Nevro Corp (NVRO) 2024 Q3 法說會逐字稿

Good afternoon. My name is Krista, and I will be your conference operator today. At this time, I would like to welcome everyone to Nevro Corp.'s third-quarter 2024 earnings conference call and webcast. Today's conference is being recorded. (Operator Instructions)

午安.我叫克里斯塔，今天我將擔任您的會議主持人。現在，我歡迎大家參加 Nevro Corp. 2024 年第三季財報電話會議和網路廣播。今天的會議正在錄製。（操作員指令）

I will now turn the call over to Angie McCabe, Nevro's Vice President of Investor Relations and Corporate Communications. Ms. McCabe, please go ahead.

現在我將把電話轉給 Nevro 投資者關係和企業傳播副總裁 Angie McCabe。麥凱布女士，請繼續。

Thank you. Good afternoon, and welcome to Nevro's third-quarter 2024 earnings conference call. With me today are Kevin Thornal, our CEO, President; and Rod MacLeod, our Chief Financial Officer. Before we get started, please note that our earnings release and the supplemental presentation accompanying this call are available on the Events & Presentations page of the Investors section of our corporate 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 corporate website shortly after the conclusion of this call.

謝謝。下午好，歡迎參加 Nevro 2024 年第三季財報電話會議。今天與我在一起的有我們的執行長兼總裁 Kevin Thornal；以及我們的財務長 Rod MacLeod。在我們開始之前，請注意，我們的收益報告和本次電話會議的補充簡報可在我們公司網站 nevro.com 的投資者部分的活動和簡報頁面上找到。此外，本次電話會議將透過網路向所有相關方進行現場直播，本次網路直播的存檔副本將在電話會議結束後不久在我們公司網站的「投資者」部分提供。

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. Results could differ materially from those expressed wide as a result of certain risks and uncertainties. Please refer to Nevro's SEC filings, including our annual report on Form 10-K filed on February 23, 2024, for a detailed presentation of risks. 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.

我想提醒大家，今天電話會議的評論可能包括聯邦證券法所定義的前瞻性陳述。由於某些風險和不確定性，結果可能與廣泛表達的結果有重大差異。請參閱 Nevro 的 SEC 文件，包括我們於 2024 年 2 月 23 日提交的 10-K 表年度報告，以了解風險的詳細介紹。本次電話會議中的前瞻性陳述僅代表截至今日的觀點，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 our ongoing business performance. Non-GAAP adjusted EBITDA excludes interest, taxes, and noncash items such as stock-based compensation and depreciation and amortization as well as litigation-related expenses, restructuring and supplier contract renegotiation charges and other adjustments. Please refer to the financial tables in our press release issued today for reconciliations of GAAP to non-GAAP financial measures.

此外，管理層將參考調整後的 EBITDA，這是一項非 GAAP 指標，用於幫助投資者了解我們持續的業務表現。非公認會計準則調整後 EBITDA 不包括利息、稅金、股票薪資、折舊和攤提等非現金項目以及訴訟相關費用、重組和供應商合約重新談判費用和其他調整。請參閱我們今天發布的新聞稿中的財務表，以了解 GAAP 與非 GAAP 財務指標的對帳。

I will now turn the call over to Kevin Thornal. Kevin?

現在我將電話轉給凱文·索納爾。凱文？

Thank you, Angie, and thank you all for joining us. This afternoon, we issued our third-quarter 2024 financial results. In my remarks today, I'll discuss the key factors that drove our financial results for the quarter and share why we remain optimistic about the future of our business and our ability to return to sustainable growth. Rod will then provide details on our third-quarter financial results as well as our full-year 2024 guidance.

謝謝你，安吉，也謝謝大家加入我們。今天下午，我們發布了2024年第三季的財務表現。在今天的演講中，我將討論推動本季財務表現的關鍵因素，並分享我們為何對業務的未來以及恢復可持續成長的能力保持樂觀。然後，羅德將詳細介紹我們的第三季財務業績以及 2024 年全年業績指引。

Our results for the third quarter of 2024 compared with the third quarter of 2023 were as follows: worldwide revenue of $96.9 million decreased 6.7% on a reported basis, and US revenue of $83.9 million decreased 6.5%. US spinal cord stimulation, or SCS, trial procedures declined approximately 15.2%. Net loss from operations was $13.9 million compared with $25.6 million in the year-ago quarter, and adjusted EBITDA was negative $1.8 million compared with a loss of $5.8 million in the year-ago quarter, reflecting the actions we took through our restructuring earlier this year and our focus on expense management as we drive toward profitability.

我們 2024 年第三季的業績與 2023 年第三季相比如下：全球營收為 9,690 萬美元，按報告基礎下降 6.7%，美國營收為 8,390 萬美元，下降 6.5%。美國脊髓刺激（SCS）試驗程序減少了約 15.2%。營業淨虧損為 1,390 萬美元，而去年同期為 2,560 萬美元；調整後 EBITDA 為負 180 萬美元，而去年同期虧損 580 萬美元，這反映了我們今年早些時候透過重組採取的行動以及我們在努力實現盈利的過程中對費用管理的關注。

And cash, cash equivalents, and short-term investments increased $3.3 million to $277 million as of September 30, 2024, from June 30, 2024. This increase reflects the benefit from our restructuring in the first half of this year and strong working capital management. And as Rod will discuss shortly, we expect our cash position to increase further in the fourth quarter. Importantly, our balance sheet remains strong.

截至 2024 年 9 月 30 日，現金、現金等價物和短期投資從 2024 年 6 月 30 日增加了 330 萬美元，達到 2.77 億美元。這一增長反映了我們今年上半年重組和強大的營運資本管理的好處。正如羅德稍後將要討論的那樣，我們預計我們的現金狀況將在第四季度進一步增加。重要的是，我們的資產負債表依然強勁。

On our second-quarter earnings call, we discussed in detail the challenges we are facing in the de novo spinal cord stimulation market as well as opportunities where we can improve our commercial execution. And in the third quarter, we continued implementing actions, including changes to our sales territories as well as reallocating marketing resources to improve our competitive positioning, drive market penetration, return to sustainable top-line growth, and continue on our path toward profitability.

在我們的第二季財報電話會議上，我們詳細討論了我們在全新脊髓刺激市場所面臨的挑戰以及我們可以改善商業執行的機會。第三季度，我們繼續採取措施，包括調整銷售區域和重新分配行銷資源，以提高我們的競爭地位，提高市場滲透率，恢復可持續的營收成長，並繼續走上獲利之路。

As we previously discussed, we promoted in our associate sales reps, or ASRs, to lead some newly created territories. In 2025, we plan on continuing to add new territories, many of which will be filled by promoting associate sales reps. There will be a ramp-up period throughout 2025 for these new sales reps as they get established in these territories, and we look forward to fostering their growth. We believe these changes will allow our sales team to reach more customers, to deeper with physicians, provide a high level of service our customers expect, while also laying the foundation for new product introductions.

正如我們之前所討論的，我們提拔了助理銷售代表（ASR）來領導一些新創建的地區。2025 年，我們計劃繼續增加新的地區，其中許多地區將由晉升助理銷售代表來填補。隨著這些新銷售代表在這些地區站穩腳跟，2025 年將有一個增長期，我們期待促進他們的成長。我們相信這些變化將使我們的銷售團隊能夠接觸到更多的客戶，與醫生建立更深入的聯繫，提供客戶期望的高水準服務，同時也為新產品的推出奠定基礎。

It is imperative that we achieve sustainable profitability, and one of our largest expenses has always been our commercial efforts. Over the years, we have made adjustments to align our commercial cost structure with our revenue base with the goal of achieving profitable growth and delivering shareholder value. As a reminder, we took more than $30 million in annual run rate expenses out of our cost structure through our two restructurings earlier this year. We had some difficult decisions to make as we went through those processes. As we were evaluating our operating expenses at the beginning of this year to accelerate our path to profitability, we made the decision to reduce our overall direct-to-consumer, or DTC, advertising spend as it is often difficult to measure the direct return on these investments.

我們必須實現可持續盈利，而商業支出一直是我們最大的開支之一。多年來，我們不斷做出調整，使我們的商業成本結構與收入基礎保持一致，目標是實現獲利成長並實現股東價值。提醒一下，我們透過今年稍早的兩次重組，從成本結構中削減了超過 3000 萬美元的年度運行費用。在經歷這些過程時，我們必須做出一些艱難的決定。為了加速實現盈利，我們在今年年初評估了我們的營運費用，並決定減少整體直接面向消費者 (DTC) 的廣告支出，因為這些投資的直接回報通常很難衡量。

Furthermore, at that time, we believe that our strong referral network, combined with our best-in-class clinical data demonstrating the effectiveness of our 10-kilohertz therapy, would be enough to continue driving customer and patient adoption of our unique SCS treatment therapy. However, based on our subsequent analysis, we now know that our DTC advertising efforts had a greater impact on patient lead generation and our US SCS trials than we previously thought.

此外，當時我們相信，我們強大的轉診網絡，加上我們一流的臨床數據，證明了我們 10 千赫茲療法的有效性，足以繼續推動客戶和患者採用我們獨特的 SCS 治療療法。然而，根據我們隨後的分析，我們現在知道，我們的 DTC 廣告活動對患者潛在客戶開發和美國 SCS 試驗的影響比我們之前想像的要大。

We also learned that patients had a higher likelihood of moving forward with SCS therapy when we spend more time educating them upfront before referring them to their chosen physician. Accordingly, we began reallocating resources on these initiatives in the middle of the third quarter.

我們還了解到，如果我們在將患者轉介給他們所選擇的醫生之前花更多時間對患者進行教育，他們接受 SCS 治療的可能性就會更高。因此，我們從第三季中期開始重新分配這些計劃的資源。

At the same time, we are implementing improvements to our DTC advertising approach that are designed to effectively convert a higher number of patient leads into trials. We are beginning to see patient interest in response to our new DTC advertising campaign and are confident we will see a meaningful improvement in trialing activity in the second half of 2025.

同時，我們正在改進我們的 DTC 廣告方法，旨在有效地將更多的患者線索轉化為試驗。我們開始看到患者對我們的新 DTC 廣告活動的興趣，並有信心在 2025 年下半年看到試用活動的顯著改善。

While it's still early, we believe the actions we are taking, including reinvesting in our DTC advertising, are beginning to have a positive impact as the rate of decline in US SCS trials in October decreased. We are laser-focused on returning to sustainable growth and are monitoring trends and sales activity on a daily basis.

雖然現在還為時過早，但我們相信，隨著 10 月美國 SCS 試驗的下降率下降，我們正在採取的行動（包括對 DTC 廣告的重新投資）開始產生積極影響。我們專注於恢復永續成長，並每天監控趨勢和銷售活動。

We continue to build and leverage our R&D pipeline, and we are excited that in September, we received FDA approval and announced the limited market release of HFX iQ with HFX AdaptivAI, which we believe further establishes our position as the leading developer of innovative technology using data-driven solutions for pain management. This is the only SCS technology using artificial intelligence and is built on a strong foundation of landmark evidence, clinical research, and Big Data, leveraging 100 million data points in 10 years of data acquisition, innovation, and patient care.

