Investing in Sleep Apnea Companies

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In this episode of Industry Focus: Wildcard, join Motley Fool contributor Brian Feroldi and host Emily Flippen as they talk about three companies trying to treat sleep apnea: ResMed (NYSE:RMD), Inspire Medical (NYSE:INSP), and Vivos Therapeutics (NASDAQ:VVOS).

To catch full episodes of all The Motley Fool’s free podcasts, check out our podcast center. To get started investing, check out our quick-start guide to investing in stocks. A full transcript follows the video.

This video was recorded on March 24, 2021.

Emily Flippen: Welcome to Industry Focus. Today is Wednesday, March 24th, and I am your host, Emily Flippen. Today, I’m joined by Fool.com’s so salty superstar sultan of sub-standard snoring securities, Brian Feroldi, in case you couldn’t infer that from the wonderful title [laughs]. We’re going to be talking about three businesses that are tackling this problem. They’re in a really interesting and exciting industry. That is sleep apnea. Brian, Mr. Sultan himself, thank you for joining.

Brian Feroldi: I’m happy to turn Wildcard Wednesday back into Healthcare Wednesday, Emily.

Flippen: I really think we should be trying to make a more conservative effort to cover healthcare companies. Although, I will admit you brought this idea to me, which of course I greatly appreciate because it’s not an industry that I know super well and it can be challenging, I think, to jump into the healthcare space because it does feel like it has a higher hurdle for understanding. A, I really appreciate the knowledge that you are going to be bringing today with these companies and this industry. But B, man, did it stir up some emotion in me, and I’m going to do my best to not let my personal feelings about the sleep apnea industry start to make their way into the podcast. If I do, maybe I will bring them at the end of the show. Prudent listeners can just skip over that section if they so desire. But it was really fun and interesting to try to learn about this industry over the past week or so. A, thank you so much and B, let’s jump into it.

Feroldi: Yeah. When we talk about medical device companies and healthcare companies, sometimes we’re talking about really small diseases that only affect a very small subset of the population. Every now and then we talk about something that’s extremely popular and extremely prevalent. When it comes to obstructive sleep apnea, this is an incredibly common medical diagnosis as we’re getting into. I would wager a bet that pretty much everybody listening to this has sleep apnea or knows somebody with sleep apnea.

Flippen: Yeah. It’s actually really interesting. When we started to prep for this show, you said, “I will take care of the companies because obviously those are the businesses that you know so well.” If you could just do some research about sleep apnea. When I was pulling in this research, the variation in the numbers of expected cases was so wide. We have it on the low end from the World Health Organization, who I believe back in 2007, estimated that there are around 100 million people in the world who suffered from obstructive sleep apnea, that’s OSA. But even they acknowledged, “Hey, this is probably a flawed analysis,” because the issue is so under-diagnosed and under-researched. More of the recent research, probably more viable research, but also more biased research, comes from the companies that we’re going to talk about today. The businesses that are trying to treat sleep apnea, and they’ve put a lot of money into research to treat sleep apnea and the estimates now were closer to, say, one billion cases worldwide of obstructive sleep apnea, around half of which the estimate are mild disease to severe cases that would need some form of treatment. It’s a widely, I guess, increasingly known issue.

Feroldi: Yes. It’s incredibly common and to your point, it’s hard to put an exact number on this. One of the big reasons why is that sleep apnea is very, very under-diagnosed. I’ve seen estimates that say as many as 80% of people that actually have sleep apnea in some form, it could be extremely mild, it could be severe, are not yet diagnosed and that’s because you don’t know if you have it. If you were sleeping through with the disease, when the disease is most prevalent, it’s really hard to tell. There was a telltale sign that people know if somebody in their house has sleep apnea or may be at risk for it and that is snoring. One of the things that sleep apnea is, is the upper airway is malformed or there is some part of the airway that gets blocked overnight, and that causes the person to stop breathing anywhere from a second to as much as 30 seconds. If you’re not breathing, you’re not getting oxygen and that just can’t be good for you over time. There’s a lot of side effects or symptoms of sleep apnea. There’s some obvious ones like snoring. As we said, you wake up, you don’t feel fully refreshed. You have a lack of energy. Maybe you have an increased risk of getting a headache or having depression. But longer-term, there are some actually huge co-morbidities to having sleep apnea. People with sleep apnea are 2X the risk of having a stroke, 2X the risk of having a cardiac disease. If you have sleep apnea, you really want to get diagnosed and you want to get treated.

