BrainsWay Ltd. (TLV:BWAY)
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Earnings Call: Q3 2021

Nov 17, 2021

Operator

Greetings, and welcome to the BrainsWay Q3 2021 earnings conference call. At this time, all participants are in a listen-only mode. The question and answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero on your telephone keypad. As a reminder, this conference is being recorded. I would now like to turn the call over to Bob Yedid of LifeSci Advisors. Thank you. You may begin.

Bob Yedid
Managing Director, LifeSci Advisors

Thank you all and welcome to BrainsWay's third quarter 2021 earnings conference call. With us today are BrainsWay's President and Chief Executive Officer, Christopher von Jako, and Chief Financial Officer, Scott Areglado. The format of today's call will be a discussion of third quarter results and a business update from Chris, followed by detailed discussion of the financials from Scott. We will open up the call for your questions. Earlier this morning, BrainsWay released financial results for the three and nine months ended September 30th, 2021. A copy of the press release is available on the company's investor relations website.

Before I turn the call over to Chris and Scott, I'd like to remind you that this conference call, including both management's prepared remarks and the question and answer session, may contain projections or forward-looking statements regarding, among other topics, BrainsWay's anticipated future operating and financial performance, business plans and prospects, and expectations for its products and pipeline, which are all subject to risks and uncertainties, including shifting market conditions from the COVID-19 pandemic, the global supply chain crisis, as well as the use of non-GAAP financial performance. Additional information regarding these and other risks are available in the company's earnings release and its other filings with the SEC, including the Risk Factors section contained in BrainsWay's Form 20-F. With those prepared remarks, it's my pleasure to turn the call over to Chris von Jako, CEO. Chris.

Christopher von Jako
President and CEO, BrainsWay

Thank you, Bob. Welcome, everyone, and thank you for joining us today. We are extremely pleased with the strong momentum in our business that continued during the third quarter. We expect that the current positive operating trends experienced throughout our company and driven by recent achievements on the commercial, clinical, regulatory, and reimbursement fronts will lead to further growth for BrainsWay going forward. I'll discuss all this in greater detail shortly, but first, I will provide a brief overview of our key third quarter financial results. We generated $8.1 million in revenue for the third quarter of 2021, which represented a substantial 34% increase over our third quarter of 2020 and is indicative of the growing demand for our Deep TMS therapy in multiple indications. We have now demonstrated year-over-year growth in five consecutive quarters.

We believe the progress we've achieved during this period is sustainable. In addition, our revenue for the first nine months of 2021 has nearly reached the total revenue achieved for all of 2020. We continue to shape our business practices to meet the challenges of the pandemic and the spread of the Delta variant during the third quarter, which appears to have had minimal impact on our business. As we've discussed previously, and as many of you are likely aware from the increasingly significant media attention it has received in recent months, mental health and addiction issues continue to rise dramatically, especially as we all live through the impacts of the pandemic. However, it seems that the pandemic really only amplified an already growing increase in depression.

According to research recently published by PharmacoEconomics, there was a dramatic rise of 13% in major depressive disorder in the U.S. during the pre-pandemic period of 2010 to 2018. During that time, the number of adults with depression grew from 15.5 million to over 17 million adults annually. The depression growth rate was even faster among adults aged 18 to 34. This study also estimates that depression carries an enormous economic burden, which now costs the U.S. $326 billion per year. Unfortunately, this trend only seems to be growing due to the pandemic. The Lancet recently shared a study on the lingering effects of COVID-19 and reported that of patients surveyed, 23% of those who contracted COVID reported feeling anxious or depressed six months after their first COVID symptoms appeared.

