Dan Goldberger from electroCore.
Thank you. Sorry about the technical difficulties. My name is Dan Goldberger. I'm the CEO of electroCore. We call ourselves a commercial stage bioelectronic medicine and wellness company. Very, very important ticker is ECOR. There we go. I'm trying to get this into a smaller font, but this is what they gave me. Overview is that the company is starting to grow pretty rapidly. We're very excited about our recent performance. Revenues for last year, $25.2 million. I know what our first quarter revenues are, but I can't tell you about them yet. I'm excited about them. Most of our business is in treating headache. We're FDA cleared for acute treatment and prevention of most types of headache. Migraine and cluster headaches are the largest demographics. A couple of years ago, we launched a health and wellness product line that we're now selling direct to consumer.
I'll tell you a little bit about all of that. Five-year CAGR of 60%+ on the revenue line, 85% gross margins. We're not quite cash positive yet, but I can see it from here. Let's see. Big business opportunities that I will tell you about. Simple capital structure, no debt, all straight common. At our 10-K, we had $12.2 million of cash. This is our flagship product. I keep mine in my pocket. We call this the gammaCore Sapphire. This is a non-invasive vagus nerve stimulator. As I mentioned, we're FDA cleared to acutely treat and prevent headaches. Acute treatment means I take it out of my pocket. There are two electrodes on the business end. I find my carotid artery. The vagus nerve travels in the same sheath as the carotid artery. I hold it, and it's programmed to run for two minutes.
I get a two-minute dose of electrical energy, completely non-invasive. For me personally, I can very quickly reduce the discomfort from a headache. In many cases, we can also completely abort that headache. In prevention, it is a little bit different protocol. We ask people to use it consistently twice a day, so think morning and evening. The pivotal data showed a statistically significant reduction in the number of headache days for patients who used it consistently twice a day. Acute treatment means you keep it in your pocket. You can knock down a headache. Prevention is a little bit more involved. This is not a drug. This is electrical energy. You can use this as a standalone therapy, but because it is not a drug, you can also use it in addition to any other therapy, whether it is drugs or nutrition.
Our largest customer is the VA hospital system in the United States. Our second largest customer is the National Health Service in the United Kingdom. In both cases, the treatment is free to the patient. A doctor or nurse writes a prescription. Prescription comes to us. We ship a handset directly to the patient. We have a customer service team that'll usually do a Zoom call to do an in-service for the patient. We send an invoice to the hospital. We get paid directly by the hospital. We've been working on, I mean, we have about 7.5 million covered lives through more commercial insurers. We're working with one very large managed care system that'll add another 12.5-13 million covered lives. We're just getting started in there. In 2026 and beyond, we have initiatives to go get additional coverage in other places.
These are the family of products. I've been talking about the gammaCore Sapphire over here. We have these two general wellness products that we launched in recent years. Truvaga is a lower power deep-featured non-invasive vagus nerve stimulator. We sell this direct to consumer through an e-commerce platform, Truvaga.com. Last year, revenues were $2.5 million, so roughly 10% of our $25 million in revenue last year. In February of this year, we went live on Amazon. We're continuing to invest in direct-to-consumer awareness. Increasingly, we're using social media, all the tools as consumers you're familiar with, to build awareness, to drive eyeballs to the e-commerce site, or more recently, to Amazon to drive consumer sales. We are very excited about the growth prospects for this product line. For the direct-to-consumer, we're positioned as a health and wellness product.
We market this for reducing stress or managing stress, for improving the quality of sleep, to boost clarity, what the military calls cognitive enhancement. A lot of what we do in Truvaga came out of this product line that we call TAC-STIM. We kind of looked into this. We were not aware that the Air Force Research Laboratories was doing a lot of work with bioelectronic medicine, candidly, to make super soldiers. They were working with a cohort of Army and Air Force Special Forces drone pilots. For the drone pilots who had access to vagus nerve stimulation, they were able to show that these kids were working better, right? They were faster at identifying a target. They were better or more precise at telling the difference between a Humvee and a school bus, for example.
Out of that, they came to us and said, "We really like your prescription product, but these are Air Force and Army Special Forces units. We need it in our own rugged, durable, black, hardened package." This TaxStim product that we're now selling in pilot deployment with some Army and Air Force Special Forces units, it's the electronics that are in here, but in a mill-spec package. This was also about $2 million of our revenue last year. The Air Force is using this for accelerated training, sustained attention, reduced fatigue, improved mood. That is kind of important to all of us. We see in the future significant opportunity for civilian crossover. Some of that is going to go to our Truvaga brand, but we're seeing interest from elite athletes, from first responders, from folks who have a lot of shift workers.
Stock analysts, several of the analysts that cover us, use a version of TAC-STIM to get through earnings season. I'm fine with that. Coming back to our prescription pipeline, we have many indications and a huge bibliography of data in primary headache. The FDA has given us breakthrough designation to treat the symptoms of post-traumatic stress disorder. VA hospital is our largest customer. Most of the PTSD data has come from the VA hospitals. We're starting to get a significant number of off-label prescriptions for PTSD. We're working with the agency to get an explicit label in PTSD. There's a pivotal trial running in substance abuse. We're not paying for it. NIDA, the National Institute on Drug Abuse, is paying for it. We had data published last month in treating traumatic brain injuries, so mild concussions.
There's data coming out of Europe in Parkinson's disease and acute stroke later this year. All of those trials are using this handset, the gammaCore handset. Once that data comes out, if it's supportive, each one of these possible indications is a dramatic increase in the total addressable market for our technology. In December, we announced the acquisition of a small public company called NeuroMetrix. Their ticker is NURO. Don't buy their stock. Buy our stock. What we get with this acquisition is their Quell product line. Initially, they have a prescription product for treating fibromyalgia. We are planning to plug that into the distribution channels that we already have in the VA hospital and certain managed care outfits. It'll roll right into the additional managed care and third-party payer activities that we have going on in 2026 and beyond.
