(NVRO) 2023 Q4 法說會逐字稿

Good afternoon, and welcome to Nevro's fourth-quarter and full-year 2023 earnings call.

下午好，歡迎參加 Nevro 第四季和 2023 年全年財報電話會議。

(Operator Instructions)

（操作員說明）

I would now like to turn the call over to Angie McCabe, Vice President, Investor Relations and Corporate Communications for Nevro.

我現在想將電話轉給 Nevro 投資者關係和企業傳播副總裁 Angie McCabe。

Please go ahead.

請繼續。

Thank you, Regina.

謝謝你，雷吉娜。

Good afternoon and welcome to Nevro's fourth-quarter and full-year 2023 earnings conference call.

下午好，歡迎參加 Nevro 第四季和 2023 年全年財報電話會議。

With me today are Kevin Thornal, our CEO and President; and Rod McLeod, our Chief Financial Officer.

今天與我在一起的有我們的執行長兼總裁凱文·索納爾 (Kevin Thornal)；以及我們的財務長羅德·麥克勞德 (Rod McLeod)。

Before we get started, please note that our earnings release and the supplemental presentation accompanying this call are available on the Events and Presentation page of the Investors section of our website at nevro.com. Also this call is being broadcast live over the Internet to all interested parties and an archived copy of this webcast will be available in the Investors section of our website shortly after the conclusion of this call.

在開始之前，請注意，我們的收益發布和本次電話會議附帶的補充簡報可在我們網站 nevro.com 投資者部分的活動和簡報頁面上找到。此外，本次電話會議還將透過網路向所有有興趣的各方進行現場直播，本次電話會議結束後不久，我們網站的投資者部分將提供該網路廣播的存檔副本。

Before we begin, I'd like to remind everyone that comments made on today's call may include forward-looking statements within the meaning of federal securities laws.

在開始之前，我想提醒大家，今天電話會議中發表的評論可能包括聯邦證券法含義內的前瞻性陳述。

Results could differ materially from those expressed or implied as a result of certain risks and uncertainties.

由於某些風險和不確定性，結果可能與明示或暗示的結果有重大差異。

Please refer to numbers, SEC filings, including our annual report on Form 10-K for detailed presentations of risks.

請參閱數字、SEC 文件，包括我們的 10-K 表格年度報告，以了解風險的詳細介紹。

The forward-looking statements in this call speak only as of today, and the company undertakes no obligation to update or revise any of these statements.

本次電話會議中的前瞻性陳述僅代表今天的情況，本公司不承擔更新或修改任何這些陳述的義務。

In addition, management will refer to adjusted EBITDA, a non-GAAP measure used to help investors understand Nevro's ongoing business performance.

此外，管理層將參考調整後的 EBITDA，這是一種非 GAAP 衡量標準，用於幫助投資者了解 Nevro 的持續業務績效。

Adjusted EBITDA excludes interest taxes, non-cash items such as stock-based compensation, depreciation and amortization, litigation-related expenses and credits, changes in the fair market value of warrants, and other adjustments such as gains from extinguishment of debt and restructuring charges.

調整後的 EBITDA 不包括利息稅、非現金項目（如股票薪酬、折舊和攤提、訴訟相關費用和信貸、認股權證公平市場價值的變化）以及其他調整（如債務清償收益和重組費用） 。

Please refer to the financial tables in our earnings press release issued today for reconciliations of GAAP to non-GAAP financial measures.

請參閱我們今天發布的收益新聞稿中的財務表格，以了解 GAAP 與非 GAAP 財務指標的調整表。

I will now turn the call over to Kevin.

我現在會把電話轉給凱文。

Kevin?

凱文？

Thank you, Angie.

謝謝你，安吉。

Good afternoon, everyone, and thank you for joining us today.

大家下午好，感謝您今天加入我們。

We're pleased with our fourth-quarter performance and the progress we are making on advancing our core three pillar strategy.

我們對第四季的業績以及在推進核心三大支柱策略方面取得的進展感到滿意。

For the fourth quarter of 2023, and as compared with the year ago period, today we reported worldwide revenue of $116.2 million, an increase of 2% on both a reported and constant currency basis, and ahead of the guidance that we provided on our third quarter 2023 earnings call.

與去年同期相比，我們今天公佈的 2023 年第四季全球營收為 1.162 億美元，按報告匯率和固定匯率計算均增長 2%，高於我們在第三季度提供的指引2023 年季度財報電話會議。

PDN sales grew 29% to nearly $22.4 million. US

PDN 銷售額成長 29%，達到近 2,240 萬美元。我們

trials were down just under 1% and in line with our expectations, and net loss from operations of $11.8 million and adjusted EBITDA of positive $8.4 million, also ahead of our expectations.

試驗下降了不到 1%，符合我們的預期，營運淨虧損為 1,180 萬美元，調整後 EBITDA 為正 840 萬美元，也超出了我們的預期。

For the full year 2023, worldwide revenue was $425.2 million, an increase of 5% on a reported and constant currency basis.

2023 年全年，全球營收為 4.252 億美元，按報告和固定匯率計算成長 5%。

Also in the fourth quarter of 2023, we acquired Vyrsa Technologies, which we are very excited about as it provides us with entry into the very high growth, sacroiliac or SI joint fusion market and have announced a debt refinancing.

同樣在 2023 年第四季度，我們收購了 Vyrsa Technologies，我們對此感到非常興奮，因為它為我們提供了進入非常高成長的骶髂關節或 SI 關節融合市場的機會，並宣布了債務再融資。

Last year, we developed and implemented our strategy to improve our commercial execution and strengthen our foundation so we can deliver stable, consistent performance, achieve long-term profitable growth, enhance stockholder value and continue to provide best-in-class therapies for patients suffering from chronic pain.

去年，我們制定並實施了策略，以改善我們的商業執行力並鞏固我們的基礎，以便我們能夠提供穩定、一致的業績，實現長期盈利增長，提高股東價值，並繼續為遭受痛苦的患者提供一流的治療來自慢性疼痛。

On today's call, I'll highlight key items that demonstrate the progress we are making on a number of fronts.

在今天的電話會議上，我將重點介紹一些關鍵項目，這些項目展示了我們在許多方面取得的進展。

Rod will discuss our fourth-quarter results and 2024 guidance for both the full year and first quarter.

Rod 將討論我們的第四季業績以及 2024 年全年和第一季的指導。

Our strategy consists of three pillars.

我們的策略由三個支柱組成。

The first is commercial execution.

首先是商業執行。

We are laser focused on improving our execution to remove sales barriers, enhance customer experience, and drive long-term profitable growth.

我們專注於提高執行力，以消除銷售障礙、增強客戶體驗並推動長期獲利成長。

To improved sales productivity, we made some changes to the commercial team's compensation structure and completed our commercial realignment.

為了提高銷售效率，我們對商業團隊的薪酬結構做了一些改變，並完成了商業調整。

For example, because healthcare is locally delivered and consumed, we implemented a more geographically focused reporting structure.

例如，由於醫療保健是在本地提供和消費的，因此我們實施了更注重地域的報告結構。

We also rolled out new incentive-based compensation plans that include rewarding sales reps who deliver accelerated growth as well as incentivizing sales leaders to focus on delivering profitable growth.

我們還推出了新的基於激勵的薪酬計劃，包括獎勵加速成長的銷售代表，以及激勵銷售領導者專注於實現獲利成長。

In addition, our market development team is now focused on increasing awareness of SCS as a treatment therapy beyond painful diabetic neuropathy.

此外，我們的市場開發團隊現在致力於提高人們對 SCS 作為疼痛性糖尿病神經病變以外的治療方法的認識。

As a reminder, there are significant growth opportunities in SCS, including nonsurgical back pain and traditional back and leg pain, and we have been at the forefront of driving awareness of new indications and our differentiated technology, as demonstrated by our success in PDN.

提醒一下，SCS 領域存在巨大的成長機會，包括非手術背痛和傳統的背痛和腿痛，我們一直處於提高人們對新適應症和差異化技術認識的最前沿，我們在PDN 方面的成功就證明了這一點。

Importantly, we continue to focus on improving physician engagement and education.

重要的是，我們繼續致力於提高醫生的參與和教育。

Last year, we completed several large new hire training sessions, conducted our first SI joint lab with advisers implemented new professional education programs such as continuum of care courses for pain interventionalists and surgeons and trained over 100 fellows.

去年，我們完成了幾門大型新員工培訓課程，與顧問開展了第一個SI 聯合實驗室，實施了新的專業教育計劃，例如針對疼痛介入醫生和外科醫生的連續護理課程，並培訓了100多名研究員。

The second pillar of our strategy is market penetration through expanded indications, HFX iQ line extensions, a robust R&D pipeline, strong clinical evidence, and targeted additive acquisitions.

我們策略的第二個支柱是透過擴大適應症、HFX iQ 產品線延伸、強大的研發管線、強有力的臨床證據和有針對性的添加劑收購來滲透市場。

We are seeing increased adoption of HFX iQ since its full market launch last March.

自去年 3 月全面推出市場以來，我們看到 HFX iQ 的採用率增加。

HFX iQ represented 53% of our permanent implant procedures in Q4 of 2023, and adoption will continue to grow throughout 2024.

2023 年第四季度，HFX iQ 占我們永久植牙手術的 53%，且採用率將在 2024 年持續成長。

Our data proves that with the HFX iQ system, combined with the cellphone app, which since proactive alerts, physicians clinical burden is reduced by 40%, and patients get back to pain relief 75% faster than patients who are using a traditional remote.

我們的數據證明，透過 HFX iQ 系統與手機應用程式結合，由於主動警報，醫生的臨床負擔減輕了 40%，患者恢復疼痛緩解的速度比使用傳統遙控器的患者快 75%。

To provide even more patients with access to the benefit of HFX iQ within the next few months, we expect to expect to launch a solution for roughly half of these patients who do not have an iPhone, including those with an alternative device.

為了在未來幾個月內讓更多患者受益於 HFX iQ，我們預計將為大約一半沒有 iPhone 的患者（包括那些擁有替代設備的患者）推出解決方案。

In 2023, we also continued to penetrate the SCS market with our expanded indications in the PDN and nonsurgical back pain patient populations.

2023 年，我們也持續滲透 SCS 市場，擴大了 PDN 和非手術背痛患者群體的適應症。

PDN accounted for 24% of our permanent implant procedures in Q4.

第四季度，PDN 占我們永久植牙手術的 24%。

Even with our success in PDN, the market remains underpenetrated at nearly 1%.