Flippen: It’s interesting because if you go back, say back to that 2007 research from the World Health Organization, a lot of the aspects that doctors and providers were looking for in determining sleep apnea, was the effects that it was having on people after they woke up. One of the biggest telltale signs was actually people getting in car accidents because they were so tired. Increasingly, I think, providers are becoming aware of how to address these issues earlier on when the person is experiencing them as they sleep. Again, to your point, things like headaches, snoring, just a general lack of energy. But the big thing is, as you mentioned, since the disease is the tightening, the restriction of the airways, it’s gasping. People whose blood oxygen is actually decreasing to a dangerous level during the night because they’re not able to get enough oxygen to their body. I’m a little skeptical when we talk about the comorbidities because one of the biggest risk factors for determining sleep apnea is actually obesity and aging. Both of those things are both associated with some of the comorbidities that you mentioned that go alongside sleep apnea. But I think if there’s one thing that everybody can acknowledge is we’re an increasingly aging population and we’re an increasingly unhealthy population. I don’t think there’s a good argument to say that sleep apnea is going away anytime soon.

Feroldi: How about this alone? If you have sleep apnea, you’re probably likely to be a snorer. If you’re a snorer, your partner is probably not very happy with you. So that alone is a reason to get diagnosed and treated. [laughs]

Flippen: No doubt about that. But I’m going to put out some data about how it is in the U.S. before we move on to our first and largest company that’s looking to treat sleep apnea. If you just look in the U.S. alone over the last year, the direct and indirect costs of sleep apnea in the U.S. were around $150 billion. It’s a pretty substantial industry that’s getting an increasing amount of attention and the businesses we’re going to talk about today are pretty small in comparison to what you would consider the market opportunities, especially when you consider that that’s just looking at the United States and this is a worldwide issue.

Feroldi: Yeah. I think that that number is enormous. That’s mostly due to indirect costs, meaning that to a loss of productivity and that kind of thing. But yes, treating sleep apnea is a big business. This is a multi-billion dollar global industry. There are numerous treatments for it. We’re going to get into three companies that provide them. I think just on the basis of, one, the industry is huge and two, it’s going to become more and more common to diagnose sleep apnea overtime, this is an industry that investors should take a look at.

Flippen: With that being said, what’s the first company that you think investors should be aware of when looking at sleep apnea? I think most people listening right now are probably familiar with it.

Feroldi: Yeah. This company is called ResMed. The ticker symbol there is R-M-D. This is the biggest of the three and we’re going based on risk levels. This is the lowest risk of the three. ResMed is the pioneer of the gold standard for obstructive sleep apnea treatment. It’s called continuous positive airway pressure or CPAP devices. These are devices that are put next to the patient while they sleep. They have a tube and a mask that goes on with them. The patient wears the masks all night long and the device constantly pumps a stream of high pressure air into the throat. That high pressure air keeps the person’s throat and airway open all night long. So that way, they get the oxygen they need and it prevents the muscles inside from relaxing. Now, ResMed has been a phenomenally, phenomenally successful company over the years. It has grown like clockwork and it has provided investors with gigantic returns since it came public in the mid ’90s. One of the reasons why is that this business is a razor and blade business. They sell you the CPAP pumps themselves. That’s a durable good that can last for a couple of years. But the company also makes money off of the supplies and those would be like tubes, the masks, accessories that go along with them. So that when combined with a growing area, the revenue for the company, which is software that is used to both diagnose sleep apnea as well as connect patients and providers with data, ResMed has been a really fantastic business.

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Flippen: So ubiquitous that when you reached out to me about wanting to cover sleep apnea, I wasn’t aware that there was a treatment for sleep apnea that wasn’t a CPAP machine. That’s what a coronary, I think, ResMed has had on the sleep apnea market. It’s the immediate go-to solution for anybody who is experiencing the symptoms of sleep apnea. I think that that has definitely showed up in its results. What’s worth mentioning is, at the start of the podcast, we said it was a $150 billion a year industry just in the United States. ResMed is less than a $30 billion market right now in terms of market cap. So it’s pretty small in relation to the market opportunity.

Feroldi: Yeah. Now the company has been selling devices for almost 40 years now. So it is a relatively mature business. It is still producing growth, especially in international markets. As I said, it’s getting into the software business. It’s made a couple of acquisitions in that space to further diversify its business, but the company puts up very steady, very predictable growth. In the most recent quarter, we saw revenue growth of 9%. This is a company that produces a gross margin of almost 60% and it’s producing net income. Last quarter, its net income grew 25% and its earnings per share grew 17%. This is such a stable, mature, and predictable business that about eight years ago, they started paying a dividend and they’ve raised that dividend ever since. But this is the gold standard of obstructive sleep apnea. As I said before, if you bought this stock on the day of the IPO in the mid 1990s, you are currently up 32,790%. Wow.

Flippen: It’s by far the safest play that we’re going to be talking about in the sleep apnea industry because I know that our next two companies are much smaller, much more growthy, but also have much higher risk as a result.

Feroldi: Yes. Totally, if you want the safe, secure, lower-risk, steady-eddy grower, ResMed is definitely the choice of the three and the ticker symbol there is RMD. A little bit pricey today. It is trading at about 44 times earnings and its dividend yield is only 0.8%. But I think that the market is paying a premium for this stock given its consistent growth. Now, let’s talk about a higher growth company. [laughs]

Flippen: Also, I love the fact that 44 times earnings per year, like it’s a little pricey. In this market, I’m like, wow, there’s earnings?

Feroldi: You said earnings? [laughs]

Flippen: Yeah. Downright cheap in this market. But yes, let’s talk about our second company.

Feroldi: Sure. The second company is called Inspire Medical. The ticker symbol there is INSP. This company is an order of magnitude smaller than ResMed. It’s about a $5.6 billion company. This company was actually started inside the medical device giant, Medtronic, and it was actually spun out in 2007. The idea was, again, focused on sleep apnea, but there’s a little secret about people with sleep apnea. At least one-third of people that are prescribed CPAP therapy, they end up abandoning the treatment. Inspire estimates that that number goes as high as 60% in some cases. People that have CPAP machines might not necessarily like them. You can have discomfort from wearing the masks. You can get nasal congestion from wearing it. There’s usually a small noise that happens with the machines themselves. Those are attractive to a lot of people and can’t get comfortable while they’re sleeping with them. Inspire took a brand-new approach to treating obstructive sleep apnea. 

They created an implantable neuro-stimulator device that is inserted into the patient’s body during a minor outpatient procedure. What happens is a mild simulator gets attached to the patient’s hypoglossal nerve, which is the nerve that controls the airway, tongue, and the muscles. When the device is turned on, it detects when a blockage is in the airway. If a blockage is detected, it gives a small electrical signal to that nerve and that stimulates the muscles to open up and for the airway to be open. What’s nice for the patient is, once this device is installed, it’s turned on and off remotely, and there is no need to use a CPAP machine. The stimulation is so small that patients sleep right through it. It essentially keeps the patient’s airways open all night long without having to use CPAP.

