Strategic MedTech Buyers Going Global: A New Era of Cross-Border M&A

Nelson Advisors
Sep 2
12 min read

Executive Summary

The global MedTech sector is entering a new era of mergers and acquisitions (M&A) characterised by a pronounced shift from broad portfolio expansion to highly selective, technology-driven acquisitions. While the broader healthcare M&A landscape experienced a decline in deal volume and value in 2024, the MedTech sub-sector demonstrated remarkable resilience. This report highlights that a period of market resurgence is underway, driven by a strategic focus on a smaller number of high-value deals. The primary catalysts for this activity are the urgent pursuit of innovations in artificial intelligence (AI), advanced surgical solutions, and digital health, as well as the imperative of market consolidation and global expansion.

This new M&A environment is not without its challenges. Dealmakers must navigate a complex web of regulatory disparities between key markets like the U.S. and Europe, heightened geopolitical scrutiny, and the intricate process of post-merger integration (PMI). Despite these hurdles, strategic buyers like Johnson & Johnson, Stryker, and Boston Scientific are demonstrating how targeted acquisitions can accelerate growth, fill portfolio gaps, and create new business segments.

The outlook for 2025 remains optimistic, with sustained momentum expected to be fuelled by improving economic conditions and the continued demand for transformative technologies. This report concludes with actionable recommendations for both acquirers and target companies, underscoring the increasing importance of specialised partners, such as MedTech Contract Research Organisations (CROs), in navigating this dynamic landscape.

The New Era of MedTech M&A: A Global Market Resurgence

The MedTech M&A market has demonstrated a clear and significant rebound, signaling a new, more disciplined era for strategic dealmaking. This sector's performance in late 2024 and early 2025 stands in stark contrast to the broader trends observed in the healthcare industry, which saw a decline in both deal volume and value. Understanding this divergence is key to appreciating the unique drivers of MedTech M&A today.

Contextualising the MedTech Rebound

MedTech M&A activity is on a definitive upward trajectory. According to J.P. Morgan, MedTech companies announced 305 M&A transactions in 2024, the second-highest count in the past decade, just behind the 2021 peak. A closer look at the data reveals that this momentum accelerated significantly in the latter half of 2024 and into 2025. In Q1 2025, the upfront value of MedTech deals surged to approximately $9.2 Billion, a dramatic jump from the $2.7 Billion recorded in Q4 2024, despite a slight dip in transaction volume from 62 to 57 deals.

This MedTech-specific data offers a crucial point of contrast with the broader healthcare M&A landscape. In 2024, the overall healthcare sector experienced a decline in deal volume and value, falling approximately 13% and 19%, respectively, compared to 2023. The MedTech sub-sector's resilience in the face of these headwinds is attributable to its strong underlying fundamentals. Strategic buyers and private equity firms are increasingly attracted to the sector's defensive characteristics, predictable cash flows, and robust growth prospects, particularly in areas like AI-driven diagnostics, wearables, and advanced surgical technologies.

Defining the "New Era": The Shift from Volume to Value

The primary characteristic of the current MedTech M&A landscape is a clear focus on fewer, yet larger and more strategic, acquisitions. This marks a fundamental departure from the previous periods of broad asset aggregation. The dramatic increase in the median upfront payment, which rose from just $14 Million in Q4 2024 to $250 Million in Q1 2025, provides tangible evidence of this shift. This trend indicates a market where buyers are exercising greater discipline and are less willing to pursue a wide range of smaller assets. Instead, they are concentrating their capital on singular, high-value investments with a high degree of confidence.

This pattern suggests a mature market where dealmakers are seeking to acquire mature companies with deeper product pipelines and established commercial traction, rather than a speculative rush into early-stage ventures. For example, a single deal, Johnson & Johnson's $13.1 Billion acquisition of Shockwave Medical, accounted for 23% of the total annual M&A investment in 2024. This kind of transaction confirms that leading companies are pursuing large, strategic deals that align with core growth priorities, a trend that is expected to continue throughout 2025.

Strategic Drivers Behind Cross-Border MedTech Acquisitions

The decision to pursue cross-border M&A in the MedTech sector is driven by a complex interplay of technological, market, and financial factors. These drivers motivate companies to look beyond their domestic borders in a quest for a competitive advantage.