儘管我們在 PDN 領域取得了成功，但該市場的滲透率仍然較低，接近 1%。

We are focused on further developing this market with our best-in-class technology and superior clinical data, showing that patients treated with 10 kilohertz therapy experienced durable pain relief and significant improvements at 24 months.

我們專注於利用一流的技術和卓越的臨床數據進一步開發這個市場，這些數據表明，接受 10 kHz 療法治療的患者在 24 個月內經歷了持久的疼痛緩解和顯著改善。

This is one of our key competitive differentiators because competitor devices are purposely designed to cause a tingling sensation to mask pain, which is a common symptom PDN patients already experienced.

這是我們的關鍵競爭優勢之一，因為競爭對手的設備經過專門設計，可以產生刺痛感來掩蓋疼痛，這是 PDN 患者已經經歷過的常見症狀。

In contrast, our 24-month data shows that PDN patients experienced durable pain relief without the use of paresthesia.

相較之下，我們的 24 個月數據顯示，PDN 患者在不使用感覺異常的情況下經歷了持久的疼痛緩解。

Notably, we recently announced the publication of a consensus statement summarizing recommendations based on outcomes from a December 2022 global interdisciplinary panel at the WorldWIDE Diabetes Virtual Global Summit.

值得注意的是，我們最近宣布發布一份共識聲明，總結了基於 2022 年 12 月 WorldWIDE 糖尿病虛擬全球高峰會上全球跨學科小組成果的建議。

The statement, which was published in Diabetes Research and Clinical Practice recommend SCS therapy, and particularly high frequency10 kilohertz SCS, to treat refractory PDN symptoms that aren't adequately addressed by first and second line treatments.

該聲明發表在《糖尿病研究和臨床實踐》上，建議採用 SCS 療法，特別是高頻 10 kHz SCS，來治療一線和二線治療無法充分解決的難治性 PDN 症狀。

Enrollment in our PDN clinical sensory study now stands at 98 patients.

目前，已有 98 名患者參加了我們的 PDN 臨床感官研究。

The study is designed to more objectively prove the sensory improvements that we observed in our initial clinical randomized clinical trial or RCT and to receive an SCS indication beyond pain.

該研究旨在更客觀地證明我們在最初的臨床隨機臨床試驗或 RCT 中觀察到的感覺改善，並獲得疼痛以外的 SCS 適應症。

We believe that this, along with our 24 months data and differentiation of our innovative therapy, will help us further penetrate the PDN market and achieve our goal of having 10 kilohertz therapy referenced in additional society guidelines for the treatment of refractory PDN.

我們相信，這連同我們 24 個月的數據和創新療法的差異化，將幫助我們進一步滲透 PDN 市場，並實現我們的目標，即在難治性 PDN 治療的其他社會指南中引用 10 kHz 療法。

Also in January, we announced that Carelon Health (sic - see slide 6, "Carelon Healthcare") will be publishing a new interventional pain management policy that expands SCS coverage for PDN effective April 14, 2024.

同樣在1 月，我們宣布Carelon Health（原文如此- 參見幻燈片6，“Carelon Healthcare”）將發布一項新的介入性疼痛管理政策，擴大PDN 的SCS 覆蓋範圍，該政策於2024 年4 月14日生效。

As a result, PDN patient coverage will expand by nearly 43 million additional lives, bringing total US covered lives to approximately 250 million.

因此，PDN 患者的覆蓋範圍將增加近 4,300 萬人，使美國覆蓋的總人口達到約 2.5 億人。

We are excited to continue working with physicians to expand awareness and offer this therapy to more patients suffering from PDN.

我們很高興繼續與醫生合作，提高人們的認識，並向更多患有 PDN 的患者提供這種療法。

Turning now to our first ever acquisition, we are excited about the Vyrsa transaction for several reasons.

現在轉向我們有史以來的第一次收購，我們對 Vyrsa 交易感到興奮有幾個原因。

First, we now have access to a large and fast-growing market.

首先，我們現在可以進入一個龐大且快速成長的市場。

The SI joint market is currently valued at $2 billion in the US alone, and we expect the increasing adoption of minimally invasive surgical procedures in this space to be a growth driver.

目前僅在美國，SI 關節市場價值就達到 20 億美元，我們預計該領域將越來越多地採用微創外科手術將成為成長動力。

Second, many physicians who perform SI joint procedures are also performing SCS implant procedures, and we are now able to offer them more options to treat patients suffering from chronic pain.

其次，許多進行 SI 關節手術的醫生也正在進行 SCS 植入手術，我們現在能夠為他們提供更多選擇來治療患有慢性疼痛的患者。

This has the added benefit of strengthening our relationship with these physicians as many of them are already our customers.

這樣做的另一個好處是加強我們與這些醫生的關係，因為他們中的許多人已經是我們的客戶。

Third, we are leveraging our commercial sales force and their current physician relationships to help drive adoption and growth.

第三，我們正在利用我們的商業銷售人員及其當前的醫生關係來幫助推動採用和成長。

It should be noted that when fully trained, we will have the largest SI joint sales force in the market.

值得注意的是，經過充分培訓後，我們將擁有市場上最大的 SI 聯合銷售團隊。

Finally, it broadens and diversifies our pain portfolio.

最後，它擴大了我們的疼痛產品組合併使其多樣化。

We estimate that approximately 15% to 30% of patients with chronic lower back pain had pain that originates in the SI joint, and we now offer options to treat patients with both mechanical and neuropathic pain.

我們估計大約 15% 到 30% 的慢性腰痛患者的疼痛源自骶髂關節，我們現在提供治療機械性疼痛和神經性疼痛的患者的選擇。

We also offer one of the most comprehensive portfolio of products in the SI joint space.

我們也提供 SI 聯合領域最全面的產品組合之一。

We are in the process of transitioning Vyrsa products to Nevro naming and branding.

我們正在將 Vyrsa 產品轉換為 Nevro 命名和品牌。

In the interim, the current portfolios comprised of NevroV1, NevroPRO, and NevroFIX.

在此期間，目前的產品組合包括 NevroV1、NevroPRO 和 NevroFIX。

NevroV1, an integrated SI joint fusion system with transfixing technology will be our flagship product is no other device like it on the market.

NevroV1 是一種採用固定技術的整合式 SI 關節融合系統，將成為我們的旗艦產品，市場上沒有其他類似的設備。

NevroV1 is proven to immediately transfix the SI joint to allow long-term fusion.

NevroV1 已被證明可以立即固定骶髂關節以實現長期融合。

Also, our proprietary instrumentation allows for optimal intra-articular SI joint preparation, which is critical to achieve joint fusion.

此外，我們的專有儀器可以實現最佳的關節內 SI 關節準備，這對於實現關節融合至關重要。

Finally, NevroV1 comes with 3D printed bone growth enhancing technology, which helps promote bone cell growth, and as a result, fusion.

最後，NevroV1 配備了 3D 列印骨骼生長增強技術，有助於促進骨細胞生長，從而促進融合。

With this full suite of products, we are able to accommodate the different SI joint approaches, available sites of service, and CPT codes to meet the preferences of different physicians and varying patient needs, ultimately helping to improve the quality of life and health outcomes for patients.

借助這套全套產品，我們能夠適應不同的 SI 關節方法、可用的服務地點和 CPT 代碼，以滿足不同醫生的偏好和不同患者的需求，最終幫助改善患者的生活品質和健康結果患者。

In early January, we launched training for our sales reps for all three of our SI joint products and will continue to train both reps and physicians throughout 2024 as we ramp up this business.

1 月初，我們為所有三種 SI 聯合產品的銷售代表啟動了培訓，並將在 2024 年繼續培訓銷售代表和醫生，以擴大這項業務。

In addition, our limited market release started this month, and while early, overall physician feedback has been positive so far.

此外，我們在本月開始有限的市場發布，雖然早期，但到目前為止，醫生的整體回饋是正面的。

Importantly, clinicians and medical societies expect that we will continue to generate the clinical evidence in the SI joint space just as we have done in SCS, which is important in driving physician adoption and payer coverage.

重要的是，臨床醫生和醫學會期望我們將繼續在 SI 關節領域產生臨床證據，就像我們在 SCS 中所做的那樣，這對於推動醫生採用和付款人覆蓋範圍非常重要。

Regarding our R&D pipeline, we continue to work on developing new revenue streams that will leverage our largest asset, our sales force, and expanding into new indications for SCS.

關於我們的研發管道，我們將繼續致力於開發新的收入來源，以利用我們最大的資產、我們的銷售隊伍，並擴展到 SCS 的新適應症。

We won't go into detail here for competitive reasons.

出於競爭原因，我們不會在這裡詳細介紹。

But as I previously communicated, one of the reasons why I joined Nevro was because of the impressive pipeline of products.

但正如我之前所傳達的，我加入 Nevro 的原因之一是因為令人印象深刻的產品線。

Finally, our third strategic pillar is profit progress.

最後，我們的第三個策略支柱是利潤進步。

Our goals are to improve efficiencies through streamline processes, scale our Costa Rica manufacturing facility, and have disciplined expense management.

我們的目標是透過簡化流程、擴大哥斯達黎加製造工廠的規模以及嚴格的費用管理來提高效率。

While there is more to do, we are making progress on this front with our leaders and teams across the organization.

儘管還有更多工作要做，但我們正在與整個組織的領導者和團隊在這方面取得進展。

In January, we implemented a restructuring which included laying off 5% of our employees.

一月份，我們實施了重組，其中包括解僱 5% 的員工。

While this was a very difficult decision, it was necessary to position Nevro for long-term growth and profitability.

雖然這是一個非常困難的決定，但有必要讓 Nevro 實現長期成長和獲利。

Rod will talk about the expected financial impact of the restructuring in his remarks.

羅德將在演講中談論重組的預期財務影響。

As I mentioned, we are leveraging our sales force that already call on physicians that treat pain to drive profitable growth in SI joint.

正如我所提到的，我們正在利用我們的銷售隊伍，他們已經聘請了治療疼痛的醫生來推動 SI 關節的盈利增長。

These procedures will require limited postoperative patient follow-up by our commercial team, allowing sales reps to grow revenue without adding patient support team members.

這些程序將需要我們的商業團隊對術後患者進行有限的隨訪，使銷售代表能夠在不增加患者支援團隊成員的情況下增加收入。

We also continue to scale our Costa Rican manufacturing facility, which is supported by world-class manufacturing experts and technology.

我們也繼續擴大我們的哥斯達黎加製造工廠的規模，該工廠得到了世界一流製造專家和技術的支持。

We will leverage it as we expand the business through new products via an R&D and tuck-in acquisition.

當我們透過研發和收購來透過新產品擴展業務時，我們將利用它。

Before I hand the call over to Rod, I want to make a couple of final comments.

