{
  "docId": "019dd923-622c-750b-8b9a-648c05e927ed",
  "docSlug": "ea3395f0d3bd",
  "documentTitle": "Inspire Medical Systems, Inc. (INSP)",
  "authorId": "60_Wolfpack_Research",
  "authorName": "Wolfpack Research",
  "documentKindSlug": "research-note",
  "documentKindLabel": "Research note",
  "sourceTypeSlug": "short_seller",
  "sourceTypeLabel": "Short seller",
  "presentationDate": "2020-04-22 00:00:00",
  "orientation": "portrait",
  "aspectRatio": 0.77272725,
  "pageNumber": 17,
  "pageCount": 57,
  "prevPage": 16,
  "nextPage": 18,
  "slideType": "villain_critique",
  "function": "expose_gap",
  "density": "overcrowded",
  "nDataPoints": 5,
  "notes": "The slide uses external data (CDC, NEJM, American Thoracic Society) to challenge the company's market sizing assumptions.",
  "elementsJson": [
    "paragraph",
    "line_chart",
    "bullet_list",
    "quote_block",
    "footnote"
  ],
  "metadataConfidence": 1,
  "imagePath": null,
  "slideHref": "/slides/019dd923-622c-750b-8b9a-648c05e927ed/17",
  "deckHref": "/decks/019dd923-622c-750b-8b9a-648c05e927ed",
  "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-648c05e927ed.json",
  "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-648c05e927ed#slide-17",
  "components": [
    {
      "bbox": null,
      "kind": "callout",
      "text": "BMI alone reduces Inspire’s addressable market by more than 30%.",
      "attrs": null,
      "subkind": null,
      "toolName": "Visual emphasis",
      "toolSlug": "visual-emphasis",
      "confidence": null,
      "componentId": "019dd953-5375-7572-b874-7723d20f08b8",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.21,
        "w": 0.66,
        "x": 0.17,
        "y": 0.25
      },
      "kind": "chart",
      "text": "US Adult BMI Distribution, 2015-2016",
      "attrs": null,
      "subkind": "line",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "116d3cbc-5b26-4ffc-adba-0b9d17f3b579",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.06,
        "w": 0.75,
        "x": 0.14,
        "y": 0.605
      },
      "kind": "list",
      "text": "3.2% prevalence in men 20-44 years old; 11.3% prevalence in men 45-64 years old; 18.1% prevalence in men 61-100 years old",
      "attrs": null,
      "subkind": "bullet",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "156123e2-626a-4499-af19-4b500575ee57",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": null,
      "kind": "metric",
      "text": "addressable market: 30%",
      "attrs": null,
      "subkind": "primary",
      "toolName": "Quantification",
      "toolSlug": "quantification",
      "confidence": null,
      "componentId": "019dd953-5375-7572-b874-7d65ca36a1b4",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.04,
        "w": 0.77,
        "x": 0.118,
        "y": 0.093
      },
      "kind": "paragraph",
      "text": "However, this was after heavy pre-screening for age, BMI and OSA severity that ensured most of the STAR study patients met the criteria for these constraints.",
      "attrs": null,
      "subkind": "paragraph",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "345079d3-7d46-40d3-8e4e-d0a6f6549790",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.03,
        "w": 0.77,
        "x": 0.118,
        "y": 0.485
      },
      "kind": "paragraph",
      "text": "BMI alone reduces Inspire’s addressable market by more than 30%. Nearly 30% of the US population has a BMI of over 32.",
      "attrs": null,
      "subkind": "paragraph",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "9d1894b0-68f2-426e-a85d-59d500ab0b1b",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.06,
        "w": 0.77,
        "x": 0.118,
        "y": 0.167
      },
      "kind": "paragraph",
      "text": "According to Inspire-sponsored studies, their initial FDA approval, and an FDA patient manual for Inspire’s device, the efficacy of Inspire’s device declines above a BMI of 32.",
      "attrs": null,
      "subkind": "paragraph",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "c03da6f4-90ab-4b12-85f6-a44e280b29dd",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.06,
        "w": 0.75,
        "x": 0.14,
        "y": 0.725
      },
      "kind": "quote",
      "text": "And in general, the older we get the more medical problems we have so, nothing is really absolute as far as upper limit [with respect to patient age]. But in general, I would say the best candidates are probably in their forties and fifties.",
      "attrs": null,
      "subkind": "pull-quote",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "58a812b9-9a7a-4ee4-95b9-fb89a76f111e",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": null,
      "kind": "quote",
      "text": "“And in general, the older we get the more medical problems we have so, nothing is really absolute as far as upper limit [with respect to patient age]. But in general, I would say the best candidates are probably in their forties and fifties.” — A sleep doctor",
      "attrs": null,
      "subkind": null,
      "toolName": "Authority citation",
      "toolSlug": "authority-citation",
      "confidence": null,
      "componentId": "019dd953-5375-7572-b874-78650c662c49",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.02,
        "w": 0.77,
        "x": 0.118,
        "y": 0.895
      },
      "kind": "source-note",
      "text": "Data taken from a 2015-2016 NHANES survey from the Centre for Disease Control",
      "attrs": null,
      "subkind": null,
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "7f530b3a-c66b-40f4-8f9a-2ca24def7f4c",
      "frameworkName": null,
      "frameworkSlug": null
    }
  ],
  "metrics": [],
  "tools": [
    {
      "name": "Chart Selection Guide",
      "slug": "chart-selection-guide",
      "agent": "Designer",
      "layer": "slide",
      "matchId": "a998ad3a-a32c-4150-a45f-454776b342f0",
      "evidence": "US Adult BMI Distribution, 2015-2016",
      "confidence": 0.7
    },
    {
      "name": "Villain slide",
      "slug": "villain-slide",
      "agent": null,
      "layer": "slide",
      "matchId": "53a416c4-302e-41cb-a35e-61afc7e6db23",
      "evidence": "According to Inspire-sponsored studies, their initial FDA approval, and an FDA patient manual for Inspire’s device, the efficacy of Inspire’s device declines above a BMI of 32.",
      "confidence": 0.9
    }
  ],
  "frameworks": [
    {
      "name": "fraud-exposure",
      "slug": null,
      "matchId": "dde0bba3-4b66-47c9-93d3-8d123fb03508",
      "evidence": "Critiquing the company's TAM calculation by highlighting ignored constraints.",
      "confidence": 0.9
    }
  ],
  "arcBeats": [
    {
      "to": 20,
      "from": 6,
      "beatId": "e9079ce5-c7de-4121-8615-3ae679f7ffcd",
      "arcName": "Overcoming the Monster",
      "arcSlug": "overcoming-monster",
      "beatName": "The Struggle",
      "beatSlug": "overcoming-monster-the-struggle",
      "evidence": "The document presents the limitations and side effects of the product",
      "position": 1,
      "confidence": 0.8,
      "parentBeatName": "Development",
      "parentBeatSlug": "development"
    }
  ],
  "loops": [
    {
      "to": 20,
      "from": 14,
      "name": "Cost Of Inaction",
      "slug": "27-cost-of-inaction",
      "bestFor": "Urgent budget requests, compliance, risk mitigation",
      "matchId": "83735121-ef20-47de-bdeb-a1fe30c3f52e",
      "evidence": "The document presents an alternative to CPAP that is effective and minimally invasive",
      "position": 1,
      "objective": "To highlight the cost of inaction for investors",
      "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point",
      "confidence": 0.6,
      "description": "Quantify what happens if the audience does nothing"
    }
  ],
  "imagePathAlt": null,
  "thumbSrc": null,
  "thumbSrcAlt": null,
  "locked": true
}