The Pursuit of Innovation and Portfolio Gap-Filling

The primary catalyst for MedTech M&A is the urgent need to acquire innovative technologies that can revolutionize healthcare delivery and outcomes. Companies are specifically targeting firms specialising in cutting-edge areas such as AI-driven diagnostics, remote patient monitoring, and advanced surgical technologies.

The acquisition of these technologies is not merely about adding a new product to a catalog; it is about securing a position in a future where reimbursement models increasingly emphasise real-world data and improved patient outcomes.

A clear trend is the acquisition of firms for their embedded, FDA-cleared AI functionality and data analytics capabilities. Stryker's acquisition of Inari Medical is a prime example of this strategy. While the deal expanded Stryker's footprint in cardiovascular care, a core driver was the integration of Inari's proprietary thrombectomy devices, which generate real-time procedural and outcomes data. This transaction aligns with Stryker's broader strategy of building a portfolio of procedural intelligence and AI-assisted technologies. The acquisition of AI assets is now a direct response to the need for data-driven solutions that can streamline clinical workflows and support new reimbursement models.

This innovation-focused approach often manifests as a "string-of-pearls" strategy, where large strategic buyers make a steady stream of smaller, targeted acquisitions to fill specific portfolio gaps. For instance, Medtronic's purchase of Nanovis' nano-surface technology was a strategic move to incorporate advanced solutions into its next-generation spinal fusion devices. Similarly, Boston Scientific has pursued multiple deals, such as its acquisitions of Bolt Medical and SoniVie, to expand its portfolio in niche, high-growth specialties like peripheral vascular intervention.

Market Consolidation and Global Reach

The global MedTech market remains highly fragmented, with a large number of small and medium-sized companies, particularly in Europe. M&A offers a direct and efficient path to consolidation, allowing larger entities to achieve critical economies of scale and streamline operations.

This market consolidation creates a "one-stop-shop" for healthcare providers, simplifying procurement processes and strengthening the bargaining power of the remaining major manufacturers.

Cross-border acquisitions are also a fundamental strategy for expanding geographic reach and gaining access to new markets. While U.S. companies dominate as both acquirers and targets, they are increasingly seeking foreign firms, particularly in regions like Asia Pacific. The motivation extends beyond market entry; companies are also acquiring targets to gain access to skilled labor, economical production, and high-quality R&D capabilities and infrastructure. This global pursuit allows multinational firms to build diversified supply chains and tap into a broader talent pool.

Economic and Financial Tailwinds

The M&A landscape is also being shaped by shifting economic and financial factors. The anticipation of a more permissive regulatory environment and potential deregulation in the U.S. under a new administration is a significant catalyst for dealmaking. This potential for a less aggressive antitrust stance could accelerate deal values and volumes over the coming year.

A key feature of the new era is the rise of more flexible, risk-shared deal structures. In response to volatile biotech valuations and economic uncertainty, acquirers are increasingly leveraging alternative deal structures such as earn-outs, royalties, and joint ventures. These structures offer a way to mitigate risk by tying additional payments to the achievement of specific, measurable objectives, such as regulatory milestones or commercial success. The persistent trend of low upfront payments since 2015, which reached a low of 8% of total deal value in 2024, reflects a long-term shift toward more conservative financial arrangements.

Case Studies in Strategic Cross-Border M&A

An analysis of recent high-profile acquisitions provides a tangible demonstration of the strategic motivations driving MedTech M&A today. Three leading players, Johnson & Johnson, Stryker, and Boston Scientific, offer compelling examples of this new, disciplined approach.

Johnson & Johnson's Strategic Expansion in Cardiovascular Care

Johnson & Johnson's MedTech strategy is to acquire businesses that immediately contribute to top-line growth and margin accretion. A core focus of this strategy has been the cardiovascular care market, a high-growth area with significant unmet needs. J&J has invested over $32 Billion in this space, with notable acquisitions including Abiomed and Shockwave Medical.

The company's acquisition of Shockwave Medical for $13.1 Billion in 2024 exemplifies this singular, high-value approach. The deal provided J&J with a device that uses shockwaves to treat calcified plaque in heart vessels, addressing a critical need in cardiovascular intervention. The rationale for the acquisition was supported by strong quantitative data; Shockwave had reported a 49% year-over-year revenue increase in 2023, and J&J expects it to become its thirteenth business with annual sales exceeding $1 Billion. This transaction demonstrates a clear focus on acquiring a market leader with proven commercial traction to fuel immediate and long-term growth.

