NeuroPace, Inc. (NPCE) Earnings Call Transcript & Summary

Welcome. I'm Robbie Marcus, the med tech analyst at JPMorgan. Happy to introduce Mike Favet, our -- the CEO of NeuroPace, which is going to be our next presentation. Joining us later for Q&A is going to be Rebecca Kuhn and Irina Ridley. Rebecca is the CFO. Reminder, just feel free to send me any questions. I can ask them in the Q&A portion. Otherwise, Mike, I'm going to turn it over to you and join you in a few minutes.

Very good. Thank you, Robbie. Thanks for the opportunity to present today. I'm going to start off. I've got the disclaimer that I'm sure everybody has seen before, and then I'm jumping into an overview. The mission of NeuroPace is to transform lives of people living with drug-resistant epilepsy. We do that through a unique technology that has an implantable neurostimulation system that is actually able to monitor brain activity, respond in real time with custom therapy provided to the patient, and we collect information, diagnostic information that's provided to the physician to allow them to optimize therapy and manage their patients. And with that technology, we've been able to collect an extensive and growing set of clinical evidence that demonstrates the improved outcomes of patients over time, improvement both in terms of individual patients getting better over time, but also our ability as a company to learn from previous experience, harvesting that data that's collected by the device to have new patients be able to get better outcomes even faster than patients treated historically. We're using this technology to address a large market opportunity, a $26 billion market opportunity for our current indication in the United States. And we've been able to leverage that clinical data to establish reimbursement that's favorable and available widely. That covers both the implantation of the device as well as the programming and the review of the diagnostic data that's stored by the device. We're selling into to comprehensive epilepsy centers or CECs in the United States. That's a very concentrated customer group. It allows us to have a very efficient commercial model. And over time, have been able to grow the revenue of the business, up to over $45 million of revenue in 2021. We just announced that preliminary revenue numbers last night, representing a 10% growth over 2020, and importantly, a 20% increase in the initial implant revenue, which is the main driver of our business over time. We are, in addition to our current indication, actively pursuing indication expansions to move into other markets within epilepsy and planting the seeds for opportunities outside of epilepsy in the long run. The market that we're competing in today or addressing today is for treatment of epilepsy. There are over 3 million people in the United States living with epilepsy. It has a big impact. The disease has a big impact at the society level with the health care costs and the impact on individual patients, especially those that are not able to control their seizures with medication, impacting their mortality, quality of life and a number of other aspects for these patients, really creating a compelling need for solutions for these patients. When we talk about the size of the market opportunity, 1 in 3 of those 3 million or over 3 million patients that have epilepsy are not able to control their seizures with medication. That drug-resistant population, representing about 1.2 million people in the United States, is the area that we're focused on. Today, our indication covers about half of those patients. And for that group, we're looking to move our technology into more and more of these centers to be able to provide solutions for these patients. On an annual core market opportunity, about 50,000 of these drug-resistant epilepsy patients each year make their way to a comprehensive epilepsy center seeking advanced treatment. That 50,000 patients per year represents our annual core market opportunity, specifically for new patients being implanted in the United States. That 50,000 patients has the same breakdown, with about half of those patients meeting our current indication. The current indication is specifically for adults, aged 18 and above, but have a type of epilepsy that's called focal epilepsy. Focal epilepsy means that there are seizures that originate at a specific location or a location within the brain, different for every patient. And then from there, those abnormal events that start at that specific location can spread and create and result in clinical seizures. That group of patients, meaning our current indication, represents over a $1 billion annual market opportunity, specifically, again, in the United States and not including the replacement device revenue that is also part of our business that results after the neurostimulator battery expires and needs to be replaced with the new system. As a company, we're also actively pursuing indication expansions into other types of epilepsy. Specifically, we have an IDE study approved to move our indication down to the age of 12 for patients with focal epilepsy. We announced recently that we enrolled the first patient in our pivotal study at the end of last year, and we're also working to expand our indication into generalized epilepsy. Generalized epilepsy is the other major type of epilepsy. I mean, in this case, the seizures originated broadly across the brain all at once, not at a focal onset location. And that represents about 40%, so the patients with epilepsy. We announced last year that we received FDA breakthrough device designation for an indication expansion into generalized epilepsy. And we are -- we received at the end of the year last year IDE approval for our pivotal study for the generalized indication. We expect that we'll be enrolling our first patient in the generalized epilepsy study around the middle of this year as we're actively completing site selection, working through the IRB process and then contracting with the sites that will be participating in that trial. When we think about and describe the way that our technology works, we have a implantable neurostimulation system with electrodes that are positioned at the focal onset location where the seizures start. The device monitors brain activity constantly, looking for abnormal events. The device is programmed to recognize these patient-specific abnormal brain activity and respond in real time with low-energy neuromodulation therapy. The low-energy therapy is not perceived by the patient, low energy below the perceptive level. And in addition to providing that real-time responsive stimulation, we also record information about those detected events. That includes information about trending of when detected events are happening. It provides information on cycles and a variety of other important information, insights that were otherwise unavailable to the physicians that are managing these patients. The data component of our system is very, very important. It really is a very differentiated part of what we provide as a therapy. The physicians use this information for a variety of different reasons. Some of the examples are here listed on the screen. It helps the physicians identify triggers of seizures. It identifies trends that allow the physician to monitor their progress, so is the device improving or not making changes. And then they're able to adjust -- the physician is able to adjust the programming of the device based on the feedback provided by the system. Many of these patients have seizure cycles, where they're more likely to have abnormal events and seizures, either at particular times of day or over multi-day cycles. Those become apparent with the data provided by the NeuroPace system. It can help identify patients that are available and good candidates for other therapies as well such as surgical intervention. It can help optimize the drug therapy, helping physicians take patients off of some of the medications that are causing side effects. And we'll try new medications and very quickly get an idea of whether those medications are making a clinical difference for the patient or not. The clinical data that we've collected is very, very extensive. The blue bars, dark blue bars that are seen on the screen now represent the median seizure reduction from the patient cohort that was part of the original FDA trial and then followed over a long term, all the way out to 9 years of follow-up. You'll notice that the median seizure reduction continues to improve year-over-year, all the way through 9 years of follow-up, up to a 75% median seizure reduction at 9 years of follow-up. The reason for that improvement is a combination of the data collected by the device provided back to the physicians, that will allow them to optimize the programming of the device for an individual patient to improve their outcomes over time. There's also a well-understood neuromodulatory effect that happens over time. But as we're providing therapy, preventing abnormal events from happening, that results in more normal activity for patients over time. So that combination resulting in improved outcomes. What's even more exciting for us is that after FDA approval, we have collected data from a number of different studies to show that the outcomes are even better, faster. The reason for this is the application of all of that learning from the FDA trial into new patients, with better ways of programming the device to provide better outcomes. The light blue bars here represent the data from a post-approval study that was conducted after FDA approval as well as a real-world outcomes study, multicenter study collected and published just last summer. Those data show that we are up to an 82% median seizure reduction at 3 years of follow-up, which is better than what we saw all the way through 9 years of follow-up in the original FDA study; and in prospective data, a 67% median seizure reduction at 1 year. When we compare that to other neuromodulation therapies, this is a chart representing the prospective data collected from 1-year follow-ups. That 67% median seizure reduction, I mean, improvement over the 44% we saw in the original FDA trial, really demonstrates the value of that clinical data that's collected by the device, the information that's applied back to new patients as well as to help improve individual patients over time. When we think about alternative therapies for people with focal epilepsy, drug-resistant focal epilepsy, they fall into 2 categories. There is epilepsy surgery, just a historical treatment for patients with focal or drug-resistant epilepsy. This requires identification of where seizures are coming from. And in some of these patients, you're able to actually surgically remove that portion of the brain or use a laser ablation probe to burn and destroy the brain tissue in that particular area. As you can imagine, those therapies are irreversible. They have a risk that's associated with it. And in many cases, in 80% of the patients, they're not candidates for a receptive or an ablative surgery because the location where their seizures are coming from would cause too much damage by resecting or ablating in that area. The other category of therapies is neuromodulation therapy. NeuroPace fits within that category. There's 2 other technologies as well that are approved for drug-resistant epilepsy with neuromodulation treatment. Both of those other therapies use a fixed anatomical target not specific to an individual patient, and they're not responding to what's happening inside of the patient's brain. These devices use what's called the duty cycle stimulation, where there's stimulation on for 30 seconds to a minute, pause for 5 minutes. And that cycle of on-off, on-off goes on continuously through the day and night. Results of that is that there's hours of stimulation provided per day versus the NeuroPace system, which is only responding to abnormal events when they happen. We're typically providing about 3 minutes of stimulation per day. So again, only stimulating when and where abnormal events are detected. The results of that from NeuroPace is that we have no seizure related -- or no stimulation-related side effects as contrasted to the other neuromodulation technologies with hours of stimulation that do have stimulation-related side effects. And all of that important diagnostic information recorded by the device provided back to the physician to optimize therapy and optimize care, that's all unique to the NeuroPace device because we're the only device that's detecting those abnormal events and then only -- the only company able to record that information in a way to provide information to the physician. When we think about the market, even though there are alternative therapies for surgical intervention or neuromodulation, most of the opportunity and most of the growth of our business has come from treating patients who are otherwise being untreated. Of those patients coming through the comprehensive epilepsy centers every year, most of those patients are continuing to be in a cycle of trying a drug, trying another drug, trying another drug. The studies have shown, and evidence is well-established, that once a patient has tried and failed 2 or more anti-epileptic drugs, the probability of any subsequent drug providing seizure relief is very, very small. I mean, so with that, our message on the commercial side is getting this out to patients and to clinicians, to move more of those patients that have tried and failed drug therapy to move on to neuromodulation therapy, specifically the NeuroPace RNS device. From a commercial execution standpoint, there are several different avenues that we're pursuing and have had good success in each of these. The strategy starts with getting the neuromodulation -- NeuroPace neuromodulation therapy, RNS therapy into more and more of these comprehensive epilepsy centers. Ultimately, we expect all comprehensive epilepsy centers, there are over 200 of them in the United States, to be using NeuroPace as part of their therapy protocol. We were able to have initial implants, one -- at least one implant in 150 of those U.S. centers in 2021. And we've also been increasing the number of prescribers. These centers are large institutions, typically. They have multiple epileptologists or epilepsy specialists that are practicing. And we're expanding within those centers to have more and more of the physicians within the center using the NeuroPace device for their patients. As we expand into more and more centers and more and more physicians using the product, then it's about getting more of the patients being treated by those physicians to be using NeuroPace or providing NeuroPace therapy for those patients. And we've been also able to expand utilization from 2020 to 2021. And that's been an important part of our growth strategy, and it continues to be as we move forward. And then a new opportunity for us is expanding into referring physicians that are outside of the comprehensive epilepsy centers. And I'll talk a little bit more about some things that we're doing there here in a couple of slides. Talking about execution and accomplishments over the last year, as with every company in the med tech space, we've had COVID headwinds that we've needed to contend with. That is including, for us, a combination of short-term effects, which is delays or postponements on procedure based on limitations put in place by various different hospitals because of caseloads and capacity within the institution. And we also have had impact because of a reduced number of patients coming through the diagnostic process at these centers. The patients coming through the epilepsy monitoring units, which is a diagnostic process required prior to implantation of the NeuroPace device, has been limited because of a combination of staffing challenges, elective procedure limitations and a number of other COVID-related factors. In spite of those headwinds, we've been able to make significant progress and had significant accomplishments in the last year and continue to expect that going forward. I mentioned some of the accomplishments on the clinical side with the first patient enrolled in the adolescent study for focal epilepsy and the IDE study approved for primary generalized epilepsy. We introduced last year an nSight Platform, which is an information system that's available to take the most relevant information stored by the device, presenting it to the physicians in a way that make the insights actionable for the physician. And we also announced in our Q3 earnings that we have submitted to the FDA for a labeling change that would increase the longevity, the claim longevity of our neurostimulation system up to almost 11 years. That's a longevity that's equivalent to a chargeable or rechargeable battery without the need to recharge. And so looking forward to getting approval from FDA for that claim expansion. On the commercial side, we've been able to have significant success. I've mentioned earlier that we grew the income or grew our revenue from initial system implants, new patients being treated for the first time, by 20% over 2020. And we did that through a combination of more centers implanting, 150 centers implanting, which is an increase of 14% over 2020. We've also been able to expand the number of physicians programming and prescribing the device. And we've also increased utilization within these centers. So more patients being treated per center over time. The forward-looking aspects of things that are changing within the business. There's a couple of areas that I wanted to highlight for this presentation. One is efforts that we are undertaking to increase awareness and demand generation. So this is really taking control of what we can control in an environment that has been impacted by COVID. That includes marketing programs that are going out to the referring physicians. I mentioned expansion and so important trends, changes that have happened within management of epilepsy. Really, just in the last few years, there's been a significant increase in the number of epilepsy specialists. It's a very growing field, more and more people coming through training, physicians coming through training. And as those physicians are coming through training and going into practice, more and more of them are setting up practice outside of the Level 4 centers. It's our understanding that there are now more epileptologists practicing outside of a Level 4 comprehensive epilepsy center than within comprehensive epilepsy center. Again, a very recent change. As an organization, we're going to be targeting those epilepsy specialists wherever they are practicing and establishing referral relationships for those epilepsy specialists to be able to get the device implanted, and then go back to the epilepsy specialists for ongoing programming and care of that patient. We're also doing activities and expanding activities to create more awareness at the patient level, being more involved with patients earlier in their diagnostic journey. That includes digital marketing efforts that we piloted in 2021. We'll be expanding those pilots as we move into 2022. And then as we identify those patients earlier in their diagnostic journey, working with them to provide information about the NeuroPace system and help them move through the process, ultimately to getting a NeuroPace device implanted. On the commercial side, there's a number of expansion and things that we're doing as we move forward to move more of those patients and accelerate the growth of the business. That includes expanding the commercial organization. We've been growing the commercial team, but we're going to do an accelerated push towards expanding commercial organization as we support more centers that are implanting the device and as we support those referring epileptologists within the community, putting the people in the organization to be able to support that commercial channel, developing those referral pathways, as I mentioned. And they're really taking more of an active role with patients that are going through that diagnostic process to be able to move them ultimately to an implantation of a NeuroPace device. Wanted to also highlight, over the longer term, some of the things that are specifically interested about the indication of generalized epilepsy, moving into that new indication. For our current indication of focal epilepsy, there is a specific pathway that patients need to go through to be diagnosed and identified as a NeuroPace candidate. That includes a visit to the hospital and in-hospital stay to have their seizures identified and localized. For 70% of our patients, they need to come back for a second stay in the hospital, about 1 week each for those stays where they have temporary brain electrodes implanted to further localize and identify specifically where seizures are coming from. Because of that diagnostic process, on average, it takes about 6 months from an initial epilepsy monitoring unit at Michigan until the implantation of the NeuroPace device. As we move into generalized epilepsy, in addition to generalized epilepsy representing 40% of patients with medically refractory epilepsy, there's a number of other aspects that are also very exciting about this opportunity. So one is that there are no other surgical alternatives. A resective procedure or an ablative procedure is not possible for generalized epilepsy because there's no specific location to be able to resect or ablate. We are using our same technology, the NeuroPace device that's approved today, for treatment of generalized epilepsy by targeting a network location within the brain, still applying responsive neurostimulation, still providing all of that valuable information, diagnostic information back to the clinician by using a network simulation approach to achieve those outcomes. We're able to have a -- what we believe will be a faster process to identify and move patients on to therapy because the diagnostic process required to identify a candidate is shorter. They don't need to come in for those extensive EMU visits. In many cases, these patients can be identified by routine outpatient EEG monitoring. I mean it does not require the implantation of these temporary electrodes and the additional stay in the hospital prior to identification. So with that process, again, we expect that it will be a faster diagnostic process to be able to move patients on to a NeuroPace device. So as we complete that study and ultimately get that indication, very excited about what that means for the application of our technology as we move forward. In addition to those expansions within epilepsy, I also wanted to highlight that we have, over time, an opportunity to expand internationally. And there's some very early stage but exciting evidence coming out about application of our NeuroPace device, responsive neurostimulation, in other conditions outside of epilepsy. There was a publication in Nature in Q4 that outlined the results of a first patient treated with the NeuroPace device with treatment-resistant depression, with very compelling outcomes for that patient. That's part of an ongoing early-stage feasibility study being conducted at UCSF. We also have patients that have been implanted using the neuro -- with the NeuroPace device for loss of control eating, for PTSD, and an opportunity for us to expand into these other indications as we show and demonstrate differentiated outcomes to be able to pursue those, to expand even beyond the treatment of epilepsy. Well, from a results standpoint, I mentioned that we preannounced yesterday a preliminary revenue of $45.2 million for the year. That represents a 10% increase. Importantly, that is driven by an increase in the number of new patients being treated. The dark blue portion here, now moving up to $33.7 million of revenue from new patients being treated with the NeuroPace device. That represents a 20% increase in that portion of our revenue. And now the new patient implants, representing about 75% of the revenue for the business, we expect that percentage to grow as we're going through a transition from a prior version of the device that had a shorter battery life to a newer version of the device that has a longer battery life. So more and more focused on growing the number of new patients being treated. In 2020, we had a result of 73.6% gross margin and continue to expect that gross margin to be solid in the mid-70s percent and growing over time as the volume of our product increases. And so with that, I'll wrap up this portion of the presentation. Just reminding that we have a unique technology, compelling set of clinical evidence, large market, established reimbursement, results that are generated from that technology being applied to more and more patients and more and more centers, and work that we're doing actively to pursue indication expansion within epilepsy and laying the foundation for expansion into other indications over time. So with that, I'll have Robbie to come back in, and we'll do some Q&A. Thanks, Robbie.

