I'm Travis Steed, the U.S. medical device analyst at Bank of America, and last session of the day, we're saving the best for last. Got ResMed here, Rob Douglas, President and Chief Operating Officer, and Amy Wakeham, Head of Investor Relations. Thanks for joining. I think Rob is going to hand it over to you to make a few opening remarks, and if you will, we can jump into some Q&A.
Sure. Thanks, Travis. Yeah, just briefly, if you don't know ResMed, we're best known for treating sleep apnea, but we actually do a lot more than that, and got really good software businesses, and we're very focused on our COPD treatments as well. As I said, the bulk of our business is treating obstructive sleep apnea, and we're way ahead the market leader in that, and it's a very good market for us. We think the total addressable market is probably close to 1 billion people. It's a very common condition, and we've seen prevalence increasing over the years, and we have really the best and most effective and most simple treatment for it, and it's the gold standard treatment.
And our generic strategies have been around driving awareness, and working on really the bottlenecks in healthcare systems around the world for getting patients to have access to that treatment. And then once they have access to that treatment, getting them conditioned to the treatment and staying on treatment. And being able to sort of execute on all of those touch points for the patient, we've seen long-term, very steady growth. The pandemic period has, you know, made comparisons difficult. Early in the pandemic, we saw sleep labs converted to respiratory wards, and so the diagnostics were challenged. We're pretty confident now that we're way back, way above the diagnostic rates of where we were before the pandemic. We made ventilators that the world needed to treat pandemic patients with.
And then as things got back to normal, we then saw really a cyclical chip shortages come through and challenging supply chains. That happens all the time, and our normal inventory settings would see us through that, but a competitor withdrew from the market as a result of a product recall two years ago. And so we've seen quite significant shifts in market share and accelerated growth while those shifts have happened. They've probably mostly happened now, and now we're in a new competitive environment that we're executing strongly in to really get back to that steady long-term growth that we expect.
Yeah, your growth's been pretty strong lately. Like I said, maybe some catch-up disruption of the competition. I don't know if you have a sense for, like, what the underlying market growth is now and, you know, impact of those competitors and, you know, when that could actually come back.
You know, our view of the market before the pandemic, we used to say that the market was a mid- to high-single-digit growth, growing market. We break out our masks, which are really the sort of the reusable component of the product and the devices, and the mask grew at the higher end of that mid- to high-single-digits, and the masks were at the lower. The devices were at the lower end of that. Really because we could keep more patients on treatment with our digital solutions, so we're extending really the lifetime of the patient on the treatment. And so we believe that that underlying growth rate is probably there.
You wouldn't be able to see it in the last few years 'cause of the perturbations in the market, but we would actually expect that long term we'll return to that type of growth rate. So as I said, over the past year, it's been about the supply chain being able to meet significant demand increases as the number two competitor in the market took significant supply out of the whole supply chain for the market. We have really taken share. There have been other new competitors that have come in and taken some of that share as well. And when Philips return to the market, they'll need to fight for their share. They'll have no automatic right to it.
We think our share is solid and good, and we've got all the settings in place to maintain and to continue to execute really well and keep that share. And Philips will have to fight for whatever they get. So our view is that we should continue to grow through the future.
Okay. When you think about supply, let's say Philips doesn't come back to the market, do you have enough supply, and are you preparing for that to kinda fulfill the demand?
Yes. Yes. We... It's taken us a while to ramp up because it was really a 50%-- an overnight 50% uplift in demand at the same time as a, as a supply chain crunch, was affecting many industries through the world. We're pretty well through that. One sort of overhang of it was that part of our strategy around that really was to deliberately build the inventory, and our current inventory settings are well above what we'd want like in the long term.
Mm.
And over the course of the next year, we'll start to see that inventory return to its current setting. But in the meantime, we've got more than enough capacity-
Okay
... to supply the whole industry if needed.
Anything on Philips' return to the market?