Stryker's Innovation-Driven Approach

Stryker has actively pursued an M&A strategy to sustain its growth at the "high end of MedTech" by integrating advanced technologies. The company completed seven deals in 2024, all of which were "tuck-in" acquisitions that fit within its existing business units. This approach is driven by a desire to build or buy technologies that can be integrated into broader care platforms and enhance the company’s product pipeline.

The company's $4.9 Billion acquisition of Inari Medical is a flagship example of this strategy. The deal was a strategic move to expand into the fast-growing peripheral vascular segment, but its deeper value was in the integration of Inari's AI-assisted technology, which generates real-time procedural and outcomes data.This acquisition builds on Stryker's other AI-focused deals, such as the 2024 purchase of care.ai , and signals a clear commitment to acquiring procedural intelligence that aligns with the future of data-driven healthcare.

Boston Scientific's Portfolio Diversification

Boston Scientific’s M&A strategy is centred on achieving "category leadership" and expanding into "high-growth markets and adjacencies" that complement its existing portfolio. The company's approach is long-term and multi-pronged, often involving early-stage venture capital investments to de-risk promising technologies before a full acquisition. This allows the company to fill portfolio gaps without overpaying.

The acquisitions of Axonics, Inc. and Silk Road Medical, Inc. illustrate this strategic focus.

The acquisition of Axonics added differentiated devices for urinary and bowel dysfunction, strengthening Boston Scientific's urology portfolio. The Silk Road deal brought in a new approach to stroke prevention, further diversifying the company’s cardiovascular offerings. These transactions demonstrate a strategy of strengthening and diversifying the company’s core business units through targeted acquisitions, rather than pursuing broad-based asset aggregation.

Notable Strategic MedTech Acquisitions (2024-2025)

Acquirer	Target	Deal Value	Date	Strategic Rationale
Stryker	Inari Medical	$4.9Bn	Feb 2025	Expand into cardiovascular care and integrate AI-assisted procedural intelligence.
Johnson & Johnson	Shockwave Medical	$13.1Bn	May 2024	Strengthen leadership in cardiovascular intervention with a high-growth, high-margin asset.
Zimmer Biomet	Monogram Technologies	N/A	N/A	Expand surgical robotics portfolio with an AI-driven, autonomous joint replacement platform.
Medtronic	Nanovis	N/A	N/A	Integrate nano-surface technology to accelerate bone growth on spinal implants.
Boston Scientific	Axonics	N/A	2024	Add differentiated devices to the urology portfolio to treat urinary and bowel dysfunction.
Boston Scientific	SoniVie Ltd	$540M	H1 2025	Expand interventional medical device portfolio in high-growth, niche specialties.
Thermo Fisher Scientific	Solventum’s purification & filtration business	$4.1Bn	2025	Strategic acquisition to expand capabilities and fill portfolio gaps.

Navigating the Complexities of Cross-Border Deals

The pursuit of strategic targets in a global market introduces significant complexities that extend beyond financial valuation and due diligence. Regulatory, legal, and cultural hurdles present major risks that require sophisticated planning and execution.

Regulatory and Geopolitical Hurdles

The MedTech regulatory landscape varies significantly between major jurisdictions, creating a key challenge for cross-border deals. In the U.S., the Food and Drug Administration (FDA) provides a centralised and generally predictable regulatory pathway, and the agency has actively tried to make the U.S. an attractive market for new devices. By contrast, the European Union's Medical Device Regulation (MDR), introduced in 2021, has created a more complex and stringent regulatory environment. The MDR requires more clinical data, which has increased costs and extended time-to-market for medical devices, making the EU a less appealing entry point for some innovative technologies.

Dealmakers must develop a nuanced, jurisdiction-specific strategy to navigate this regulatory dichotomy In addition to regulatory approval, cross-border deals face heightened geopolitical and legal scrutiny.

Governments around the world are increasingly implementing stricter controls on foreign investment to protect national security interests, especially for sensitive technologies like AI that have dual commercial and military applications. Furthermore, acquiring a foreign entity can subject the target to additional compliance requirements, such as U.S. anti-corruption laws like the FCPA, which can add complexity and risk to the transaction.