They also have a product line for treating pain, lower back pain, for treating lower extremity pain. On the direct consumer side, they have a lot of data in exercise recovery, which we think is also going to be interesting to our military customers. We think there's a lot of synergy on the sales side, and that will be able to turn this into a major revenue contributor for electroCore. I mentioned Quell. We also have a distribution agreement with ReliefBand to sell Relaxis, which is for treating nausea post-anesthesia and secondary to chemotherapy. We have a distribution agreement recently announced with Spark Biomedical to sell their Sparrow product for treating the symptoms of substance abuse. We're trying to leverage the distribution channels that we've already built by adding product to our sales bag.
We have a lot of patents, more in the pipeline. We are very confident that we can protect our non-invasive vagus nerve stimulation franchise. $25 million last year, continuing to grow. Healthy CAGR. Really, the business started to grow aggressively as we came out of the pandemic. Our sales guys could get in to speak to prescribers in various hospital settings. As much as we try to do e-commerce, there is still nothing like showing up and giving a sales pitch in person. We still have to do that. Same numbers, nine consecutive quarters of sequential revenue growth. I know what our first quarter numbers are. Cash, we are still using too much cash. $1.25 million of cash used in operating activities. I hate to say we burned it, but we burned $1.2 million in cash last quarter on $7 million of revenue with 85% gross margin.
We pay 25%-30% commissions. Our cost associated with an incremental sale is 40%-45%. In other words, the contribution margin from another dollar of revenue is, call it 60%, probably closer to 65%. We need another $1,500,000 or $2 million of quarterly revenue to be cash positive. With our growth rates, I can see that we get there from here. No debt. It is all straight common. In many cases, I point out the pre-funded warrants. Two of our institutional investors explicitly report ownership of about 9.9% of the company, but they also have an additional 5% or 6% or 7% in the form of pre-funded warrants. Many of these warrants down here are in the money, but I do not think the options will ever get exercised.
I think about it as sort of an $8 million, $8.2 million fully diluted capitalization of the company. That's me. Joshua Lev was recently promoted to the Chief Financial Officer position. He's been with the company five years. I've been with the company for five years. Peter Staats is one of the co-founders of the company. He's a board-certified anesthesiologist. He's had a really distinguished academic career. He's a co-inventor of many technologies, including this one. He was very successful in private practice. He was the Chief Medical Officer for Premier Pain Centers, which is, I think, the second or third largest chain of pain management clinics. We're very fortunate to have him as our part-time Chief Medical Officer. That's the story. The ticker is ECOR. Revenues are growing. We're knocking on the door of being cash positive. GAAP profitability will follow after that.
This is my gammaCore Sapphire, but you can go to www.truvaga.com and buy your very own. Any questions? Yes, sir. Okay. Thank you. This one requires a prescription. This is a higher power device. Yeah. Right. We have been watching Pulsetto very carefully. They have a very good product. They are a vagus nerve stimulator. Their method of action is consistent with what we do. Our therapy takes two minutes. The Pulsetto is a wearable device, which has pluses and minuses. It takes a lot longer to get the same therapeutic effect that our two-minute dose does. Their pricing is pretty aggressive. At the end of the day, it is a very, very large market opportunity, even more so when you start looking at health and wellness. There is room for both of us. Yes, ma'am. Thank you. Yes. The drug therapy does not work great. Exactly.
Getting the data was key, right? This is pilot data that's now been published. That gives us the confidence to start designing a pivotal trial and execute on a pivotal trial. Ideally, we'll find third-party financing to support that pivotal trial from somebody, maybe not our federal government this year, but some academic or government money to sponsor a pivotal trial and then go through the regulatory process. In the meantime, doctors, especially in the VA hospital system where they already are quite comfortable using our technology, doctors can prescribe off-label. The data that was presented last month in Toronto is Dr. Michael Lament, who's in private practice in the Denver area. He has a cash pay practice, and he is prescribing to his cash pay patients for concussion out of his practice. It's just he's prescribing off-label, and insurance will not be available off-label.
To do a pivotal trial, executing it would take a year and a half. Class two. Class two, just like our headache product. Yes, sir.
Is this technology worked for people who have car accidents and have the nerve abuse?
Yes. That's exactly the data that the young lady was talking about. It was a cohort of trauma victims, overwhelmingly car accidents. Yes, sir. Rockaway, New Jersey. We have about $5 of components that come from China. And so if that $5 doubles to $10 or $12, it's a couple of points on our gross margin. We are watching it, but it's not really an issue for us. Yes, sir. Yes. Yeah. Our prescription products are, and recently, the Truvaga products are now you can go through a process to use an FSA or HSA card. Okay.
At the end of last year, we heard from someone about the gaps behind it. Yes. Yes. I got three minutes left. I see it. Kaiser is an initiative of ours. About a year ago, we went on formulary to treat headache in Kaiser Northern California and Kaiser Southern California. We have a distribution partner that works, that manages the prescription adjudication benefit plans and deductibles and copays. There is a lot of arcane back office stuff that goes on when you work with a private insurer. We have most of that worked out. We have about 40 prescribers in the Kaiser system now. That is how you start. A couple of prescribers have success. They start prescribing it more vigorously for their own patients. They start talking to their colleague across the hall. We are in that very early stage of penetration with Kaiser.
We're going to use the success that we've had in the VA hospital system and Kaiser next year to talk to CMS about Medicare, to talk to United and Aetna about getting the usual large national players to take it on. I think I'm out of time. All right. Thank you all very much. Sorry about the technical difficulties. Thank you to the folks at Planet Microcap. Great people.