This is an appropriate segue into the discussion of our recent FDA clearance for anxious depression, our third FDA clearance in just the past 12 months. The expanded FDA labeling now allows BrainsWay to market its Deep TMS system for the treatment of not only depressive episodes, but also for depression patients with comorbid anxiety symptoms. This makes BrainsWay the only TMS device with labeling specifically addressing anxiety in depressed patients, further highlighting the competitive advantages of our products. In the same short treatment session, BrainsWay's deeper and broader stimulation, which is unique to our Deep TMS system, allows us to therapeutically address multiple areas of the brain which are associated with both depression and anxiety symptoms. Anxiety is the most prevalent comorbidity to a primary diagnosis of depression. In fact, between 60% and 90% of patients with depression also have moderate to severe anxiety.

Anxious depression is linked to greater severity of depression symptoms, higher risk of suicide, reduced response rates to treatment, and higher risk of cardiovascular disease and diabetes. We have already increased our direct-to-patient promotion of anxious depression through our marketing and advertising campaigns and have now completed sales force training around this new expanded indication. This clearance was achieved after we submitted comprehensive clinical data to the FDA and has already contributed to the success achieved this quarter. This all serves to further enhance the message of our holistic approach to mental health care. Collectively, these trends and recent achievements further support our continued efforts to increase awareness among patients and clinicians. During the third quarter, we hosted five well-attended webinars, including one focused on our expanded anxious depression FDA label. We also continued to promote education on the benefits of Deep TMS therapy.

As in recent quarters, I'm pleased to report that our organic website traffic again increased significantly, up nearly 80% in the first nine months of 2021 as compared to the prior year period. In the third quarter, we began an overhaul of the content on our website, which we expect to complete by year-end, aimed at improving the user experience, increasing speed, and building on our search engine optimization efforts to make Deep TMS therapy more visible for all in need. We also added a new chat robot, aptly named H-Coil. While this feature is currently in beta version, it's already yielding significant information on what website visitors are searching for and how we can better serve their needs. It's also been useful in linking prospective customers with our sales team, thereby potentially serving as another important asset in our commercial toolbox.

As October was Depression Awareness Month, which also included World Mental Health Day and OCD Awareness Week, we executed on a number of patient awareness initiatives. These included posting a patient story each week via our social media channels. Each patient provided an overview of their mental health journey, what BrainsWay's treatment means to them, and where they are today because of their experience with Deep TMS therapy. We also started an initiative to gather additional patient testimonials that our clinics can use on their own sites to help promote their practices. QR codes were provided for patients to load the app and tell their story. Additionally, BrainsWay has received positive media coverage through several recently highly viewed news features, including a recent appearance by Dr. Aron Tendler, our Chief Medical Officer, on CBS News during National Suicide Prevention Week.

Dr. Tendler discussed the alarming escalation in suicide trends and current treatment options, including Deep TMS therapy. Overall, our strategic investments in digital media this year have garnered an unprecedented 60 million impressions this quarter, supporting our efforts to create broad awareness of our technology and its therapeutic benefits. Collectively, the goal of these initiatives is to reach any patient seeking an alternative to traditional medical management of their mental health. Of course, as important as our digital efforts are, we all know there's no substitute for in-person interactions. In this regard, I'm pleased to report that our sales professionals' in-person access to customers remained steady this quarter. Our return to live in-person conferences that began in the second quarter has also continued.

We recently had a significant presence at the Psych Congress in San Antonio and the Neuroscience Education Institute in Colorado Springs, with attendance at an additional in-person conference planned for December. I will now turn to Deep TMS for the treatment of OCD. As a reminder, BrainsWay is the first TMS device to have achieved FDA clearance for this hard-to-treat condition and remains the only TMS company to receive this clearance based on pivotal data conducted on its own device. During the third quarter, we shipped 33 add-on helmets for OCD treatments, increasing the total number to 280. Moreover, the overwhelming majority of the systems shipped in Q3 included an add-on helmet for OCD, contributing to the strong revenue achieved this quarter. We are pleased that nearly 40% of our total installed base now includes OCD treatment capability.