Flippen: What’s worth mentioning about the market for Inspire and ResMed, and the reason why I think both of these companies can succeed at the same time, is that you actually have to qualify to be a patient for Inspire Medical. Not every person who suffers from mild or even moderate sleep apnea will qualify for the surgery offered by Inspire Medical. It’s really aimed at those with higher moderate to severe issues related to sleep apnea. You go through a process of evaluation to determine if you need the surgery. It does have to do with the fact that one is selling you a machine that you use at night and the other one is quite literally putting you under the night. But to your point, Brian, Inspire Medical surgery, it’s a relatively simple procedure. I think a lot of people may hear that it’s surgery and may think to themselves that there’s a natural barrier or a lack of desire from patients to have this solution. But I think if you’re somebody you are actively suffering from the effects of sleep apnea, and for many people, especially those with moderate to severe sleep apnea, it keeps them up every single night. It wakes them up in the middle of the night. They’re not able to get a good night’s sleep. They want something that can permanently fix their problem. I think Inspire Medical, especially when compared to the CPAP machine, which can be uncomfortable, does have maybe a more niche, but also exciting aspect of the market that allows both of these businesses to succeed.

Feroldi: Yes, totally. There are definitely some downsides to Inspire. To your point, you do have to try CPAP first. You do have to fail on that. You typically have to have a more severe version of sleep apnea, and the device itself requires surgery and costs much more. It’s tens of thousands dollars to get this device installed. But even with all those caveats in place, it’s very clear that the market demand for Inspire systems is very high. This company, first off, they’re in the scale-up phase, so they are really focused on commercialization right now. They’ve done a great job with that. The company has $220 million lives under coverage in the United States. That includes Medicare. They’ve done a really great job to get coverage for this thing. The company’s most recent results clearly show that it is having an impact on the market. Last quarter, revenue for this company grew 71% to $46 million. The vast majority of that is in the United States, but this company already is in international markets and is selling in Europe. 90% of sales are in the U.S. But I like seeing that they are already having some success in Europe too. 

The growth margin here is very impressive, 85% for the company. While they are losing money, the net loss is negligible. Last quarter, the net loss was $8 million, and this is a company with over $230 million in cash on hand. They have been a hypergrowth stock since they came public. The stock was up over 700% since their 2018 APL. Given the growth rate and the potential of this business, I understand why Wall Street is so excited.

Flippen: I don’t think it occurred to me until you just mentioned that they have Medicare coverage. I don’t think it occurred to me what a big component that is for sleep apnea, because at the offset, we mentioned that one of the biggest risk factors for sleep apnea was actually age. It’s associated with an aging population. So having Medicare coverage, I didn’t realize, and this is such a cutting-edge technology. That, to me, is a really compelling aspect of this business.

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Feroldi: Yes. With any medical device, insurance coverage is key. You can come up with the greatest thing in the world, but if insurers won’t pay for it, you’re going to have a heck of a time commercializing it. It’s really great to see that essentially, since this company came public, it has consistently won over insurance companies and gotten more and more lives covered.

Flippen: To the point you made about valuation on ResMed, this is not a business that has any [inaudible] , has no earnings to speak of here. I think investors, if they are interested in Inspire, which is definitely an interesting business, it’s certainly an interesting technology, you are paying up for that.

Feroldi: This is a company that is currently trading at 46 times sales, 46 times sales, not earnings like we said before. So yeah. Wall Street is really into this growth story and they have bid it up appropriately. But if the company can maintain its gross rate. Again, this is a company with an 84% gross margin and rising. Fast-growth and fast-growth margin deserves a high valuation.

Flippen: In the last stock we’re going to talk about today for the sleep apnea industry, is our by far, smallest business. I have to give the caveat before we talk about this business. It’s super cool, but it’s super spicy. I like that word. It’s a good description of what this business is doing. But because it is so new and it is so small, it’s worth noting, this is a sub $200 million company. It’s not nearly as liquid, it’s not nearly as proven as the other two businesses we’ve talked about. I think it would be silly to have a conversation about sleep apnea and not mention this company, because their technology is so unique. Again, Brian, when you brought it to the drawing table, your drawing board, you sent me down a rabbit hole researching this technology and I love it. It’s definitely worth talking about. But I want to add the caveat for all of our listeners that, while we do spend a lot of time talking about larger businesses that are more liquid as to not potentially expose investors to unnecessary risk, this is a very, very risky business, but also a very, very cool business, doing exciting things in sleep apnea. We did want to talk about it.