我們將繼續建立和利用我們的研發管道，我們很高興在 9 月獲得了 FDA 批准，並宣佈在有限市場上發布帶有 HFX AdaptivAI 的 HFX iQ，我們相信這進一步確立了我們作為使用數據驅動解決方案進行疼痛管理的創新技術領先開發商的地位。這是唯一使用人工智慧的 SCS 技術，建立在里程碑證據、臨床研究和大數據的堅實基礎之上，利用了 10 年的數據收集、創新和患者護理中的 1 億個數據點。

We know that chronic pain is a dynamic, multifaceted condition unique to each individual. Therefore, therapies must be personalized based on the patient's changing experience of pain. Competitor SCS systems require programming paresthesias to a preferred setting in the physician's office using trial and error methods. This often results in patients requiring frequent in-office reprogramming visits over many months. Only HFX AdaptivAI engages with the patient to personalize the delivered SCS therapy using evidence-based algorithms to drive from our proprietary data set for specific indications.

我們知道，慢性疼痛是一種動態的、多方面的疾病，每個人的症狀都不一樣。因此，必須根據患者不斷變化的疼痛體驗實施個人化治療。競爭對手的 SCS 系統需要使用反覆試驗的方法將感覺異常編程為醫生辦公室中的首選設定。這通常會導致患者需要在數月內頻繁到診所進行重新編程。只有 HFX AdaptivAI 與患者合作，使用基於證據的演算法從我們專有的數據集驅動特定適應症，從而個性化提供的 SCS 治療。

Through AI, the algorithm is just programming in real time using multidimensional metrics of pain release, sleep quality, function, and satisfaction. It is also important to remember that HFX is a paresthesia-free therapy.

透過人工智慧，該演算法只是使用疼痛釋放、睡眠品質、功能和滿意度等多維指標進行即時編程。還需要記住的是，HFX 是一種無感覺異常的療法。

Examples of the advanced technology incorporated in HFX AdaptivAI include tailoring dosing over time while maintaining pain relief provides the opportunity to dramatically reduce charging requirements to as few as six times per year. This is compared to previous generations of our SCS devices that require some patients to charge once per week up to 52 times per year. Proprietary bipole interlacing technology that stores the patient's programming usage and pain relief history to bespoke programming sequences that brings patients back to pain really faster or even to improve patients that have already achieved pain relief of greater than 50%. HFX AdaptivAI is raising the bar on what is considered adequate pain release.

HFX AdaptivAI 所採用的先進技術包括隨著時間的推移調整劑量，同時保持疼痛緩解，從而有機會將充電需求大幅減少至每年六次。相較之下，我們的前幾代 SCS 設備要求一些患者每週充電一次，每年充電次數多達 52 次。專有的雙極交錯技術，將患者的編程使用情況和疼痛緩解歷史存儲到定制的編程序列中，使患者更快地恢復疼痛，甚至改善已經實現疼痛緩解超過 50% 的患者。HFX AdaptivAI 正在提高對充分緩解疼痛的標準。

Continuous device-based monitoring of the patient's pain relief state device performance and usage that automatically alert our field-based care team to contact the patient to resolve clinical or device performance issues that might arise. Proactive intervention is now a reality.

透過設備持續監測患者的疼痛緩解狀態、設備性能和使用情況，自動提醒我們的現場護理團隊聯繫患者，以解決可能出現的臨床或設備性能問題。主動幹預現在已成為現實。

HFX AdaptivAI is truly a game changer for patients, physicians, and Nevro, and importantly, closes the loop that matters. Since the limited market release in late September, HFX AdaptivAI is off to a great start and already delivering improved clinical outcomes to patients. Our early data demonstrates that patients are achieving pain relief 41% faster when compared to our prior version, HFX iQ 1.0. Patients start achieving and maintaining meaningful pain relief plus filling the benefit of our smart power and bipole interlacing additions.

HFX AdaptivAI 確實改變了病人、醫生和 Nevro 的遊戲規則，而且重要的是，它完成了重要的循環。自 9 月底在市場上限量發布以來，HFX AdaptivAI 取得了良好的開端，並已為患者帶來了改善的臨床效果。我們的早期數據表明，與我們先前的版本 HFX iQ 1.0 相比，患者的疼痛緩解速度提高了 41%。患者開始獲得並維持有意義的疼痛緩解，並享受我們的智慧電源和雙極交織附加療法的好處。

Importantly, for our shareholders, HFX AdaptivAI is also providing significant reduction in the administrative and clinical burdens to our organizational infrastructure that would otherwise be needed to provide long-term clinical care to these patients. In patients who are now utilizing HFX AdaptivAI, we are seeing an almost 40% reduction in the number of patient calls to our support teams, with an almost 50% reduction in call time duration and a 20% reduction in-office patient reprogramming visits when comparing de novo AFX adaptive AI patients to Omnia, a previous generation of Nevro's non-AI driven SCS platform.

重要的是，對於我們的股東而言，HFX AdaptivAI 也顯著減輕了我們組織基礎設施的行政和臨床負擔，否則這些負擔將需要為這些患者提供長期臨床護理。對於現在使用 HFX AdaptivAI 的患者，當將 de novo AFX 自適應 AI 患者與 Omnia（Nevro 上一代非 AI 驅動的 SCS 平台）進行比較時，我們發現患者致電我們的支援團隊的次數減少了近 40%，通話時長減少了近 50%，門診患者重新編程訪問次數減少了 20%。

While we are still in the early days of this product release, we are extremely pleased with both the benefit we are providing to patients and the significant expense reductions we should realize with this product over the long term. This limited market release marks a major milestone not only for our product offering, but the AF market as well, as it is the first therapy to put patients in control of their pain relief, while at the same time, providing physicians the ability to monitor the patient's pain journey. We look forward to the full US market launch later this month.

雖然我們仍處於該產品發布的早期階段，但我們對該產品為患者帶來的益處以及長期來看將實現的顯著費用降低感到非常滿意。這次限量上市不僅對我們產品供應具有重要里程碑意義，對 AF 市場亦是如此，因為這是第一種讓患者能夠控制疼痛緩解的療法，同時讓醫生能夠監測患者的疼痛歷程。我們期待本月稍後全面推出美國市場。

We are also thrilled to announce that we recently received regulatory approval to offer HFX iQ and CE Mark countries in the European Union. HFX iQ will be available in select regions of the EU through a limited market release beginning later this month. We anticipate a full market release in the first quarter of 2025. This marks a major milestone in advancing our efforts in the EU, and I want to congratulate our teams who worked long and hard to get this approval over the finish line.

我們也很高興地宣布，我們最近獲得了監管部門的批准，可以在歐盟國家提供 HFX iQ 和 CE 標誌。HFX iQ 將於本月稍晚開始在歐盟部分地區限量發售。我們預計將於 2025 年第一季全面上市。這是我們在歐盟推進努力的一個重要里程碑，我要祝賀我們的團隊，他們長期努力工作，最終獲得此批准。

As part of our longer-term plan to become a more comprehensive pain management company and drive market penetration in very large and underserved markets over the next few years, we are working to grow our business through expanded SCS indications, next-generation SCS therapy, and alternative therapies that are earlier in the care continuum. As we've communicated previously, the PDN market remains underpenetrated at less than 1%. We continue to focus on growing this business by educating, referring physicians, and raising patient awareness on the benefits of SCS as treatment therapy for these patients.

我們的長期計劃是成為一家更全面的疼痛管理公司，並在未來幾年推動在非常龐大且服務不足的市場的市場滲透，作為該計劃的一部分，我們正在努力透過擴大 SCS 適應症、下一代 SCS 療法和處於護理過程早期的替代療法來發展我們的業務。正如我們之前所傳達的，PDN 市場滲透率仍然不足 1%。我們將繼續致力於透過教育、推薦醫生以及提高患者對 SCS 作為這些患者治療療法的益處的認識來發展這項業務。

Building on our strong foundation of robust clinical data, new data was recently published in the Journal of Pain Research, demonstrating long-term improvements in pain intensity with our high-frequency SCS therapy. Notably, the analysis is the first study of SCS to demonstrate long-term significant and clinically meaningful reductions in hemoglobin A1c and weight in study participants with PDN and type 2 diabetes who received high-frequency SCS therapy.

基於我們強大的臨床數據基礎，最近在《疼痛研究雜誌》上發表了新的數據，證明我們的高頻 SCS 療法可以長期改善疼痛強度。值得注意的是，該分析是第一個關於 SCS 的研究，證明接受高頻 SCS 治療的 PDN 和 2 型糖尿病研究對象的糖化血紅蛋白和體重長期顯著且具有臨床意義的降低。

It was this data that led us to initiate a feasibility study to specifically evaluate the use of 10-kilohertz therapy to affect HbA1c. At the 12-month point of this study, we are seeing very encouraging and similar results as with the PDN study, with patients demonstrating significant and clinically meaningful reductions in HbA1c. Our clinical work in this area is very exciting and there is a signal of the possible metabolic benefits of 10-kilohertz SCS for diabetic patients. This clinical work continues to build evidence on the importance of new treatment options, such as 10-kilohertz SCS therapy for patients that suffer from PDN and other diabetic-related comorbidity.

正是這些數據促使我們啟動了一項可行性研究，專門評估使用 10 千赫茲療法對 HbA1c 的影響。在這項研究的第 12 個月，我們看到了非常令人鼓舞且與 PDN 研究相似的結果，患者的 HbA1c 顯示出顯著且具有臨床意義的降低。我們在該領域的臨床工作非常令人興奮，有跡象表明 10 千赫茲 SCS 可能為糖尿病患者帶來代謝益處。這項臨床工作持續為新治療方案的重要性提供證據，例如針對患有 PDN 和其他糖尿病相關合併症的患者進行 10 千赫 SCS 治療。

Regarding the Senza-Sensory RCT, the interim analysis is ongoing, and we continue to expect to read out in early 2025. Recall that this trial is designed to more objectively prove the sensory improvements we observed in our initial randomized trial and to obtain an SCS indication beyond just pain. Depending on the outcome, this may allow for early publication followed by potential review on specific conclusion of Nevro's proprietary 10-kilohertz SCS therapy into evidence-based guidelines, particularly those published by the American Diabetes Association. We're excited that our PDN sensory protocol design abstract has been accepted as an oral presentation at the 2025 NANS Annual Meeting and will be presented by Dr. Erika Petersen, Director of the section of functional and Restorative Neurosurgery at UAMS Medical Center.

關於 Senza-Sensory RCT，中期分析仍在進行中，我們預計在 2025 年初讀出結果。回想一下，這次試驗的目的是為了更客觀地證明我們在最初的隨機試驗中觀察到的感覺改善，並獲得除了疼痛之外的 SCS 指徵。根據結果，這可能允許早期發布，隨後可能對 Nevro 專有的 10 千赫 SCS 療法的具體結論進行審查，將其納入循證指南，特別是美國糖尿病協會發布的指南。我們很高興我們的 PDN 感覺協議設計摘要已被接受為 2025 年 NANS 年會的口頭報告，並將由 UAMS 醫學中心功能和修復神經外科科主任 Erika Petersen 博士進行報告。

As we've shared previously, our SCS devices have rechargeable batteries with a very long functional life, yet they will need to be replaced. We began treating a significant number of patients commercially beginning in late 2015, which means that IPG and planted at that time are now nearing end of life. We believe many of our patients, in consultation with their physicians, will want to continue using our best-in-class clinically proven treatment therapy and they will now have access to the significant benefit of HFX AdaptivAI technology in treating their chronic pain.