We continue to view this progress as a testament to our customers' strong belief in the benefits of Deep TMS treatment for OCD and early progress on the reimbursement front. As a reminder regarding this reimbursement landscape, to date, there are approximately 40 million covered lives eligible for reimbursement on our OCD therapy. This includes members covered by both Centene and HCSC, an independent licensee of Blue Cross Blue Shield and the fourth-largest healthcare plan overall in the U.S.. These OCD developments, both in terms of customer adoption and in reimbursement, are indicative of the exciting traction we are seeing with this key indication. With that, I'd like to now provide a brief update on our commercialization plan for Deep TMS for smoking addiction. This offering, the first of its kind in the medical device space and our first addiction product, is being launched at a phased rollout.

We are pursuing this strategy in order to further cultivate on our messaging, develop optimized business models for customers, refine ideal addressable patient population, and build post-marketing data to develop a reimbursement strategy. We previously completed the first phase, which was a controlled market release, and a limited market release is now underway. We continue to receive excellent patient feedback, including very encouraging anecdotal quit rates. We also conducted a qualitative and quantitative market research study in conjunction with our phased release strategy to better understand the messaging and target markets for our smoking launch. One outcome from the market research that seems likely to have a strong traction with smokers is the finding that two out of three completing patients that had quit remained abstinent for the duration of the 16-week follow-up. We believe that this is a sign of durability, which will resonate strongly with smokers.

Completing our efforts on the commercialization side, we were pleased in the third quarter to have the positive data from a pivotal multi-center clinical trial supporting the use of Deep TMS therapy as a safe and effective treatment for smoking addiction, published in the renowned journal World Psychiatry. Publishing these data in a peer-reviewed medical journal allows us to both enrich the evidence around the treatment and also to further disseminate this critical information to providers who are seeking effective, non-invasive options to help their patients. Moving on, I'd like to take this opportunity to welcome Dr. Zafiris Daskalakis to the BrainsWay Scientific Advisory Board. Dr. Daskalakis is currently the Chair of the Department of Psychiatry at the University of California San Diego School of Medicine.

He has been on the forefront of expanding the clinical understanding of brain stimulation, and his insight and direction will be invaluable to us as we continue to enhance our technology and grow our business. Turning to investor relations, we hosted a well-attended KOL event for investors and analysts in the third quarter that highlighted the OCD indication. This virtual event featured a presentation by Dr. Kimberly Cress, Past President of the Clinical TMS Society and the Regional Medical Director of the Texas region for Greenbrook TMS. Dr. Cress discussed the current treatment landscape and unmet medical need in treating patients with OCD. In addition, Dr. Aron Tendler presented Deep TMS as an effective treatment for OCD. We also presented at several healthcare investment conferences in the recent months and conducted multiple institutional and high-net-worth focused virtual non-deal roadshows.

Finally, as always, I would like to thank our valued customers who contribute each day to battling the mental health crisis, as well as to the entire BrainsWay team for their better, stronger, and bolder dedication to our mission of advancing neuroscience to improve health and transform lives. With that, I will now pass the call to Scott for his review of our third quarter 2021 financial results. Scott.

R. Scott Areglado
CFO, BrainsWay

Thank you, Chris. BrainsWay had another strong quarter of revenue growth, and as Chris mentioned, it is the fifth consecutive quarter of growth versus the prior year period. For the third quarter of 2021, revenue was $8.1 million, a 34% increase compared to third quarter 2020 revenue of $6 million. As I've noted previously, sequentially, third quarter revenue of 2021 grew $1.1 million or 15% over the second quarter of 2021. We believe this growth demonstrates the continued value of the BrainsWay solution, given typical third quarter seasonality and the uncertainty of the ongoing pandemic. For the first nine months of 2021, revenues were $21.2 million, representing a 41% or $6.2 million increase compared to revenue of $15 million for the first nine months of 2020.