Comparative Analysis of US vs. European MedTech M&A

Feature	United States	Europe
Primary Regulatory Authority	FDA (Centralised)	EU Medical Device Regulation (EU MDR)
Approval Process	Predictable, though rigorous	Stricter, with increased clinical data requirements and longer timelines
Deal Structure	Purchase price adjustments (PPA) are universal	"Lock box" structures are more common
Earn-out Metrics	Revenue-based earn-outs are more prevalent	EBIT/EBITDA is the preferred metric
Liability Caps	Typically lower (10% or less) due to widespread R&W insurance	Typically higher (25% to 50%)
Dispute Resolution	Litigation is the default method	Arbitration is much more common, especially in cross-border deals
Profitability	Generally higher operating margins due to lucrative market access	Generally lower operating margins; market is more fragmented

The Post-Merger Integration Imperative

The success of any M&A transaction hinges on effective post-merger integration (PMI), a process that is particularly complex in the MedTech sector. Operational and IT integration is a significant hurdle, as it involves merging clinical and administrative systems while ensuring uninterrupted patient care and maintaining regulatory compliance.

A fumbled IT integration can lead to severe consequences, including disrupted patient care, data loss, and regulatory non-compliance. The challenges are compounded by the fact that many healthcare entities use notoriously customised Electronic Health Record (EHR) systems that are difficult to merge. To mitigate these risks, experts recommend that PMI planning begin during the due diligence phase, with a phased integration approach to minimise disruption.

Beyond the technical aspects, cultural and talent integration present some of the most unpredictable challenges. The value of a MedTech company often lies not just in its tangible assets but in its talent and the entrepreneurial culture that fuels its innovation engine. While cultural friction between national and organisational cultures can pose a risk to integration, studies have found that foreign ownership can nonetheless enhance the profitability of acquired firms. To address these risks, strategic acquirers are adopting decentralised operating models to help maintain the distinctive culture and entrepreneurial spirit of acquired firms. For example, Johnson & Johnson has transitioned to a decentralised structure, moving 32,000 associates into individual business units, and Stryker’s decentralized operating model is cited as a key to its success.

Outlook and Strategic Recommendations for MedTech Leaders

The strategic focus and cautious optimism that defined the MedTech M&A market in late 2024 are expected to persist and even accelerate in 2025. This momentum, combined with a sustained focus on technological innovation, will shape the future of the sector.

Future Trends and the Road Ahead

The outlook for the second half of 2025 is for sustained M&A growth, driven by improving macroeconomic conditions, continued portfolio gap-filling, and the relentless pursuit of innovation.The focus on AI, digital health, and advanced surgical technologies will remain paramount, with companies that possess embedded, FDA-cleared AI functionality becoming prime acquisition targets.This is a direct consequence of the shift towards outcomes-based reimbursement models, where solutions that incorporate real-world data are becoming central to product differentiation.

The increasing importance of emerging markets will also become a more prominent trend. Acquirers are not just seeking market access but are also targeting these regions to acquire skilled labor, economical production, and R&D capabilities to supplement their domestic operations. This reflects a more sophisticated cross-border strategy focused on building diversified, global footprints.

Actionable Recommendations for a New Era

In this new era of selective, high-value dealmaking, both acquirers and target companies must adapt their strategies to maximise value and mitigate risk.

For acquirers, the shift to high-value deals necessitates a more rigorous and comprehensive diligence process. The analysis indicates that strategic buyers should prioritise early-stage diligence on technology, legal, and intellectual property (IP) assets to uncover potential risks and liabilities. Furthermore, developing a robust, pre-deal PMI strategy that addresses operational, IT, and cultural integration challenges is essential for unlocking a deal's anticipated synergies.

For target companies, the path to a successful exit has become more focused. To attract strategic buyers and secure higher valuations and upfront payments, companies should concentrate on building a strong, defensible technology portfolio, especially one with embedded AI and data capabilities, and achieving proven commercial traction.

A critical, final consideration for all dealmakers is the increasing role of specialized partners in the MedTech M&A ecosystem. MedTech Contract Research Organisations (CROs) are emerging as key enablers of cross-border transactions, providing the necessary expertise to navigate complex regulatory frameworks, clinical trials, and market access hurdles. These specialised partners can de-risk a foreign target and streamline the post-merger integration process, making them an indispensable component of a successful M&A strategy.

Nelson Advisors > HealthTech and MedTech M&A

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