正如我們之前所分享的，我們的 SCS 設備具有可充電電池，使用壽命非常長，但需要更換。我們從 2015 年底開始對大量患者進行商業化治療，這意味著當時植入的 IPG 現已接近使用壽命的終點。我們相信，許多患者在諮詢醫生後，都希望繼續使用我們一流的、經過臨床驗證的治療方法，現在他們將能夠享受 HFX AdaptivAI 技術在治療慢性疼痛方面的顯著益處。

We believe that over time, a growing number of our implants will be in patients who have already enjoyed effective high-frequency SCS therapy with Nevro technology for many years and whose devices are nearing their natural life of their IPG battery.

我們相信，隨著時間的推移，越來越多的患者將接受我們的植入物，這些患者多年來一直享受著採用 Nevro 技術的有效高頻 SCS 治療，並且他們的設備 IPG 電池的自然壽命已接近極限。

Remember that we began treating a significant number of patients commercially in late 2015. And now, more than 115,000 patients globally are using our 10-kilohertz SCS therapy. Our longer-term goal is to become the leading provider of treatment options with the most diversified, differentiated, and innovative product portfolio in the pain management space. We continue to ramp and scale our SI joint fusion business and anticipate that it will contribute more meaningfully to our growth beginning next year. SI joint pain is seriously underdiagnosed, and fusion technology provides a new and simpler approach to this procedure. One of the ways we are educating surgeons and standing out from legacy devices is through the publication of positive clinical data.

請記住，我們在 2015 年底就開始為大量患者提供商業治療。現在，全球有超過 115,000 名患者正在使用我們的 10 千赫 SCS 療法。我們的長期目標是成為疼痛管理領域最多樣化、差異化和創新產品組合的領先治療方案提供者。我們將繼續擴大和擴展我們的 SI 關節融合業務，並預計它將從明年開始為我們的成長做出更有意義的貢獻。SI 關節疼痛的診斷嚴重不足，而融合技術為手術提供了一種新的、更簡單的方法。我們教育外科醫生並從傳統設備中脫穎而出的方法之一是透過發布積極的臨床數據。

We are pleased that comparative biomechanical data on Nevro1, our novel posterior integrated single-cage system, has been accepted in a peer-reviewed publication assessing the biomechanical fixation, invasiveness, infusion characteristics of the Nevro1 SI joint transfixing fusion system as compared to other commercial SI joint transfecting devices. Nevro1 was found to be equivalent or superior to these devices, including the lateral triangular Roth system. The officers conclude that Nevro1 provides a significantly better opportunity for robust SI joint arthrodesis. We continue to receive positive feedback from physicians through our trained and outperforming SI joint fusion procedures with Nevro1.

我們很高興，我們新穎的後部整合單籠系統 Nevro1 的比較生物力學數據已被同行評審的出版物所接受，該出版物評估了 Nevro1 SI 關節固定融合系統與其他商業 SI 關節轉染裝置的生物力學固定、侵入性和輸注特性。我們發現 Nevro1 與這些設備（包括側三角 Roth 系統）相當或優於它們。官員們得出結論，Nevro1 為強大的 SI 關節融合提供了更好的機會。透過我們訓練有素且表現優異的 Nevro1 SI 關節融合手術，我們不斷收到醫生的正面回饋。

We believe that the success of our expanding portfolio of SCS and SI joint products will help create the type of scale, growth, operating leverage, and sustainability to unlock the kind of shareholder value that our Board and management team are intent on creating.

我們相信，不斷擴大的 SCS 和 SI 聯合產品組合的成功將有助於創造規模、成長、經營槓桿和永續性，從而釋放我們的董事會和管理團隊致力於創造的股東價值。

With respect to our previously announced exploration of strategic options to accelerate growth, diversify our product portfolio, and deliver shareholder value, the activity is ongoing, and we are evaluating several options. Beyond this, we will not provide any further comment or update on the process.

關於我們先前宣布的探索加速成長、多樣化我們的產品組合和實現股東價值的策略選擇，該活動仍在進行中，我們正在評估幾種選擇。除此之外，我們不會對該過程提供任何進一步的評論或更新。

In the meantime, we remain laser-focused on executing our strategy and the actions we implemented to return to sustainable growth and drive towards profitability and are excited by the direction of the company as we begin to close out 2024 and head into 2025. We have the most advanced technology in the space supported by robust clinical edits. With our launches of HFX AdaptivAI in the US and HFX IQ in the EU, the growth opportunity in an underpenetrated SCS market and our diversification into the SI joint space, we have an exciting and compelling path ahead of us.

同時，我們仍將全神貫注於執行我們的策略和行動，以恢復永續成長並推動獲利，並對公司在即將結束 2024 年、邁向 2025 年之際的發展方向感到興奮。我們擁有該領域最先進的技術，並得到強大的臨床編輯支援。隨著我們在美國推出 HFX AdaptivAI 和在歐盟推出 HFX IQ，在滲透率不足的 SCS 市場中獲得成長機會，以及我們在 SI 聯合領域的多元化發展，我們面前有一條令人興奮且引人注目的道路。

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

現在，我將把電話轉給羅德，討論我們的第三季財務業績以及 2024 年第四季和全年的指引。桿？

Thanks, Kevin, and good afternoon, everyone. To echo Kevin's comments, we are proactively making decisions and reallocating resources to better execute commercially while embarking on a process aimed at accelerating our growth, diversifying our business, and creating stockholder value. Note that Q3 2024 had one additional day versus prior year.

謝謝，凱文，大家下午好。與凱文的評論相呼應，我們正在積極做出決策並重新分配資源，以便更好地執行商業計劃，同時著手進行旨在加速我們的成長、多元化我們的業務和創造股東價值的進程。請注意，2024 年第三季與前一年相比增加了一天。

For the third quarter of 2024 and compared with the year-ago period, worldwide revenue decreased 6.7% as reported and 7.6% (sic - see slide 5, "7.0%") on a constant currency basis. US trial procedures decreased approximately 15.2%, mainly due to competitive pressures, ongoing softness in the core US SCS market as well as commercial execution. US revenue decreased 6.5% to $83.9 million, primarily due to the aforementioned factors, and international revenue of $13 million decreased 7.7% as reported and 9.6% on a constant currency basis.

2024 年第三季度，與去年同期相比，全球營收報告下降 6.7%，以固定匯率計算下降 7.6%（原文如此 - 參見投影片 5，「7.0%」）。美國審判程序減少了約 15.2%，主要原因是競爭壓力、美國核心 SCS 市場持續疲軟以及商業執行。美國收入下降 6.5% 至 8,390 萬美元，主要由於上述因素，國際收入為 1,300 萬美元，報告下降 7.7%，按固定匯率計算下降 9.6%。

As was the case in the second quarter of this year, our International business was primarily affected by the short-term impact of negative SCS-related media reports in Australia, where we have the largest market share that resulted in cases being postponed or canceled as well as the impact of healthcare reform in Germany that caused a delay in procedures in the current year quarter. The impact of these two factors did abate somewhat in the third quarter, and we began to see an uptick in procedures in both of these markets.

與今年第二季度的情況一樣，我們的國際業務主要受到澳洲 SCS 相關負面媒體報告的短期影響（我們在澳洲擁有最大的市場份額），導致案件被推遲或取消，以及德國醫療改革的影響，導致本季度程序延遲。這兩個因素的影響在第三季確實有所減弱，我們開始看到這兩個市場的業務量都有所上升。

Gross profit of $64.6 million decreased 7.1% compared with the third quarter of last year. Gross margin was 66.7% and in the third quarter, down slightly from the same period a year ago, primarily as a result of a meaningful charge for previously capitalized variances and overhead as we discussed on prior quarter's earnings calls.

毛利6460萬美元，較去年第三季下降7.1%。第三季的毛利率為 66.7%，較去年同期略有下降，這主要是由於我們在上一季的收益電話會議上討論的先前資本化的差異和間接費用的重大支出。

We continue to make progress in shifting additional work toward Costa Rica manufacturing facility to further leverage our investment there and continue on the path towards achieving a long-term gross margin in the mid-70% range and drive toward profitability. Operating expenses decreased to $78.5 million compared with $95.1 million in the prior-year quarter. Excluding restructuring charges, intangible amortization, contingent consideration revaluation, and the year-over-year decrease in litigation-related expenses, OpEx was $83.5 million or an approximately 12.2% and year-over-year improvement over the year-ago period. This improvement reflects the benefits from our restructuring activity in the first half of this year as well as our continued focus on expense management and operational efficiencies.

我們繼續在將更多工作轉移到哥斯達黎加製造工廠方面取得進展，以進一步利用我們在那裡的投資，並繼續朝著實現 70% 左右的長期毛利率和盈利目標邁進。營業費用從去年同期的 9,510 萬美元下降至 7,850 萬美元。不包括重組費用、無形資產攤銷、或有對價重估以及訴訟相關費用的同比減少，營運支出為 8,350 萬美元，比去年同期增長約 12.2%，同比增長。這項改善反映了我們今年上半年重組活動帶來的好處以及我們對費用管理和營運效率的持續關注。

We also strengthened our cash position in the third quarter. Cash, cash equivalents, and short-term investments were $277 million at September 30, 2024, increasing $3.3 million from June 30, 2024. This increase reflects the benefits from our two restructurings in the first half of 2024, as well as our focus on working capital management.

我們也在第三季加強了現金狀況。截至 2024 年 9 月 30 日，現金、現金等價物和短期投資為 2.77 億美元，比 2024 年 6 月 30 日增加 330 萬美元。這一增長反映了我們在 2024 年上半年兩次重組的好處，以及我們對營運資本管理的關注。

Turning now to our 2024 full-year guidance. We are maintaining our full-year 2024 worldwide revenue guidance of approximately $400 million to $405 million, representing an approximately 5% to 6% decrease from our 2023 worldwide revenue on both a reported and constant currency basis. This guidance takes into account the impact of market challenges that we are facing and reduced DTC marketing spend from earlier this year as well as some impact in the fourth quarter from the two hurricanes that hit the southeast that caused a shortage in IV bags and that's the delay in procedures.

現在來談談我們 2024 年的全年指引。我們維持 2024 年全年全球收入約 4 億至 4.05 億美元的預期，按報告和固定匯率計算，較 2023 年全球收入下降約 5% 至 6%。該指引考慮了我們所面臨的市場挑戰的影響、今年早些時候 DTC 營銷支出的減少、以及第四季度襲擊東南部的兩次颶風造成的靜脈注射袋短缺以及程序延遲的影響。

While we are stepping up our commercial execution by optimizing our sales territories and amping up our DTC advertising program, we don't anticipate seeing the benefits from these actions in US SPF trialing growth rates for a few quarters.