As of September 30, 2021, BrainsWay's installed base totaled 717 Deep TMS systems, which reflects an increase of 35 net systems on a sequential basis and an increase of 124 net systems or 21% as compared to the end of the third quarter of 2020. Gross profit for the third quarter of 2021 was $6.1 million compared to $4.5 million during the prior year period. Gross margin for the quarter was 76% as compared to 75% in the third quarter of 2020. Gross profit for the first nine months of 2021 was approximately $16.5 million or a 78% margin compared to an $11.5 million gross profit or a 77% margin during the prior year period. Margins can fluctuate slightly.

However, we expect margins to stay within this range in the fourth quarter. Moving on to operating expenses. For the third quarter of 2021, research and development expenses were $1.8 million as compared to $1.4 million in the third quarter of 2020. Research and development expenses for the first nine months of 2021 were $4.4 million as compared to $4.2 million in the prior year period. We expect our investments in R&D to increase as we continue to invest in our current indications, depression, OCD, and smoking addiction, as well as some additional future indications. Sales and marketing expenses for the third quarter of 2021 were $4 million compared to $2.4 million for the third quarter of 2020.

This increase reflects our continued investments in the commercial activities to drive future growth. For the first nine months of 2021, sales and marketing expenses were $11.4 million as compared to $8.3 million in the prior year period. Moving on to G&A. Expenses for the third quarter of 2021 were $1.5 million compared to $1.3 million for the third quarter of 2020, and $4.3 million for the first nine months of 2021 as compared to $3.4 million in the prior year period. Total operating expenses were $7.4 million for the third quarter of 2021 compared to $5.1 million for the same period in 2020.

Total operating expenses for the first nine months of 2021 totaled $20 million as compared to $15.9 million in the prior year period. As I mentioned last quarter, the increase in operating expenses on a year-over-year basis is reflective of cash preservation efforts to mitigate the effects of the pandemic in 2020. Operating loss for the third quarter was $1.2 million compared to an operating loss of $600,000 for the same period in 2020. Operating loss for the first nine months of 2021 totaled $3.5 million as compared to $4.4 million in the prior year period.

For the third quarter ended September 30th, 2021, we incurred a net loss of $1.8 million compared to a net loss of $1 million in the third quarter of 2020. For the first nine months of 2021, net loss was $5.1 million as compared to a net loss of $5 million in the prior year period. Moving on to the balance sheet. We ended the quarter with cash equivalents, and short-term deposits of $55.3 million compared to $17.2 million as of December 31st, 2020.

We believe that our strong balance sheet allows us to continue our sales and marketing efforts to drive additional adoption of our multi-indication Deep TMS system, as well as invest further in R&D in order to commercialize additional potential indications of our differentiated innovative technology. We are confident that these initiatives and investments will support long-term shareholder value. This concludes our prepared remarks. I will now ask the operator to please open up the call for questions. Operator?

Operator

Thank you. We will now be conducting the question and answer session. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star two if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment please while we poll for your questions. Our first question has come from the line of Steve Lichtman with Oppenheimer. Please proceed with your questions.

Steve Lichtman
Managing Director and Senior Equity Research Analyst, Oppenheimer

Thank you. Good morning, guys, and congratulations on the quarter. Chris, you obviously saw a clear step-up in OCD H-coils again here this quarter. Are you seeing the pickup in areas where reimbursement coverage by Centene and HCSC is stronger, or is it broader than that because of the halo effect of the positive reimbursement news earlier this year? Any more color on that would be great.

Christopher von Jako
President and CEO, BrainsWay

Thanks, Steven. Good morning, and thank you for your comments about the quarter. Yeah. We're really excited about the quarter as you can possibly tell. Regarding OCD, yeah, I would say it's more of a halo effect. You know, most of the systems that we shipped this quarter came with an OCD helmet. So we're very pleased. As I mentioned that in the comments that we prepared, we really feel that people are getting on board because we're gaining some traction with reimbursement.