在將電話轉交給羅德之前，我想發表幾點最後的評論。

First, I want to thank our Nevro team members for their focus on executing our strategy and steadfast commitment to freeing patients from the burden of chronic pain.

首先，我要感謝我們的 Nevro 團隊成員專注於執行我們的策略，並堅定致力於讓患者擺脫慢性疼痛的負擔。

Second, we recently held our 2024 national sales meeting for our US-based commercial team.

其次，我們最近為美國商業團隊舉行了 2024 年全國銷售會議。

For many of the participants, this was their first Nevro sales meeting and team member show great enthusiasm for our core business, new entry into the SI joint space, and excitement for our future.

對於許多參與者來說，這是他們第一次參加 Nevro 銷售會議，團隊成員對我們的核心業務、新進入 SI 聯合領域表現出極大的熱情，並對我們的未來感到興奮。

We are dedicated to our mission and are building on the progress we made in 2023 to stabilize and strengthen our foundation, which will allow us to transform our business through the opportunities that lie ahead.

我們致力於履行我們的使命，並在 2023 年取得的進展的基礎上鞏固和鞏固我們的基礎，這將使我們能夠利用未來的機會實現業務轉型。

10 kilohertz therapy, which is supported by superior clinical data in multiple RCTs across several indications, is enabling us to provide patients greater access to our innovative therapies.

10 kHz 療法得到了多個適應症的多個 RCT 的卓越臨床數據的支持，使我們能夠為患者提供更多獲得我們創新療法的機會。

Our goals remain the same to execute our strategy and capitalize on meaningful leverage opportunities to drive profitable, long-term growth, positive operating cash flow, and increase shareholder value.

我們的目標保持不變，即執行我們的策略並利用有意義的槓桿機會來推動獲利、長期成長、正營運現金流並增加股東價值。

I'll now turn the call over to Rod for a discussion of our fourth-quarter financial results and 2024 guidance.

我現在將電話轉給 Rod，討論我們的第四季財務業績和 2024 年指引。

Thanks, Kevin, and good afternoon, everyone.

謝謝凱文，大家下午好。

For the fourth quarter of 2023 as compared with the prior year period, worldwide revenue grew to $116.2 million, an increase of 2% as reported and on a constant currency basis.

與去年同期相比，2023 年第四季全球營收成長至 1.162 億美元，以固定匯率計算成長 2%。

Both the current and prior year periods had the same number of selling days.

本年度和上一年期間的銷售天數相同。

PDN represented 20% of permanent implant procedures worldwide, resulting in approximately $22.4 million in PDN indication sales and growing 29% over prior year.

PDN 佔全球永久植入手術的 20%，導致 PDN 適應症銷售額約 2,240 萬美元，比上年增長 29%。

US revenue grew 2% to $101.5 million.

美國營收成長 2%，達到 1.015 億美元。

International revenue was $14.7 million, increasing 4% as reported and flat on a constant currency basis.

國際營收為 1,470 萬美元，按報告成長 4%，以固定匯率計算持平。

Gross profit increased 8.3% to $81.5 million and gross margin increased 400 basis points to 70.1%, driven primarily by a shift to higher margin products, as well as well as lower scrap related charges in the current period.

毛利成長 8.3%，達到 8,150 萬美元，毛利率成長 400 個基點，達到 70.1%，這主要是由於轉向更高利潤的產品以及本期廢品相關費用的降低。

Operating expenses decreased 1.4% to $93.3 million, primarily due to reduced spend across the business, offset by $3 million of onetime Vyrsa-related spend.

營運費用下降 1.4% 至 9,330 萬美元，主要是由於整個業務支出減少，但被一次性 Vyrsa 相關支出 300 萬美元所抵消。

Excluding the Vyrsa-related expenses, operating expenses finished down 5% versus prior year.

不包括 Vyrsa 相關費用，營運費用較前一年下降 5%。

Litigation-related legal expenses were $2.9 million compared with $1.2 million in the fourth quarter of '22.

與訴訟相關的法律費用為 290 萬美元，而 2022 年第四季為 120 萬美元。

Cash, cash equivalents and short-term investments increased $2.5 million from September 30, 2023 to $322.7 million as of December 31, 2023.

截至2023年12月31日，現金、現金等價物及短期投資從2023年9月30日增加250萬美元至3.227億美元。

Cash activities include $47 million in net funds received from our November 2023 debt restructuring, offset by $40 million in cash paid for our acquisition of Vyrsa.

現金活動包括從 2023 年 11 月債務重整中收到的 4,700 萬美元淨資金，被我們收購 Vyrsa 支付的 4,000 萬美元現金所抵銷。

As we previously announced, we acquired Vyrsa for $40 million in cash at closing on November 30, 2023, and agreed to pay up to an additional $35 million in cash or stock tied to the achievement of certain development and sales milestones.

正如我們先前宣布的，我們於 2023 年 11 月 30 日交割時以 4000 萬美元現金收購了 Vyrsa，並同意額外支付最多 3500 萬美元的現金或股票，以實現某些開發和銷售里程碑。

The transaction was immaterial to our fourth quarter revenue results.

該交易對我們第四季的營收結果並不重要。

As Kevin commented in his remarks, we believe that physicians will begin treating patients in need as we train them on the procedure over the next few months.

正如凱文在他的演講中評論的那樣，我們相信，在接下來的幾個月裡，當我們對醫生進行手術培訓時，他們將開始治療有需要的患者。

We continue to expect the transaction to be accretive to both revenue and adjusted EBITDA this year.

我們仍然預計該交易將增加今年的收入和調整後的 EBITDA。

The first half of the year will focus on training physicians and Nevro commercial field personnel, while the second half of the year will begin to reflect increasing revenue traction.

今年上半年將重點培訓醫生和 Nevro 商業領域人員，而下半年將開始反映出收入成長的勢頭。

As a reminder, for 2024, we expect revenue contribution from SI joint to be immaterial to the overall year.

提醒一下，對於 2024 年，我們預期 SI 聯合的營收貢獻對全年而言並不重要。

Also on November 30, 2023 we announced the restructuring of a majority of our debt, pushing the maturity out to 2029 through a six-year $200 million term loan credit facility.

同樣在 2023 年 11 月 30 日，我們宣布重組大部分債務，透過為期六年的 2 億美元定期貸款信貸安排將到期日推遲到 2029 年。

The proceeds were used to repurchase the majority of our 2025 convertible notes as well as for working capital and other general corporate purposes.

所得款項用於回購我們的大部分 2025 年可轉換票據以及營運資金和其他一般公司用途。

Turning now to a discussion of our 2024 full-year and first-quarter guidance.

現在討論我們的 2024 年全年和第一季指引。

For the full year 2024, we expect worldwide revenue of approximately $435 million to $445 million, representing an increase of 2% to 5% over full year 2023 on a reported and constant currency basis.

對於 2024 年全年，我們預計全球收入約為 4.35 億至 4.45 億美元，按報告和固定匯率計算，較 2023 年全年增長 2% 至 5%。

As a reminder, our major competitors have all reported their most recent quarterly results and appears that the SCS market grew in the low to mid-single digit range, excluding what we believe is primarily replacement activity by one of our competitors.

提醒一下，我們的主要競爭對手都報告了他們最近的季度業績，並且 SCS 市場似乎在中低個位數範圍內增長，不包括我們認為主要是我們競爭對手之一的替代活動。

We expect gross margin to be approximately flat with 2023 gross margin of 68%.

我們預計毛利率將與 2023 年 68% 的毛利率大致持平。

Our Costa Rican manufacturing facility continues to produce excellent results on low labor and material costs for manufactured products.

我們的哥斯達黎加製造工廠繼續以低廉的勞動力和材料成本生產出色的產品。

However, higher than the initially projected inventory levels and higher Omnia mix will delay the full margin expansion impact a few quarters.

然而，高於最初預期的庫存水準和更高的 Omnia 組合將使全面利潤率擴張的影響推遲幾個季度。

We're excited about the cost improvements Costa Rica can deliver, and we continue to project longer-term gross margins in the mid-70s, assuming pricing holds at current levels.

我們對哥斯達黎加能夠實現的成本改善感到興奮，並假設定價保持在當前水平，我們將繼續預測 70 年代中期的長期毛利率。

We expect operating expenses to be in the range of $390 million to $392 million and largely flat compared with 2023.

我們預計營運支出將在 3.9 億至 3.92 億美元之間，與 2023 年相比基本持平。

Our 2024 operating expense guidance includes ongoing litigation expenses and investments to drive growth in our PDN and our SI joint fusion product portfolios.

我們的 2024 年營運費用指南包括持續的訴訟費用和投資，以推動我們的 PDN 和 SI 聯合融合產品組合的成長。

We expect adjusted EBITDA to be negative $8 million to negative $14 million.

我們預計調整後 EBITDA 為負 800 萬美元至負 1,400 萬美元。

This includes a $14 million to $15 million benefit from our restructuring, which we announced and implemented in January 2024 which we expect will be largely offset by normal operating expenses including inflation, merit increases, and other acquisition-related expenses.

這包括我們於2024 年1 月宣布並實施的重組帶來的1,400 萬至1,500 萬美元收益，我們預計該收益將在很大程度上被正常營運費用（包括通貨膨脹、績效成長和其他收購相關費用）所抵消。

To help with your modeling, we expect normal seasonality with Q1 sales to be our lowest quarter, down approximately 16% from Q4 2023.

為了幫助您進行建模，我們預計正常季節性第一季的銷售額將是最低的季度，比 2023 年第四季下降約 16%。

We are projecting the remainder of the year to play out in historical fashion, where Q2 demonstrates a pickup from Q1, Q3 is flat to down sequentially from Q2, and then we finished with a strong Q4.

我們預計今年剩餘時間將以歷史方式結束，第二季較第一季有所回升，第三季較第二季持平或下降，然後第四季表現強勁。

These revenue results with slightly stronger second half growth also reflects what Kevin mentioned earlier regarding our efforts to improve our commercial execution.

這些下半年成長略強的收入結果也反映了凱文之前提到的關於我們努力提高商業執行力的內容。

Similarly, operating expenses will follow our typical seasonality where Q1 as our large largest spend quarter due to events such as our national sales meeting, the NANS conference, and SI joint training for customers and our field team.

同樣，營運費用將遵循我們的典型季節性，其中第一季是我們最大的支出季度，原因是我們的全國銷售會議、NANS 會議以及為客戶和我們的現場團隊提供的 SI 聯合培訓等活動。

For the first quarter of 2024, we expect the following: worldwide revenue of approximately $97 million to $99 million, representing an increase of 1% to 3% over the first quarter of '23 on a reported and constant currency basis; operating expenses of approximately $105 million, which include higher than normal spend related to restructuring costs and SI joint training; and adjusted EBITDA to be approximately negative $15 million to negative $16 million.