雖然我們正在透過優化銷售區域和加強 DTC 廣告計劃來加強商業執行，但我們預計這些舉措在未來幾季內不會在美國 SPF 試驗成長率中看到好處。

We continue to expect full-year gross margin to be approximately 66% or 68%, excluding the $6 million supplier charge that we discussed on our second-quarter call. We continue to see our Costa Rica manufacturing facility produced excellent results with labor and material costs, meeting our expectations for manufactured products. Additionally, we have continued to move headcount from the United States down to Costa Rica to leverage our investment.

我們繼續預計全年毛利率約為 66% 或 68%，不包括我們在第二季電話會議上討論的 600 萬美元供應商費用。我們繼續看到我們的哥斯達黎加製造工廠在勞動力和材料成本方面取得了優異的成績，滿足了我們對製造產品的期望。此外，我們繼續將員工從美國遷移到哥斯達黎加，以利用我們的投資。

As I mentioned earlier in my remarks, we continue to project long-term gross margins in the mid-70s, assuming pricing holds at current levels. Also, as we previously communicated on our first-quarter earnings call, we projected we would see second-half gross margin headwinds due to the accounting of inventory variances and overhead that occurred in 2023, as we are transitioning from a heavy reliance on contract manufacturing to bringing manufacturing in-house. Therefore, gross margin in the fourth quarter of 2024 will be lower than what the business delivered in the first half of this year. Also, note that lower production volumes from decreased sales in 2024 will continue to create some margin headwinds next year.

正如我之前在評論中提到的，假設價格保持在當前水平，我們繼續預測長期毛利率在 70 年代中期。此外，正如我們之前在第一季財報電話會議上所說的那樣，我們預計，由於我們正在從嚴重依賴合約製造轉向內部製造，由於 2023 年發生的庫存差異和間接費用的核算，下半年的毛利率將面臨阻力。因此，2024 年第四季的毛利率將低於今年上半年的毛利率。另請注意，2024 年銷售下降導致的產量下降將繼續對明年的利潤率造成一些阻力。

We expect our full-year 2024 operating expenses to be approximately $369.1 million, down $20.2 million or down 5.2% from 2023. As we communicated on our second-quarter 2024 earnings call, we expect our restructuring efforts to generate savings of more than $25 million in 2024 and full-year annualized run rate savings of over $30 million. We remain laser-focused on maintaining a cost structure aligned with the size of our business and continue to look for additional efficiencies to drive margin improvement.

我們預計 2024 年全年營運費用約為 3.691 億美元，較 2023 年減少 2,020 萬美元或下降 5.2%。正如我們在 2024 年第二季財報電話會議上所說的那樣，我們預計重組工作將在 2024 年節省超過 2500 萬美元，全年年化運行率節省超過 3000 萬美元。我們始終專注於維持與業務規模相適應的成本結構，並繼續尋求額外的效率來提高利潤率。

We are also raising our full-year 2024 adjusted EBITDA guidance to a range of negative $18 million to negative $16 million from the prior guidance range of negative $20 million to negative $18 million. It is also important to point out that our restructuring efforts and focus on managing working capital should also drive an increase to our cash, cash equivalents, and short-term investments in Q4 2024 as well.

我們也將 2024 年全年調整後 EBITDA 指引從先前負 2,000 萬美元至負 1,800 萬美元的指引範圍上調至負 1,800 萬美元至負 1,600 萬美元。還需要指出的是，我們的重組工作和對營運資本管理的關注也將推動我們的現金、現金等價物和短期投資在 2024 年第四季的增加。

While we aren't providing 2025 guidance at this time, as we look ahead to next year, we expect to reap the benefits from the changes to our commercial team and territories to drive growth and market penetration -- increased investment in DTC advertising, continued ramping of our SI joint fusion business, and greater revenue contributions from IPG replacements as we move throughout the year.

雖然我們目前還沒有提供 2025 年的指引，但展望明年，我們期望從商業團隊和地區的變化中獲益，從而推動成長和市場滲透——增加對 DTC 廣告的投資，繼續擴大我們的 SI 關節融合業務，以及隨著我們全年的發展，IPG 替代品帶來的收入貢獻增加。

In closing, as we look to close out this year and ahead to 2025, the entire Nevro team remains committed to executing our strategy to grow and diversify our business and getting us back on the path to profitability and value creation.

最後，當我們展望今年並展望 2025 年時，整個 Nevro 團隊仍然致力於執行我們的策略，以實現業務成長和多元化，並讓我們重回盈利和創造價值的道路。

We will now open the call up for questions.

我們現在開始回答問題。

(Operator Instructions) Chris Pasquale, Nephron Research.

（操作員指示） Chris Pasquale，Nephron Research。

Thanks, and congrats on some of the cost-cutting initiatives starting to show through in the reduced OpEx and cash burn, it's nice to see. Kevin, I wanted to ask kind of a big picture question about the outlook for the core SCS business.

謝謝，並祝賀一些削減成本的措施開始在降低營運支出和現金消耗中發揮作用，很高興看到這一點。凱文，我想問一個關於核心 SCS 業務前景的宏觀問題。

By our math, your trials, excluding PDN, have been declining now for the better part of the last three years. And the trend this year has been really bigger declines each quarter. There's competitive noise in there and some launches that have probably impacted share. It really feels like there is less interest or at least stagnating interest in SCS in general as a solution for these patients.

根據我們的計算，您的試驗（不包括 PDN）在過去三年的大部分時間裡一直在下降。今年的趨勢是每季的降幅都更大。其中存在競爭噪音，一些產品的發布可能會影響市場份額。確實感覺大家對 SCS 作為這些患者的解決方案的興趣正在減少，或者至少停滯不前。

You talked about the great work you're doing to develop clinical evidence on the PDM side, on the SI joint side. I'm wondering if you feel a need to maybe generate some new data to really support the use of SCS in the core market, especially given the fact that your technology has evolved quite a bit since the last really big clinical initiative you had for back and leg pain.

您談到了在 PDM 方面、在 SI 關節方面開發臨床證據方面所做的出色工作。我想知道您是否覺得有必要產生一些新數據來真正支持在核心市場中使用 SCS，尤其是考慮到自上次針對背部和腿部疼痛的真正大型臨床計劃以來，您的技術已經有了很大的發展。

Yeah, Chris, thanks for the question and for the shout outs there with our restructuring cost. Look, we looked at all of our competitor data. We do the same analysis you guys do on what's going on in the market. And as you know, historically, this SCS market is traditionally volatile as new products launch back and forth between competitors and what have you. In addition, we're still focused on creating that clinical data. We've done so both in the PDN side as well as nonsurgical back pain, which is a new indication that we did just a few years ago as well that will take some time to be able to ramp that up, and that is in the core back in the leg space.

是的，克里斯，感謝您的提問，也感謝您對我們的重組成本的關注。看，我們查看了所有競爭對手的數據。我們對市場動態的分析和你們一樣。眾所周知，從歷史上看，由於競爭對手之間不斷推出新產品，SCS 市場歷來波動較大。此外，我們仍然專注於創建臨床數據。我們在 PDN 方面以及非手術性背痛方面都進行了嘗試，這是我們幾年前也做過的一個新適應症，需要花一些時間才能逐步推廣，這是在腿部空間的核心部位。

If you also recall in the second-quarter earnings call, we talked about those MIS procedures that are often in front of SCS and those procedures continue to grow. And we believe that those patients will continue to get back to SCS to complete their full pain management journey. So with that, I think that when you look at our direct-to-consumer spend, we talked about it on the call, we turned that down. We saw an effect. That was not just in PDN, but also in our core back and leg market. So as we turn that dial backup and really begin to be more focused on those efforts and nurturing those patients, we're actually seeing a return of trials in all those areas. And so we have to control what we control, and we're excited about AdaptivAI and our launch there to be able to compete against our bigger competitors as well.

如果您還記得，在第二季的財報電話會議上，我們討論了那些經常在 SCS 之前進行的 MIS 程序，而這些程序還在不斷增長。我們相信這些患者將繼續回到 SCS 完成他們的整個疼痛管理之旅。因此，我認為，當你看到我們的直接面向消費者的支出時，我們在電話會議上討論過這個問題，我們拒絕了。我們看到了效果。這不僅發生在PDN，也發生在我們的核心背部和腿部市場。因此，當我們重新調整策略並真正開始更加關注這些努力和培養這些患者時，我們實際上看到所有這些領域的試驗都在回歸。因此，我們必須控制我們所控制的東西，我們對 AdaptivAI 以及我們在那裡的發布感到興奮，能夠與我們的更大的競爭對手競爭。

Do you have any plans to capture the impact of AdaptivAI in a way that's comprehensive and can generate some publications to put that in front of physicians?

您是否有計劃以全面的方式捕捉 AdaptivAI 的影響，並產生一些出版物將其呈現給醫生？

Yeah. We always look at what we can do in real-world data to be able to bring new points out there. And as you heard during our call, we talked about statistics of what we're already seeing in our limited market release, and we believe some of those physicians that we're involved there would love to do investor-initiated trials there. And so we do want to continue our focus on clinical trials as we always have to bring out important data.

是的。我們總是關注在現實世界的數據中我們能做些什麼來帶來新的觀點。正如您在電話會議中聽到的那樣，我們談到了我們在有限的市場發布中已經看到的統計數據，我們相信我們參與的一些醫生會很樂意在那裡進行投資者發起的試驗。因此，我們確實希望繼續關注臨床試驗，因為我們始終需要提供重要的數據。

And not only does this bring clinical data and benefits for the patients, benefits for the physicians because they're getting less phone calls because the patients are actually getting back to pain relief really quickly automatically from the algorithm. But also, we're seeing less of a burden on our internal staff on reaching out to those patients because they're getting back to the pain relief on their own using the algorithm and just answering four easy questions today. So we're excited about it bringing not only clinical value but also commercial value in quite often going to be some cost of putting in cost savings for us as an organization as well.

這不僅為患者帶來了臨床數據和益處，也為醫生帶來了好處，因為他們接到的電話更少了，因為患者實際上可以透過演算法自動快速地緩解疼痛。但同時，我們發現內部員工在聯繫這些患者時的負擔也減輕了，因為他們可以使用演算法自行緩解疼痛，今天只需回答四個簡單的問題。因此，我們很高興它不僅帶來臨床價值，而且還帶來商業價值，而且往往為我們組織節省一些成本。

Thanks.

謝謝。

Shagun Singh, RBC Capital Markets.

加拿大皇家銀行資本市場 (RBC Capital Markets) 的 Shagun Singh。

Hi. Thank you so much for taking the questions. I guess I just wanted to get back to US trials down 15%. And you called out competition market execution. And then you did call out the DTC impact that it sounds like it will take up to a second half to '25 to really yield some results. Can you just elaborate on each of those buckets? Where are you seeing more pressure versus the other?

你好。非常感謝您回答這些問題。我想我只是想回到下降 15% 的美國試驗。您也呼籲競爭市場執行。然後你確實提到了 DTC 的影響，聽起來它要到 25 年下半年才能真正產生一些結果。能詳細說明一下每個桶子嗎？與其他相比，您認為哪個方面的壓力較大？

And I guess just as a follow-up, can you elaborate on your US sales force dynamics? How much of the heavy lifting is behind you? What still needs to be done as we look into 2025, that would be helpful. Thank you.

