{ "docId": "019dd923-622c-750b-8b99-9ee2a1e788fb", "docSlug": "1233d0b05ad9", "documentTitle": "PROCEPT BioRobotics Corporation (PRCT)", "authorId": "54_Spruce_Point_Capital", "authorName": "Spruce Point Capital Management", "documentKindSlug": "activist-deck", "documentKindLabel": "Activist deck", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2025-01-16 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 53, "pageCount": 100, "prevPage": 52, "nextPage": 54, "slideType": "market_sizing", "function": "size_opportunity", "density": "overcrowded", "nDataPoints": 10, "notes": "Includes a testimonial/interview excerpt to support the claim of misapplied diagnosis codes.", "elementsJson": [ "headline_text", "paragraph", "data_table", "callout_box", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b99-9ee2a1e788fb/53", "deckHref": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb", "deckJsonHref": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-53", "components": [ { "bbox": { "h": 0.28, "w": 0.43, "x": 0.55, "y": 0.42 }, "kind": "callout", "text": "As we discussed earlier, just 4% of men over 70 have prostates above 100g, and our research found that Aquablation is most competitive versus MISTs and other resective procedures for larger prostates, above 80-100g. Thus, even if we assume 10% of active patients have large prostates, 9.6 million patients, and a 2% annual intervention rate, that implies only 19,200 of the annual 192,000 estimated annual BPH interventions are “best suited” for Aquablation.", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "333f07a8-7c91-460f-9751-b9eabe0339b8", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "metric", "text": "Annual Resective Procedures: 290,000", "attrs": null, "subkind": "primary", "toolName": "Quantification", "toolSlug": "quantification", "confidence": null, "componentId": "019dd952-ee36-760b-9299-7d03472e0f75", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.22, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "Finally, we perform an approximate top-down analysis using data from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other healthcare data. Based on our research, we believe the diagnosis code for BPH is misapplied when ordering PSA tests so that the 12 million patients referenced by Procept is an overestimation. The NIDDK notes that, consistently over the past decade, just 2% of BPH patients each year pursue any form of surgical intervention (MIST or resective). Based on disclosed UroLift volumes from Teleflex and our estimate of current Rezum volumes, we believe just 55% of total interventions are resective surgeries. Thus, similar to the other data referenced, our top-down estimate of annual resective procedures falls far short of the 290,000 figure marketed by Procept.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "3463e422-7323-474b-bc90-367e974b6284", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.12, "w": 0.73, "x": 0.25, "y": 0.72 }, "kind": "quote", "text": "…if you're looking at diagnosis codes, so guys that have the N40.1 or the subcodes beneath that who have a diagnosis of symptomatic BPH…that's a really misleading number, because that code will get dropped in all kinds of situations that really may not mean this guy has symptomatic BPH. It's just a function of how a lot of PSA tests are ordered; people just use that code for that. So there's probably a significant overestimation of total disease burden.", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "cc4644e7-5a50-41b3-b1fc-17671d78951b", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“...if you're looking at diagnosis codes, so guys that have the N40.1 or the subcodes beneath that who have a diagnosis of symptomatic BPH...that's a really misleading number, because that code will get dropped in all kinds of situations that really may not mean this guy has symptomatic BPH. It's just a function of how a lot of PSA tests are ordered; people just use that code for that. So there's probably a significant overestimation of total disease burden.” — Spruce Point Interview with Private Practice Urologist, Dec 2024", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd952-ee36-760b-9299-792f8779efb0", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.1, "w": 0.96, "x": 0.02, "y": 0.87 }, "kind": "source-note", "text": "(1) From Procept October 2024 investor presentation (2) Spruce Point estimate (3) From NIDDK's Urologic Diseases in America 2024 (4) Based on Teleflex guidance of 60-70K UroLifts performed annually and estimation of current Rezum volumes", "attrs": { "numbered": true }, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "dd7594c0-d038-4b16-900c-a2f051d335ce", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.28, "w": 0.52, "x": 0.02, "y": 0.42 }, "kind": "table", "text": "Spruce Point's Top-Down Analysis of BPH Resective Procedures", "attrs": null, "subkind": "data", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "645a2eb3-1781-4375-ac0e-4d3bf863d910", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.08, "w": 0.65, "x": 0.31, "y": 0.03 }, "kind": "title", "text": "Finally, A Top-Down Approach Also Fails To Yield Anything Close To 290,000 Resective Procedures", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "d669883a-6fa7-4b42-892b-0f280d42279a", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [ { "name": "Analytical method", "slug": "analytical-method", "agent": null, "layer": "slide", "matchId": "1b969ba5-63c5-40d0-9d64-5d37ff76722b", "evidence": "The slide presents a top-down analysis using data from reputable sources.", "confidence": 0.7 }, { "name": "Quantification", "slug": "quantification", "agent": null, "layer": "slide", "matchId": "24ec087f-c116-4181-a2ed-373bee07d47c", "evidence": "The slide includes specific numbers and estimates, such as 290,000 resective procedures.", "confidence": 0.8 } ], "frameworks": [ { "name": "market-sizing", "slug": null, "matchId": "a43bbf9c-7440-4f69-a13f-c5f704f1b2f5", "evidence": "Top-down calculation of addressable market", "confidence": 0.9 } ], "arcBeats": [], "loops": [ { "to": 54, "from": 47, "name": "Mece Breakdown", "slug": "40-mece-breakdown", "bestFor": "Problem structuring, ensuring completeness, strategic analysis", "matchId": "9211b273-dc66-4de8-bf7b-81d8ab88c313", "evidence": "Analysis of Procept's market sizing estimate and its flaws", "position": 1, "objective": "Breaking down Procept's market sizing estimate and highlighting its limitations", "structure": "The Whole -> Category A (distinct) -> Category B (distinct) -> Category C (distinct) -> Complete Coverage", "confidence": 0.7, "description": "Divide a complex topic into mutually exclusive, collectively exhaustive categories" } ], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }