{
  "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": 86,
  "pageCount": 239,
  "prevPage": 85,
  "nextPage": 87,
  "slideType": "expose_contradiction",
  "function": "expose_contradiction",
  "density": "overcrowded",
  "nDataPoints": 6,
  "notes": "The slide uses a red circle to highlight a specific table from a medical paper, emphasizing the discrepancy between real-world outcomes and company claims.",
  "elementsJson": [
    "headline_text",
    "paragraph",
    "screenshot",
    "data_table",
    "quote_block",
    "footnote"
  ],
  "metadataConfidence": 1,
  "imagePath": null,
  "slideHref": "/slides/019dd923-622c-750b-8b9a-2a2468219173/86",
  "deckHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173",
  "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173.json",
  "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-2a2468219173#slide-86",
  "components": [
    {
      "bbox": {
        "h": 0.12,
        "w": 0.88,
        "x": 0.06,
        "y": 0.82
      },
      "kind": "callout",
      "text": "“10 kHz SCS therapy showed promise as a treatment for refractory low back and lower extremity pain in the SENZA-RCT study […] These data differ greatly from the results we have found in real world practice. In the current study, we looked at explant rate of the 10 kHz SCS device as the primary outcome and found that over 20% of implanted stimulators were either explanted outright or exchanged for traditional SCS over two years and that at least 32.5% were explanted or exchanged over the course of the four years of data collection despite repeated reprogramming sessions in the effort to achieve therapeutic optimization.”",
      "attrs": null,
      "subkind": "primary",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "c38e2d59-fa5c-46b7-b10a-f972f70cc3e4",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": null,
      "kind": "callout",
      "text": "A paper presented in January 2020 at NANS, the key annual neuromodulation meeting, indicated explant rates of 22% within 2 years and 33% within 4 years for Nevro’s product “despite repeated reprogramming sessions in the effort to achieve therapeutic optimization” – dwarfing the 1.2-3.7% rates Nevro’s own “paper” claimed by ~10-30x.",
      "attrs": null,
      "subkind": null,
      "toolName": "Visual emphasis",
      "toolSlug": "visual-emphasis",
      "confidence": null,
      "componentId": "019dd953-3f3d-76db-b33d-ca739d0cdb92",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.45,
        "w": 0.55,
        "x": 0.06,
        "y": 0.33
      },
      "kind": "image",
      "text": "Explantation rates of high frequency spinal cord stimulation in two outpatient clinics",
      "attrs": null,
      "subkind": "screenshot",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "6170fb52-e131-4b65-bd1f-1ea09b999db6",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": null,
      "kind": "metric",
      "text": "explant rate: 33%",
      "attrs": null,
      "subkind": "primary",
      "toolName": "Quantification",
      "toolSlug": "quantification",
      "confidence": null,
      "componentId": "019dd953-3f3d-76db-b33d-d35c7a341157",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.12,
        "w": 0.88,
        "x": 0.06,
        "y": 0.13
      },
      "kind": "paragraph",
      "text": "A paper presented in January 2020 at NANS, the key annual neuromodulation meeting, indicated explant rates of 22% within 2 years and 33% within 4 years for Nevro’s product “despite repeated reprogramming sessions in the effort to achieve therapeutic optimization” – dwarfing the 1.2-3.7% rates Nevro’s own “paper” claimed by ~10-30x. The study indicated that the purported results in Nevro’s pivotal SENZA study “differ greatly from the results we have found in real world practice.”",
      "attrs": null,
      "subkind": "paragraph",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "fa2c0c31-4e4a-4860-a443-f795d82db6b9",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": null,
      "kind": "quote",
      "text": "“10 kHz SCS therapy showed promise as a treatment for refractory low back and lower extremity pain in the SENZA-RCT study […] These data differ greatly from the results we have found in real world practice. In the current study, we looked at explant rate of the 10 kHz SCS device as the primary outcome and found that over 20% of implanted stimulators were either explanted outright or exchanged for traditional SCS over two years and that at least 32.5% were explanted or exchanged over the course of the four years of data collection despite repeated reprogramming sessions in the effort to achieve therapeutic optimization.” — NANS 2020 paper",
      "attrs": null,
      "subkind": null,
      "toolName": "Authority citation",
      "toolSlug": "authority-citation",
      "confidence": null,
      "componentId": "019dd953-3f3d-76db-b33d-cc4e522a326e",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.02,
        "w": 0.15,
        "x": 0.06,
        "y": 0.96
      },
      "kind": "source-note",
      "text": "Source: NANS 2020 poster",
      "attrs": null,
      "subkind": null,
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "4777ef41-46ef-4bda-a20c-35f7af0566e3",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.25,
        "w": 0.36,
        "x": 0.58,
        "y": 0.33
      },
      "kind": "table",
      "text": "Years after implant (years) | Cumulative risk of explantation (95% CI) | Patients at risk | Number of patients explanted",
      "attrs": null,
      "subkind": "data",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "f41dccce-64af-4621-aa9b-6463c30d43dc",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.03,
        "w": 0.45,
        "x": 0.06,
        "y": 0.09
      },
      "kind": "title",
      "text": "6. A covered-up device failure and explants crisis",
      "attrs": null,
      "subkind": "headline",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "228b85aa-bf8f-4ffb-84c2-86a747b74181",
      "frameworkName": null,
      "frameworkSlug": null
    }
  ],
  "metrics": [],
  "tools": [],
  "frameworks": [
    {
      "name": "fraud-exposure",
      "slug": null,
      "matchId": "7d5f6b4b-d1d9-414a-ae75-77df89b9b55f",
      "evidence": "The slide explicitly contrasts company claims with real-world data to allege a cover-up.",
      "confidence": 0.9
    }
  ],
  "arcBeats": [
    {
      "to": 150,
      "from": 51,
      "beatId": "903c076a-f368-4ca1-844c-277874c1afb2",
      "arcName": "Overcoming the Monster",
      "arcSlug": "overcoming-monster",
      "beatName": "The Victory",
      "beatSlug": "overcoming-monster-the-victory",
      "evidence": "The deck presents a conclusion that Nevro's problems are insurmountable",
      "position": 2,
      "confidence": 0.8,
      "parentBeatName": "Turn",
      "parentBeatSlug": "turn"
    }
  ],
  "loops": [],
  "imagePathAlt": null,
  "thumbSrc": null,
  "thumbSrcAlt": null,
  "locked": true
}