Hello, everyone. Afternoon. My name's David Low. I cover healthcare in Australia for J.P. Morgan. This afternoon, we've got Mick Farrell, CEO of ResMed, over to Mick .
Perfect. Thanks, David, and thanks everyone for joining us. You can read through our disclaimers on our website and on here if you're a speed reader, and I'll move through. ResMed at a glance. So, ResMed is the global leader in respiratory medicine. ResMed stands for respiratory medicine. We're also the global leader in residential care. We make the smallest, the quietest, the most comfortable, and most cloud-connected, and most intelligent therapies on the planet. We are the global leader in digital health solutions, with over 22.5 million, 100% cloud-connectable medical devices, selling in over 140 countries worldwide. And we have an asset that's a lot more valuable than our $25 billion market cap, which is 16 billion nights of medical data in the cloud.
We liberate those data, and then we use them to extract value for patients to improve patient outcomes directly with myAir. We improve business outcomes in the healthcare system for our customers, the providers and the physicians, and we lower the costs of delivering healthcare, lowering labor costs by up to 50% for people in our channel. We're growing at double digits in the volume of patients we treat every year, and we're leading this market as the number one leader in over 140 countries worldwide. So sleep apnea is a global epidemic. It impacts over 1 billion people today worldwide. They suffocate every night. Not everyone knows Greek for without breath, apnea, so I say suffocation. It shows what it is.
People stop breathing, and the only reason they don't die acutely is because their neurovascular and cardiovascular system sends a surge of norepinephrine and adrenaline that wakes them up and their bed partner. Sorry for the people in the back, that was a little loud, but that's what the bed partner goes through every time there's an apnea. To be clinically significant, there need to be five apneas, suffocations per hour with any symptoms of sleepiness or 15 times per hour with no symptoms. That's every four minutes of sleep you need this in the U.S. In some other countries, it's higher than that. We make the world's best non-invasive treatment for this, the lowest cost and the most efficacious.
We're also in a number of other big markets, you know, chronic obstructive pulmonary disease we treat directly with our non-invasive and life support ventilating, as well as some neuromuscular diseases, Duchenne muscular dystrophy and others. We also treat OSA combined with COPD and the overlap syndrome. We've got some brand-new cognitive behavior therapy technology, CBTi, for insomnia. CBTi is treating patients in Germany and Australia right now. It's early days. We basically take the psychologist, psychiatrist and put them into an app, and we've been able to move that at scale, and it's growing fast for us. Number of millions of revenues. Early days, but when you overlap OSA and insomnia, that is clinically called COMISA.
When we talk about adherence rates, I think one of the best ways we can drive adherence in our own space is with the technology we already have around combined insomnia with sleep apnea. We'll talk about that a little later. So look, we're here at the J.P. Morgan Healthcare Conference. We're all looking at these global, global issues, these global trends, but we have aging populations in most of the countries we're in, and we have growing populations in most of the other countries that we're operating in. We have an acute shortage of respiratory therapists and sleep pulmonary doctors. This is across all of healthcare. Everyone's seeing this. No nurses, no therapists, no doctors where you need them. And we're also seeing labor costs shoot through the roof, not just through inflation, but through the scarcity of supply.
We're seeing that we don't actually have a healthcare system in the U.S. or globally. We have a sick care system, where we wait until you're really sick, and then we take care of you with or without insurance at an emergency room, in a sick care system of a hospital or a high-intensity, high-cost environment. ResMed has north of 90%-95% of our revenues and profits outside the hospital. We think that's the future of healthcare. That's where we compete, that's where we win, and we think that's where most governments, most payer providers, most anybody who's looking at both the costs and management of the healthcare system wants to move healthcare, is from the hospital and preferably to the home. Definitely to a lower cost, lower acuity environment.
So at ResMed, you know, we transform the world with personalized, intelligent, and life-saving therapy, and I'll show the data for that last statement. Our vision is actually to be a digital health concierge for the patient. An assistant that helps the patient get from a sleep-concerned consumer, "I might have a problem sleeping or breathing," through to "I have a path," to screening, to diagnostic, to prescription therapy, but most important, to long-term management, lifetime management of the patient. We provide the highest efficacy at the lowest cost compared to all alternatives, including ones we've invested in or bought. We think there are some fantastic other therapies for sleep apnea, but you should start with the highest efficacy, the lowest cost, the lowest acuity first, and then work your way through.