Feroldi: Yes. I’m glad this is clear to the legal team here, because this is a super interesting business, and one that we got that I first heard about from one of our listeners on Fool live. They said, ”Hey, have you ever heard of this company?” I said ”No,” checked it out, and just like you just said Emily, when I first looked over I was like, ”Wow, are there others? Interesting angle here.” Both companies that we’ve talked about thus far, ResMed and Inspire, they are focused on treating the symptoms of obstructive sleep apnea. One through CPAP technology, the other one through an implantable neuro-stimulator. This company, Vivos Therapeutics, ticker symbol VVOS, they are focused on curing what causes sleep apnea in the first place. The simplest way of describing this technology, is that it’s a three-dimensional braces system. So it is a device that is custom to your mouth, worn in the face, and it works in a very similar way to braces. There’s a series of screws that are in this device. When you wear this, you wear this device for 12-16 hours per day, it slowly transforms the shape and outlook of your upper airway overtime, and it molds your upper airway to gradually make it easier for you to breathe at night. The company actually has clinical data that shows that people that use this device end up breathing easier, and in some cases, their obstructive sleep apnea actually becomes cured.

Flippen: Okay. I understand this business, from what you’ve just said. It’s almost like Invisalign, but instead of trying to fix your teeth, it’s trying to fix your airways. The thing that I don’t understand, is why, and in preparation for this podcast, you felt the need to include a photo of their devices in our outline, because I wish I could share screens with all the people listening to this podcast right now, but these things look like torture devices. I will tell you what, if I was a patient, there’s no way I’m putting this thing in my mouth.

Feroldi: If you’ve ever seen a retainer, if you’ve ever had a retainer, the old school retainer that goes into your mouth, it’s like that but uglier, and it makes sense that it needs to be. Invisalign is just designed to move the shape of your teeth. In this case, this device is designed to change the shape of your upper mouth and airway. It needs to be able to put constant pressure on there. So yes, this design is not going to win any beauty awards. However, if this can cure your obstructive sleep apnea, I can see it being pretty popular.

Flippen: I agree, and in defense of Vivos, this is a product that I think more consumers may be willing to try, just because we’re accustomed to putting things in our mouth a little bit more than maybe we should be. I think all the different dentistries have become pretty good about selling people on the health impacts, especially having things like retainers or small adjustments over time. The concept itself is probably pretty easy to sell to people who are suffering with sleep apnea. I like the aspect that you wear it for, I think, you say 12-16 hours a day in the early evening and then over the course of your night, it’s not obtrusive enough that you’re unable to drink, swallow, breath. You can talk, you may have a little difficulty, but you can talk through wearing it. All of those things, despite how ugly and aggressive it may appear, doesn’t seem to put you out that much as a user.

Feroldi: To your point, again, this is a removable device, so it’s not like braces if it’s in and then you wear it for two years. This is a device that the user puts in and out. You can drink with it, you can breathe with it, talk with it, you just can’t eat with it. What I found fascinating about this technology, is first off, it’s not experimental. This device is already out there in the market. It’s already FDA approved and over 15,000 patients worldwide have already been treated on it. What I find the most fascinating about this business, is their business model. Their business model is to drive patient interest to this device, through dentist offices. They already have 1,200 dentists in the United States that are trained on using this device, and they sell it through the dentist office. 

If you are in dental practice and you want to offer this treatment to your patients, you partner with Vivos, you actually have to pay Vivos a multi-thousand dollar fee to get set up on this practice. I’ve been researching medical device companies for a long time. It’s extremely rare for a company that says, ”Oh, you want to sell our device? You have to pay us a fee to get up and running on it.” So far, 1,200 dentists have been willing to do that. That is really impressive. That is one of the company’s revenue sources right now. Again, because this technology is relatively new, they get paid an average of $28,000 by a dentist to get set up. The second way that they make money is by selling the actual systems themselves. They receive a revenue of about $1,600 per adult or about $400 for a kid, and the dentist typically charges their patients about $9,000 on top of that. The reason that dentists are willing to pay this company to offer it, is it becomes a revenue source for the dental practices. 