對於 2024 年第一季度，我們預計：全球營收約為 9,700 萬美元至 9,900 萬美元，按報告和固定匯率計算，比 23 年第一季度增長 1% 至 3%；營運費用約為 1.05 億美元，其中包括與重組成本和 SI 聯合培訓相關的高於正常支出的費用；並將 EBITDA 調整為約負 1500 萬美元至負 1600 萬美元。

Adjusted EBITDA will exclude a $5 million to 6 million restructuring charge related to the January layoffs.

調整後的 EBITDA 將不包括與 1 月裁員相關的 500 萬至 600 萬美元的重組費用。

As we previously communicated, beginning in the first quarter of 2024, we will no longer provide a breakout of our PDN indication sales.

正如我們之前所傳達的，從 2024 年第一季開始，我們將不再提供 PDN 適應症銷售的細分數據。

In closing, we made significant changes in 2023 to strengthen our foundation and further position our business for long-term profitable growth.

最後，我們在 2023 年做出了重大改變，以鞏固我們的基礎並進一步定位我們的業務以實現長期獲利成長。

And we know that we have more work to do.

我們知道我們還有更多工作要做。

We are excited about the opportunities ahead of us and remain committed to executing our strategy to deliver enhanced stockholder value.

我們對眼前的機會感到興奮，並繼續致力於執行我們的策略，以提高股東價值。

Regina will now open the call for questions.

里賈納現在將開始提問。

(Operator Instructions) Kallum Titchmarsh, Morgan Stanley.

（操作員指令）Kallum Titchmarsh，摩根士丹利。

Yeah.

是的。

Thank you very much for taking the question.

非常感謝您提出問題。

Just wanted to dig into the 2024 guidance a bit more if possible.

如果可能的話，我只是想進一步深入了解 2024 年的指導方針。

You're guiding for between 2% to 5% top-line growth.

您的目標是實現 2% 到 5% 的收入成長。

I know you've historically called out the SCS market growing around 6% to 9% historically.

我知道您曾經說過 SCS 市場的成長率在 6% 到 9% 左右。

You've obviously got some softer comps from '23.

很明顯你從 23 開始就得到了一些更軟的補償。

The sales force restructuring is now in place, too.

銷售隊伍重組現已到位。

Just be helpful if you could help us to reconcile that guidance in relation to the broader market.

如果您能幫助我們協調與更廣泛市場相關的指導，請提供協助。

Is this just being conservative or is there something else we should be considering here?

這只是保守還是有其他我們應該考慮的事情？

Thanks a lot.

多謝。

Yeah.

是的。

Thanks for the question, Kallum.

謝謝你的提問，卡勒姆。

Really, if you look at the last few quarters of our competitors and now, this is a quarter where we already have all of our three competitors public company make their announcements.

真的，如果你看看我們競爭對手的最後幾個季度，現在，這個季度我們已經讓所有三個競爭對手上市公司都發布了公告。

They are flat to down in maybe some of the US markets there.

那裡的一些美國市場的股價可能持平甚至下跌。

We believe we'll outperform some of our competitors in this space, given our ramp up a new sales force as well as the excitement around new products and the indication growth with PDN and nonsurgical back pain.

我們相信，鑑於我們新的銷售隊伍的壯大、新產品的興奮以及 PDN 和非手術背痛適應症的增長，我們將在這個領域超越一些競爭對手。

So that gives us a little bit of a pause as we're looking for the year and don't want to get out in front of our skis and think that the market's going to be already overnight back to that 6% to 9%.

因此，這讓我們有點停頓，因為我們正在尋找今年的走勢，並且不想走到滑雪板前並認為市場將在一夜之間回到 6% 至 9% 的水平。

So right now with the market looking to be low to mid-single digit growth, we felt this is a good guidance for us to start off the year.

因此，目前市場預計將出現低至中個位數的成長，我們認為這對我們新年伊始來說是一個很好的指導。

Got you.

明白你了。

And just one more follow-up if that's okay.

如果可以的話，就再進行一次後續行動。

On PDN, obviously no indication specific guidance as expected, but just eyeballing the street, I think the estimate here is just under 30% growth year over year.

在 PDN 上，顯然沒有任何預期的具體指導，但只要觀察一下街道，我認為這裡的估計同比增長略低於 30%。

How do you feel about that number, given the tougher comps that will come into play?

考慮到即將到來的更艱難的比賽，你對這個數字有何看法？

I think we saw around that level in 2023 Q4.

我認為我們在 2023 年第四季度看到了這個水平。

Just curious how we should be thinking about a setup here for the rest of the year in absence of the guide.

只是好奇，在沒有指南的情況下，我們應該如何考慮今年剩餘時間的設定。

Thanks a lot.

多謝。

Yeah, Kallum, we're not -- as we said, we'll not be providing guidance or breaking out PDN going forward.

是的，Kallum，我們不會——正如我們所說，我們不會提供指導或突破 PDN。

As we said in the past, we really think the right way to look at the market is from an overall SCS perspective and all of our competitors are in PDN now.

正如我們過去所說，我們確實認為看待市場的正確方法是從整體 SCS 角度出發，而我們所有的競爭對手現在都在 PDN 中。

They've posted -- they've been in it for a couple of quarters.

他們已經發布了——他們已經參與了幾個季度了。

The last couple of quarters have been in that kind of flattish to maybe low-single digit growth.

過去幾季的成長一直持平，甚至可能是低個位數成長。

And the way Kevin just outlined our overall SCS growth for this year, I think is the right way to think about it.

Kevin 剛剛概述了我們今年 SCS 的整體成長，我認為這是正確的思考方式。

Larry Biegelsen, Wells Fargo.

拉里·比格爾森，富國銀行。

Hi.

你好。

This is Nathan Treybeck, on for Larry.

我是內森·特雷貝克（Nathan Treybeck），替補拉里（Larry）。

Just a question on Vyrsa.

只是一個關於維爾薩的問題。

So the market for SI fusion devices seems to be crowded.

因此SI融合設備的市場似乎很擁擠。

How do you plan to differentiate Vyrsa?

您打算如何讓 Vyrsa 脫穎而出？

And Nevro built its reputation on clinical data.

Nevro 的聲譽建立在臨床數據之上。

I guess what's the plan to develop data from Vyrsa?

我猜開發 Vyrsa 數據的計劃是什麼？

Thanks.

謝謝。

Yeah.

是的。

Obviously, it's a crowded space, but also it's a fast-growing space.

顯然，這是一個擁擠的空間，但也是一個快速成長的空間。

And we looked at a lot of different companies as we were evaluating getting into the space, and almost all of them -- some of the smaller private companies were growing double digits.

在評估進入該領域時，我們考察了許多不同的公司，幾乎所有這些公司——一些較小的私人公司都實現了兩位數的成長。

That's what gave us confidence that this was a fast-moving space and addressing a clinical need for patients.

這讓我們相信這是一個快速發展的領域並能滿足患者的臨床需求。

And the reason why we acquired Vyrsa is they had all the products that you could utilize for this category, all three, an allograft, a screw, as well as a transfixion device.

我們收購 Vyrsa 的原因是他們擁有該類別中可以使用的所有產品，所有這三種產品，同種異體移植物、螺絲以及貫穿裝置。

And so that gave us confidence that it was the right company to go after.

這讓我們相信它是值得追尋的正確公司。

Additionally, as I mentioned, we have by far the largest SI joint sales force now in the market, especially once we get them all trained that which will take some time.

此外，正如我所提到的，我們擁有迄今為止市場上最大的 SI 聯合銷售隊伍，尤其是當我們對他們進行全部培訓後，這將需要一些時間。

So we feel that in combination with the relationships we have with the SCS implanting physicians and our reps' relationships with those physicians that we'll be able to utilize those relationships to be able to get off to a fast start once they're trained.

因此，我們認為，結合我們與 SCS 植入醫生的關係以及我們的代表與這些醫生的關係，我們將能夠利用這些關係，在他們接受培訓後能夠快速啟動。

Okay.

好的。

Thanks for that.

感謝那。

And for my follow-up, what are your expectations for our new SCS competition in '24?

我的後續問題是，您對 24 年新的 SCS 比賽有何期望？

And I guess how does that influence your ability to take share in the year?

我想這對你今年分享份額的能力有何影響？

Thanks.

謝謝。

As a reminder, we're the only high-frequency 10 kilohertz therapy out there and everybody else is coming into the market, they are all low frequency with a few different bells and whistles competing against each other.

提醒一下，我們是唯一的高頻 10 kHz 療法，其他所有人都在進入市場，它們都是低頻療法，有一些不同的花哨功能相互競爭。

And just listening from commentary from those other companies, we believe that the target that they're going after is physicians that are still believers in the low frequency technology.

僅聽其他公司的評論，我們相信他們的目標是仍然相信低頻技術的醫生。

So we'll continue steadfast in following our clinical superiority and our clinical studies that we have out there to differentiate us from the competition.

因此，我們將繼續堅定不移地遵循我們的臨床優勢和臨床研究，使我們在競爭中脫穎而出。

And so while we never want to look away from any competitor, we believe that our guidance incorporates having those two new players in the market.

因此，雖然我們永遠不想忽視任何競爭對手，但我們相信我們的指導包括在市場上擁有這兩個新參與者。

Shagun Singh, RBC Capital.

沙貢辛格，加拿大皇家銀行資本。

Great.

偉大的。

Thank you so much.

太感謝了。

Kevin, I was wondering if you could talk a little bit about your key priorities and goals for 2024.

Kevin，我想知道您是否可以談談您 2024 年的主要優先事項和目標。

When we can expect Nevro to kind of get back into the share take position?

我們什麼時候可以期望 Nevro 重新獲得股份？

Because it seems like your '24 outlook doesn't reflect that.

因為你的 24 年展望似乎並沒有反映出這一點。

And then lastly, I was just wondering if there are any updates on acquisitions and how you're thinking about further filling the bag.

最後，我只是想知道收購方面是否有任何更新，以及您如何考慮進一步充實這個袋子。

Thank you for taking the questions.

感謝您提出問題。

Of course, of course.

當然，當然。

Yeah, as we've said last year, I came onboard end of April and Greg Siller, our Chief Commercial Officer came on in the summer and we looked at the realignment of the sales force and the talent that we had in certain positions and really started to make some of those changes.

是的，正如我們去年所說，我於四月底加入，我們的首席商務官格雷格·西勒 (Greg Siller) 在夏天上任，我們研究了銷售隊伍的重組以及某些職位的人才，確實開始做出一些改變。

And as a result, as you know, it takes six to nine months for some of these reps to get up to speed.