Really, it's sort of only I can speculate off what the public information is. We're not seeing anything particular. We're hearing different bits of news from different parts of the world as to what's happening. We hear about the fact there's a consent decree being negotiated. It seems like it's taking a long time, which may indicate that it's not very desirable. But other than that, I'd really just be speculating.
All right. And there's been a lot of focus on China. I don't know how much visibility what your China business is like, but, you know, macro-wise, there's, you know, a lot going on in China right now, so I'm sure you've been asked about it today. So I'm just kinda curious what your message is on China.
Yeah, no, for us, China is a really interesting market. Back about 2016, 2017, we acquired a company called Curative Medical, that was a local Chinese manufacturer and R&D design shop with a good product and a good reputation in the market. We integrated the teams, and our aim was to have a dual brand strategy in the market. Turns out our really good Curative sales team is really good at selling ResMed branded products as well as Curative branded products, and we've invested and got a strong team there now. And there's a couple of factors of the market. It's mostly not reimbursed, so there is a direct consumer/patient market, and we have very good online capabilities there.
Our R&D team and manufacturing team are able to just do local manufacturing of products and local supply chain, and we're actually able to risk manage both ways in terms of decoupling. It's a little bit hard as to where the overall global trade situation will be in terms of our supply chain. Most of the ResMed supply chain is in Asia, but more oriented towards, Southeast Asia and obviously Singapore as well. Meanwhile, we've got local suppliers and, and a good position in China as well, and we're seeing good growth. It's not yet material to the point where we'd break it out, but I'm confident that over the next few years, it will be.
Okay, great. And we'll move to the next big topic, GLP-1s. And I guess, like, you guys have been phrasing it as a positive. The stock's not, you know, seeing it that way. So what do you think the biggest mismatch is and, you know, misunderstanding with investors on GLP-1s?
I think we've got to understand, really got to get in some deep insight into around what the sleep apnea market is and what it isn't. While obesity is very much a factor of many patients, and when you look at patients, you'll see our patient population, you'll see a significant factor of obesity, but it's not a single or linear relationship between obesity and sleep apnea. And so, our sort of our broad term view is if these drugs have, you know, a decent fraction of what's being promised in terms of their effect, it'll be great for health systems and great for many people. And we think it'll be good, a good thing, and so we're totally not arguing or fighting with it. But remember, the total addressable market for sleep apnea is about nearly a billion patients around the world.
Many of those patients who, by the way, are in countries that are not recognized as having an obesity problem, so it's, it's not just that. But suppose that, you know, there's an impact of, say, 10% or 15% on that total addressable market. We're only working on a few tens of millions so far, and so there's a huge, huge distance for us to go there. As the, as the drugs become available and people understand them, there'll be a lot of patients activated to go to medical care, looking for prescriptions, for weight loss. But good medical practice would probably see those patients get evaluated for other chronic conditions, you know, cardiac conditions and metabolic conditions, and have a, a workup or a check of their sleep as well.
Mm-hmm.
So in the short to medium term, that could actually see more patients activated into sleep apnea awareness and diagnosis than what we've otherwise seen. And in any case, if you have a serious sleep apnea condition, how long do you wait for a weight loss effect to prove that? Perhaps these patients should be on treatment in the interim, and then, you know, it's very unclear exactly what the data of. There's not a linear relationship between weight loss and sleep apnea, and the clinical impacts of sleep apnea. And so it's sort of not clear at the moment in terms of what that weight loss that could come from the drugs, what impact it'll have on the sleep apnea. Certainly, at the high obesity levels and high AHI levels, it'd be a very steep drop.
But there's data around, and I think you know, the SCALE Trial showed that there's a nonlinear relationship as you get to lower, lower weights and lower AHIs. So a 50% reduction in AHI, Apnea-Hypopnea Index, for a patient who's got an AHI of 40 puts them at 20, which is still severe sleep apnea and should be treated with a treatment that gets it back down to under 5-
Mm-hmm
... which is what CPAP will do. So I think it's not obvious that there'll be a one-on-one on that. We have data. We have around 21 million patients in our database that are using the system and that our connected devices connect to. We have pretty good data, and we're actually by tokenizing and anonymizing and matching to equivalently otherwise tokenized data, we can do analysis of things like other healthcare claims in several healthcare systems around the world. And we're actually able to identify which of the patients have been on these drugs. We've got a cohort of around about 17,000. It's relatively small at this stage.