So we've invested in dental, we're investing in hypoglossal nerve stim, and we're investing in pharma too. But we know the costs, and we know the benefits of each, and we're investing across the spectrum. ResMed stands for respiratory medicine, not CPAP company, but it is the lowest cost and the most efficacious, and so we always lead with that. While we're lowering the labor cost of setting up our therapy by 50%, we're also doing more than that. We're improving the efficiency for fixed healthcare systems, and we're driving adherence rates at the 90-day period, the 365, and 720 and beyond, higher and higher every day. We get up to 87% adherence on a device where you have to physically place this device on your face every night.
That's higher than most pharmaceuticals achieve across the board, and we do it through digital engagement. I'll walk through some of our latest technologies on that. This slide shows our, our ecosystem at its highest level. This is where the 16 billion nights of medical data reside. But we put our digital health solutions into practice every day. We liberate their data to the cloud so that seven million patients, almost 6.9 million patients, have downloaded our myAir app, and they can access their own data, personalized to them, daily with a myAir score. And this is engaged with the same way a Fitbit is for daily exercise. And the Apple Watch and the Samsung and, and Fitbit themselves, now owned by Google, getting into sleep wellness and sleep architecture analysis is a huge.
I think it's a huge tidal wave of flow of patients that can come into our funnel. As patients get to see, well, consumers get to see these data before they're a patient. They get to see the data from their fitness app, their wellness app. They will start to recognize the signs and symptoms of this, and we're working with the big tech companies to turn that information they have in those supercomputers, the Samsung or the Apple phone or the watch, into actionable information that says, "You have some risky breathing. You have some disturbed sleep, and here's a pathway to therapy." And ResMed's goal is to be there with the person as they walk through that. We have 25 million patient records in our Air Solutions system, and the physician and the provider can access that through our cloud-based system called AirView.
But we also, in the bottom right-hand corner of that cloud, we have 140 million patient care records for home medical equipment, for home health, for home nursing, and beyond, through brands like Brightree, MatrixCare, and our latest acquisition, MEDIFOX DAN in Germany. The bottom line is what we want to do is improve patient outcomes. We want to improve business process and clinical process efficiency. We want to lower costs to ultimately deliver the best healthcare at the lowest cost in the right environment. And I'll talk a little bit about our, our work in artificial intelligence and machine learning a little later, particularly some generative AI products that we've actually launched to market. So I've walked through some of these stats before. The one I'll focus on or the concept I'll focus on on this slide is interoperability.
I see some folks in the audience who've run companies like Allscripts and, folks around the room I know. David over there took Cerner over to Oracle and, and Judy at Epic. All of them talk about interoperability, and all of them are incredible at what they do in EMR and EHR records within the hospital system. But outside the hospital, it gets really, really dicey to find good data. ResMed is the global leader in starting to roll together outside hospital healthcare data. We've got 140 million patient records, but our goal around it is interoperability. In the bottom left of that screen, you see 125 API, API calls per second.
That's engaging with Epic, with Cerner, with Allscripts, but it's also engaging with the National Health Service in Sweden or Finland or France, the NHS in the U.K., so that a physician can see the data in the system they're used to, where they're used to seeing it, how they're used to seeing it, combined with all the other data on that patient. And yes, we're gonna get the ResMed brand there. We're gonna get the myAir brand there, the AirView brand there, but it's gonna be data that can be actionable for the physician, and that's how they want it. By the way, the calls go both ways, and the data comes back into our system, our ecosystem as well.
So rather than do a video presentation and walk through a whole bunch of details on AI, I'm sure you've been overloaded by it in the conferences the last few months. I'll just focus on two examples of where we're using AI within ResMed's ecosystem and customer-facing ones. I'm not gonna talk about the off-the-shelf stuff we're doing on supply chain and clinical outcomes that everyone's using. But the number one I want to talk about is provider outcomes focused on our an AI software product that we just launched into the U.S. market a couple of quarters ago, and it's called Compliance Coach. And what it does is it helps the respiratory therapist, the sleep physician, the whole sleep management practice to preemptively predict behavior of a patient.