我想作為後續問題，您能詳細說明您在美國銷售團隊的動態嗎？您已經完成了多少繁重的工作？展望 2025 年，我們還需要做哪些工作呢？謝謝。

Sure. Yeah, I'll start with the last one first. Our commercial efforts in the US. As you recall, in 2023, we made quite a bit of structural changes and reporting line changes and brought on a lot of new people. Most of those were in entry-level type sales positions called associate sales reps, and that's why now, those reps have been out in the field for 1.5 years and are ready to take on their own territories. That was planned all along, so that they can hit the ground running much quicker someone who's coming from outside of the spinal cord stimulation market. Most of those are taking over expansion territories that are within the territory in which they were providing assistance over the last 1.5 years. So they know the physicians, they know the doctors that are in that area, and areas where they can go out and convert competitive business as well.

當然。是的，我先從最後一個開始。我們在美國的商業努力。大家還記得，2023 年，我們進行了相當多的結構調整和報告路線變更，並引進了許多新員工。他們中的大多數都是初級銷售職位，被稱為助理銷售代表，這就是為什麼現在這些銷售代表已經在這個領域工作了 1.5 年，並​​準備好接管自己的領域。這是他們一直以來的計劃，這樣他們就可以比來自脊髓刺激市場以外的人更快地開始行動。其中大多數正在接管其過去 1.5 年提供援助的領土內的擴張領土。因此，他們了解醫生，了解該地區的醫生，以及他們可以去哪裡轉化競爭業務。

If you go through and look at what components were the headwinds of that 15.2%. There's one thing just to remember here. As our replacements continue to grow and be more part of our overall business, you will see a disassociation between trialing and revenue. because you do not do a trial when you're replacing the IPG, I just wanted to make that point. So you can still see revenue growth despite some pressure on trials.

如果你仔細看看，你會發現哪些因素對這 15.2% 造成了阻礙。這裡有一件事要記住。隨著我們的替代品不斷增長並成為我們整體業務的一部分，您將看到試用和收入之間的脫鉤。因為您在更換 IPG 時不需要進行試驗，所以我只是想說明這一點。因此，儘管試驗面臨一些壓力，你仍然可以看到收入成長。

The second is DTC. These are really hard things to measure. We have some great Board members that sit on companies that also spend a lot on direct-to-consumer advertising. And it's always difficult to tell how much of an impact they're having or not having an impact until you increase it or you're decreasing and see the effects of that. And so we made that decision back earlier in 2024 to turn it down a bit.

第二個是DTC。這些確實都是很難衡量的事情。我們有一些優秀的董事會成員，他們所在的公司也在直接面向消費者的廣告上投入了大量資金。並且，除非你增加或減少它並看到其效果，否則很難判斷它們有多大影響或沒有影響。因此，我們早在 2024 年初就做出了這個決定，將其稍微降低一些。

It takes a little bit of time before you see the effects on that. But as soon as we did, we were now able to realize that it does make an impact on returning that volume back up. And we're already seeing the benefits of that in the early days since we turned the volume back up. So it's really difficult to try to put a percentage of what is providing that headwind, but we do believe that all of our changes in all of our responses to that will reverse that trend.

需要一點時間才能看到效果。但我們一旦這樣做，就能夠意識到它確實對恢復銷售產生了影響。自從我們重新提高音量以來，我們在早期就已經看到了它的好處。因此，很難確定造成這種不利因素的百分比，但我們確實相信，我們對此做出的所有反應的所有變化都將扭轉這一趨勢。

Thank you.

謝謝。

Robbie Marcus, JPMorgan.

摩根大通的羅比馬庫斯 (Robbie Marcus)。

Chris, congratulations on some pretty impressive cost cuts here. And maybe to that point, I wanted to ask on R&D spend. It came down pretty meaningfully about a third. It's the lowest, I believe, outside of the depths of COVID since 2017. How do we balance sort of the cost cutting initiative versus future innovation here? And maybe you could give us a little insight into what was cut, how it was cut and how you think about this impacting forward growth? And then I have a follow-up.

克里斯，祝賀你取得了相當令人印象深刻的成本削減。也許到了那個時候，我想問一下研發支出的問題。它下降了約三分之一，意義重大。我認為，這是自 2017 年以來，除新冠疫情最嚴重時期之外的最低水準。我們如何平衡成本削減計劃和未來創新？也許您可以向我們稍微介紹一下削減了哪些內容、如何削減以及您認為這將對未來成長產生什麼影響？然後我有一個後續問題。

Sure. Yeah, this is Rod. I'll take that. There's a couple of things to keep in mind here. We always want to be investing in what's going to be driving future growth. And we really protect those investments that are going to provide an ROI. I think what you're seeing here is focus in the organization towards those projects that do have an ROI associated with them.

當然。是的，這是羅德。我接受。這裡有幾件事要記住。我們始終希望投資於能夠推動未來成長的領域。我們確實保護了那些能夠帶來投資回報的投資。我認為您在這裡看到的是組織重點關注那些確實具有投資回報率 (ROI) 的項目。

Also, note that there's some clinical spending that goes on in that category, and we saw some reduction or some focus in that area as well. So we've got a bias towards growth. Kevin and I, we -- our entire careers have been about driving growth in the business, and we're really going to try to drive that focus in an organization towards those projects that can generate revenue returns over the next couple of years.

另外，請注意，該類別中存在一些臨床支出，我們也看到該領域的支出減少或集中。所以我們偏向成長。凱文和我整個職業生涯都致力於推動業務成長，我們確實會努力將組織的重點轉向那些可以在未來幾年產生收入回報的專案。

And I'll add a little bit here, Rob, it's Kevin. On that clinical side, you will see some bonuses up or down just based upon the enrollment in the timing. And so we obviously had a couple of clinical trials roll off and come to completion. And we have our sensory trial been going, but it's the preplanned midterm stop. And so you'll see reduction in spending as that occurs. So that will go up or down, and that's in our R&D line.

我在這裡補充一點，羅布，我是凱文。在臨床方面，您會看到一些獎金的增加或減少，這取決於報名時間。因此，我們顯然已經進行並完成了幾項臨床試驗。我們的感覺試驗總是進行，但這是預先計劃好的期中停止。當這種情況發生時，你會看到支出減少。因此，其將會上升或下降，而這正是我們的研發方向。

And as Rod mentioned, we are still focused on the diversification of that product portfolio, along with spinal cord stimulation next-generation devices, as you can see with AdaptivAI, that's not the last one. We'll continue to focus on innovation there, along with getting us into new markets that are already established in the pain management space today.

正如羅德 (Rod) 所說，我們仍然專注於產品組合的多樣化，以及脊髓刺激下一代設備，正如您在 AdaptivAI 中看到的那樣，這不是最後一個。我們將繼續專注於該領域的創新，同時進入目前在疼痛管理領域已經建立的新市場。

Great. And it's been touched on in some questions already. But maybe just help us understand this year, you cut expenses, you cut headcount and sales came down. And we're going to see probably one of the flattest third to fourth quarter as the company has ever had coming up now. How do you -- especially, I imagine headcount exiting the year is going to be lower by a good amount than during the year. And I know you're adding some territories next year, but how do we think about the plan to grow revenues in '25, despite some pretty meaningful expense and likely headcount cuts throughout '24? So I imagine you're going to have tough comps at the beginning of next year on that count. Just help us understand how you can balance a lot less spending with growth. Thanks a lot.

偉大的。一些問題已經涉及這個問題。但也許只是幫助我們了解今年，你削減了開支，削減了員工人數，銷售額下降了。我們可能會看到該公司有史以來最平淡的第三至第四季之一。您如何看待這種情況？ 尤其是，我預計今年離職的員工數量將比今年同期減少很多。我知道您明年會增加一些地區，但儘管24年會有相當大的開支和可能的裁員，我們如何考慮在25年增加收入的計劃？因此我想，明年年初你們將會面臨嚴峻的競爭。只需幫助我們了解如何在減少支出和實現成長之間取得平衡。多謝。

Yeah, this is Rod again. It's a good question. I mean as you look at the $30 million-plus that we've pulled out on an annualized basis, I think we got probably close to 90% of it, right? When you do make those sort of reductions, you are going to find a couple of areas where, like Kevin mentioned on DTC, where maybe we turned down the volume a little bit too much.

是的，我又是羅德。這是個好問題。我的意思是，當你看到我們每年提取的 3000 多萬美元時，我想我們可能已經提取了其中的 90%，對嗎？當你確實做出此類削減時，你會發現幾個方面，就像 Kevin 在 DTC 上提到的那樣，我們可能把音量調低了一點。

I think as we sit here right now, we're confident that we have a much better sense as to what is going to drive that revenue? What has impacted that revenue. We feel confident that we can close that gap that we saw in Q3 there with the cost structure that we have in place.

我想，當我們坐在這裡時，我們有信心我們對推動這些收入的因素有了更好的了解。哪些因素影響了該收入？我們相信，透過現有的成本結構，我們可以彌補第三季出現的差距。

As Kevin mentioned, we're dialing up the DTC. We're making some key investments in certain parts of the commercial execution and the commercial organization to help drive that growth into the future. So I think we got the majority of it right, but there were definitely a couple of areas where it may have had a little bit of an impact on the business.

正如 Kevin 所提到的，我們正在撥打 DTC。我們正在對商業執行和商業組織的某些部分進行一些關鍵投資，以幫助推動未來的成長。所以我認為我們大部分事情都做對了，但肯定有幾個方面可能對業務產生了一點影響。

Yeah, it's Kevin here. Just to add in to one of the exciting portions and the reason we put it in the prepared remarks around AdaptivAI is the ability to grow without needing to add 1:1 ratios with that new patient population that continues to expand, right? As we implant more new patients -- that means we have more patients to take care of. However, those new patients that start on AdaptivAI and those that will eventually be replaced with AdaptivAI as their old IPGs sort of go to their end of life or end of their battery, we need less people to be able to take care of those patients. That's what AI does across all the industries, right? It's making those changes automatically that used to be people that used to have to do a lot of that work. And so as we expand in the future technology will allow us to do that as well.

是的，我是凱文。只是為了補充一個令人興奮的部分，我們把它放在有關 AdaptivAI 的準備好的評論中的原因是它能夠隨著不斷擴大的新患者群體而增長，而無需添加 1：1 的比例，對嗎？隨著我們接收更多新患者，這意味著我們需要照顧更多患者。然而，對於那些開始使用 AdaptivAI 的新患者以及那些由於舊 IPG 的使用壽命或電池壽命耗盡而最終將被 AdaptivAI 取代的患者，我們需要更少的人來照顧這些患者。這就是人工智慧在所有行業所做的事情，對嗎？它會自動進行這些更改，而以前需要人工來完成大量工作。因此，隨著我們未來的擴張，科技也將使我們能夠做到這一點。

Matt Taylor, Jefferies.

傑富瑞的馬特泰勒 (Matt Taylor)。

Hi. Thanks for taking the question. I just wanted to be clear about the comments on trialing because you said that ramping back of DTC would improve them the trial trends by second half '25. But are we expecting the next few quarters for the trialing trends to be similar to what we saw in Q3? And then could you provide any color on the quantum of DTC spending that you toggle down and up? It sounds like you said 90% right? So is it 10% of the $30 million that you're toggling back up?