The third way that this company makes money is they have developed their own billing system that helps with training and it helps get this through insurance companies. That’s a recurring revenue source for this company. Now in all three cases, we’re not talking about a lot of revenue here. The company’s revenue through the first nine months of 2020, that’s all the data we have because this is a relatively new IPO, for a nine month period, this company’s revenue was less than $10 million. So it is very much still in the scale-up phase. However, those three revenue sources that we talked about are pretty high-margin. This company’s gross margin already is 79%. I think that there’s room for that number to grow.

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Flippen: What I think is really interesting and I didn’t expect when looking at this business, Vivos, was how cheap that system is and it’s FDA-approved, how cheap this system is in comparison to the alternatives already on the market. My impression was new technology, especially cutting-edge technology, tends to be more expensive. We saw the scale up in the comparison between ResMed and excuse me, the name is Inspire. Between ResMed and Inspire, the jump in the costs, we’re talking $5,000, $10,000 difference. But the actual process for Vivos, it’s a system that costs, I think he said $1,500, $2,000 for an adult. Readily affordable in a way that I didn’t quite expect.

Feroldi: The revenue to Vivos will be that much money. The actual choice that the dentist practices charge is closer to $9,000. But yeah, keeping the scale of cost is actually important here.

Flippen: I take it all back.

Feroldi: If you want to go on a CPAP machine, the cost to get started on that is about $2,500 and then there are also all those consumable fees for the rest of your life. Not to mention the fact that CPAP doesn’t cure anything, it just treats the symptoms. To go for Inspire’s device, which again is you’ve failed or you’ve gone up to CPAP machine, it doesn’t work for you and you’re going through a surgery, the total cost of the Inspire system is about $30,000-$40,000 depending on where you are in the country because again, there is a surgical component to that. Again, that doesn’t cure your obstructive sleep apnea, it just treats it in a less intrusive way. By comparison, Vivos at $9,000 does sound expensive, but if it can take you from having sleep apnea to not having sleep apnea, I don’t think that’s all that expensive. Aren’t braces $3,000 or $4,000?

Flippen: Yeah, I believe so. Every single time I go to the dentist, I’m constantly being told that I need to get Invisalign, even though my teeth, well, admittedly, may be a little bit crooked, are perfectly fine and I think the Invisalign out-of-pocket costs is something similar to that, that I could expect from getting braces. Think about how much dentists love to push stuff that can make their money. I think if Vivos is approaching dentists and saying, “Hey, this is something that you can, again, upsell your existing customers. It helps improve their life. Even if it costs them $9,000, it generates around $1,500, $1,600 in revenue for Vivos.” It’s a pretty compelling business, even if I was slightly wrong on the total costs.

Feroldi: That’s OK. You do have to keep that, costs do matter certainly. Of course, those are the least prices we are talking about, the prices that patients actually pay. There’s a bazillion things that goes into that. But I think keeping the scale of each his mind. It’s also worth saying that Vivos is not designed to treat the most severe cases of obstructive sleep apnea. It is mostly designed around people that have the mild-to-moderate, and it doesn’t work in every case. Some people still have to go on CPAP afterward, but they do have clinical data that shows that your sleep apnea typically does improve. Some people never have it. Again, other people, the severity of it declines. But either way, I think that Vivos is a pretty compelling idea.

Flippen: Completely agreed.