To focus their limited efforts with the labor costs and constraints on themselves, having no time left in the healthcare system, to deal with the highest impact opportunities that can deliver the best outcomes with the most at-risk patients. We're leveraging the learning over the ecosystem of 25 million patients. So everyone in this room is an individual, but you all have a lot of patterns. You all have a lot of patterns that you do and you behave by, and if we can predict those and find the patients that are highest at risk and get the efforts focused on them, whether it's a digital effort, a human effort, or no effort, just that simple triage can save $10s of millions for the healthcare ecosystem. And so we're at early stages of Compliance Coach, but I can tell you, the customers that have adopted it.
By the way, we're charging for this. It's software as a service. It's one of the first SaaS plays within our core ResMed ecosystem. Obviously, we do that in Brightree, MatrixCare, MEDIFOX DAN, that's their whole business is SaaS, but this is the first software as a service in our core ecosystem, and I think it's doing incredibly well in the controlled product launch. We just went to phase two on that, and actually, it's hard to keep up with the demand. And the beauty of this is it's not a physical product. I don't have to manufacture parts from Asia through Singapore plant and ship it over or fly it over. This will scale at the speed of AWS or Microsoft Azure. The second example I want to talk about is patient outcomes.
We have an in-market beta trial of a generative AI software product that acts as that digital patient concierge that I was talking about, digital consumer concierge. It helps a group of people we've identified and we call sleep-concerned consumers, people who are engaged with looking at their sleep wellness data and are asking questions, whether it's to Google or to some other search engine or they're actively getting involved, and we help them find their way to Dawn. Dawn is the name that we gave to our, our generative AI product. Without going into too much detail, it will help identify, engage, and enroll millions of patients. We're test marketing this in Australia and New Zealand, but we think this could be something that could go to all 140 countries worldwide.
It'll help people on that path to better breathing, better sleep, help them find a path to screening, to diagnosis, to appropriate treatment, whether it's ours or a competing technology, and help them move in and out of the different technologies along their, their life journey, along their patient journey. And our goal is the best outcomes for the patient, the best treatment, and the best long-term care. So watch this space. I think this is obviously moving fast in all industries, but as the market leader here, you know, with $4 billion in revenue, $25 billion market, up 16 billion nights of data, we believe we have really an obligation to be the leader in applying AI.
We're not going to be the best at AI, but we're going to be the best at applying AI in the field of sleep medicine, respiratory medicine, and residential care worldwide. So I'll spend just a couple of moments on our latest platform, the AirSense 11. We're in tens of countries with this, but we sell in hundreds of countries. We're in 140 countries worldwide, and so the rollout of this has been slowed down a little, you know, because we launched during COVID and had some supply chain constraints that we all did on semiconductors and others. But I can tell you that this device is the smallest, quietest, most comfortable and most connected and most engaging therapy on the planet for sleep apnea, and that digital engagement is key.
The only stat I'll draw your attention to on this slide is the sign-up for the app, the myAir. So what we're seeing in the AirSense 11, because it's got two-way comms, it's got a digital screen and an engager, talks to the patient, engages with the patient, it encourages them to download the app. We get a 55% uptake of the patients on this using the myAir app. That compares to a 25% uptake on the AirSense 10. We look across med tech, getting 55% of patients to do anything in the channel, let alone download an app, put it on their phone and use it, is incredible.
That's, I think, a factor that as we continue to launch AirSense 11 country by country and get that technology out there, that engaged technology, we're gonna see more engagement of the patients in myAir. What does that mean? Well, if the patient's engaged with this app that is coaching them, sending videos, and it's personalized therapy and working how to best empower them to better sleep and better breathing, it means higher adherence. This is not just the CEO saying this. I'll show you peer-reviewed, published data showing higher adherence on myAir, and that leads to higher mask usage, and that leads to, obviously, better outcomes for the patient and for us, but it leads also to lower costs of the total healthcare system. I'll talk about the dose-response relationship between patient adherence and outcomes in a moment.
So these are the data I was talking about. This is peer-reviewed, published evidence. The N on this study is 85,000 at the bottom line and 42,000 patients on the top line there. But these are the published largest published data to date on adherence. The baseline adherence on CPAP is around... You know, if you have an average model going through an average provider, an average engagement with a clinician, you're gonna get around 60% adherence. It's a pretty good therapy because of the symptomatic relief of sleepiness and moderation of symptoms. So 60% is sort of the baseline. But if you just add one thing, if you just have the physician use our cloud-based patient management system called AirView, that goes up to 70% adherence.
