{ "docId": "019dd923-622c-750b-8b9a-2a2468219173", "docSlug": "ce565b841c40", "documentTitle": "Nevro Corp. (NVRO)", "authorId": "58_Scorpion_Capital", "authorName": "Kir Kahlon", "documentKindSlug": "activist-deck", "documentKindLabel": "Activist deck", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2021-01-07 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 199, "pageCount": 239, "prevPage": 198, "nextPage": 200, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 0, "notes": "The slide uses a series of quotes and summaries from medical and state-level reviews to undermine the company's value proposition.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/199", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-199", "components": [ { "bbox": null, "kind": "callout", "text": "Thus, it remains unclear whether SCS provides meaningful long-term benefits to all patients.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b348-51b704d67e69", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.88, "x": 0.06, "y": 0.58 }, "kind": "paragraph", "text": "Yale/Hopkins paper notes lack of patient benefit and low quality of SCS studies purporting efficacy", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "7dd5379c-925e-4f32-8507-f05d81d7f79a", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.88, "x": 0.06, "y": 0.13 }, "kind": "paragraph", "text": "Our interviews indicate that other states such as California are following Washington’s lead. We note that CMS recently proposed a prior authorization requirement, indicating pressure at the national level as well. The findings in the WA study are echoed by numerous independent reviews, in particular the recent Public Citizen review of stimulators (p.31) and a 2018 Yale and Johns Hopkins paper that came to a similar conclusion, expressing “an additional major concern with the SCS efficacy studies”: “they tend to be industry funded with numerous financial conflicts of interest.”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "8b32e6db-3f1f-4664-95ae-c031643cd9d4", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.06, "w": 0.88, "x": 0.06, "y": 0.43 }, "kind": "paragraph", "text": "Oregon state review of 6 years of SCS outcomes indicated little impact in reducing pain or opioid use, and found that half of patients needed revision surgery or device removal, within about a year", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "93898e67-90a5-40d7-9ba4-db018dba37ed", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.88, "x": 0.06, "y": 0.31 }, "kind": "paragraph", "text": "Study concluding that SCS fails to provide pain relief for workers comp patients", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "98c54ca5-7c46-41cb-bbc4-fe40c5330f60", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.88, "x": 0.06, "y": 0.5 }, "kind": "quote", "text": "The spinal cord stimulator is considered a permanent device to reduce the injured worker's pain and decrease the utilization of pain medications. We are not seeing significant positive impact in either of these areas.", "attrs": null, "subkind": "pull-quote", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "285271d2-08c5-47ad-ad60-48309e8c5df2", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.88, "x": 0.06, "y": 0.35 }, "kind": "quote", "text": "In sum, we found no evidence for greater effectiveness of SCS versus alternative treatments in this patient population after 6 months.", "attrs": null, "subkind": "pull-quote", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "8f2f50a8-671b-410a-9af1-bf2ac0e0409a", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.22, "w": 0.88, "x": 0.06, "y": 0.62 }, "kind": "quote", "text": "It is important to note that efficacy studies often rely on patient-based outcome measures to quantify pain relief, such as the pain visual analog scale (VAS) and patient satisfaction. Such measures are subjective, and patients may report high satisfaction via placebo effects, clinician influences, or secondary gain reasons. The long-term effects and/or benefits of SCS for back pain are also unclear. Most trials had relatively short follow-ups of six to 12 months or even less, and only three trials had follow-ups of up to 24 months (Table 1). Indeed, one study has suggested that while pain relief can be observed after six months, these benefits from SCS dissipated after 12 months [48]. Thus, it remains unclear whether SCS provides meaningful long-term benefits to all patients.", "attrs": null, "subkind": "pull-quote", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "93c52c89-f999-40dd-9c56-59612525f288", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "an additional major concern with the SCS efficacy studies: they tend to be industry funded with numerous financial conflicts of interest. — Yale and Johns Hopkins paper", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b348-5442288fea91", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.06, "y": 0.91 }, "kind": "source-note", "text": "Source: https://pubmed.ncbi.nlm.nih.gov/19875232/; https://wcd.oregon.gov/medical/mac/Documents/meetings/2016/7-8-16/SCS-data-from-SAIF.pdf;; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153614/pdf/yjbm_91_3_323.pdf", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "23d5e637-61b1-4800-b77d-734c9a2d5b54", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.88, "x": 0.06, "y": 0.09 }, "kind": "title", "text": "16. The SCS market growth story fueled by Wall Street is false and undermined by escalating payor backlash", "attrs": null, "subkind": "action-title", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "9a3a957c-fa00-4e27-a694-e8486d9de8b6", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.35, "x": 0.06, "y": 0.04 }, "kind": "title", "text": "Scorpion Capital | Nevro (NYSE: NVRO)", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "659dafdd-9281-4f38-a896-27915bb2cbdf", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }