Nuvectra?

Nice to have an adult in the room...

 

Because you are being called into question people aren't adults?

 

I agree, proportion of share, etc remains to be seen. One thing I do know is Medtronic interstim, and DBS REPS are used to no competion and have treated customers like shit. Thal ol MdT cockiness will bite them in the ass the way it always has! They have forgotten how to sell and cant wait to see their ill ways bite them where it hurts most.

 

Lol, come on dude!

 

Who will compete against interstim first? Nuvectra or Axonics?

 

Good question! It's anyone's guess at this point in the game.

 

AXONICS is ahead of Nuvectra in terms of commercializing

 

According to what? Isn't Nuvectra going to pretty much use the Algovita system with a new lead? What's there to commercialize besides a lead? What kind of volumes is Axonics even doing to say whether they are even commercialized or not?

 

And what kind of volumes is Algovita doing to say whether it is even commercialized?

 

So I keep hearing Nuvectra has the smallest , most energy efficient battery requiring least charging. Also, most easy to maneuver leads with best patient experience (smoother more comfortable energy flow/ waveform) 12 channels vs 8 offering better coverage/ pain relief, most power sources and easiest guide wire to steer for Drs. and most discreet patient charger with best programming options. Sounds pretty darn good !!
Naysayers/?

 

Would love to see some substantiation for that. I haven't seen any data about whose battery charges the most efficiently or whose is most energy efficient or if there's a practical difference. I can tell you thought that patients get pissed when their charging paddles break. It is a good thing NVTR has deep discharge recovery. That is a nice and unfortunately necessary feature for devices that have to be recharged at least weekly. Bottom line is that the battery just needs to work and last a reasonable time.

• Batteries probably made by ITGR
  • NVRO requires the most charging (daily) but it is not the same class of device. NVRO is made somewhere in South America by ITGR, and they probably provide the batteries also. Might not though since ITGR bought that company that makes NVRO's stimulator rather than developing it themselves.
  • ITGR also probably makes NVTRs batteries since they manufacture the rest of the device.
• Companies that roll their own.
  • BSX batteries are made in Minnesota in the same manufacturing plant that makes their batteries for implantable pacemakers and defibrillators.
  • STJ makes batteries at their Liberty South Carolina plant but not sure if they make the SCS batteries there. Let's hope they don't come from the same place that made their pacemaker batteries that suffered from dendrite growth. Those came from an external company - probably ITGR.
  • MDT probably makes their own in Brooklyn Center, Minnesota.

Advantage: BSX and maybe STJ/MDT as they control their own destiny.

From my experience, this is not true. The stylet can get stuck before the electrode. This is annoying. The paddle lead has an articulating hinge. That does help for maneuverability if you are a surgeon that uses those. NVTR has stretchy leads. This has some benefits but their leads have other known issues.

• There was a manufacturing problem that caused the stylet to come out of end of the lead during surgery. You are actually supposed to try get the stylet to come out the end before you use it. Their CEO said this problem is solved.
• There are also reports of parts of the lead detaching from the device and getting stuck in the patient's body. The company has not said anything about this to my knowledge.
  • https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/detail.cfm?mdrfoi__id=6258606&pc=LGW
  • https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/detail.cfm?mdrfoi__id=6139651&pc=LGW
  • https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/detail.cfm?mdrfoi__id=5831495&pc=LGW

Their CEO does talk about the fidelity and cleanliness of their waveform. I have not seen a whitepaper or poster, much less a peer-reviewed publication supporting that that is true or that, if true, it actually contributes to meaningful patient experience. He is also found about talking about their 85% trial success rate. He is comparing that to the lower success rate he had while working at ANS. The wheel keeps turning, and the world has moved on. A 65% success rate is not the norm.

Nuvectra put together a quick comparison chart on their website in the investor relations section of their website. It is slide 10 of the March investor presentation. Very nice snapshot. Look it up.

• The number of channels ranges from 16 (MDT/STJ) to 32 (BSX). NVTR is in the middle with 24 (either 3 leads of 8 poles or 2 leads of 12 poles). BSX has 36 independent channels. NVTR has 24 independent channels. The others have fewer channels and they aren't independent. Keep in mind that all of the systems have a practical limit to the number of electrodes that can fire simultaneously because there's a limit to how much total amperage can be delivered at the same time. Advantage BSX.
• NVTR has the highest max amplitude at 30mA. MDT is worst at 10.5 mA. Advantage NVTR.
• MDT/STJ is constant voltage. BSX/NVTR are constant current. Constant current is better as tissue impedance changes over time. MDT's next gen will have the option of constant current or constant voltage. I have not tried NVRO. I do not know if it is constant voltage or current. Advantage BSX/NVTR.
• With high frequency you get paresthesia free which is preferable for most patients as they feel nothing as opposed to numb/tingling. MDT/BSX/STJ cap themselves at 1200 Hz. This is probably to avoid getting sued by NVRO who has a patent above 1200 Hz. NVTR has chosen to go up to 2000 MHz. If they were a significant threat, they would probably be sued. Advantage NVRO by a wide margin but again not the same type of device. Within the category, advantage NVTR.
• NVTR has the widest range of pulse width. 20-1500 microseconds. BSX/NVRO are 20-1000 micro seconds. Advantage NVTR.
• The 12 polar extended lead does let you stimulate three dermatomes with the same lead. That is nice. It especially helps my shittier colleagues that can't properly deliver their leads. Advantage NVTR.
• Stimulator volume is comparable except for NVRO. The others run between 18 cc (STJ) and 22 cc (BSX). NVRO is the only "loser" here, but it's not even really targeted at the same patient population. Otherwise it is a draw between all of the others.

Who is advancing clinical science and has the data to back up their device? MDT has the longest history but has regulatory problems that are distracting them. RestoreSensor? Yawn. For STJ, Sunburst was a disaster. NVRO is a different type of device. Some exciting things there but still a niche product. NVTR has little published clinical data. BSX just quietly chugs along. If you're looking to sell multiple therapy types to different types of physicians, NVTR is one of the few companies you could do that. NVTR is working on other indications. They have SCS and have submitted a system for sacral nerve stimulation. This is suppose come out later this year. They also are working on DBS but that is a partnership. According to their complaints in the MAUDE database, it looks like they might be working on occipital nerve stimulation quietly. Interesting that they would not have sanitized “ONS” out of the MAUDE report. They don't seem to have a clinical trial for it. Maybe it is just off label.

• https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/detail.cfm?mdrfoi__id=6156884&pc=LGW

 

You must have a lot of free time.

 

probably an "investor"

 

All STJ batteries in SCS devices come from external suppliers.

All STJ SCS devices are constant current.

 

Medtronic is a voltage system and it's 10.5v. 10.5v can deliver current based on the impedance of the circuit. With a circuit impedance of 250 ohms the device could deliver 42 mA at max voltage.

 

Fuzzy math at best you ask me

 

How is the math fuzzy? It's not ohms fuzzy
math suggestion, its ohms law. V=IR.

 

What's fuzzy math is the Q1 results

 

What Q1 results? Not released.

 

Ah, yes they were