Great. Thanks, Mike. So let's start with fourth quarter as it's very topical here. So maybe you can walk us through what drove the better-than-expected results versus the sell side? What kind of trends you're seeing through the quarter in terms of new implants, also replacement implants? And then we'll talk about your exit trends afterwards.

The growth of the business in Q4 really came from a combination of the more centers implanting the device and higher utilization. It's really the trend that we've seen throughout 2021 and what we expect to be the trend continuing as we move into 2022 and beyond. As you would expect, we did have impact on the business because of COVID, Delta at the beginning of the quarter, Omicron at the end of the quarter. But in spite of that, we were able to continue to have increase in the number of patients, new patients being treated with the NeuroPace system. We also had patients that had replacement devices. Robbie, as we've talked about before, we know that that's a decreasing trend here over the next few years until we hit the replacement cycle of the new longer-lasting device. But that came in a little bit ahead of where we expected as well, driven primarily by timing. So devices being replaced a little bit earlier than we had projected, that they would be from those older systems.

Got it. Okay. So let's focus on towards the end of the quarter and, I guess, the implication is for how we think about next year. And you, on the third quarter call, gave us some early thoughts in the low to mid-20% growth on implants for 2022. So now that we're a little further, Delta has -- seems to have gone. Omicron is here. Any updated thoughts that you want to share on how we think about first quarter, given Omicron, and just your low to mid-20% growth in implants for next year?

We haven't provided specific guidance around Q1 as we think about the impacts of Omicron. I will comment that we did start seeing the impact of Omicron at the tail end of Q4. That impact has expanded as we moved into Q1. There's just a lot of uncertainty all of us have around how long the effect is going to last, how big the effect is going to be, how long the effect is going to last. So not commenting specifically on what that means for Q1. The directional guidance that we provided about a longer-term growth of low to mid-20s percent for the initial system implants, that's still consistent, understanding that when we communicated that, that there would be periods of time where the business is more impacted or less impacted, depending on what's happening in a particular time with COVID. But as we think about that over the longer run, no changes to the way that we've been thinking about that from the Q3 earnings.

And then, Mike, there's a delicate balance here between the attractiveness and the innovation of the NeuroPace system, offset by just the complexities of COVID. So maybe -- you touched on this about the 6 months from start to finish, but maybe walk through some of the more identifiable impacts and why getting these -- the testing and the implants are so complicated by COVID in this environment?

Yes, I have mentioned there's 2, I'll say, categories of impact that we have for our business. One is a shorter-term impact, which is scheduling of the implantation of the device. And so that has been impacted because of limitations on elective procedures that have happened at various different institutions over the last couple of years. Your question, I think, is more specifically about the impact that COVID has had on the pipeline of patients that are coming through. And I have mentioned in my comments that patients that get the NeuroPace device come into comprehensive epilepsy centers. They go through the epilepsy monitoring unit. For all of those patients, it means that there's approximately a one week in-hospital stay, where they're admitted. Patients are admitted and they're monitored to identify do they have epilepsy, do they have focal epilepsy and, where possible, identifying where seizures are coming from, which is required before they could get the implantation of our device. For 70% of our patients, they come back into the hospital a second time for another approximately one week stay, where they have had temporary electrodes implanted into the brain, and then they're monitoring those patients for a week in the hospital with those temporary electrodes. As you can imagine, the elective procedure limitations that have happened over the last couple of years have impacted those patients coming into the epilepsy monitoring unit. Those are considered to be elective procedures, unfortunately, for most of these institutions. And there's also been patient reluctance, in some cases, to come in where they know they're going to be spending a week in the hospital with the things that are going on; limitations on visitors, which impacts people that may want to come in or the timing of when patients may want to come in. And then more recently, we've been seeing staffing limitation. So that has been a issue, just kind of general staffing over the last couple of years, but more recently, with Omicron, compounded by the effects of hospital staff that's in quarantine are not able to come into the hospital on a baseline that was understaffed to begin with. And so a result of that is, the last couple of years, the number of patients in the epilepsy monitoring units have been less than 2019 pre-pandemic levels. And that's coming off of a history where the number of patients coming through epilepsy monitoring units has been increasing. So historically, we've been seeing more and more patients coming through epilepsy monitoring units. The last couple of years, that's been decreased. We've been able to, as a business, grow our business in spite of that. That's through more centers implanting, higher conversion rate of those patients. We expect to be able to continue to do that. And at some point, we know that the epilepsy monitoring unit visits will get back to 2019 levels and grow from there, providing additional catalysts for us to grow over the long term. But in the medium term, where those epilepsy monitoring unit reductions -- numbers of patients have been reduced, continuing to execute on the commercial strategy the way we have been to generate the growth that we've been driving.