你好。感謝您回答這個問題。我只是想清楚地說明有關試驗的評論，因為您說 DTC 的減少將會在 25 年下半年改善他們的試驗趨勢。但是，我們是否預期接下來幾季的試驗趨勢將與第三季的趨勢相似？然後，您能否提供有關 DTC 支出量的詳細信息，以了解具體情況？聽起來你說的是 90% 對嗎？那麼，您要重新調撥的金額是 3,000 萬美元中的 10% 嗎？

No, we can't really do that math. On the spending, the good news is, in today's world, getting to our patient population is pretty targeted. And we even got better now than we did before by the channels in which we can find these patients easier.

不，我們真的無法做這個計算。關於支出，好消息是，在當今世界，我們接觸患者群體是相當有針對性的。而現在我們可以透過更方便的管道找到這些病人，這比以前更好了。

The reason why there's a little delay there is obviously, as these patients call in to learn more about this exciting therapy to help them out, specifically with their back and leg pain or painful diabetic neuropathy. We've learned is we need to nurture those patients and educate them before we hand them off to their preferred physician. And we've seen a really good increase of those referrals and those leads going into consultations with their preferred physician. And that typically takes four to six months after they have their initial consultation before they would have a trial that would lead to a permanent implant. So that's why it's going to take a little bit of time as these patients -- the patient flow starts coming back in.

顯然，之所以會稍微延遲，是因為這些患者打電話來是為了了解更多有關這種激動人心的療法的信息，以幫助他們，特別是緩解背部和腿部疼痛或糖尿病神經病變疼痛。我們了解到，在將這些患者轉交給他們喜歡的醫生之前，我們需要對他們進行培養和教育。我們看到這些轉診和潛在客戶與他們首選的醫生進行諮詢的數量有了很大的增長。通常，在初次諮詢後需要四到六個月的時間才能進行最終確定永久植入的試驗。所以這就是為什麼這些病人——病人流量開始恢復需要一點時間。

As far as what we're spending on DTC, we've never put that number out there before, but we're able to do so, and it wouldn't have an effect on the $30 million that we said is going to be saved this next year.

至於我們在 DTC 上的支出，我們之前從未透露過這個數字，但我們能夠這樣做，而且這不會對我們所說的明年將節省的 3000 萬美元產生影響。

Hey, Matt, just to pile on there a little bit. So in some of our press release, our slides, we said that for Q4, we're not commenting on 2025 at this point. But for Q4, we did -- we assume the trialing doesn't improve. And as Kevin mentioned, we still believe that our $30 million of annualized cost reductions are in place, and we'll continue to see some benefit of that. But kind to your math, it is not a huge investment, but it's something that we -- once we realized that it was having an effect, we were able to turn on and get that investment flow going pretty quickly.

嘿，馬特，我只是想再說一點點。因此，在我們的一些新聞稿和幻燈片中，我們表示，對於第四季度，我們目前不評論 2025 年的情況。但對於第四季度，我們確實假設試驗沒有改善。正如凱文所說，我們仍然相信，我們每年 3000 萬美元的成本削減計劃已經到位，而且我們將繼續看到由此帶來的好處。但根據你的計算，這並不是一項巨大的投資，但一旦我們意識到它正在產生影響，我們就可以啟動並很快獲得投資流。

All right, great. Thank you, guys.

好的，太好了。謝謝你們。

Thanks, Matt.

謝謝，馬特。

Joanne Wuensch, Citi.

花旗銀行的 Joanne Wuensch。

Hey, guys. Good afternoon. This is Anthony on for Joanne. I guess your gross margin guidance and EBITDA guidance for the year, that implies a pretty big step-up in OpEx in the fourth quarter. Is that all related to DTC and expanding sales force or is there anything else in there that we should keep in mind?

嘿，大家好。午安.這是安東尼 (Anthony) 代替喬安妮 (Joanne)。我猜測，您今年的毛利率指引和 EBITDA 指引意味著第四季度的營運支出將大幅增加。這些都與 DTC 和擴大銷售團隊有關嗎？

Yeah, I can take that. We had -- first of all, we had a pretty strong Q3 from an adjusted EBITDA perspective, and some of that was related to the revenue over performance versus where we guided to as well as some spend reductions as well as some timing on some spend. So from a timing perspective, some of that timing is pushing into Q4. And there are some additional investments, some commercial related, some related to AdaptivAI that are impacting the P&L from a timing perspective, some of those we thought would have hit in Q3, but it looks like they're going to be more of a Q4 expense. So it's primarily timing in terms of that shift really from Q3 to Q4.

是的，我可以接受。首先，從調整後的 EBITDA 角度來看，我們的第三季表現相當強勁，這在一定程度上與收入超過業績預期有關，也與一些支出減少以及一些支出的時間安排有關。因此，從時間角度來看，部分時間正在推遲到第四季。還有一些額外的投資，一些與商業相關，一些與 AdaptivAI 相關，從時間角度來看，這些投資會對損益表產生影響，我們認為其中一些會在第三季度達到，但看起來它們將更多地成為第四季度的支出。因此，這主要涉及從第三季到第四季的轉變的時間。

Okay, that's helpful. And then just one on Versa. Can you talk about how that integration is going and if that's performing to internal expectations so far?

好的，這很有幫助。然後就只剩下一個關於 Versa 了。您能談談整合的進度如何以及目前的執行是否符合內部預期嗎？

Thanks, Anthony. Yeah, so we're still in the integration process. As a reminder, it was a small spin-out of a small spine company there, and they handed us great technology, but we had to build up a lot of the things needed to be able to fully launch that, one of which is the trade that you need perform the procedure that need to be turned and flip back out. We now are finally at full capacity there. so that we're able to cover any kind of the trials that's ongoing.

謝謝，安東尼。是的，我們仍處於整合過程中。提醒一下，它是那裡一家小型脊椎公司的分拆公司，他們向我們提供了出色的技術，但我們必須建立許多必要的東西才能全面啟動它，其中之一就是您需要執行需要翻轉和重新翻轉的程序的交易。現在我們終於已經滿載運轉了。這樣我們就能報道任何正在進行的試驗。

One of the things we talked about before is that we are changing the paradigm for where those patients are treated Traditionally, they've been treated by neurosurgeons and orthopedic surgeons because of the procedures that were commercially available, we're pretty intensive -- and if you needed some help, if you did something wrong during that procedure, you needed to have a little bit different skills than the physicians that we normally call on.

我們之前談到的一件事是，我們正在改變這些病人接受治療的模式。

Now, with this posterior approach, it's opened up a new world for the interventionalists to do this procedure, and we spend a lot of time training physicians for the first time. And so instead of them referring those physicians to neurosurgeons like they had in the past, they're now able to keep those patients in their own practice, but that's going to take them some time to be able to build up that patient flow and that patient base that stays within the practice, so we're liking how it's progressing.

現在，透過這種後入路技術，為介入科醫生進行此項手術開闢了一個新世界，我們首次花費大量時間培訓醫生。因此，他們不再像過去那樣將這些內科醫生轉介給神經外科醫生，而是能夠讓這些患者留在自己的診所，但這需要一些時間才能建立起患者流量和留在診所內的患者群，所以我們對目前的進展感到滿意。

Obviously, we always more than what you have right now. But we're in line with where we want to go as far as the training number of physicians that are trained, how they're building their practices and our rep's ability to learn and be able to upscale to be able to be proficient in covering those cases. And we expect that it will have a more meaningful impact, as we said, as we head into 2025.

顯然，我們擁有的總是比你現在擁有的更多。但我們在培訓醫生的數量、他們如何建立自己的實踐以及我們的代表的學習能力和提升能力方面與我們希望達到的目標一致，能夠熟練地處理這些病例。正如我們所說，我們預計，在邁入 2025 年時，它將產生更有意義的影響。

Great. Thank you for the question.

偉大的。感謝您的提問。

Brandon Vazquez, William Blair.

布蘭登·巴斯克斯、威廉·布萊爾。

Hi, everyone. Thanks for taking the question. First, I just wanted to focus on the P&L. You guys have done a great job here taking some costs out. I guess the question being now as we go to 25-plus is kind of the next leg of improvements in profitability going to be coming from just reaccelerating the top line? Or is there another lag of OpEx that might come out next year as you guys look towards moving even closer to breakeven and eventually profitability?

大家好。感謝您回答這個問題。首先，我只想關注損益表。你們在這裡做得很好，節省了一些成本。我想現在的問題是，當我們達到 25 歲以上時，獲利能力的下一階段改善是否將僅來自於重新加速營收成長？或者，當你們希望進一步接近收支平衡並最終實現盈利時，明年是否會出現另一次營運支出落後的情況？

Hey, Brandon. This is Rod. I'll take that. As we continue to run this business, we continue to look for areas where we can drive focus in the business and get more efficient in what we're doing, right size the business for the size of that particular aspect of the business. So we still have some projects in areas that we're going after to drive efficiencies in this business, and we'll continue to do that on a go-forward basis.

嘿，布蘭登。這是羅德。我接受。在我們繼續經營這項業務的同時，我們也會繼續尋找能夠集中精力、提高工作效率的領域，並根據業務的規模確定合適的業務規模。因此，我們在一些領域仍有一些專案需要推進，以提高該業務的效率，並且我們將繼續向前邁進。

And additionally, we'll continue to go after working capital, we saw pretty good size reductions in inventories and receivables in the third quarter, and that's going to be a strong part of our offense is -- we're really trying to drive this business towards a place where we control our own destiny, both from a profit and a cash flow perspective.

此外，我們將繼續追求營運資本，我們看到第三季庫存和應收帳款大幅減少，這將成為我們進攻的強大部分——我們確實在努力推動這項業務走向我們自己掌控命運的境界，無論是從利潤還是現金流的角度。

And I'll just add on to that, Brandon. As we talked about in the prepared remarks, we also are moving some -- the people down to Costa Rica, so they can be closer to the manufacturing plant when they're manufacturing engineering and people like that as well, and so that will continue to have some benefits that we don't fully realize yet.

我只想補充一點，布蘭登。正如我們在準備好的發言中談到的那樣，我們還將把一些人轉移到哥斯達黎加，這樣他們在進行製造工程時就可以更靠近製造工廠，人們也是如此，因此，這將繼續帶來一些我們尚未完全意識到的好處。

And then as I mentioned earlier on another question, we really believe that using AI, not only in product but across the organization, will give us opportunities for us to become more efficient, and allow us to grow our top line without having to add a 1:1 ratio, if you will, of people to be able to take care of our large and growing installed patient base. And so that will be a cost avoidance and allow us to be able to do more with less people because AdaptivAI is doing a lot of that work in the right now or in previous generations, a person would be left to do to reprogram.