Steve Lichtman
Managing Director and Senior Equity Research Analyst, Oppenheimer

Okay, great. Thanks, Chris. I'm wondering on the next steps in the smoking addiction launch. You know, I think you were at 10 centers initially. Are you moving that up now to another tranche before going full? And when do you expect to move to a full launch?

Christopher von Jako
President and CEO, BrainsWay

Yeah. I think we may have mentioned on the last call, we went from the 10, the first in the controlled market release, then we went up to 15 in the controlled market release, and we're now in the limited market release phase. We actually trained the entire sales force. I think I mentioned that on the last call. Then, we started in this limited launch where we're taking orders and we're delivering systems to particular people. I think, Scott, what do we have now totally installed?

R. Scott Areglado
CFO, BrainsWay

Closer to 30.

Christopher von Jako
President and CEO, BrainsWay

Closer to 30, I guess, at this point.

Steve Lichtman
Managing Director and Senior Equity Research Analyst, Oppenheimer

Including the limited

Christopher von Jako
President and CEO, BrainsWay

Yeah.

Steve Lichtman
Managing Director and Senior Equity Research Analyst, Oppenheimer

Controlled market release.

Christopher von Jako
President and CEO, BrainsWay

Controlled market release. Yeah.

Steve Lichtman
Managing Director and Senior Equity Research Analyst, Oppenheimer

Got it. Great. I guess just lastly from me, I'll jump back in queue on the sales force and apologize if I miss this. I know you were at 16 last quarter, targeting to get to 18 by year-end. Is that still the case? Any update on the sales force side?

Christopher von Jako
President and CEO, BrainsWay

Yeah, thanks. I think on the last call we had 16 sales professionals. We're up to 17 sales professionals. We're still targeting that 18 for, you know, before the year ends.

Steve Lichtman
Managing Director and Senior Equity Research Analyst, Oppenheimer

Okay, great. Thank you, guys.

Christopher von Jako
President and CEO, BrainsWay

Thanks, Steve. Appreciate it.

R. Scott Areglado
CFO, BrainsWay

Nice to hear from you, Steve.

Operator

Thank you. Our next question has come from the line of Jeffrey Cohen with Ladenburg Thalmann. Please proceed with your questions.

Destiny Hance
Associate Director of Equity Research, Ladenburg Thalmann

Good morning, Chris, Scott. This is actually Destiny on for Jeff. How are you?

Christopher von Jako
President and CEO, BrainsWay

Good, Destiny. How are you? I was gonna say, you didn't sound like, Jeff.

Destiny Hance
Associate Director of Equity Research, Ladenburg Thalmann

Yeah, no. A little more feminine maybe, but anyway. I was wondering, I'd like to start. There was a press release regarding seizures a couple of months ago, and I was wondering if you could talk a little bit about that and what impacts you think that has on the overall TMS market.

Christopher von Jako
President and CEO, BrainsWay

Oh, good question. I thought this, perhaps may come up on the call today. You know, at the outset, let me just say that TMS systems, which have been researched over many years, have a very favorable safety record, including the BrainsWay Deep TMS system. My belief is that it's a mistake for the industry overall to even talk about seizure rates as if they were an issue, and it's unfortunate that some in the industry feel they need to raise it. As long as you brought up the topic, I wanna be clear, whether using traditional TMS systems or the BrainsWay's Deep TMS system, seizures are an extremely rare but a well-known side effect associated with brain stimulation. We regularly publish our own seizure rates, and we did so last November.

BrainsWay comprehensive data involved about 95,000 Deep TMS patients and found seizure rates to be about two in 10,000 when following instructions for use. This is comparable to previous published outcomes seen with other TMS studies also. As for the specific claims about the document that you were talking about, in particular with the higher seizure rates regarding Deep TMS' H1 Coil, these were based on a questionnaire that were distributed via SurveyMonkey, which was misleadingly presented and worse, the analysis was based on really shoddy science. Specifically, the survey claims to have resulted from outcomes of 25,000 TMS patients, less than 2,000 of which had been treated with Deep TMS.

