Sentiment Analysis of the earnings transcript to help figure out if there are any bullish or bearish sentiments that could be gathered from it. We're doing ML and AI based analysis on the earnings call to get some more insights.
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| With that said, we've been very consistent in stating that we do believe this business today has sufficient cash on the balance sheet to reach profitability given the pace at which our revenue is growing and our plans to support the business, the operating expense increase, we are showing EBITDA improvement in 2024 |
| Given this positive momentum, we believe Aquablation therapy is laying the foundation to become the BPH surgical standard of care and PROCEPT is emerging as a leading global urology company |
| Third, and most importantly, the largest cost component of our disposable handpieces are fixed overhead expenses, which at forecasted production levels and spend in 2024 provide us with increased confidence that we will begin to more fully absorb these expenses, which we believe will allow us to show consistent gross margin expansion |
| We believe our strong balance sheet will provide the liquidity and capital resources needed to support and grow our current business |
| The significant increase in new accounts in conjunction with our ability to get these accounts of the utilization care faster, further amplifies my pride in our team's accomplishment throughout the year |
| Given the strong underlying demand for Aquablation therapy, we were able to deliver average utilization of approximately 6.6 handpieces per account per month in 2023 and a record 7.3 handpieces per account in our fiscal fourth quarter |
| Due to this rapid rate of adoption and support for Aquablation therapy, I am more confident than ever in our company's ability to become the standard of care for BPH patients |
| As we enter 2024, we believe there are several positive factors which will allow us to continue to execute against our long-term growth plan, while being disciplined in showing a path to profitability |
| We believe these underlying fundamentals like the technology that is laying the foundation to become the BPH surgical standard of care and a business that will be a leading urology franchise globally |
| So if you look at where consensus was, I mean, that was really set after Q3, right? And the reality is we did see outperformance in the fourth quarter primarily around utilization, and our guidance, as I said in my prepared remarks, is really informed by what we're seeing in the market |
| Given the shortcomings of current surgical alternatives, an aging population that continues to increase, and the millions of men who currently forego treatment, we believe underlying market growth will be attractive for many years to come |
| We also believe urology patient volumes at our accounts continue to grow nicely |
| Through these persistent headwinds, we were able to achieve our 2023 sales goals |
| Utilization outperformance in the fourth quarter was due to normal fourth quarter seasonal strength from elective procedure volumes, the direct reflection of strong commercial execution, and surgeons taking the next step to adopt Aquablation therapy as their treatment of choice for all resective procedures |
| In 2023, we revised OpEx guidance a few times throughout the year and our cadence and goal this year as a business is to not do that as we move throughout the year, which I also think will be a proof point for investors to show that we have a business with a high degree of recurring revenue, great operating expense leverage, and expanding gross margins that will demonstrate a pathway to profitability |
| I provide this context to demonstrate why 2024 will begin to show meaningful margin expansion |
| That will continue to improve as we get more systems installed and become more even greater than that with recurring revenue |
| And when we look at utilization, we had a fantastic fourth quarter |
| In fact, since we announced our prostate cancer initiative in September, we have received numerous inquiries from urologists all around the world, who are not only interested in BPH, but also very enthusiastic about the potential to treat prostate cancer |
| Given another strong quarter and positive momentum in the United Kingdom, we expect full year international revenue to be approximately $18 million, representing growth of approximately 60% |
| Overall, we feel very good about the underlying trends of our business and see strong momentum in our account |
| But again, we still feel very good about the leverage we're demonstrating in the business on OpEx and our guidance |
| Given our strong commercial momentum and expanding pipeline, 2023 was an investment year to meaningfully increase headcount and add capacity to support future growth |
| I mean, we're in an enviable position where we're in a market, where, as you pointed out, we agree with you, we think the market, given the 12 million men being actively managed for BPH and the lack of good surgical alternatives available today, we definitely think that market could grow |
| While the primary driver of procedure volume continues to be active surgeon growth, our ability to also sustain surgeon retention rates above 90% quarter-to-quarter demonstrates the clear patient and surgeon benefits of our technology, which ultimately leads to increased utilization |
| As a company, we benefit greatly from this high-level of surgeon retention as our commercial team can focus on adding new surgeons |
| Great to see the strong finish of the year |
| However, we believe patients actively researching Aquablation therapy and following through to see a surgeon is another positive indicator for our expanding product awareness and presence in the marketplace |
| Surgeon retention was very strong |
| However, I'm very happy to say in that environment we were able to deliver and exceed our guidance |
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| Gross margin for the fourth quarter of 2023 was 49%, which was negatively impacted by approximately $2.5 million of items primarily associated with the relocation of our corporate headquarters on September 2023 |
| Additionally, we moved into a new and larger facility and hired a significant number of commercial team members, which presented its own execution challenges that the team was able to successfully navigate |
| 2023 was a challenging year for most hospitals due to accelerating inflation pressure to lengthen the average recovery from the pandemic |
| 2023 was a fairly difficult environment |
| Adjusted EBITDA was a loss of $23.3 million compared to a loss of $21.7 million in the fourth quarter of 2022 |
| Second, the pace of hiring production personnel will slow in 2024 |
| Second, we produced fewer units than anticipated in the back half of 2023, thus increasing the average cost of inventory sold due to unabsorbed overhead expense |
| Regarding quarterly cadence, similar to 2023 seasonal trends, we expect first quarter 2024 utilization sequentially decline compared to the fourth quarter of 2023 |
| Regarding 2024 gross margins, we believe 2023 was a transition year with temporary headwinds associated with moving into a larger facility and investments to support future growth |
| Lastly, given our move to San Jose is complete, we expect 2024 CapEx spend to be more normalized at approximately $6 million to $8 million, down significantly from $25.2 million in 2023 |
| We expect a full year 2024 adjusted EBITDA loss to be approximately $73 million |
| Net loss was $27.5 million for the fourth quarter of 2023 compared to $28.2 million in the same period of prior year |
| And if you look historically, we've bounced around a bit quarter-to-quarter, been somewhat unpredictable, and that is just due to the rapid growth in the business coupled with our move |
| Quite frankly, it's difficult to predict with the IDNs |
| While these forward-looking statements are based on management's current expectations and beliefs, these statements are subject to several risks, uncertainties, assumptions, and other factors that could cause results to differ materially from the expectations expressed on this conference call |
| So as far as utilization, what we see is typical seasonality trends, trends that we see in other combat companies, Q4 generally is very strong, Q1 is the lowest |
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