for innovative products and therapies,

• advances in medical technology,

• the growing health consciousness, which increases the demand for healthcare services and facilities, and

• the increasing demand for digital health services for patients.

In the emerging countries, additional drivers are:

• expanding availability and correspondingly greater demand for basic healthcare, and

• increasing national incomes and hence higher spending on healthcare.

Overall, OECD countries² spent an average of 9.3% of their GDP on healthcare services in 2024 (2023: 9.2%). The average share of healthcare expenditure in national income across OECD countries remained significantly higher in 2024 than before the COVID-19 pandemic (2019: 8.8%), reflecting persistent structural cost pressures despite the end of emergency crisis funding.

The United States recorded the highest expenditure per capita with a finalized figure of US$13,432 for 2023 and an estimated US$13,950 for 2024. Based on current OECD data, Germany continues to rank among the top spenders, placing fourth in the OECD comparison with an expenditure of US$8,441 per capita in 2023 (2022: US$8,011), while its total healthcare spending as a share of GDP reached 12.3% in 2024.

In order to limit the constantly rising expenditure in the healthcare system, cost bearers are increasingly reviewing care structures to identify potential savings. However, rationalization alone cannot compensate for the rise in costs. For this reason, market-based incentives for cost- and quality-conscious action in the healthcare sector should also be created. In this way, treatment costs can be reduced by improving the overall quality of care. As a result, prevention programs are becoming just as important as innovative compensation models that are linked to the quality of treatment. The digitalization of the healthcare system in particular can also contribute to improved patient care and greater cost efficiency.

The markets for biopharmaceuticals, clinical nutrition, MedTech, generic IV drugs, and IV fluids³

The market for biopharmaceuticals from the therapeutic areas of oncology, ophthalmology, and autoimmune diseases – consisting of originator products and biosimilars – grew by approximately 12% to around €300 billion, of which the biosimilars market was approximately €25 billion with a growth rate of 21% versus the prior year. The total market for biosimilars, including therapeutic areas not yet addressed by Fresenius Kabi, amounted to approximately €31 billion in 2025. The acquisition of a majority stake in mAbxience significantly strengthened Fresenius Kabi in this growth market, in which the company participates through biosimilars and contract development and manufacturing of biopharmaceuticals. The market for biopharmaceuticals is a fast-growing and innovative segment, which will gain even more relevance for the care of patients going forward. Competitors in the biosimilars market include Amgen, Sandoz, Celltrion, Pfizer, Biocon, Biogen, Organon, and Teva.

In 2025, the addressed global clinical nutrition market reached approximately €12 billion, reflecting growth of 4% versus the previous year. Despite these positive developments, there remains considerable potential for further growth, as nutrition therapies continue to be underutilized in patient care, despite evidence of their medical and economic benefits. Research indicates that these therapies can help reduce hospital costs by shortening patient stays, particularly in cases involving health- or age-related nutritional deficiencies.

Fresenius Kabi, a leading provider of parenteral nutrition and a notable player in the enteral nutrition market, is focusing on addressing this growth opportunity. The company plans to introduce its clinical nutrition offerings in countries where its current portfolio is limited. By expanding its range of products and leveraging additional distribution channels, Fresenius Kabi seeks to enhance its global market presence.

The competitive landscape includes Baxter, B. Braun, Kelun Group, and JW Pharmaceutical in the parenteral nutrition market, while Abbott, Nestlé, and Danone are among the main competitors in the enteral nutrition segment.

The MedTech Infusion and Nutrition Systems (INS) product portfolio of Fresenius Kabi is broad and composed of product groups such as infusion and nutrition pumps and their dedicated disposables, extended by software-based solutions focusing on application safety, user workflows, increased therapy efficiency and interoperability with hospital systems, non-dedicated disposables, anesthesia monitoring devices, and dedicated sensors. The market for devices and related dedicated disposables is estimated to be around €5 billion with a growth rate of around 3%. There is a significant further market for non-dedicated disposables. The MedTech Infusion System product range has been extended with the Ivenix portfolio, designed to address specific needs for the U.S. market. In the MedTech INS segment, Fresenius Kabi ranks among the leading suppliers worldwide.