Our publication is more comprehensive, again, with 95,000 Deep TMS patients, which is a vastly larger sample size than the dataset used in that misleading survey. I just wanted to point out, as a comparative reference, the most popular antidepressants and antipsychotic medications show significantly higher seizure rates ranging between 1-6 out of 1,000 patients, not 10,000 patients.

Finally, Destiny, I just wanted to add, I think it's worth noting that BrainsWay systems are used at some of the top psychiatric hospitals in the country, like Johns Hopkins, McLean Hospital, which is the largest psychiatric teaching hospital and part of the medical school here in Boston, Stanford University Medical Center, UC San Diego Health, among others. This is not to mention the largest TMS provider in the country, Greenbrook, who also uses BrainsWay. I don't think any of these centers would be using the BrainsWay Deep TMS system if they felt there was any type of safety issue. Hopefully, that addresses your question there.

Destiny Hance
Associate Director of Equity Research, Ladenburg Thalmann

Yes, that's super helpful. Thank you for all that color. I'm curious if you could just maybe remind investors and whoever else may be new to the story about the importance of having this dual-pronged strategy where you not only are driving commercial expansion, but also providing your psychiatrists with other indications of use. Could you just help, you know, expand a bit more on that and how it impacts the company in the longer term?

Christopher von Jako
President and CEO, BrainsWay

Yeah, good. That's a great question. I think, one of the things that we've seen, since I joined is really the overall, I would say, market adoption of our platform and why people end up choosing our technology. I think obviously depression, OCD has been big, and we've seen it now, especially with reimbursement coming on. Smoking addiction, we're just early into. I think with our latest, you know, FDA clearance on anxious depression, which I think is really, really important, for not only the providers to be able to talk about anxiety within depression patients, but also to be able to talk to the patients about it. I think it really makes a real good thing for our platform. Does that help?

Destiny Hance
Associate Director of Equity Research, Ladenburg Thalmann

Yes, definitely. Maybe just lastly from me, I'm curious if you could talk to maybe some of the trends for Q4. Not necessarily guidance or anything, but more around what you're seeing in terms of seasonality versus COVID versus staffing disruptions, et cetera.

Christopher von Jako
President and CEO, BrainsWay

Yeah. I think, you know, I think our trends that we had in Q3 were extremely powerful. We were less, I think, affected by Delta variant than maybe some of the other manufacturers and people in, within medical device as well. We see, you know, continued positive momentum in our business. You know, it's really tough to tell. I think I've mentioned this on previous earnings calls as well. A lot of our secret sauce happens, you know, in the last several weeks of the quarter. It all feels really good right now as we're heading into, you know, the later stages of the quarter.

Destiny Hance
Associate Director of Equity Research, Ladenburg Thalmann

Got it. That's really helpful. Thank you so much. I'll jump back in queue.

Christopher von Jako
President and CEO, BrainsWay

Thanks.

R. Scott Areglado
CFO, BrainsWay

Thanks, Destiny.

Operator

Thank you. Our next question has come from the line of Jayson Bedford with Raymond James. Please proceed with your questions.

Jayson Bedford
Managing Director of Medical Technology, Raymond James

Good morning. Just a few questions, I guess, from me. Just on the OCD momentum there, near 40% of your installed base has a helmet. Can we assume that the other 60% is just waiting for more established reimbursement coverage? Is that kind of the speed bump here?

Christopher von Jako
President and CEO, BrainsWay

Yeah, Jayson, great question. I think I may have mentioned this in previous calls as well, but I'm glad you brought it up. There are some practices where, you know, we have our systems in psychiatric offices, they don't really focus on OCD, and we've seen that. I think, you know, the latest, you know, round of systems we've been selling this year, especially since we've had the momentum on reimbursement, we've seen much more people, much more of our customers taking the OCD helmet. I think we will see, you know, the installed base also start to do that at some point. It probably, my guess, will get over 50% of our installed base at some point, maybe even closer to 60%.