正如我之前在另一個問題中提到的那樣，我們確實相信，不僅在產品中使用人工智慧，而且在整個組織中使用人工智慧，都將為我們提高效率提供機會，並使我們能夠增加營業收入，而不必按照 1：1 的比例增加人員來照顧我們龐大且不斷增長的患者群。這樣可以避免成本，讓我們能夠用更少的人做更多的事情，因為 AdaptivAI 現在或在前幾代做了很多這樣的工作，而之前的工作需要人來重新編程。

And that additional work that they were doing doesn't really give meaningful reimbursement to the physician nor zero reimbursement for us at Nevro1 or revenue for us at Nevro1. So it's not only a cost avoidance, but allows us to do more meaningful things that actually can drive the top line.

他們所做的額外工作實際上並沒有為醫生帶來有意義的報銷，也沒有為我們 Nevro1 帶來任何報銷或收入。因此，這不僅可以避免成本，還使我們能夠做更多有意義的事情，從而真正推動營收成長。

Got it. And Kevin, on that last point that you were making, I think with HFX iQ, even you are already starting to lower some of the barriers or some of the pain points of programming these patients. So maybe can you walk us through a little bit of like what's the patient workflow look like for [NIQ] versus an AdaptivAI patient when they're coming in and then later down the road, just so that we can understand a little bit of what's the incremental gain points here that AdaptivAI can really take the next leg on? Thank you.

知道了。凱文，關於您提到的最後一點，我認為透過 HFX iQ，您已經開始降低對這些患者進行程式設計的一些障礙或痛點。那麼，您能否向我們稍微介紹一下 [NIQ] 與 AdaptivAI 患者入院時的工作流程以及之後的治療過程，以便我們能夠稍微了解一下 AdaptivAI 真正能夠在下一步中獲得哪些增量增益點？謝謝。

IQ was the first AI-powered, big data-driven device, but we didn't put AI in the name because we weren't using the full capabilities of our AI power. And so now we're up to over 100 million data points that we can leverage. And so, the AdaptivAI now gives us a full range of capabilities in all of the programming available. on our devices, high frequency, low frequency, IQ mode. There's a ton of different modes. And I don't want to miss this point because I said it pretty quickly in the prepared remarks.

IQ 是第一款由人工智慧驅動、大數據驅動的設備，但我們沒有在名稱中加入“人工智慧”，因為我們沒有充分利用人工智慧的力量。現在我們可利用的數據點已超過 1 億個。因此，AdaptivAI 現在為我們提供了所有可用程式設計的全部功能。在我們的設備上，高頻、低頻、IQ 模式。有大量不同模式。我不想忽略這一點，因為我在準備好的發言中已經很快地談到了這一點。

One of the biggest differences here is because the algorithm is changing the therapy quickly, we're now able to dial that in and likely reduce for many patients the burden of the energy use of the battery of the device. And so you think about someone who maybe was on an older generation device that needed to charge once per week because their IPG was still set on that initial first higher-power type waveform.

這裡最大的區別之一是，由於演算法可以快速改變治療方法，我們現在能夠調整它，並可能為許多患者減輕設備電池的電能使用負擔。因此，您可以想像一下，有人可能正在使用舊一代設備，該設備需要每週充電一次，因為他們的 IPG 仍然設置在最初的第一個高功率類型波形上。

Now, over time, as we get to dial in and personalize that therapy, we see patients now that are only going to need to charge six times per year -- so that's a massive decrease in the burden of charging and something that we're really excited about in this new AdaptivAI that wasn't available in the IQ system previously.

現在，隨著時間的推移，我們可以撥打電話並個性化治療，我們看到患者每年只需要充電六次 - 因此，這大大減少了充電負擔，而我們對新的 AdaptivAI 感到非常興奮，這是 IQ 系統中以前沒有的。

Bill Plovanic, Canaccord.

加拿大銀行 (Canaccord) 的 Bill Plovanic。

Great, thanks. Good evening. Thanks for taking the question. Just first off, I was wondering if you could help quantify the magnitude of the changes for the territory managers as you promote these? Maybe from probably the low point of right after the changes you made earlier this year in cost cuts and then kind of where you expect to be next year? Are you increasing at 10%, 20%, or 30%? And then I have a follow-up.

太好了，謝謝。晚安.感謝您回答這個問題。首先，我想知道您是否可以幫助區域經理量化您在推廣這些變革時所帶來的變化的幅度？也許是在您今年早些時候削減成本之後的最低點，那麼您預計明年的成本會達到什麼水平？您增加 10%、20% 還是 30%？然後我有一個後續問題。

Yeah. We haven't given a number yet, but there was quite a few people that we hired in 2023. There were assisted sales reps or therapy consultants that are now ready to take on their territory. And just, Bill, you've been watching the story for a long time. So in past, sometimes, we would add territories that were pretty much brand-new dirt that had zero revenue and you put in a high-priced sales rep to sort of grow that business, even the best of the best takes years to be able to build up a sizable business and converting those physicians from competitors.

是的。我們還沒有給出具體數字，但是我們在 2023 年僱用了不少人。有協助銷售代表或治療顧問現在已經準備好接管他們的地盤。比爾，你已經觀察這個故事很久了。所以在過去，有時，我們會增加一些幾乎是全新、沒有收入的地區，然後你投入高價的銷售代表來發展這項業務，即使是最好的銷售代表也需要數年時間才能建立起規模可觀的業務並將這些醫生從競爭對手那裡轉化過來。

So the approach is since 2023 was you put in these assistant sales reps in territories that have a full-line sales rep that is already proficient and been in the space for a while where they get to learn from them. and go to the outreaching areas, if you will, from that -- where that sales rep is located today. And so a lot of these ASRs are taken over a piece of dirt that they know that is sort of adjacent to the territory in which they have today. So we believe that they'll be more effective sooner than just pulling somebody off the street, but we've not given any numbers for how many that we've added.

因此，我們的方法是，自 2023 年以來，將這些助理銷售代表安排到擁有全線銷售代表的地區，這些銷售代表已經熟練並在該領域工作了一段時間，他們可以向這些銷售代表學習。如果你願意的話，可以從那裡前往外展區域——也就是該銷售代表目前所在的位置。因此，許多 ASR 都佔領了他們所知道的一塊與他們現在的領土相鄰的土地。因此，我們相信，與僅僅將人從街上救出來相比，它們會更快地發揮效力，但我們尚未公佈增加了多少名人員的具體數字。

Okay. And then just on the AdaptivAI product, as you start full launch of that you had the HFX iQ. Historically, you've seen a price premium for new products as you bring them to market. How should we think about that as you go full launch on the AdaptivAI?

好的。然後就在 AdaptivAI 產品上，當您開始全面推出產品時，您就有了 HFX iQ。從歷史上看，新產品推向市場時，你會看到其價格溢價。當您全面推出 AdaptivAI 時，我們應該如何考慮這一點？

Yeah. A lot of these things are done through contracts, and it takes some time for us to get through additional products on contract, so we're just now having those conversations. We couldn't do it until we get received FDA approval, of course. So we're still just a few weeks into that. But we're applicable, obviously, we'll always be able to drive a premium for new technology if it brings value to those physicians. But it's really early right now to try to give an ASP increase because it's still going to be starting off as a smaller portion of our total implants.

是的。很多事情都是透過合約完成的，我們需要一些時間來完成合約中的附加產品，所以我們現在才進行這些對話。當然，我們必須獲得 FDA 批准才能這樣做。因此，我們距離這一目標只剩下幾週的時間。但我們是適用的，顯然，如果新技術能為那些醫生帶來價值，我們將始終能夠推動新技術的溢價。但現在嘗試提高平均售價還為時過早，因為它在我們的總植入物中所佔的比例還很小。

Great. Thanks for taking my questions.

偉大的。感謝您回答我的問題。

Suraj Kalia, Oppenheimer.

蘇拉傑‧卡利亞 (Suraj Kalia)、奧本海默 (Oppenheimer)。

Kevin, I'm at the airport, so pardon at the background noise. I'll ask both of my questions upfront. So Kevin, you mentioned Adaptiv iQ. And if I heard correctly, 20% reduction in office visits, 41% sooner reduction in pain relative to HFX 1.0, maybe you can just give us how does that compare to other platforms to the extent that you can talk about it? And also, how should we think about the robustness of the 100 million data points that you have referenced in your prepared remarks?

凱文，我在機場，所以請原諒背景噪音。我會提前問這兩個問題。凱文，你提到了 Adaptiv iQ。如果我沒聽錯的話，與 HFX 1.0 相比，就診次數減少了 20%，疼痛減輕了 41%，您能否給我們講講與其他平台相比的情況？另外，我們應該如何看待您在準備好的評論中提到的 1 億個數據點的穩健性？

And the second question, if I may, quickly, Kevin, what percent of systems, Nevro systems are HFX10 versus the more modular waveforms? Thanks for taking my questions.

第二個問題，如果可以的話，凱文，我快速地問一下，Nevro 系統中有多少百分比是 HFX10，而不是更模組化的波形？感謝您回答我的問題。

Thanks, Suraj. Safe travels. It's AdaptivAI, not Adaptiv iQ, just I want to make sure I sort of blended those together in talking. And look, we've compared against our previous version, AdaptivAI versus HFX iQ and those brand-new patients and seeing how quickly they get to pain relief. And so that was that 41% number.

謝謝，蘇拉傑。旅途平安。它是 AdaptivAI，而不是 Adaptiv iQ，我只是想確保在談話中將它們融合在一起。你看，我們將 AdaptivAI 與 HFX iQ 與先前的版本進行了比較，並針對這些新患者觀察了他們緩解疼痛的速度。這就是 41% 的數字。

And then when you look at our 40% reduction of patient visits, 50% reduction in call time, and 20% reduction in-office patient reprogramming, that's versus Omnia, which was our previous version before iQ that did not have any AI-powered technology in that. And so we have not done any head-to-head against any of the competitors out there because, again, we're still in limited market release. And so we'll continue to provide some of those data points as we get into a full market release starting later in this month.

然後，您會發現，我們的患者就診次數減少了 40%，通話時間減少了 50%，辦公室內患者重新編程減少了 20%，這是與 Omnia 相比的，Omnia 是我們在 iQ 之前的版本，其中沒有任何人工智慧技術。因此，我們還沒有與任何競爭對手進行正面交鋒，因為我們的產品仍處於有限的市場發布階段。因此，我們將在本月稍後開始全面發布市場時繼續提供一些數據點。

As far as percentage of HF10 versus the other, we exited the quarter with --

就 HF10 與其他產品的比例而言，我們在本季結束時--

Yeah. So we were -- Q3 was about 68% of our mix of iQ product. And if you're specifically talking about HF10, almost all of our patients exclusively use the HF10 therapy versus any of the other wavelengths. In fact, it's probably north of 95%.

是的。所以，Q3 約占我們 iQ 產品組合的 68%。如果您特別談論的是 HF10，那麼幾乎我們所有的患者都只使用 HF10 療法，而不是任何其他波長的療法。事實上，這一比例可能超過 95%。

Richard Newitter, Truist Securities.

Truist Securities 的 Richard Newitter。

Hi. Thanks for taking my questions. Maybe just on the first, going back to the DTC. Just curious, is it am I reading this right that if you're expecting a back half 25% impact from turning the switch back on midway through 3Q, is that a longer timeframe to see the ROI from that investment in DTC versus what happened when you turned it off midway through 1Q hitting in the third quarter? Maybe just -- are they equal timeframes or why would it be longer on the back end?