因此，如您所知，其中一些銷售代表需要六到九個月的時間才能跟上進度。

We had some of the largest sales training classes in the history of the company in the third and fourth quarter.

我們在第三和第四季舉辦了公司歷史上規模最大的一些銷售培訓課程。

So yeah, we expect that now they're starting to hit their stride a little bit as we get into probably Q2 and Q3 this year.

所以，是的，我們預計，隨著今年我們可能進入第二季度和第三季度，他們現在開始取得一些進展。

And then obviously, we threw in a new acquisition to learn all at the same time.

顯然，我們投入了一項新的收購來同時學習所有內容。

While we know that longer term, this is going to be a great market, it will take us some time to get them up to speed on.

雖然我們知道從長遠來看，這將是一個巨大的市場，但我們需要一些時間才能讓他們加快步伐。

But we do like our chances in competing head to head with our competitors with the new sales reps we have out in the field.

但我們確實希望有機會與我們的競爭對手以及我們在該領域的新銷售代表進行正面競爭。

And the second question is as far as on how long it may take them to get up to speed, like we said, nine months would be hitting most of those at the Q2 mark.

第二個問題是，他們需要多長時間才能加快步伐，正如我們所說，九個月將達到第二季的大多數水平。

Rod will take the

羅德將採取

--

--

Shagun, you also asked about what other acquisitions we might be thinking about to fill the bag with.

Shagun，您也詢問了我們可能會考慮進行哪些其他收購來填補這個空缺。

Yeah.

是的。

And Kevin can comment on this as well, but I think with everything Kevin just outlined, we got a lot of effort and energy go into training our sales force on Vyrsa, getting the physicians in the field trained and maybe let us get a couple of quarters under our belt and we can talk a little more about what some other future opportunities might be.

凱文也可以對此發表評論，但我認為凱文剛才概述的一切，我們投入了大量的努力和精力來培訓 Vyrsa 的銷售人員，讓現場的醫生接受培訓，也許讓我們得到一些我們可以更多地討論未來可能存在的其他機會。

Adam Maeder, Piper Sandler.

亞當梅德，派珀桑德勒。

Hi, good afternoon and thank you for taking the questions.

您好，下午好，感謝您提出問題。

Two quick ones from me.

我的兩個快的。

I wanted to ask about pricing in 2024 and how we should think about that with the continued launch of IQ and maybe just flesh out what's assumed in the guidance for price.

我想問一下 2024 年的定價，以及隨著 IQ 的持續推出，我們應該如何考慮這個問題，也許只是充實價格指南中的假設。

And then the second question, I feel like I have to ask about the new revenue streams comment, Kevin, and new indications for SCS.

然後是第二個問題，我覺得我必須詢問新的收入來源評論，Kevin，以及 SCS 的新適應症。

And I know you're not going to say a ton here, but is it fair to assume that this is still in some way shape or form still pain related?

我知道你不會在這裡說太多，但是可以公平地假設這仍然在某種程度上與疼痛相關嗎？

Or is it something else?

還是別的什麼？

And how do we think about timing there?

我們如何考慮那裡的時機？

Is this potentially a '24 event or 2025?

這可能是 24 年或 2025 年的活動嗎？

Thank you.

謝謝。

Yeah, I'll take the second first and then turn it over to Rod.

是的，我先拿第二個，然後交給羅德。

Yeah, on the new product development, you caught that right.

是的，關於新產品開發，你說得對。

We are working with our R&D teams.

我們正在與我們的研發團隊合作。

When I joined the company, I saw some of the places that they were going.

當我加入公司時，我看到了他們要去的一些地方。

And as we've talked about, we said we want to leverage our largest asset that we have in the organization, which is our over 500-person sales organization, and we will stay really close to home and make sure that their products that can leverage those call points and those education in what our reps do extremely well, which is sell on clinical superiority and great customer-centric mindset and the DNA that we have where those Nevro loyalists who love working with us like what we bring to the table there.

正如我們所討論的，我們說我們希望利用我們在組織中擁有的最大資產，即我們超過 500 人的銷售組織，我們將離家很近，並確保他們的產品能夠利用這些呼叫點和教育，我們的代表做得非常出色，即推銷臨床優勢和偉大的以客戶為中心的心態，以及我們擁有的DNA，那些喜歡與我們合作的Nevro 忠誠者喜歡我們帶來的東西。

So we'll stay close to home and won't do anything crazy that would dilute our sales channel.

所以我們會留在家附近，不會做任何會稀釋我們銷售管道的瘋狂事情。

And then Rod will take first one.

然後羅德將拿走第一個。

Yeah.

是的。

Hi, Adam.

嗨，亞當。

On pricing, the way to think about it is if you think about the average selling price of one of our implantable devices, as that mix continues to shift towards IQ, we should overall see that average price go up a little bit.

在定價方面，考慮的方法是，如果你考慮我們的一款植入式設備的平均售價，隨著這種組合繼續轉向智商，我們總體上應該會看到平均價格會上漲一點。

So from a modeling perspective, flat to slightly up is probably a pretty reasonable assumption.

因此，從建模的角度來看，持平到略有上升可能是一個相當合理的假設。

Joanne Wuensch, Citi.

喬安妮‧溫施，花旗銀行。

Good afternoon.

午安.

This is actually Anthony on for Joanne.

這其實是安東尼為喬安妮代言的。

Thanks for taking our questions.

感謝您回答我們的問題。

First, on the sensor study.

首先，關於感測器的研究。

I know it's pretty early, but I guess just thinking broadly, is this opportunity more about getting additional patients in terms of indication?

我知道現在還為時過早，但我想只是廣泛思考一下，這個機會更多的是為了在適應症方面獲得更多患者嗎？

Maybe patients aren't experiencing chronic pain but have neurologic-related sensory issues.

也許患者沒有經歷慢性疼痛，但有神經相關的感覺問題。

Or is it more about just bolstering the evidence that you have as you can maybe get some more payers under your belt and get into guidelines?

或者更多的只是支持你所擁有的證據，因為你也許可以讓更多的付款人接受並進入指導方針？

And then I just have a follow-up.

然後我有一個後續行動。

Yeah, it's both, Anthony.

是的，兩者都是，安東尼。

So number one is this will be the first indication that's outside of pain.

首先，這將是第一個除了疼痛之外的跡象。

So having that sensory indication will be new and we'll be first to market and likely more difficult for others to sort of tag onto that one because there's a lot of things that we're looking into that will come out of that clinical study.

因此，擁有這種感官指示將是新的，我們將第一個進入市場，並且其他人可能更難對其進行標記，因為我們正在研究的許多東西都將來自該臨床研究。

So it's more than just the typical, did you feel better and what was your responder rate.

因此，這不僅僅是典型的情況，您是否感覺好些了以及您的回覆率是多少。

We're going to actually be showing biopsies and other clinical benefits of the technology.

我們將實際展示該技術的活檢和其他臨床益處。

And then the second is for sure.

那麼第二個是肯定的。

Right now, as you know, we have just a plethora of information and clinical study evidence for 10 kilohertz on pain, but we've only had one for specifically on PDN, that's a large RCT study.

如您所知，目前我們只有大量 10 kHz 治療疼痛的資訊和臨床研究證據，但我們只有一個專門針對 PDN 的資訊和臨床研究證據，這是一項大型 RCT 研究。

And this will allow us to have a second really large study showing significant differences between us and low frequency.

這將使我們能夠進行第二項大型研究，顯示我們和低頻之間的顯著差異。

And we believe that gives us an opportunity to have -- to be into additional guidelines and maybe strengthening the guidelines in which we're in.

我們相信，這給了我們一個機會去製定更多的指導方針，並可能加強我們所遵循的指導方針。

We look at most of societies, they typically require more than just one RCT prior to them really recommending strongly in their guidelines.

我們觀察大多數社會，在他們的指南中真正強烈推薦之前，他們通常需要不只一項隨機對照試驗。

And so this will give us a better chance of doing that in addition with payers as well.

因此，這將使我們有更好的機會與付款人一起這樣做。

And you had a follow-up.

你有後續行動。

Yeah, just sort of in the same vein.

是的，有點類似。

I know you just announced Carelon, I think it was in January, 43, million lives.

我知道你剛剛宣布了 Carelon，我想那是在 1 月，43 萬人的生命。

Are there any other really big or substantial wins left on the payer side either for PDN and NSRBP or is it just more sort of smaller insurance carriers at this point?

對於 PDN 和 NSRBP 而言，付款方是否還有其他真正重大或實質的勝利，或者目前只是規模較小的保險公司？

Yeah.

是的。

It's so diluted there, right?

那裡太稀釋了，對嗎？

There's a lot of different local payer decisions.

當地付款人有很多不同的決定。

There's obviously Medicare decisions and all that as well.

顯然還有醫療保險決定等等。

I'm really proud of our team.

我真的為我們的團隊感到自豪。

Our team is the one that put together the clinical evidence that got the PDN indication in the first place.

我們的團隊首先整合了獲得 PDN 適應症的臨床證據。

And it was our clinical evidence that was utilized to be able to gain those all of the Medicare reimbursement for PDN, which we're now fully covered on.

正是我們的臨床證據被用來獲得 PDN 的所有醫療保險報銷，我們現在已完全承保。

So we still have a few that we'd like to take down.

所以我們還有一些想要刪除的內容。

But don't forget, we have a team of people that are here to help our customers through the price -- the process of prior authorization.

但不要忘記，我們有一個團隊在這裡幫助我們的客戶完成價格——預先授權的過程。

And also how you look at denials and getting those overturned, we have a really high success rate.

還有你如何看待否認並推翻這些否認，我們的成功率非常高。

And so what that does once we gain those new coverages is this allows us to go through the process much quicker and with a lot less friction in the system.

因此，一旦我們獲得了這些新的承保範圍，我們就能更快地完成整個過程，並且系統中的摩擦也更少。

So we're going to continue to do that and leverage all of our clinical evidence.

因此，我們將繼續這樣做並利用我們所有的臨床證據。

So there'll be a few more to come here in the future as well.

因此，未來還會有更多人來到這裡。

Anthony Petrone, Mizuho Group.

安東尼‧佩特龍，瑞穗集團。

Anthony, you might be on mute.

安東尼，你可能處於靜音狀態。

Richard Newitter, Truist.

理查德·紐特，真理主義者。

Hi.

你好。

Thanks for taking the questions.

感謝您提出問題。

Maybe just to start at Vyrsa.

也許只是從維爾薩開始。

I'm curious, you begin the commercialization here.