Jayson Bedford
Managing Director of Medical Technology, Raymond James

Okay. That's helpful. Just on OCD reimbursement, you've got coverage for what? 40 million lives. Are there any additional reimbursement wins anticipated over the next couple quarters?

Christopher von Jako
President and CEO, BrainsWay

Well, it's obviously tough to predict, and I don't like giving guidance. I remember when we did the call earlier in the year, you know, I was very hopeful, hoping before the end of the year, we would get at least one insurance coverage before the end of the year. We got two, as obviously I mentioned, with Centene and HCSC. Of course, we got the positive coverage determination, but it was a draft policy from Palmetto, and that still hasn't been finalized. We have reached out to over 60 of the top insurance companies in the country. Of course, with the Medicare MACs, we've reached out to all of them and talked to them.

In fact, at the end of September, there was a public call which happened, I think it was on September 29th. It was all the Medicare MACs, excluding Palmetto. They all got together and in this public call, they brought on six or seven experts, those six or seven experts actually reviewed all of BrainsWay's literature about OCD. It was really exciting to listen to the call, but in the end, it's really difficult to know whether the other MACs will all pick up coverage, some of them will pick up coverage, or maybe they'll delay it. I was really encouraged by the call. That's what I'll say.

Jayson Bedford
Managing Director of Medical Technology, Raymond James

Okay. Okay, that's helpful. On the label expansion that you received mid-quarter or 3Q for decreasing anxiety symptoms, you mentioned, I think, in the call that it's already contributed to the success. Can you identify orders that you believe directly stem from this label? Just on the timing of the marketing and the sales force training efforts, did this occur in September?

Christopher von Jako
President and CEO, BrainsWay

The training happened early in September. Yeah, really close after our, you know, I think we got the clearance in August, I believe, at the end of August. I actually remember exactly where I was. It definitely contributed to the quarter. It's hard to put on specifically what systems didn't, but hearing from the sales force and talking to the sales force, the ability to talk about anxiety and depression patients makes a big deal. I mean, I could talk for hours about this, really. In a nutshell, I think it's pretty powerful to be able to have our customers be able to speak about anxiety within their depression patients.

It's such a comorbid issue, and the ability to use our H1 Coil in the depression treatment in the same setting, not only handle the depression, but also anxiety, is extremely powerful. The data was really compelling. I think it was something that we'd known for some time, but the ability to look at it in these controlled, you know, clinical studies where we really saw the difference between, you know, the placebo or sham, you know, was just really compelling. Even actually, we compared it to medication as well. But I think the differentiation really helps from a competitive sales standpoint when we get in there as well. It's another further offering that we have.

Jayson Bedford
Managing Director of Medical Technology, Raymond James

Right. I guess what I'm getting at is, I assume that this label will have a bigger impact in Q4 than in Q3, just given that you'll have it for the full quarter here, versus what is, you know, a partial quarter and a summer quarter at that. Okay. Maybe just for Scott. Perhaps I missed it, but what was direct versus recurring revenue in the quarter?

R. Scott Areglado
CFO, BrainsWay

Yeah. It was about 60% direct versus 40% recurring.

Jayson Bedford
Managing Director of Medical Technology, Raymond James

Okay. Thank you.

Christopher von Jako
President and CEO, BrainsWay

Yeah, just back to the comments about anxious depression. Look, it's just it becomes part of our overall toolkit for our sales team to go out and continue to market, right?

Jayson Bedford
Managing Director of Medical Technology, Raymond James

Yep.

Christopher von Jako
President and CEO, BrainsWay

Thanks, Jayson.

Operator

Thank you. Our next question has come from the line of Ram Selvaraju with H.C. Wainwright. Please proceed with your questions.

Christopher von Jako
President and CEO, BrainsWay

Hi, Ram.

Speaker 8

Hi. This is Bhubalan dialing in for Ram Selvaraju. Can you hear me okay?