We've got more—a lot more work to do to work on this, but has been prescribed it, and we'll be able to watch for signals of, are there increased drop-offs for those patients or reductions in treatment pressures and that type of thing. And it's very early days. We're really only starting it, but at this stage, we're not seeing a signal-
Mm-hmm
... that it's significant. But we will be able to put that data out and, publish it as it gets properly analyzed and peer-reviewed and that. But that'll happen over the next few quarters. It's,
Can I ask when we can see that data the next few quarters?
Yeah, maybe a bit further out, depending on where we publish it and-
Right
... and what type of review it needs or for those types of things. So, we would sort of feel like this is a really interesting development, and it may actually change the demographics of our patient population. If it has this positive effect on chronic diseases, it may skew our patient population older, because people will be living longer. And, you know, sleep apnea is also age-related.
Mm-hmm.
It's also male gender-related. But, you know, with that age-related, we may see older populations, and then I don't think the world's thinking through this, that we will react to these types of things and change our targeting and our messaging in the way our digital solutions work as well.
Yep.
So the reactions are a little bit overdone, I would say.
Right. What about the, like, the potential for you've got people coming in for CPAP, and they're like, "I want to try the drug before I go on CPAP?" Just like maybe it's a small speed bump near term. But are you hearing that from, like, doctors or the potential risk for that?
Totally not seeing it. In fact, a better medical thing would be, "Okay, why don't you go on CPAP while you're on the drug.
Right.
And then see what the impact is?
Yeah. And there's a big trial coming in, you know, early next year, the OSA readout.
Yes. Yeah.
Like, I guess the expectations are from investors at least are, you know, pretty big reduction in OSA from that trial. Just, I'm curious how you think about that, you know, in terms of what the clinical community could think of it or that trial, or any thoughts on that?
Yeah. So that trial has a targeted endpoint of some undefined percentage reduction in AHI, so it's not actually a huge hurdle. So I'd expect that we would definitely see a reduction. Other alternate treatments have actually also run trials and gone for endpoints like 50% reduction in AHI, and, you know, you could hypothesize maybe that'll be what happens. But as I said earlier, you know, a 50% reduction in AHI is a wonderful thing. But in the U.S., you can get treated for sleep apnea if your AHI is five and if you have a comorbidity like sleepiness or hypertension, or metabolic condition in addition to that.
And so, the real question that'll need—even when that data comes out, it'll be, well, what fraction of patients would fall off, you know, go from clinically significant sleep apnea to clinically insignificant? And as we've said there, there'll be really obese patients who need really high pressures to spin open their airway, that have compliance problems because breathing on 18 cm of water pressure is quite difficult. But their pressure might come down to 10, and they'll be able to be more compliant patients as well. So, it's very much not a one-way or zero-sum equation, and I think that's underrecognized.
Okay. That, that's helpful, context. You talked a little bit about the supply chain and stuff. I guess last quarter, the gross margin was a little lighter, some mix, some inflation in there, spot buys. How should we think about the gross margin here and how much inflation can roll off and, you know, some of the improvements that you're seeing on the, on the inflationary environment?
Yeah. So the gross margin is... Our gross margins always been a headwind, tailwind story, and the factors in the headwind, tailwind story are pricing, a product mix, geographic mix, you know, cost of operating, and foreign exchange is also a factor as well. And there's a few others, but they're the main ones. And accurately predicting those headwinds, tailwinds on a short-term basis has been challenging, and it was a surprise for the market in our last results when we felt we'd hit a nine here, but we just didn't quite get there. We're pretty confident that through this financial year, we'll definitely see the margin improve.