我很好奇，你從這裡開始商業化。

Do you expect your initial users, the physicians that are already performing SI joint fusion, or are you planning on first focusing initially on building practices from the ground up?

您是否期望您的初始用戶，即已經進行 SI 關節融合的醫生，或者您是否計劃首先專注於從頭開始建立實踐？

Obviously, patients are at all of those different locations, but I think the smart play here is to leverage the relationships that we have that are already Nevro loyalists that are also interested in or already doing the procedure on.

顯然，患者分佈在所有這些不同的地點，但我認為明智的做法是利用我們已有的關係，這些人已經是 Nevro 的忠實擁護者，他們也對手術感興趣或已經在進行手術。

And so as we look at the limited scale of what we're doing with trades and all of the manufacturing and training and everything else, the first place we're starting are with those people that are the closest to us.

因此，當我們考慮到我們在貿易、所有製造、培訓以及其他一切方面所做的有限規模時，我們首先從那些與我們最親近的人開始。

And our team -- also those that have maybe been involved in clinical studies with Nevro in the past, people that we have a good relationship with, we'll start there, but then continue to expand because this is, we believe, a really good device for patients to experience.

我們的團隊——還有那些過去可能參與過 Nevro 臨床研究的團隊，與我們有良好關係的人，我們將從那裡開始，然後繼續擴展，因為我們相信，這是一個真正的供患者體驗的好裝置.

And so we don't want to hold back and just go to one area of the market, but we have to make sure that we do it in a cadence that was safe and effective for the physicians to learn, not only the procedure, but also some of them will need to learn all of our different tools and things that need to go through.

因此，我們不想猶豫不決，只進入市場的某個領域，但我們必須確保我們以一種安全有效的節奏來做這件事，讓醫生能夠學習，不僅是程序，而且是他們中的一些人也需要學習我們所有不同的工具和需要經歷的事情。

And also our sales reps to feel confident standing in the operating theater and helping those physicians through their first three or four or five cases to get them comfortable.

我們的銷售代表也能自信地站在手術室裡，幫助那些醫生完成前三、四或五個病例，讓他們感到舒適。

Got it.

知道了。

Thanks.

謝謝。

Kevin, you've obviously been very thoughtful so far as you've been guiding, and execution is clearly incredibly important.

凱文，到目前為止，您的指導顯然非常周到，而且執行力顯然非常重要。

So congratulations so far on the success on that.

到目前為止，祝賀您取得了成功。

I'm just curious, as we think of your -- it's your first full-year outlook I think if we think about the different buckets of market growth, share gain potential, PDN differentiation, and maybe even overage for Vyrsa.

我只是很好奇，當我們想到你的時候——這是你的第一個全年展望，我想如果我們考慮不同的市場成長、份額成長潛力、PDN 差異化，甚至可能是 Vyrsa 的超額。

You tell me what the buckets are, but where do you feel most confident that you've baked in conservatism?

你告訴我這些桶子是什麼，但你對自己在保守主義中的表現最有信心的是什麼？

Where would you expect to see potential overages relative to the guide if it were to come?

如果指南出現的話，您預計會在哪些地方看到潛在的超額情況？

Where are you most confident in that?

您對此最有信心的地方在哪裡？

Yeah.

是的。

Thanks for the question there and for the kudos.

感謝您的提問和榮譽。

It's also -- we still have a long way to go.

我們還有很長的路要走。

What I'm most confident in is our team.

我最有信心的是我們的團隊。

We have spent six months of the last year, both of people that have been here for many, many years, including decades on some, as well as new people coming on board.

去年我們在這裡度過了六個月，其中既有已經在這裡工作了很多年的人，其中一些已經工作了幾十年，也有新加入的人。

I feel really good about the energy and passion and what we've done to realign our sales force and adding the new talent there.

我對我們的活力和熱情以及我們為重新調整銷售團隊和增加新人才所做的努力感到非常滿意。

That's what I'm probably the most proud about.

這可能是我最自豪的事。

However, obviously, there's headwinds and tailwinds that come and go, and I always like to have more opportunities in different revenue streams to do that.

然而，顯然，逆風和順風來來去去，我總是希望在不同的收入來源中有更多的機會來做到這一點。

And I feel that the Vyrsa acquisition with three different products, the three indications that we now have on SCS gives us a chance to maybe counteract any of those headwinds with some good tailwinds as well.

我認為，Vyrsa 收購了三種不同的產品，我們現在在 SCS 上得到的三個跡象讓我們有機會用一些好的順風因素來抵消這些逆風因素。

And so right now, it's too early to tell, but I really like where our team is sort of coming out of the national sales meeting.

所以現在說還為時過早，但我真的很喜歡我們的團隊在全國銷售會議上的表現。

We've got a global sales meeting coming up here next week, and I think we'll exit that one also feeling good about heading into the year with our team.

下週我們將在這裡召開一次全球銷售會議，我想我們會在結束這次會議時也對與我們的團隊一起進入新的一年感覺良好。

Brandon Vazquez, William Blair.

布蘭登·巴斯克斯，威廉·布萊爾。

Hi, everyone.

大家好。

Thanks for taking the questions.

感謝您提出問題。

Maybe first one on the PDN side, are there any metrics that you can give us on PDN, maybe like number of referring physicians, or same-store growth kind of figures?

也許是 PDN 方面的第一個，您可以在 PDN 上向我們提供任何指標嗎，例如轉診醫生的數量，或同店成長的數據？

So just trying to understand like where you are in the terms of the adoption curve and especially how durable this can be with the physicians today.

因此，我只是想了解一下您在採用曲線方面的情況，尤其是對於當今的醫生來說，這種情況的持久性如何。

Yeah.

是的。

The stat we're showing right now is that we're still under 1% penetration.

我們現在顯示的統計數據是我們的滲透率仍低於 1%。

I mean, we are in the missionary selling phase, and I described that as we're building believers that they didn't learn this in their schooling, right?

我的意思是，我們正處於傳教士銷售階段，我描述說，當我們建立信徒時，他們在學校教育中沒有學到這一點，對嗎？

And so this is something new for those endocrinologists or podiatrists or any of the other referring physicians.

因此，這對內分泌科醫生、足病醫生或任何其他轉診醫生來說都是新鮮事。

And so in some of those territories, there may be one or two big endocrinologist groups that's providing a lot of that growth in a city.

因此，在其中一些地區，可能有一兩個大型內分泌學家團體為城市的成長做出了巨大貢獻。

And then there's another city where there's 10 different podiatrists that are referring one patient each month to the surrounding physicians.

在另一個城市，有 10 位不同的足病醫生，每個月將一名患者轉介給周圍的醫生。

So it's kind of hard to do a blanket statement.

因此，很難做出一攬子聲明。

But we do feel that we're going to continue the efforts of missionary selling and going out there and showing the clinical superiority of our technology versus any of the others that have the indication but none of the clinical evidence to prove that.

但我們確實認為，我們將繼續努力進行宣教式銷售，並走出去，展示我們的技術相對於任何其他有適應症但沒有臨床證據證明這一點的技術的臨床優勢。

So I'd say we're so early into this that right now, we're taking anybody those first movers that say, you know what, I have put my first three or four patients through.

所以我想說，我們現在還處於早期階段，我們正在接受那些先行者，他們說，你知道嗎，我已經讓我的前三四個病人通過了。

They've come back with unbelievable results.

他們帶著令人難以置信的結果回來了。

And so now, I'm highly confident in referring these patients.

所以現在，我對轉診這些患者非常有信心。

Again, go back to the comments in the prepared remarks, we've had not only great clinical evidence, but also now consensus statements and people coming out showing the great results from PDN.

再次回到準備好的評論中的評論，我們不僅有很好的臨床證據，而且現在還有共識聲明，人們出來展示 PDN 的巨大成果。

So I think we still have a long way to go, and we're excited about helping that patient population.

所以我認為我們還有很長的路要走，我們很高興能夠幫助這些患者群體。

Okay.

好的。

And maybe one last one for me.

也許對我來說是最後一件事。

Kevin, you've been in the seat coming up in a year soon.

凱文，一年後你就坐上了這個席位。

You've been looking at this core SCS market.

您一直在關注這個核心 SCS 市場。

What do you think needs to happen here now that you've had a little more experience with it to get from this flat to down to that maybe closer to the high-single digit range.

既然您已經有了更多的經驗，那麼您認為這裡需要發生什麼，才能從這個平坦的位置下降到可能更接近高個位數範圍的位置。

It seems to be one of the markets that still hasn't seem to have recovered post-COVID.

它似乎是新冠疫情後仍未恢復的市場之一。

So curious what your thoughts are as you gain more experience.

當你獲得更多經驗時，很好奇你的想法是什麼。

Thanks.

謝謝。

Yeah, look, we have to control what we can control.

是的，看，我們必須控制我們能控制的事情。

And the one thing that we know we can do is increase our effectiveness in the sales force.

我們知道我們能做的一件事就是提高銷售團隊的效率。

That's why it's one of the top three pillars.

這就是為什麼它是三大支柱之一。

And we feel great about the teams that we have coming into this year, where they are.

我們對今年加入的團隊以及他們所處的位置感到非常滿意。

And regardless what the market growth is, it's our job to go out and take share.

無論市場成長如何，我們的工作就是走出去並獲得份額。

And I always say we have a moral obligation to do so because of our superior clinical evidence.

我總是說，由於我們擁有優越的臨床證據，我們有道德義務去做。

It's our job to win to get patients but we believe implanted with a product that is better for them.

我們的工作就是贏得患者的青睞，但我們相信植體對他們更有利的產品。

Now it's obviously the doctors opinion on what they want to put through, but we obviously are confident in our technology.

現在顯然是醫生對他們想要實施的方案有意見，但我們顯然對我們的技術充滿信心。

From a market growth standpoint, don't forget the core SCS market also includes nonsurgical back pain, and we believe PDN and also new indications that we're continuing to work on from our clinical evidence standpoint.

從市場成長的角度來看，不要忘記核心 SCS 市場還包括非手術背痛，我們相信 PDN 以及我們從臨床證據角度繼續研究的新適應症。

So we believe that the entire SCS market has opportunity to not only recover, but also to experience growth in the future.

因此，我們相信整個 SCS 市場不僅有機會復甦，而且在未來也有機會成長。

To predict that would be impossible.

預測這是不可能的。

But I like our chances now with a diversified product portfolio, including the -- now we're entering the SI joint, regardless of what the core back and leg market does, we have a lot of other growth drivers that have led us to the 2% to 5% guidance growth for 2024.