Christopher von Jako
President and CEO, BrainsWay

Yes. Hi, Bhubalan. How are you today?

Speaker 8

Yeah, doing great. Great. Congrats on your progress. Just couple of questions from our end with respect to OCD. I know OCD is an umbrella disease comprising of at least four disorders. Do you think the Deep TMS system could be particularly effective against one disorder versus the other within the umbrella of OCD?

Christopher von Jako
President and CEO, BrainsWay

Can you just expand what you mean by the four disorders?

Speaker 8

This was mentioned during the KOL call.

Christopher von Jako
President and CEO, BrainsWay

Okay. Got it. It was a very good point. Yeah, there's sort of other deviations of OCD, right? Like, body dysmorphic disorder and things like that. Yeah. We're doing further studying for that, and we plan to do further studying to see how it will impact those other different variations. I think obviously, you know, this is a big pool population. You know, six million people will just get pure OCD in their lifetime, and about three million of those, half of those, obviously will not respond to medication. As I think I probably have mentioned in the past, you know, with depression, there are over 40 medications, and then, you know, you can do combination of medications, there are only five medications approved for OCD. It's obviously a much more complex disorder.

Speaker 8

Great. The four disorders that were mentioned during the call were body dysmorphic disorder, hoarding disorder.

Christopher von Jako
President and CEO, BrainsWay

Yeah.

Speaker 8

Hoarding disorder, Hair pulling disorder, and Skin picking disorder. Just for reference.

Christopher von Jako
President and CEO, BrainsWay

Yeah.

Speaker 8

Yeah. All right. Thanks for the clarity there. Lastly, it appears at least, OCD takes 14-17 years to diagnose. Given BrainsWay's penetrating the OCD market, what potential marketing strategies might be required to ensure patients can obtain benefits of early treatment?

Christopher von Jako
President and CEO, BrainsWay

I think one of the things that we're doing. Well, let's just say first, the clinicians are completely aware of this, right? We are, you know, working in lockstep with them. Obviously the earlier diagnosis, the earlier treatment, they're gonna benefit quite a bit more from it. You know, to date, obviously, our clearance is for 18 and older, and we do actually have a study going on in younger adults at the moment.

It's more of a pilot study at one of the large universities in the U.S. We're looking forward to getting those results over time. We know that, you know, patients are treated off-label at a younger age, but I think you're right. You know, the earlier we can get this diagnosis treated, and you probably heard from that KOL call, the better the you know, the better outcomes you'll have in the patients in general. By the way, the same thing goes for depression as well.

Speaker 8

Okay. One lastly, maybe this is for Scott. The gross margin continues to be impressive. Just curious to hear your thoughts on whether inflation would affect your gross margins moving forward. If yes, what mitigating strategies might be required to lessen the impact?

R. Scott Areglado
CFO, BrainsWay

Yeah. It's a great question and something we've been thinking about and watching the economic trends. You know, I think at least for the fourth quarter, you know, most of our inventory is in and built and, you know, already ready to ship because we have parts with some longer lead times. And then, you know, we're just working to really manage through this and haven't really thought about our outlook too far for 2022 yet as we sort of have enough inventory for the near term here. You know, if the inflationary pressures continue, it'll obviously have an impact on our cost of parts, and we'll have to determine how we can either pass that on or how we'll manage through it.

Speaker 8

Okay. Thanks. Congrats again.

Christopher von Jako
President and CEO, BrainsWay

Thank you.

R. Scott Areglado
CFO, BrainsWay

Thank you.

Operator

Thank you. We have reached the end of our question and answer session period. I would now like to turn the call back over to Chris von Jako for any closing comments.

Christopher von Jako
President and CEO, BrainsWay

Thanks. I'd like to thank all the investors, analysts, and other participants for their interest in BrainsWay. With that, please enjoy the rest of your day.

Operator

This does conclude today's teleconference. We appreciate your participation. You may disconnect your lines at this time. Have a great day.

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