The Q1 may be more challenging and look more like the last quarter that we just had, but we'll certainly see improvement throughout the year, going through on that. Pricing is a tailwind, and actually historically it hasn't been, but it, so, so it's helpful at the moment. We've got a very high inventory of parts that we've procured during the shortage and deliberately so that we could respond to the patient needs, and we understand this, but our days inventory is probably 50% higher than we'd like our normal run rate to be, and we'll be working that down.
And as we work that down, some of these higher-cost parts will start to come out, and then the mix will naturally change because the share shift in devices from the absence of a competitor is a one-off thing. And in a sense, we anniversary that, going forward. So, we'll actually see the device growth rates moderate back towards market growth rates, but then we'll see mask growth rates staying elevated above that, because of the, you know, incumbent patient population and all of that, and that should turn into a tailwind, for it as well. And then, again, who can say on FX? It's sort of a put or take-
Sure
-to come through there. But, but we're confident that our, our margin profile will continue to improve from here.
Where, like, how much improvement could you get over the next, you know, two, three years and where gross margins could likely end up?
We're a little reluctant to provide clear guidance on it, but we should be able to reverse sort of the negativity that we've had over the last few years.
Okay. And then, in terms of pricing, better pricing now, how sustainable is that?
Well, pricing's always a factor of, you know, your market position, your quality, and your competition, and all of those. We've actually, through the whole shortage period, been extremely disciplined and thoughtful around our, our pricing. We're very much taking the view we're the industry leader, and we've had to support our, our customers through it, and we understand where they're at in terms of a reimbursement model. But, you know, in the inflationary times, CMS, who are responsible for about a quarter of our U.S. patients, have given inflation adjustments match with inflation, inflation the last few Januaries and will the next January there. So, we think, we don't think pricing short term to medium term will turn into a headwind.
But with 1 billion untreated patients, and what we really are is a volume game around those patients, we suspect that long-term pricing won't be a tailwind. It is important in order to understand this, though, this treatment's incredibly efficient and incredibly low cost compared to the value that it creates.
But when, when you think about other areas in, in sleep apnea, hypoglossal nerve and the Inspire kind of technology is getting more attention, and they've done really well. Almost got a billion-dollar business now. Is that an area that you've looked at? I think you may have an investment there.
Yes.
Just curious what you think of that space?
Yeah, we think it's an interesting space. We take our view that we are a therapy company and a respiratory medicine company, and sleep's the area that we know really well, and so we're very interested in anything that improves how people sleep and their sleep therapy. And by the way, everyone with a good idea comes to us pretty early in the piece as well. So we've disclosed that we've invested in Nyxoah, who are really a second-generation implant stimulator. People know we've acquired a dental mandibular repositioning device, a custom dental prosthesis to treat mild to moderate sleep apnea, and so we're definitely quite interested in alternative treatments around there.
I mean, we would—we think Inspire have done a good job, but we would note that their patient volumes are a lot smaller than ours, but their revenue per patient's a lot more. And we've—we're impressed with what they've done, but actually, you couldn't see that as a factor in our growth rate, and more likely, the advertising, which frankly, we don't particularly love, as it does demonize CPAP. I think a better strategy would be to work on awareness, but it still creates awareness. And probably for all of the negativity, the advertising, the awareness is probably good for us as well. So our view is, having options for patients coming in or starting to talk about their sleep and sleep apnea is actually good for the overall market growth.
And by the way, I'd say the same thing about the weight loss drugs in that-
Right
- context as well.
Any other interest in other M&A? I guess you've done some acquisitions in the software side and stuff like that. Just curious what, how we should think about your M&A strategy from here.
So our long-term growth as we see as we think about our core markets around sleep apnea, COPD, they're still incredibly attractive markets with very attractive growth rates, and so we'd be interested in M&A that enables our capability in those types of chronic therapy, out-of-hospital therapies, but we're probably not going to get into, you know, different types of conditions and stuff like that. Yeah, we've developed a really good software business starting with Brightree, which gives us really good relationships with the providers who are also the customers of the device business, and even greater insight into chronic care, in out-of-hospital care settings through our MatrixCare business.
And our MediFox Dan is doing the same thing for us in Germany and is operating really well, by the way, and should, in the future, be a platform for further development in Europe on that. And then those software businesses are really great for bolt-on acquisitions because they are all API-driven, and we have partnerships with other providers and products that we, we may even cross-sell them. And so, we, we know them and know their technology, and they're already technically integrated. They're great acquisitions if we can do-
Right
- those bolt-ons, and Snap, for example, and Citus Health would be examples of that.
The SaaS business kind of struggled through COVID-19. When do you expect to... and how do you expect to get back to kind of the double-digit growth rates there?
Yeah. So actually, our Brightree business for the HMEs did well through COVID-19. Brightree, you know, those customers actually performed well through the pandemic. The big challenge was that one of our large sectors was skilled nursing facility in the U.S., in the east of the U.S., and we're census-based. Our billing to our customers, where we really provide sort of ERP and electronic health record and staff scheduling and all those types of tools, as I say, are census-based. And during and after the pandemic, when there was quite a lot of political stuff going on, people didn't really want to be in nursing homes, so there would have been challenge with patient levels in there that consequently affects the growth of that segment.
All of these businesses that are our customers have a major problem related to staffing, and so their ability to load up patients also depends on their ability to get staff. Now, our technology could help with that staffing questions, both in terms of training and efficiency and ease of use and, and effectiveness of the staff. But when they're short of staff, they can't bring patients in as well, so that's really a reflection of the segment. Other than that, the business is going very well.
Good. And then-
And we would expect over time to get them back to, above double-digit growth rates.
Uh
- and be long-term accretive to our growth rate.
Okay. And talk to some about artificial intelligence. You said you're 2-3 years ahead of your competitors. Maybe just kind of expand on kind of where you're going, your vision is for, for the artificial intelligence.
Yeah, I mean, we've been working on it for, for many years. We have things like, our, you know, our complex ventilator-support ventilator devices. When they come in for service or if there's a fault, they need diagnosis. In fact, in those products, you've got to get to root cause on every fault, part of the quality culture. Years ago, we did machine learning on all of the data we had that and started automating that sort of analysis, so that we could more quickly and be more efficient in getting products repaired and back out to customers with less, less people. There's many of those types of examples of operational excellence improvement tools, and it's one of the pretty easiest areas.
Then in our go-to-market, I've talked a lot about the large data that we have, and we have billions of nights of sleep data, lots of information around the patterns of use, and we're actually from that able to pretty early tell by learning from the data, which patients, when they start using a device for a few days, are potential to not pass the compliance thresholds that, say, the insurance rules have sometime over the next 90 days. And so we're able to flag to the providers: "Hey, these are the patients you want to focus on. Don't put resources into these other ones because they're going to pass." And so we're able to actually automatically triage where the focus is.
We're able to go further than that and start to automatically recommend and even execute some of the interventions that you might want to keep patients on treatment. Our software-as-a-service business actually can do the same thing for residents of nursing homes, and we can predict which patients are sort of doing less well and at risk of having a problem during the day, say, a fall over or whatever, and actually advise the nurses when they start their shift who to focus on and the first thing to do with problems. Those are incredible value creators.
Yep.
Actually, all those examples are real, and we've got a lot more in the works.
When do you think we should see the impact on the business metrics?
Yeah, you know, I think that'll be a steady growth, and it'll fall into the natural leverage of our business.
Mm-hmm.
And as we're able to turn our business back to its long-term status of being a forecast or demand-driven business, running a sophisticated MRP system to plan and get the supply, you'll see our business start to continue to have optimization and leverage through that. The business is big enough, and the pathway for patients is complicated enough that no one solution provides you an inflection point that you can say, "Oh, you know, the growth rate changed because you did this." It'll be much more that we'll have to work on several fronts to sustain the growth rate, and we'll build leverage off that.
Okay, great. Does anybody have a question?
Sorry, can I just give you the mic?
Apologies for bringing us back to the GLP-1 , one debate. But could you give us a bit of an update on or refresh us on referral pathways for most of your patients that go on therapy? So, you've obviously got sleep labs, which are a primary driver of patients ending up on devices, but how do patients end up in sleep labs?
Yes.
And then, sort of, we don't know how the referral pathways for obesity is necessarily going to play out fully, but how much of an overlap do you think there is between those physicians? Because you're calling out the potential for those patients seeking treatment coming in the top of the funnel for you as well.
Yeah.
And then the second question is, for those physicians that are referring, have you had any discussions with the physicians that might be referring for obesity therapies and how they're thinking about the knock-on impacts for sleep apnea treatment?
Yeah. So, the issue around how the sleep referrals work, the sort of the generic patient pathway starts with awareness, so awareness that sleep may be an issue. By the way, that's usually a bed partner saying, "If you don't stop snoring and gasping and suffocating, we're not going to be able to continue this relationship." And so then you'll have typically someone questioning their primary care, but they may be looking online as well, for that. Hopefully, you'll have your primary care aware enough that it's important enough to refer to a sleep specialist, and the sleep specialist will have some control or relationship with a sleep lab or a home sleep test that they'll put you in.
The pretest probability, by the way, is extremely high of being positive, and then when a positive test, then you're referred to a provider, some form of home medical equipment provider, or in Europe, they might be called a home care provider or whatever, who'll then look after you long-term and manage your billing and stuff through that. So in terms of how that would interact with other comorbidities, we also know that there's another pathway, that's a lot of patients will be seeing a cardiologist, and one of the generic cardiologist questions are: Tell me about your sleep. And that's been there, you know, it's 15 years ago, the standard of care for hypertension said, "Check for reversible conditions." The number one is untreated sleep apnea. And so a cardiologist then would refer that.
Now, this is an issue in different markets. Sometimes a cardiologist will actually start a treatment, start a diagnostic and treatment process for sleep. In other markets, they'll be obliged to refer to a sleep specialist, and so we'll need collaboration there. But many, many patients are coming through cardiologists, and then endocrinologists should be doing the same. Turns out a lot of dentists are doing it as well, but that's because they're hoping to, particularly in the U.S., sell you a custom prosthesis that they've made. Sell it, by the way, at an order of magnitude more cost than CPAP treatment would be as well. So there are all of those things.
Probably, the endocrinologists are more likely to be related with the obesity ones, and as I said earlier, would. This is all still to be developed as standards of managing these drugs come out and stuff like that. But you would expect that people seeing some sort of specialist or maybe primary care for obesity should be evaluated for chronic comorbidities as well as to see if there's anything that really needs to be dealt with there. So it'd be cardiac issues, metabolic issues, and sleep issues at least as well. And so we would expect, you know, all of those things to come up and then referral out of that primary care to whatever the appropriate treatment is.
It may well end up being that we all need to be talking to obesity specialists about short-term treatment of sleep apnea as well, but those are the types of things that we could introduce in response to where it's going. Now, the second part of your question was?
It was basically any discussions that you've had with those sorts of specialists since the demand for therapy has increased. What is the treatment cascade that those specialists have been talking about recommending to patients?
I think it's early days for us on that. And when I make my comments, it's my understanding of what would be good medical care. I think that still needs to be evaluated, and there'll be groups working together to establish how that should all work and what those sort of standards of care should be. I would say the hype around the drugs has come up relatively recently, and we're still putting our data position together on that. We ourselves will generate data into that type of statement because there'll be issues around how you manage patients as their weight changes and what to watch out for on that. As I've said, our own data has a lot of patients in it that are on treatment, but also on a GLP-1 drug.
We'll be able to virtually use that as a registry to create observations about what the trajectory is and what to watch out for.
Yeah, I was hoping to talk some competitive dynamics just on some of the smaller competitors entering the market that you mentioned earlier. It's not in distributors' best interest to have, kind of, you as the single dominant player after kind of a big exit by your peer, and so just what's the risk that distributors prop up competitors that weren't really relevant before?