但我喜歡我們現在擁有多元化產品組合的機會，包括——現在我們正在進入 SI 聯合體，無論核心背部和腿部市場如何，我們還有許多其他成長動力，這些驅動力使我們能夠實現2024 年指導增長2% 至5%。

Bill Plovanic, Canaccord Genuity.

比爾‧普洛瓦尼克 (Bill Plovanic)，Canaccord Genuity。

Bill, you might be on mute.

比爾，你可能處於靜音狀態。

Good evening.

晚安.

Thanks for taking my question.

感謝您提出我的問題。

The first question is -- and maybe I heard this wrong, did you say you think the Vyrsa will contribute $2 million in 2024?

第一個問題是──也許我聽錯了，你是說你認為 Vyrsa 會在 2024 年貢獻 200 萬美元嗎？

And then, what do you think just total growth like as we think of the US/OUS split for the global business, like how are you thinking about that?

然後，您如何看待總成長，就像我們對全球業務的美國/海外分裂一樣，您是如何看待這個問題的？

And then I have an expense question.

然後我有一個費用問題。

Okay.

好的。

Good job getting in three as always, Bill.

一如既往，幹得好，取得了三分，比爾。

On the first one, no, I did not say $2 million in 2024.

關於第一個問題，不，我沒有說 2024 年 200 萬美元。

I just commented that for our overall guidance for all-in Nevro, we said 2% to 5% is our is our guidance range that we put out there, which includes everything.

我剛剛評論說，對於我們對 Nevro 的整體指導，我們說 2% 到 5% 是我們在那裡發布的指導範圍，其中包括所有內容。

As far as the global breakout, we think that we have some opportunities.

就全球突破而言，我們認為我們有一些機會。

We really feel good about our leadership and our international teams and our opportunities now that in international markets, there is still a lot of pent-up demand and a lot of hospital staffing shortages that still were going on, believe it or not in 2023 and likely a little bit into 2024.

我們對我們的領導力、我們的國際團隊以及我們的機會感到非常滿意，因為在國際市場上，仍然存在大量被壓抑的需求，無論您相信與否，2023 年仍然存在大量醫院人員短缺的情況，並且可能會到 2024 年。

But we believe our international team has a good opportunity next year.

但我們相信我們的國際團隊明年會有很好的機會。

In so doing, we also believe that our US team is much better off now than we were back in the summer or back when I joined.

透過這樣做，我們也相信我們的美國隊現在比夏天或我加入時要好得多。

And so we feel confident that our teams are ready for 2024 and probably equal growth spread globally.

因此，我們相信我們的團隊已為 2024 年做好準備，並且可能在全球範圍內實現平等的成長。

Okay.

好的。

And then on expense management, I mean, listen, the fourth quarter was excluding that one-time charge for the deal is $90 million, right?

然後在費用管理方面，我的意思是，聽著，第四季不包括這筆交易的一次性費用 9000 萬美元，對嗎？

You're annualizing at $360 million, you're taking a 5% headcount reduction, but you're guiding OpEx much higher.

您的年化收入為 3.6 億美元，員工人數減少了 5%，但營運支出卻高得多。

I'm just trying to understand what the puts and takes are, especially the commentary also on the gross margin at 68% when you just put up a 71%.

我只是想了解看跌期權和看跌期權是什麼，尤其是當你只提出 71% 時，毛利率也達到 68%。

I mean, it seems like from an expense standpoint, I mean that's a real low bar unless I'm missing something.

我的意思是，從費用的角度來看，這似乎是一個非常低的門檻，除非我錯過了一些東西。

Yeah.

是的。

So a couple of things -- good question, Bill.

有幾件事——問得好，比爾。

First of fall, margins were 70.1%, not 71% for Q4.

第一季的利潤率為 70.1%，而不是第四季的 71%。

Also remember the seasonality of our spend.

也要記住我們支出的季節性。

So Q4 is actually one of our lower operating expense quarters.

因此，第四季度實際上是我們營運費用較低的季度之一。

So that's not necessarily the best one to take for -- to annualize.

因此，這不一定是年度化的最佳選擇。

For Q1, we're anticipating it'll be close to $105 million.

對於第一季度，我們預計將接近 1.05 億美元。

There are some restructuring charges in there that are running through operating expenses that are driving that up a little bit.

其中一些重組費用計入營運費用，導致營運費用略有上升。

But if you remember last year, we did a little bit over $100 million in operating expenses in Q1 as well.

但如果您還記得去年，我們第一季的營運支出也略高於 1 億美元。

So yeah, we do -- and we do have the impact of the 5% layoffs that will be probably benefiting from throughout the year in our P&L, but there is also the traditional merit increases, inflationary pressures.

所以，是的，我們確實受到了 5% 裁員的影響，這可能會在我們的損益表中全年受益，但也有傳統的績效成長和通膨壓力。

We do have to invest in Vyrsa this year to train reps and physicians on.

今年我們確實必須投資 Vyrsa 來培訓代表和醫生。

So all of those kind of -- as we said, will largely offset the layoffs -- the benefits we get -- that we receive from that and will basically lead us to a roughly flattish operating expense on what the 2% to 5% guided top-line growth.

因此，正如我們所說，所有這些都將在很大程度上抵消裁員——我們從中獲得的好處——並且基本上將使我們的營運費用與 2% 至 5% 的指導水平大致持平。營收增長。

Anthony Petrone, Mizuho Group.

安東尼‧佩特龍，瑞穗集團。

Thanks.

謝謝。

And apologies.

並道歉。

I am hopping between calls.

我在通話之間來回切換。

So sorry about that.

對此感到非常抱歉。

I actually want to go to just looking at broader market conditions as an ancillary to spinal cord stim, meaning spine procedures look like they've actually rebounded here based on some of the competitor results you have in the past seen pull through from failed back and leg surgeries We're seeing spine come back.

實際上，我只想把更廣泛的市場狀況作為脊髓刺激的輔助手段，這意味著脊椎手術看起來實際上已經反彈，這是基於您過去看到的一些競爭對手的結果，從失敗的背部和恢復中恢復過來。腿部手術 我們看到脊椎恢復了。

Should we still be thinking about that, let's say, 9 to 12 months out, that could be a driver?

我們是否仍然應該考慮 9 到 12 個月後，這可能會成為一個驅動因素？

Is that the right way to think about that?

這是正確的思考方式嗎？

And a quick follow-up for Kevin would be it looks like after the close here, you have a new Board member.

凱文的一個快速後續行動是，在此結束後，您將擁有新的董事會成員。

So maybe talk about just high-level strategy as the Board shifts here a little bit.

因此，隨著董事會的稍微調整，也許只討論高層策略。

Do you think we have a strategy that's largely intact with tuck-in acquisitions and a refocus on the core or could we expect a slight deviation?

您認為我們的策略是否基本完整，包括收購和重新專注於核心業務，或者我們可以預期略有偏差？

Thanks again.

再次感謝。

Yeah, thanks, Anthony, and no problem.

是的，謝謝，安東尼，沒問題。

So yeah, on market conditions, spine sometimes can be a good analog and then sometimes it's not right.

所以，是的，在市場條件下，脊椎有時可以是一個很好的模擬，但有時卻是不正確的。

We do know that there are a lot of different procedures that patients need to go through before they can get to a spinal cord stimulation approval for implementation.

我們確實知道，患者需要經過許多不同的程序才能獲得脊髓刺激的實施批准。

And as a reminder, if you jump off that journey, you don't get the start where you left off.

提醒一下，如果您跳下這段旅程，您將無法從上次中斷的地方開始。

You have to go back to go and sort of go through that conservative care before you get there.

在你到達那裡之前，你必須回去接受保守的護理。

So that says a lot about that lagging.

這說明了很多關於滯後的問題。

I don't know, 9 to 12 months is the right number there, but we are -- we do like some of the trends that we're seeing in other procedural growth and rebound that we're hearing from markets that are peripherally close to us.

我不知道，9 到 12 個月是正確的數字，但我們確實喜歡我們在其他程序性成長和反彈中看到的一些趨勢，這些趨勢是我們從外圍市場聽到的對我們來說。

But it will take the time for those patients to go through that continuum of care before they get to spinal cord stimulation implant.

但這些患者在接受脊髓刺激植入前需要一段時間才能接受連續照護。

One of those is obviously mechanical back pain as well before you treat neuropathic back pain, which is what led us to get into the SI joint procedure market.

其中之一顯然是機械性背痛，在治療神經性背痛之前也是如此，這就是我們進入 SI 關節手術市場的原因。

That's like I said, 15% to 30% of patients will experience both mechanical as well as neuropathic pain.

就像我說的，15% 到 30% 的患者會同時經歷機械性疼痛和神經性疼痛。

So that gives us a chance to maybe grab some of these patients a little bit earlier in their continuum of care.

因此，這使我們有機會在持續護理過程中儘早抓住其中一些患者。

And as far as the close as well with the Board, yeah, we routinely work with our shareholders.

就與董事會的結束而言，是的，我們經常與股東合作。

It's something that we do.

這是我們所做的事情。

We talk to them after all of our calls.

我們在打完所有電話後都會與他們交談。

We're excited to have Kirt on our Board.

我們很高興 Kirt 加入我們的董事會。

As we mentioned in the announcement, he's local, down the street here for us and he's got extensive experience in acquisitions, financial acumen.

正如我們在公告中提到的，他是本地人，就在我們這裡的街道上，他在收購和財務敏銳度方面擁有豐富的經驗。

And he's also worked on the other side and as an investor as well.

他也曾在另一邊工作並擔任投資者。

So we believe he is going to be helpful for us.

所以我們相信他會對我們有幫助。

And so right now, we believe we have good alignment and a good cooperative agreement with our shareholder and the change in our Board.

因此，現在，我們相信我們與股東以及董事會的變更有良好的一致性和良好的合作協議。

I do want to make sure that through this, it gives us opportunity to say thank you to one of our Board members that will be outgoing towards the opening period this summer with Frank.

我確實想確保，透過這次活動，我們有機會向我們的一位董事會成員表示感謝，他將在今年夏天與弗蘭克一起離職。

He will be leaving our Board in the summertime, and he has been instrumental to our growth and instrumental for taking us public, for taking us through a lot of variations that we've had through the business.

他將在夏季離開我們的董事會，他對我們的成長、讓我們上市、帶領我們經歷業務中的許多變化都發揮了重要作用。

And we wanted to thank him for his time.

我們要感謝他抽空來。

And he's been a long-standing Board member and he's been with the company for a really long time.

他一直是董事會的長期成員，並且在公司工作了很長時間。

So we do not believe that our strategy will change.

所以我們不相信我們的策略會改變。

And we have good, supportive Board members with the plethora of experience both in medical devices and financial acumen.