Great. So Mike, you're starting the IDE trial for generalized epilepsy. Maybe walk people through how this is different than focalized, why you're optimistic your product should be able to treat generalized as well? And how that effects, potentially simplifies, the patient experience from start to finish.

Yes. We're very excited about the potential for our technology to expand into generalized epilepsy. Commenting again about the technology itself, we're using the same device that we're -- that's indicated today and approved today for treating focal epilepsy. So there's no device development that's required. It's really about studying this new patient set. We're applying our technology in a slightly different way in that for generalized epilepsy, we've identified a network location within the brain that we believe is the right location to sense the activity, detect abnormal events and provide stimulation. Prior to getting the indication -- prior to getting the IDE approved, the pivotal study IDE approved, we were able to provide information to the FDA that showed that we can detect signals within this network location. Those signals are smaller amplitude signals, but our device is capable of sensing those small amplitude signals and applying the response of neurostimulation. And we believe that, that approach that we've taken with focal epilepsy will be expandable into the patients with generalized epilepsy. I mean, with that opening up a new opportunity in terms of more patients that will be indicated, but also, as I mentioned, a group of patients that requires a -- that doesn't require as an extensive diagnostic process. I talked extensively about COVID impact, the EMU visits and the multiple weeks in the hospital. That diagnostic pathway for generalized epilepsy is a much simpler pathway. And so excited about not just the larger group of patients, but also a patient group that we think can be treated more quickly.

And, Mike, you recently got the label updated to move the battery life, I believe, from 8 to 11 years, how important is this in driving patient adoption? I'm just trying to think, is this a brain surgery? Every 11 years seem terrible, whether it's 8 or 11 years. So is this an incremental? Or is this more of a medium to major type of incremental change?

Let me start off by clarifying. We actually have not received that indication yet. We submitted to the FDA for that indication in Q4, but we have not yet received that. So we're looking forward to that so we can be able to talk to our customers and to prospective patients about that. We believe it's important. So as you mentioned, especially as we move into younger and younger patients being treated with the NeuroPace device. On average, the patients in our clinical study were in their 30s. And as we move into indication expansion down into adolescent patients, this is a condition that you have for life. And so if you're a 30-year-old person, you get a NeuroPace device that's implanted. You know, for the remainder of your life, there's going to be replacement surgeries that are happening over time. So with that, the movement from the prior generation device with the shorter battery life to the new device now with expanding indication all the -- what we anticipate to be expanded indication up to an 11-year battery life on average. That's important for an important consideration. Many other companies have been trying to implement rechargeable technologies that allow that kind of battery life, but that requires patients to interact by every day or week, charging up their device, we're able to get that same kind of benefit for the patients without the patients needing to interact to charge the device. So we think it's important.

Okay. Maybe one last question, Rebecca, I'll bring you into the conversation here. You had a successful IPO last year. How should we think about your cash burn and your cash position today? And will that bring you to breakeven?

So at the end of the third quarter, we had $123 million in the bank. We have a strong balance sheet, and we believe we have the capital we need to run our business for the next couple of years. We will be making additional investments in the business in 2022 as we implement all of the programs that Mike discussed in his presentation, including expanding our field team and implementing new marketing programs. But let me just conclude or summarize by saying that we believe we have the capital we need to run our business for the next couple of years.

Okay. Great. Well, unfortunately, we're out of time here. Thank you for a great session and wish you and everybody else a great rest of your day.

Great. Thanks, Robbie.

Thanks, Robbie.