Competitors in the MedTech INS market include Baxter, B. Braun, Becton Dickinson, and ICU Medical.

In 2025, the market for MedTech Transfusion Medicine and Cell Therapies (TCT) was about €4 billion. Fresenius Kabi holds market-leading positions in blood as well as in plasma collection where, especially for the latter, increased demand for plasma-derived therapies has resulted in attractive market growth. Due to newly approved treatments, the cell and gene therapies segment continues to be the fastest-growing market within TCT. Our Lovo device has quickly become an industry standard for automated cell washing and concentration. Cue is fast gaining traction in the market for additional manufacturing unit operations within the cell and gene space.

Competitors in the MedTech TCT market include Terumo, Haemonetics, and Macopharma.

In 2025, the global market for generic IV drugs and IV fluids was around €50 billion⁴. With significant regional differences, the market generated low-single-digit growth. Fresenius Kabi was able to enter additional segments of the global addressable market due to the expansion of our product portfolio in the areas of complex formulations, differentiated generics, and prefilled syringes, among others.

Fresenius Kabi’s competitors in the market for generic IV drugs include Pfizer, Teva, Sandoz, Viatris, and Hikma. Competitors in the market for IV fluids include Baxter, B. Braun, ICU Medical, and Grifols.

The hospital market⁵

The market volume for acute hospitals in Germany in 2024 was around €145 billion⁶. Measured in terms of total gross costs, around 61% of this was attributable to personnel costs and 37% to material costs, which increased by around 8% and 4%, respectively.

Based on the number of admissions, Helios Germany is the leading company in the German market for acute hospitals, with a market share of around 7%⁷. The Helios clinics mainly compete with individual hospitals or local and regional clinic associations. Private competitors include Asklepios Kliniken, Sana Kliniken, and the Ameos Group.

The increase in the compensation of hospital services in the German flat rate per case billing system (DRG system) is based on what is known as the change value (“Veränderungswert”). It is agreed on an annual basis. For 2025, the change value was 4.41% (2024: 5.13%).

The flat rates per case are used to determine the reimbursement of inpatients. The related nursing staff costs per case at the bedside have been carved out from the flat rates since 2020. The nursing staff costs are reimbursed in full by the care budget based on the actual costs incurred. It is not tied to services provided, and is individually negotiated by the contractual partners as part of the overall budget negotiations.

From 2025, the costs of midwives are included in the nursing care budget, in addition to the costs of specialist and assistant nursing staff. What are referred to as other professions have been reintegrated into the DRG accounting.

Hospital beds by operator

Mainly due to the inflation-related general cost increases, the economic situation of the German hospitals has deteriorated. The proportion of hospitals with an annual surplus was only 23% in 2024 (2023: 30%). 66% of German hospitals posted losses in 2024 (2023: 61%)⁸. In addition, there is a significant need for investment. The German Hospital Federation (DKI) estimates that the annual investment requirements of German hospitals amount to about €7 billion.

To financially support hospitals in Germany, the federal government decided in 2025 to introduce a surcharge on hospital invoices, which applies for the period from November 1, 2025 to October 31, 2026. The surcharge is a percentage mark-up of 3.25% on inpatient or partially inpatient hospital treatment invoices for patients insured under the statutory health insurance scheme, and is billed separately.

In 2025, the shortage of specialist staff and problems filling vacancies in the nursing care sector continued to pose a challenge for inpatient hospital care in Germany.

The central topic in the German hospital sector in 2025 was the hospital structure reform. The reform is based on the Hospital Care Improvement Act (“Krankenhausversorgungsverbesserungsgesetz” – KHVVG) which came into force in January 2025. The aim is to make healthcare provision in Germany fit for the future by reorganizing hospital structures and hospital compensation.

A key element is the expansion of hospital financing to include volume-independent maintenance flat rates linked to specific medical service groups, which in turn are subject to defined structural and quality criteria. Among other things, this is intended to ensure that complex treatments may only be carried out in hospitals that have the appropriate personnel and technical equipment.