我們擁有優秀且支持我們的董事會成員，他們在醫療設備和財務敏銳度方面擁有豐富的經驗。

So we believe we will stay the course here.

所以我們相信我們會堅持到底。

Suraj Kalia, Oppenheimer.

蘇拉吉·卡利亞，奧本海默。

Good afternoon, Kevin, Rod, can you hear me alright?

下午好，凱文，羅德，你們聽得到我說話嗎？

Yes.

是的。

Yes.

是的。

Perfect.

完美的。

Kevin, I know your one year anniversary is coming up and I was curious if you could just frame a couple of things for us.

凱文，我知道你的一周年紀念日即將到來，我很好奇你是否能為我們設計一些東西。

So Kevin, as you looked at the business, our recollection is roughly about a third of the traditional SCS for Nevro was from NSRBP.

Kevin，當您查看該業務時，我們記得 Nevro 的傳統 SCS 大約有三分之一來自 NSRBP。

Has that changed?

那改變了嗎？

Because I sense a shift in the tone on the call more so towards traditional opportunities versus PDN.

因為我感覺到通話中的語氣更多地轉向傳統機會而不是 PDN。

So if you could just characterize where NSRBP is today, that would be great.

因此，如果您能夠描述 NSRBP 目前的狀況，那就太好了。

And the second question, Kevin, if I could.

第二個問題，凱文，如果可以的話。

Our field checks have told us that Vyrsa did roughly around $7 million, $8 million-ish in '23 and was on track for doing $15 million and '24.

我們的實地調查告訴我們，Vyrsa 在 23 年的收入約為 700 萬美元至 800 萬美元左右，並且預計在 24 年實現 1500 萬美元的收入。

Correct me if I'm wrong so that we can slice and dice it in terms of FY24 guidance.

如果我錯了，請糾正我，以便我們可以根據 2024 財年的指導進行切片和切塊。

Thanks for taking my questions.

感謝您回答我的問題。

Yeah, the first one, no, I think we have a lot of opportunities for the core markets, which we say back and leg as well as on nonsurgical back pain and PDN.

是的，第一個，不，我認為我們在核心市場有很多機會，我們說的是背部和腿部以及非手術背痛和 PDN。

And so we take all comers.

所以我們歡迎所有來者。

There are patients that probably experienced both of those at the same time, for instance, you might have back and leg pain and also be suffering from painful diabetic neuropathy at the same time.

有些患者可能同時經歷這兩種情況，例如，您可能有背部和腿部疼痛，同時也患有痛苦的糖尿病神經病變。

So no, we believe that the market still has a big opportunity.

所以不，我們相信市場仍然有很大的機會。

Nonsurgical back pain is still the largest opportunity that we have on, and failed back surgery would be second and then PDN, just because it's still early in the game, would be the third.

非手術背痛仍然是我們面臨的最大機會，失敗的背部手術將排在第二位，然後 PDN，因為它還處於遊戲早期，將是第三位。

So not really a lot of change there other than the fact of you're seeing a really tremendous growth in the PDN space because we're coming from a brand new start of that.

因此，除了您看到 PDN 領域真正巨大的成長之外，並沒有太大的變化，因為我們正處於一個全新的起點。

As far as on field checks, we're not commenting anything on there.

至於現場檢查，我們不會對此發表任何評論。

One thing I will add is just we are moving from a primarily distributor model to a direct model.

我要補充的一件事是我們正在從主要經銷商模式轉向直接模式。

And so it will take us time to make sure that we have our direct sales force trained and up to speed as well as scale that organization from an operational perspective from both manufacturing and for some of the trades that are needed to perform the procedure.

因此，我們需要時間來確保我們的直銷隊伍接受過培訓，並從製造和執行該程序所需的某些行業的運營角度來看，加快並擴大該組織的規模。

Mike Polark, Wolfe Research.

麥克‧波拉克，沃爾夫研究中心。

Hey.

嘿。

Good afternoon.

午安.

Thank you.

謝謝。

I'll just ask again on Vyrsa.

我再問一下維爾薩的事。

So look, it sounds like you don't want to say a number about what's built into the '24 guide.

所以聽著，聽起來你不想透露有關 '24 指南中內建內容的數字。

I can appreciate that.

我很欣賞這一點。

I suspect on calls maybe we'll be asking what the number is at least get a level set.

我懷疑在打電話時我們可能會詢問號碼是多少，至少得到一個級別設定。

So maybe I'll ask it for a third time here.

所以也許我會在這裡第三次問這個問題。

At the end of the period, can you comment about what's considered in the 2024 guidance for Vyrsa revenue?

在此期間結束時，您能否評論一下 2024 年 Vyrsa 收入指南中考慮的內容？

And if not, just -- I guess, formally making a note and we'll probably be asking every quarter on calls like this until you give it to us or at least frame it.

如果沒有，我想，正式做一個記錄，我們可能會每個季度都會詢問這樣的電話，直到您將其交給我們或至少將其框架化。

So thanks for taking the question.

感謝您提出問題。

Yeah.

是的。

I completely appreciate the desire to want to know where we are right now.

我完全理解想要知道我們現在在哪裡的渴望。

Don't forget we're still early and this is a really small company with some really great technology that we're excited about.

不要忘記我們還處於早期階段，這是一家非常小的公司，擁有一些非常出色的技術，我們對此感到興奮。

And our market checks and due diligence showed that we think we have a differentiated device in the V1 device, which is the flagship one.

我們的市場調查和盡職調查表明，我們認為我們在 V1 設備中擁有一款差異化設備，這是旗艦設備。

So we did that.

所以我們就這麼做了。

And I just mentioned we are going from distributor to direct.

我剛剛提到我們將從分銷商轉向直銷商。

And so that takes some time to ramp up the organization.

因此，這需要一些時間來加強組織。

It's so non-material right now, but it's just not the right time to start breaking that out but we can appreciate that that will be something that will be desired into the future.

現在它是如此非物質化，但現在還不是開始打破這一點的正確時機，但我們可以理解，這將是未來所期望的事情。

Robbie Marcus, JPMorgan.

羅比馬庫斯，摩根大通。

Okay, great.

好的，太好了。

Thanks for taking the question and congrats on a good quarter.

感謝您提出問題，並祝賀您度過了一個美好的季度。

Maybe I want to ask for Vyrsa but maybe as you help us understand the assumed ramp in sales growth in the second half of the year, Nevro's had several guides that were back-end loaded, some like in 2022, it worked out, others that didn't.

也許我想問 Vyrsa，但也許當你幫助我們了解下半年銷售成長的假設斜坡時，Nevro 有幾份後端加載的指南，有些像 2022 年，它成功了，其他的則沒有。

So I think investors want to help understand the drivers there.

所以我認為投資者希望幫助了解那裡的驅動因素。

You talked about the sales force restructuring.

您談到了銷售團隊的重組。

We were under the impression Vyrsa was also about $7 million on track to do about $15 million, $16 million this year.

我們的印像是，Vyrsa 今年的收入也約為 700 萬美元，預計將達到 1,500 萬美元、1,600 萬美元。

Is that really where it's coming from?

它真的是從那裡來的嗎？

Is it a sales force, some revamp, and selling more SCS?

是銷售團隊、進行一些改造並銷售更多的 SCS 嗎？

I think organic and inorganic, and I understand immaterial, but the guides a few percentage points.

我認為有機和無機，我理解無關緊要，但指南有幾個百分點。

So even $4 million is -- it's a percent.

所以即使 400 萬美元也只是一個百分比。

So maybe help us understand exactly where it's coming from and get confidence in the back half ramp.

因此，也許可以幫助我們準確地了解它來自哪裡，並對後半坡道充滿信心。

Thanks.

謝謝。

Yeah.

是的。

It's really all the above.

確實就是以上這些。

I mean, as we mentioned, I think in the past the hard part was we did have PDN as a new indication in nonsurgical back pain.

我的意思是，正如我們所提到的，我認為過去最困難的部分是我們確實將 PDN 作為非手術背痛的新適應症。

But it was a prediction of a little bit more of a market recovery that all boats would rise with the rising tide a little bit there on top of the foundation that Keith, prior to me, that had set up, professionalize the organization, and we have the opportunity to jump off all the hard work that he's done, and that had been done here by the Nevro team prior.

但這是對市場復甦的預測，即在基斯（在我之前）建立的基礎上，所有船隻都會隨著漲潮而上升，使該組織專業化，我們有機會擺脫他所做的所有艱苦工作，而這些工作之前是由Nevro 團隊在這裡完成的。

But at the same time we did have some -- we did call it restructuring, realignment of the sales force and also some turnover that we caused by upping some of the sort of the sales talent in a couple of spots across the organization, which does take some time to get up to speed, right?

但同時，我們確實進行了一些——我們確實稱之為重組、銷售隊伍的重新調整，以及我們透過在整個組織的幾個位置上增加某些銷售人才而造成的一些人員流動，這確實需要一些時間來加快速度，對嗎？

So that's a little bit of why it's back-end loaded.

這就是為什麼它是後端加載的一點原因。

The other part is just seasonality.

另一部分只是季節性。

I mean, you look at all four of us in this space.

我的意思是，你看看這個空間裡的我們四個人。

Q4 is always much bigger than Q1 or Q2, and it's just seasonality with people's co-pays and everything else that happened.

第四季總是比第一季或第二季大得多，這只是季節性因素，包括人們的共同支付和其他發生的事情。

So that's just natural seasonality has been there for decades in this space.

所以這就是這個領域幾十年來一直存在的自然季節性。

And then lastly, yeah, I mean, it's not material right now in our business going from really small to, yeah, we're expecting that to do better every single quarter as we move forward.

最後，是的，我的意思是，目前我們的業務從很小到，是的，我們期望隨著我們的前進，每個季度都能做得更好。

And so we have a new device, a new market that we're in -- three new devices that are new markets that we're in.

所以我們有一個新設備，一個我們所處的新市場——三個新設備，我們所處的新市場。

And so I think that that helps justify a little bit of the back end of the year.

所以我認為這有助於證明今年年底的一些合理性。

Specifically since we need to train so many of our reps out there.

具體來說，因為我們需要在那裡培訓如此多的代表。

Training 20 reps is a lot different than training over 400 or 500-odd to be experts in this device.

訓練 20 次與訓練超過 400 或 500 多次以成為該設備的專家有很大不同。

So it will take us some time to do that.

所以我們需要一些時間來做到這一點。

Ladies and gentlemen, that does conclude today's call.

女士們、先生們，今天的電話會議到此結束。

We thank you all for joining and you may now disconnect.

我們感謝大家的加入，現在您可以斷開連線了。