Feroldi: One other thing that’s worth noting here, while the company just did come public, it is still losing money. It’s net loss after the first nine months of 2020 was about $6 million. We should actually get more up-to-date information on this company tomorrow when it reports and that will be its first earnings report as a public company. One thing that I think is an interesting thing to note is that Mark Zuckerberg, yes. Mark Zuckerberg, his dad is a dentist, and he is actually on Vivos’ Board of Directors. That’s an interesting thing to note. [laughs]

Flippen: Actually really compelling for the dentistry angle of Vivos. I think that is what maybe sets this offering apart from the other companies that we talked about today.

Feroldi: Yes, totally. But Emily, we pitched three companies here, a low risk one, a high risk one, and a super high-risk one. Which ones interest you the most?

Flippen: Well, what I will say is I think there’s different value provided by each of these businesses and I think depending on what type of investor you are, or whether you’re more focused on growth or dividends in the case of ResMed, you can probably make yourself a pretty compelling basket with any number of these companies. But, and this is maybe where I go off on a little bit of a tangent and I apologize in advance, I think the sleep apnea industry in general worries me a little bit, especially as it applies to ResMed because of how they sell the products through these sleeps centers whose sole purpose it is, is to diagnose people with sleep apnea and get them to buy CPAP machines. When in reality, a lot of those people may be struggling with other issues that affect their sleep and the failure rate with CPAPs are still high because they’re so uncomfortable. I think those things make me a little bit skeptical of ResMed. Not that it’s a bad business, but out of the three, I’m not sure if it’s the one that I personally would want to own. 

I actually think I lean toward Inspire. It’s maybe a safer play than Vivos. Vivos is super interesting, but it’s a little edgier. It’s a little smaller than companies that I typically buy. I really appreciate the technology that I think Inspire has created. The idea that we’re talking about a machine you can insert in your body that sends your brain wave signals to open your throat, that concept is just so amazing to me. I have a lot of respect for the technology and I appreciate the fact that you have to qualify to have the surgery. They’re not potentially overtreating people the way that people can be overtreated in these so-called sleep clinics that we see jumping across the country. For that reason and without going off on too much of a tangent there, I think Inspire is the one that if I had to choose between the three, would jump out to me the most. But Vivos is also very interesting.

Feroldi: Yeah, I’m right there with you. I think that Inspire is probably the most interesting of these three picks. It clearly has proven product market fit and it is run by a founder-led management team. It was spun out of Medtronics, so it has that technology back to it. You are paying through the nose to get your hands on shares but I understand the interest in there. Although I think if I had to pick, I might go with Vivos. It’s definitely the smallest, it’s definitely the spiciest, but I really like the idea that the company is one, selling through dental offices. I think that will give it an edge to have these dentists essentially become the sales force. Two, I like the fact that they are actually curing it. Now, I think that the market is so big and that all three of these companies there’s plenty of room for all three of them to grow and prosper. But if I had to pick, I think I’m going with Vivos.

Flippen: I love that. Again, I can’t wait to see what happens with Vivos. It is such an interesting business. I had no clue it even existed until you brought it to today’s conversation, so I appreciate all the diligent research you have done to make this conversation possible.

Feroldi: Any time, I always love talking about medtech, especially high-growth ones.

Flippen: We’ll have you on more often. We need to bring back a medical or healthcare Wildcard Wednesdays to be a more frequent thing. I’m all ears anytime you want to talk.

Feroldi: You’ll be the first to get pitches then, Emily.

Flippen: [laughs] Listeners, that does it for this episode of Industry Focus. If you have any questions or just want to reach out to say “Hey,” you can always shoot us an email at industryfocus@fool.com or tweet at us @MFIndustryFocus. As always, people on the program may own companies discussed on the show, and The Motley Fool may have formal recommendations for or against any stocks mentioned, so don’t buy or sell anything based solely on what you hear. Thanks to Tim Sparks for his work behind the screen today. For Brian Feroldi, I’m Emily Flippen. Thanks for listening and Fool on!

This article represents the opinion of the writer, who may disagree with the “official” recommendation position of a Motley Fool premium advisory service. We’re motley! Questioning an investing thesis — even one of our own — helps us all think critically about investing and make decisions that help us become smarter, happier, and richer.



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