你好。感謝您回答我的問題。也許只是先回到 DTC。只是好奇，我讀得對嗎？也許只是——它們的時間範圍是否相等或為什麼後端的時間會更長？

Yeah. So as we said earlier, what we do when you turn it back on, you get patients to see the ads and they say, wow, this is great technology. I want to learn more about it. They have a call to action, which goes into a call center that's within our team and great team, by the way, these HFX coaches that we have to take care of the patients. So I want to give a shout out to the great work that they're doing.

是的。正如我們之前所說的，當您重新打開它時，我們會讓患者看到廣告，然後他們會說，哇，這是很棒的技術。我想了解更多相關資訊。他們發出了行動號召，這報告進入了我們團隊內部的呼叫中心，順便說一下，這些 HFX 教練告訴我們必須照顧好病人。因此我想對他們所做的偉大工作表示讚賞。

And then they talk to them numerous times to get them to along the pathway towards getting referred to their physician of choice. And once they do, we see those referrals turn into consultations because we know when they get booked in to see the physician. After the book to see the physician, it's going to take 4 to 6 months for those patients to then go through that continuum to make sure they're worked up and ready for the procedure. So that's a little bit where you see the delay. As far as on the front end, right, when you're doing direct-to-consumer, you have months and months of those patients that are part of the -- it's still part of the process.

然後，他們會多次與患者交談，幫助他們找到自己選擇的醫生。一旦他們這樣做了，我們就會看到這些轉診變成諮詢，因為我們知道他們什麼時候預約看醫生。預約看醫生後，這些患者需要花 4 到 6 個月的時間進行整個過程，以確保他們已經做好了接受手術的準備。所以您會看到一點延遲。就前端而言，當你直接面向消費者時，你會花數月的時間與這些患者打交道——這仍然是流程的一部分。

And so when we turned it down, you don't see an immediate impact of that because there's still patients within that process. And so as soon as we saw it start to dip down as those patients were out of the funnel, that's when we turned it back on. And as we said in the prepared remarks, that was in the middle of the third quarter is when we started reinvestment. And as we also said, in October, we already have seen a flow of those patients back in and already two consultations, and it will take some time before they go to a trial and into a per procedure.

因此，當我們拒絕時，你不會立即看到影響，因為過程中仍然有患者。因此，當我們看到當那些病人離開漏斗時水位開始下降時，我們就把它重新打開。正如我們在準備好的評論中所說的那樣，那是在第三季中期我們開始再投資的時候。正如我們所說的，在 10 月份，我們已經看到一群患者回來了，並且已經進行了兩次諮詢，他們還需要一段時間才能接受試驗和程序。

Okay, thanks a lot. Kevin, what gives you confidence that you haven't -- I mean, congratulations on the work you've made on rightsizing the P&L. But what gives you confidence that you haven't cut too far into muscle and that it's limited to the DTC area that perhaps you went a little too far?

好的，非常感謝。凱文，是什麼讓你有信心呢？ 我的意思是，恭喜你在調整損益表方面所做的工作。但是，什麼讓您有信心您沒有過度削減肌肉，並且這僅限於 DTC 區域，也許您削減得有點過了呢？

And then just one follow-up would just be any commentary that you can provide on kind of the 4Q as a jump-off point in for expenses? And anything we should be considering as we refine our '25 models based on where the consensus sits?

然後，還有一個後續問題，您能就第四季的費用起點提供什麼評論嗎？當我們根據共識改進我們的 25 模型時，我們應該考慮什麼？

Yeah. As Rob said, we've got about 90% of it right. What we missed was the DTC. The other areas, while it's never exciting or fun or even doesn't feel good as a human being to have to make readjustments and refocus teams and restructure like that. We do believe we were very thoughtful in how we went about that.

是的。正如 Rob 所說，我們已經完成了 90% 左右的工作。我們錯過了 DTC。而其他領域，從來都不是令人興奮或有趣的，甚至作為一個人，進行重新調整、重新集中團隊並進行重組感覺也不好。我們確實相信我們已經非常認真地考慮過如何解決這個問題。

and really focusing on those areas that will have a bigger impact on our revenue and profit over the next plan period of time versus maybe some of those expenditures that would be great. possible home run or a moonshot that could turn into something maybe 15, 20 years from now.

並真正關注那些在下一個計劃期間對我們的收入和利潤產生更大影響的領域，而不是一些可能很大的支出。有可能實現本壘打或登月計劃，也許 15 至 20 年後就會實現。

Obviously, we had to make the hard decisions to say, hey, let's focus on the ones that are more bird in the hand that are great projects that we should continue to fund. So we believe we did a good job on trying not to affect the top line. In fact, as Rod mentioned, we are investing into our sales channel now as we expand these territories. We have new products that are launching, and we're educating more physicians than we ever have on our courses. And so we still feel good about our commercial efforts as far as an investment perspective. as far as expenses as we head into 2025, I'll let Rod answer that.

顯然，我們必須做出艱難的決定，說：嘿，讓我們把重點放在那些更有利可圖、我們應該繼續資助的偉大項目上。因此，我們相信我們在不影響營業收入方面做得很好。事實上，正如羅德所提到的，我們在擴大這些地區的同時，也正在投資我們的銷售管道。我們有新產品上市，而且我們透過我們的課程培訓的醫生比以往都多。因此，從投資角度來看，我們仍然對我們的商業努力感到滿意。至於 2025 年的開支，我請羅德回答。

Yeah. We're not providing any '25 guidance at this point. What I'd say is similar to what we spoke about earlier in that we're going to continue to look at areas of the business where we can drive efficiencies, both internally and also as it relates to products, as Kevin mentioned, AdaptivAI helps drive a lot of efficiencies in our overall commercial model. So we've still got some work to do. We've got some areas that we're going after. We continue to leverage our Costa Rica investment, both from a manufacturing as well as kind of more of a back office perspective, and we'll continue to look at those as we go into 2025 and thereafter.

是的。目前我們還沒有提供任何‘25指導。我想說的與我們之前談論的類似，我們將繼續研究可以提高效率的業務領域，包括內部和與產品相關的領域，正如凱文所提到的，AdaptivAI 有助於提高我們整體商業模式的效率。所以我們還有一些工作要做。我們正在探索一些領域。我們將繼續利用我們在哥斯達黎加的投資，無論是從製造角度還是從後台角度，我們將在 2025 年及以後繼續關注這些投資。

Thank you, guys.

謝謝你們。

David Rescott, Baird.

大衛雷斯科特，貝爾德。

Great. Thanks for taking the questions. Two, on the AdaptivAI platform, and I'll ask them both upfront. The improvement on the reduction in patient visits and time that the patients are on the phone of the rep may be with the AdaptivAI program, I think sounds pretty promising. And so my first question is how replicable do you think this becomes as you roll this out to a broader number of patients that are out there when you compare that to those in the launch versus those when you have expanded to a higher number of reps or patients out there?

偉大的。感謝您回答這些問題。二、關於AdaptivAI平台，我會事先問他們兩個。使用 AdaptivAI 程序可能會減少患者的就診次數以及患者與銷售代表通話的時間，我認為這聽起來很有希望。因此，我的第一個問題是，當您將這項服務推廣到更廣泛的患者群體時，您認為這項服務的可複製性如何？

And then the second piece, it feels like one of the bigger kind of pain points, again, has been around the higher reprogramming rates versus what you see from other kind of stimulation technologies? So what I'm wondering more on the AdaptivAI platform side, is it this is the technology that maybe could level the playing field or not sort of level playing field, but I guess, just bring up your margins or bring up your, I guess, you have better margins, more rep time when you have this type of technology out in the field? Thank you.

然後第二部分，感覺像是最大的痛點之一是與其他刺激技術相比更高的重編程率？所以，我在 AdaptivAI 平台方面更想知道的是，這種技術是否可以創造公平的競爭環境，或者說，不是公平的競爭環境，但我想，只是提高你的利潤率，或者說，當你在現場擁有這種類型的技術時，你會有更好的利潤率、更多的銷售時間？謝謝。

Yeah. We believe it will, and we're seeing it in the early patients. And while we're not telling you how many patients we've implanted during the limited market release, it's plenty to in is very large, and so it gives us a high degree of confidence that it will have these impacts across a broader installed base, if you will.

是的。我們相信它會起作用，而且我們在早期患者身上也看到了這一點。雖然我們沒有告訴您在有限的市場發布期間我們植入了多少患者，但這個數字已經足夠大了，因此我們高度有信心它將對更廣泛的安裝基礎產生影響。

Also, don't forget, when we launched iQ, we talked about it being a platform technology that will allow us as the only company to be able to go backwards compatible for patients that would like to upgrade just the software portion of the device. And so a portion of those patients that have been on AdaptivAI that we've seen these stats are patients that had the first-generation 1.0. We've brought them back in and downloaded the new software for AdaptivAI on their older IPG, and we're seeing those benefits from where they were just a week before to where they are a week afterwards. And so it gives us a high degree of confidence that not only in de novo brand-new patients install with AdaptivAI, but those that we've also upgraded, we've seen those benefits.

另外，別忘了，當我們推出 iQ 時，我們談到它是一種平台技術，它將使我們成為唯一一家能夠為只想升級設備軟體部分的患者提供向後相容的公司。因此，我們看到這些統計數據顯示，使用 AdaptivAI 的部分患者是使用第一代 1.0 的患者。我們讓他們回來並在他們舊的 IPG 上下載了 AdaptivAI 的新軟體，我們看到了他們一周前和一周後的優勢。因此，我們高度相信，不僅新安裝 AdaptivAI 的患者，而且我們已經升級的患者也看到了這些好處。

And as far as reprogramming rates, yeah, those are some of the biggest cost burdens on us as an organization as well as physicians because it involves drive time, it involves trying to find a time on the physician's calendar, and you sort of have to meet three people all at once to be able to make that reprogramming happen, whereas now it's happening in the cloud behind the scenes.

至於重新編程率，是的，這些是我們作為一個組織以及醫生最大的成本負擔之一，因為它涉及駕駛時間，涉及嘗試在醫生的日曆上找出時間，並且您必須同時與三個人會面才能使重新編程發生，而現在它發生在幕後的雲端。

One of the other things that we were excited about that we saw is in our systems, we get alerted when patients aren't doing well. And so this is for the first time that we see proactive management what allows our people that are on a phone to reach out to those patients and be able to rectify anything that needs to be rectified without them calling into us or into their physician, and proactive taking care of patients is always more cost effective than waiting for something to happen, so we're excited about it.

令我們興奮的另一件事是，在我們的系統中，當患者狀況不佳時，我們會收到警報。因此，這是我們第一次看到主動管理，它使我們的工作人員能夠透過電話聯繫到那些患者，並能夠糾正任何需要糾正的問題，而無需他們打電話給我們或他們的醫生，而且主動照顧患者總是比等待事情發生更具成本效益，所以我們對此感到很興奮。

Thank you. And that does conclude the question-and-answer session. And with that, that does conclude today's conference call. Thank you for your participation, and you may now disconnect.

謝謝。問答環節到此結束。今天的電話會議到此結束。感謝您的參與，您現在可以斷開連接。