{ "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": 30, "pageCount": 239, "prevPage": 29, "nextPage": 31, "slideType": "villain_critique", "function": "name_villain", "density": "overcrowded", "nDataPoints": 0, "notes": "The slide uses expert quotes to undermine the company's clinical claims.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "metadataConfidence": 0.95, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/30", "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-30", "components": [ { "bbox": null, "kind": "callout", "text": "It is therefore not surprising that Nevro and its peers appear downright paranoid about doing any long term studies, preferring to cease evaluation at the 3-12 month mark lest they blow up reimbursement.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-3f3d-76db-b339-5810a509a857", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.9, "x": 0.05, "y": 0.13 }, "kind": "paragraph", "text": "It is therefore not surprising that Nevro and its peers appear downright paranoid about doing any long term studies, preferring to cease evaluation at the 3-12 month mark lest they blow up reimbursement. The “Clinical Evidence” page on Nevro’s site has a chart for “Long-Term Responder Rates,” which the footnotes indicate refer to only 12 and 24 month data – an eon in the stim space. We quote one of Nevro’s consultants and highest volume implanters, who despite his enthusiasm notes the rapid fall off in efficacy within 1-2 years; admits that 50% of patients need to consider an explant by year 5; and that stimulators fail to reduce the need for pain medications like opioids. A second Nevro implanter stated that “long term, stimulators don’t work as well.”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "e902e108-0d2e-45a3-9275-7c46f18357a6", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.3, "w": 0.9, "x": 0.05, "y": 0.4 }, "kind": "quote", "text": "“All of the SCS devices at the five-year mark really start to drop off. I'm always curious about what it is that happens after a year or two for these patients...No one has really studied that. That's the problem. For all SCS devices, I would say 50% have reached the point at 5 years where it's no longer helpful enough to keep using them and maybe even consider an explant. At 5 years they're explants or they move on to a different therapy but continue to use the stim, or they may even stop using the stim. We've seen patients say I am using the stim but I still need injections every three months. Or I need oral opioids. Some go on to have pumps. SCS was originally sold as a good opportunity to avoid having to return to ongoing injections or opioids. There was a retrospective review of changes in opioid use with stim because many companies would say \"Oh, you know, you just how to solve the opioid crisis\", but they found that you know with stim opioids don’t necessarily go down.” – High volume Nevro implanter", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "8bc983d3-9a00-43f4-91a4-fbb63a3bcf46", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.9, "x": 0.05, "y": 0.82 }, "kind": "quote", "text": "“There were less than 10 neuromodulation studies in 50 years, only 6 even worth quoting. There’s not much evidence.” – Longtime Medtronic executive in SCS", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "9dfdbe8f-d32f-4b25-aa6e-1632002f7359", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.08, "w": 0.9, "x": 0.05, "y": 0.72 }, "kind": "quote", "text": "“Long term, stimulators don’t work as well. Patient are desperate, say it works, then say it doesn’t work. It’s usually a misleading trial in a patient. The published data says stim doesn’t work in 30% of patients.” – High volume implanter and moderate Nevro user", "attrs": null, "subkind": "testimonial", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "b8e17ab9-0229-4177-a1e4-fbaa5c4e7595", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "All of the SCS devices at the five-year mark really start to drop off. I'm always curious about what it is that happens after a year or two for these patients...No one has really studied that. That's the problem. For all SCS devices, I would say 50% have reached the point at 5 years where it's no longer helpful enough to keep using them and maybe even consider an explant. At 5 years they're explants or they move on to a different therapy but continue to use the stim, or they may even stop using the stim. We've seen patients say I am using the stim but I still need injections every three months. Or I need oral opioids. Some go on to have pumps. SCS was originally sold as a good opportunity to avoid having to return to ongoing injections or opioids. There was a retrospective review of changes in opioid use with stim because many companies would say \"Oh, you know, you just how to solve the opioid crisis\", but they found that you know with stim opioids don't necessarily go down. — High volume Nevro implanter; Long term, stimulators don't work as well. Patient are desperate, say it works, then say it doesn't work. It's usually a misleading trial in a patient. The published data says stim doesn't work in 30% of patients. — High volume implanter and moderate Nevro user; There were less than 10 neuromodulation studies in 50 years, only 6 even worth quoting. There's not much evidence. — Longtime Medtronic executive in SCS", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-3f3d-76db-b339-5f0aeab55556", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "Source: Consultation calls with experts", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "dbddffe5-4ea7-444b-b820-cc227f83f1e3", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.4, "x": 0.05, "y": 0.04 }, "kind": "title", "text": "Scorpion Capital | Nevro (NYSE: NVRO)", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "5b1ec681-8223-4bf0-ad87-1dde162d9d76", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.05, "y": 0.1 }, "kind": "title", "text": "1. Introduction to Nevro", "attrs": null, "subkind": "subtitle", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "1e4aa18a-fecf-4c39-8ab4-63da164b388c", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [ { "to": 50, "from": 21, "beatId": "88afdd76-4cd8-403f-9d7e-4634fdd1d420", "arcName": "Overcoming the Monster", "arcSlug": "overcoming-monster", "beatName": "The Struggle", "beatSlug": "overcoming-monster-the-struggle", "evidence": "The deck details the struggles faced by Nevro's patients and the company's response", "position": 1, "confidence": 0.8, "parentBeatName": "Development", "parentBeatSlug": "development" } ], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }