Nevro Nonsense:A Failed One-Trick Pony At 15X Sales, Reeking of Study Fraud, Kickbacks, and Explant Crisis

[drusso]

Can anyone confirm this?

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[pmrmd]

I heard this about Nevro. An investigator said executives and corporate reps were there for patient followups and the answers and data were skewed favorably. Nevro results are terrible IMO.

 

[lobelsteve]

Hit piece. The author is a noted short sale activist. Written to drop stock to sell off.
dropped to 155, back over 170. Meh.
Not my experience at all.

 

[deleted472101]

The paper is long (200 some odd pages) and harsh for the company.

 

[Agast]

I’d be curious to know how many explants were people who had axial back pain.

 

[drusso]

I heard this about Nevro. An investigator said executives and corporate reps were there for patient followups and the answers and data were skewed favorably. Nevro results are terrible IMO.

Can you elaborate?

 

[callmeanesthesia]

I’ve seen plenty of good results. Certainly no worse than other stim companies. This sounds like a deliberate attempt to tank the stock just long enough to profit off the movement. Sounds like it worked too.

 

[epidural man]

The explant story is old news...and fake I think.

 

[paindoctor2014]

A lot of patients have been explanted in my area. Know that’s anecdotal but the main neurosurgeon putting them in has gone away from them based on results and put another system in.

 

[lobelsteve]

A lot of patients have been explanted in my area. Know that’s anecdotal but the main neurosurgeon putting them in has gone away from them based on results and put another system in.

PM his name and I can tell you who pays him off the most...

 

[Espn123]

This certainly was an act to bring down the stock, but a lot of truth in there too

 

[fathead88]

My understanding is the explant rate for nevro was the same as other rechargeable systems (all of which are higher than primary cell?)

Therapy‐Related Explants After Spinal Cord Stimulation: Results of an International Retrospective Chart Review Study - PMC

Clinical trials of spinal cord stimulation (SCS) have largely focused on conversion from trial to permanent SCS and the first years after implant. This study evaluates the association of type of SCS and patient characteristics with longer‐term ...

www.ncbi.nlm.nih.gov

 

[Orin]

My understanding is the explant rate for nevro was the same as other rechargeable systems (all of which are higher than primary cell?)

Therapy‐Related Explants After Spinal Cord Stimulation: Results of an International Retrospective Chart Review Study - PMC

Clinical trials of spinal cord stimulation (SCS) have largely focused on conversion from trial to permanent SCS and the first years after implant. This study evaluates the association of type of SCS and patient characteristics with longer‐term ...

www.ncbi.nlm.nih.gov

That's a weird study.

Being female is a risk factor for explantation, but doing it off label for peripheral neuropathy was protective.

 

[PainandGain]

I consider myself a cautious and ethical implanter. I know how well this therapy works in the right patients and if patients are on the fence after a trial I will advise against or trial another system. I can honestly say 80% of my explants are Nevro. I loved them when they came out. But I kept seeing patients with good trials do poorly with implants and ask for explant. Clearly more often than other systems I use.

 

[Agast]

I have explanted mostly Nevro as well, but to be honest they had pretty messed up spines and many of them thought the stimulator was making them worse and wanted it out. It became a scapegoat for their pains. Now minus stimulator one of them told me she wished she had kept it, the others are just as poorly off. Neuromodulation isn’t magic. I would have been more concerned if they were straightforward postlaminectomy pain. Those are still doing well.

 

[painfree23]

Went to Nevro talk once and the speaker said he’s never explanted a Nevro in 5 years. Later learned he’s a stakeholder in the company

 

[BobBarker]

I read it. I think the part about the speakers bureau was overkill. I don’t think Nevro abuses this more than anyone else. Pain doctors make a lot of money so it costs a lot of money to hire one to promote your company.

 

[Crybaby]

I see a fair amount of patients who have had or want an explant and patients who do no use their stimulator from all companies. I think overly hyped trial success, poor patient selection, and lead migration take the cake in terms of explant reasons, rather than just Nevro.

I have had a string of unsuccessful Nevro trials however, so maybe I should drink this Koolaide.......