An average of 60% of the compensation is to be distributed independently of performance via the maintenance flat rates and the care budget. The volume-based compensation based on flat rates per case will be limited to 40%. The reform is to be implemented over a period of several years.

As part of the Hospital Reform Adjustment Act (“Gesetz zur Anpassung der Krankenhausreform” – KHAG), the introduction of the structural reform is to be postponed by one year. The law is expected to be adopted in the first half of 2026.

Further information on the hospital structure reform can be found in the Outlook section.

In order to promote outpatient care, since the beginning of 2023, day treatments without overnight stays in the hospital can be billed using flat rates per case. This is intended to reduce night shifts, particularly in nursing, in order to create additional capacity for nursing staff on the day shift.

The first hybrid DRGs were introduced on January 1, 2024, which provide the same level of compensation for treatments in hospital and by general practitioners. These services were expanded in 2025.

The market volume for private hospitals in Spain was around €22.5 billion in 2024⁹.

With a sales share of around 13%, Helios Spain is the leading company in the private hospital market. Its competitors are a large number of privately run individual hospitals or smaller chains, including Vithas, HM Hospitales, Hospiten, Ribera Salud, Hospitales Sanitas, and HLA.

In Spain, about 82% of the hospital beds are in the public health system with around 296 beds per 100,000 population, which is significantly below the EU average of 525 beds per 100,000 population.¹⁰

Public healthcare facilities in Spain are largely tax-financed and are generally open to the population without further charges or co-payment obligations. The public coverage ensures access to essential services for all residents.

In addition, the Spanish government promotes the private healthcare sector through tax reliefs for private health insurance purchased by employers, among other things. It allows insured persons to receive treatment in a private hospital or by a private physician, thereby enabling shorter waiting times for surgical procedures or specialist care, and it also gives them the opportunity to obtain a medical second opinion.

Private health insurance supplements, but does not replace, public coverage in Spain. About 28% of residents had private coverage in 2024. The average premium of private health insurance in Spain is about €58 per month. The final cost varies by age, location, provider, and coverage level.¹⁰

A challenge in some regions of the country continued to be the shortage of skilled workers, particularly in the care sector. In addition, a certain shortage of doctors is emerging in some specialist areas due to the steadily increasing demand for healthcare services.

In addition to inflation-related cost increases, the shortage of specialists and changes in the regulatory environment, digitalization is another challenge for the hospital sector in Germany and Spain. At the same time, it offers enormous opportunities, for example by standardizing and automating processes to a greater extent. New technologies offer the possibility of tapping into efficiency potential while maintaining at least the same, and often even higher, quality, and reducing costs. It is estimated that in Germany alone, around 12%¹¹ of total expenditure on healthcare and patient care can be saved through digitalization.

This information represents further information in accordance with ESRS 2 SBM-1.40g of the Sustainability Statement.

¹ European Central Bank, 2025

² The following key figures and explanations are based on OECD health data and corresponding OECD publications; the available data refers to the year 2024 or the latest available figures from the previous year.

³ Market data is based on company research and refers to the markets relevant for Fresenius Kabi. This is subject to annual volatility due to currency fluctuations and patent expiries of original drugs in the IV drug market, among other things.

⁴ As in the previous year, the market definition also includes revenue of off-patent products.

⁵ In each case, the most recent market data available refers to the year 2024 as no more recent data has been published: German Federal Statistical Office, 2024 data

⁶ The market is defined by total costs of the German acute care hospitals (gross), less academic research and teaching.

⁷ Measured by Helios Germany’s number of acute care admissions in 2024 in relation to total admissions numbers in Germany in 2024 (German Federal Statistical Office, 2024 data)

⁸ German Hospital Institute (DKI) 2025, Krankenhaus Barometer 2025

⁹ Market data based on company research and refers to the addressable market of Quirónsalud. Market definition includes both inpatient and outpatient healthcare services. It includes neither public-private partnership (PPP) nor occupational risk prevention centers (ORP). The market definition may differ from the definition in other contexts (e.g., regulatory definitions).

¹⁰ Spain Healthcare Statistics, Trends & Facts (2025)

¹¹ Digitalization in German hospitals, McKinsey & Company, Healthcare September 2018