Yeah, I think, there's a few things here. Anyone who was totally 100% committed to the wrong supplier will get into a lot of trouble. And our view is that there is no role for a single. You know, the market structure doesn't allow for a single provider, but what share should the best player have? You know, our view is, I think we're defining that. We believe that we've got the best solutions, we've got the best products, the most innovative masks, and the best software solutions around there, and they're not easy. The smaller players have a way up the learning curve from where they were a few years ago, and their volumes are up, and they'll develop.
And, you know, we know in some of them, their innovation history has been quite oriented around being a follower of where we've been. So we'll need to keep our own innovation up and running and driving very quickly. We think, by the way, that many device choices are made by a prescription, so it's sort of part of the medical decision. And so, the ability to have the data showing the outcomes that you've got and the quality of the products in that, and making that data available for medical profession, we think is important as well, and that'll be a factor as well. But, we actually think that the industry is different from what it was. It's not going to go back to what it was.
And there'll be, you know, a larger player and these other players having to come back and fight for their share and execute as well, and we'd say today it is a competitive industry and we're competing.
Just one, just one more on the GLP-1s. Do you have any data on how adherence changes as the severity of the AHIs change for a particular patient? So a patient that's got AHI of 40, how does their adherence compare to a patient that's got an AHI of 20?
We do have that data. We haven't disclosed it all, but probably to say there's a lot of factors, and it's the thing with AHI is it's not a perfect measure of anything, actually, and it's not a linear measure. It is used as a measure of severity, but the actual severity of your symptoms could be quite different. And so you could have no problem sleeping, but a real problem with your blood pressure, because of your sleep apnea. Those patients are actually often harder from a compliance or adherence point of view. But yeah, typically, the person with 40 is going to feel pretty bad and be more likely to get very good feedback to say: "Yeah, I really want to use this." A person on 15 may get that or they may not.
A person on 40 or 50 or whatever may be on a very high pressure, that means their mask leak, and they've got quite a lot of complications to get that benefit. And, one of the comments we've made, that actually a weight loss that took that pressure down from, say, close to 20 down to a bit above 10, would actually aid adherence as well, because it's much easier to live with that lower pressure. So again, it's a multifactorial thing, and, and any view of sort of drawing single straight lines between two points and saying this is a trend of everything is probably oversimplifying it.
Time for one, one more on margins?
Yeah, one more.
Just gross margins. Travis obviously asked you a few of these, but it looks to me like you've had a lot of negatives going for you on the gross margins. You've had the negative device mix, you've had the sales of the AS10, which-
Yeah
... is also a negative for-
Yeah
... your device gross margin mix.
Yeah.
It looks like there's been some pretty stiff price competition in masks. And then at the same time, you've got the FX and the spot buys, and it looks like a lot of those, like the FX and the spot buys, should start to roll through the balance sheet. So it looks like there's a pathway to getting well above the gross margins that you had pre-pandemic. Just what, what are your thoughts on, on, how aggressive you're prepared to be as Philips reenters the market, and whether you're, you're more likely to reinvest the, the, the additional gross margin you might get from, from the reversal of some of those factors into price as opposed to profitability?
Yeah, I think that. And by the way, these are factors we've been dealing with for 30 years, and it's not going to be fundamentally different. We would look for our products, based on quality and innovation, and quality of the software solutions and the connectivity, to be easy to use and to get better patient compliance and adherence outcomes, and patients to accept them more, to be worth earning a premium for, and we'd look to support that premium through there. But it can only be so big, so we'll have to do that. If you look at our volumes in the market and our strategy and our design strategy, we'd be pretty confident we've got a very good cost base, so as you say, notwithstanding some of the shorter term headwinds there.
But, it'd be a bold move to start a price war against us, I would have thought. And so, you know... But that said, we would then trade off sort of profit performance versus leverage, and long term, we've been quite leverage-oriented and volume leverage-oriented. So I don't want to really preplay any discussion for any circumstance, but what I would say is, I think in our toolbox, we've got everything we need to compete pretty strongly, regardless of what strategies our potentially emerging competitors take. But it. We're not going to give up share easily.
Great. Thanks a lot for coming today, and we'll end there. I think we're out of time, so thanks a lot.
Thank you so much.
Yep.