 

[paindoctor2014]

I think patient selection and setting expectations is the biggest issue with any of the technologies.

If the patient complains of 9 different pain sources a stimulator will not help them, period.

 

[callmeanesthesia]

I think patient selection and setting expectations is the biggest issue with any of the technologies.

If the patient complains of 9 different pain sources a stimulator will not help them, period.

Exactly this. I think Nevro’s claim of success with axial back pain more than any inherent problem with the technology. People raced to add it to their algorithm for mechanical back pain, where it doesn’t belong.

 

[sloh]

I think patient selection and setting expectations is the biggest issue with any of the technologies.

If the patient complains of 9 different pain sources a stimulator will not help them, period.

Haha and the large majority of patients who get these stimulators have “pain all over.”

 

[lobelsteve]

Haha and the large majority of patients who get these stimulators have “pain all over.”

Vast majority in your nursing home?

 

[sloh]

Vast majority in your nursing home?

I certainly hope not. It's the last thing these patients need.

 

[epidural man]

This Twitter account was created December 2020. That is a little fishy.

 

[epidural man]

Okay so even though this was written horribly, I mean just atrocious - I wonder if it has some good points.
Even if the technology is okay - isn’t it way over valued? Can current sales justify a market cap of 6 billion?

I might buy a put or two on this.

 

[BobBarker]

It is way overvalued but the vast majority of stocks are. Apple has double in value and revenue is flat over the last two years.

 

[drusso]

I see a fair amount of patients who have had or want an explant and patients who do no use their stimulator from all companies. I think overly hyped trial success, poor patient selection, and lead migration take the cake in terms of explant reasons, rather than just Nevro.

I have had a string of unsuccessful Nevro trials however, so maybe I should drink this Koolaide.......

 

[Crybaby]

View attachment 327841

Just did a really brief search on SCS explantation rate in general and came up short. Anyone have a ballpark figure for explant rates? Not just Nevro?

 

[lobelsteve]

Just did a really brief search on SCS explantation rate in general and came up short. Anyone have a ballpark figure for explant rates? Not just Nevro?

Informal study:
Explants: BS>SJ>MDT>Nevro>interstim>bone stim. I think it is based on how well the sales team works the local docs as well as how aggressive local docs are at implanting failed trials.

 

[BobBarker]

@lobelsteve you explanted some paddles?

 

[lobelsteve]

One was a failure to implant, canal too narrow, one explanted with Ortho Spine. Last one is an S8. I just yanked it out.
I used to go to OR with my patients for fusions and SCS by surgeons. Was educational.

 

[BobBarker]

Why did you take out the Intellis?

 

[lobelsteve]

Needed it for my collection. Like 90%, rep talked them into it despite poor trial.

 

[BobBarker]

I’m going to start yanking out the Interstims, too. I remember you gave me advice on that several years ago but didn’t realize you had pulled out so many.

 

[lobelsteve]

Gentle traction. Tines on the wires holding them in. But they pull out and don’t break easily.

 

[Green Grass]

Just did a really brief search on SCS explantation rate in general and came up short. Anyone have a ballpark figure for explant rates? Not just Nevro?

Anywhere from 6-25% depending on the study and time period reviewed.

Two solid publications on the topic:

Treatment-Limiting Complications of Percutaneous Spinal Cord Stimulator Implants: A Review of Eight Years of Experience From an Academic Center Database - PubMed

SCS is an effective treatment for chronic noncancer pain. It is a minimally invasive procedure, safe, and with good long-term outcomes. However, the surgical revision and explant rates are relatively high. As the use of SCS continues to grow, research into the causes of and risk factors for...

pubmed.ncbi.nlm.nih.gov

Therapy-Related Explants After Spinal Cord Stimulation: Results of an International Retrospective Chart Review Study - PubMed

This international, real-world study found higher explant rates for conventional rechargeable and high-frequency SCS than nonrechargeable systems. The increased rate for conventional rechargeable stimulation persisted after covariate adjustment.

pubmed.ncbi.nlm.nih.gov