Then, if you just add one thing, that patient downloading that app, myAir, and engaging with that app, we're able to show up to 87% adherence to the patient at 90 days and maintaining. You can see it's actually increasing as it gets towards that 90 days. That's incredible, and it's the market leading, but that also means that 13% of the patients aren't adherent, and we have to help them find a path to dental sleep therapy in Western and Northern Europe, where we make a product called Narval or onto other therapies around the world that the substitute therapies that we all know about. And ResMed wants to be the concierge to help those 13%, but we also want to raise that 87% to 90, 92, 95. There will be a limit.
Not everybody is gonna work with every therapy, but we think, achieving that 87% adherence at this level is a great challenge to us to say, "Well, what can we do more beyond that?" And this is the only other peer-reviewed, data I'll show from this, but this is the largest real-world data on CPAP mortality in sleep apnea. I used to be able to get up here, and I would get close to saying, "CPAP is a case of life and death," and my lawyer, Dave Pendarvis, was in the front row saying, "No, you don't." But now I'm like... Well, Dave's not here, but, he's on a golf course in Palm Desert. He retired, but, my new lawyer, Mike, won't let me do that either until we had these data.
This is N equals 176,000 patients. The P value is less than 0.01. So I'm only 99% confident that CPAP is a case of life and death. This showed that within three years, the mortality difference is 39% on patients who are adherent to CPAP versus those who are non-adherent. These were data across our ecosystem with the French public publicly available information. And so 39% increase in survival rate, it's pretty important to drive that adherence rate from 60% to 70% to 87%. For the doctor, for the patient, for the whole healthcare system, it's a case of life and death. In addition to being life and death, it's also economically valuable.
There's actually a dose-response relationship between every hour spent on CPAP treatment if you're a sleep apnea patient versus not. And that dose-response relationship is a 7% reduction in total healthcare costs for every hour on CPAP therapy. Now, that limits out at 7 hours. You know, you can't sleep for 12 hours and have 84% reduction in costs. But at 7 hours, it's a 49%-50% reduction in total healthcare system costs, and we've actually shown that. So it's not just use it, it's use it all night, and that's one of our, our biggest challenges, is to drive that adherence rate up and make sure patients are engaging 365 days. So a topic that's obviously been incredibly prevalent across, you know, all of med tech, all of healthcare, has been the new GLP-1 class of medicines.
I do think this is another wave similar to the wave of hypercholesterolemia drugs, of high blood pressure drugs. It'll be a new class, like statins, like blood pressure meds that are gonna come to market over the coming decade. And obviously, we've had them in market for a decade in the first generation, and two or three years now of these latest generation GLP-1s. And you know, there was a large correction on ResMed's share price in the last six months, and it really moved incredibly dramatically under an assumption of a bunch of myths. And I'll walk through some of the myths and how we're proving them wrong. But I think these data that we presented in our last earnings call were really to talk about, well, let's...
You know, we're the world leader in this space. Let's get the epidemiology data that was peer-reviewed and published in Lancet, and which we worked on, and then let's take it forward a couple of decades, and let's look at aging populations, growing populations, and let's run some scenarios of different pharmaceutical impact scenarios. We ran, you know, what's listed here as the high impact scenario and just presented that. Today, the new part is we've got a mid-range scenario and, you know, the no-impact scenario. If you ask me what I think the likely case scenario is, you know, this shows a total available market in 2050 of somewhere between $1.2 billion and $1.4 billion.
I would say the likely case scenario is actually between the blue and the red line, somewhere in the sort of no real reduction, I mean, continued growth of the prevalence, but just at a lower rate in that sort of coming year period, and then moving up back in line with the rest of the lines here. So somewhere between the blue and the red, probably 1.35 billion patients. I think that's the most likely scenario, given current adherence rates, costs, and penetration rates of these pharma meds. But we've put these three scenarios out there, and the whole point is there is no point on this curve.
By the way, the line at the bottom is how many devices we have in market right now, 22.5 million cloud-connected devices in market right now, and we grew that at 6% CAGR, just to sort of keep in line with most of the sell side models on the bottom. There is no point in any of those curves where the delta between our penetration and the total addressable market is less than 900 million patients in the high impact scenario. In the likely impact scenario, there's no point on any of the curves where it's less than one billion patients between what we've got treated and what's available. That's my whole point. This is an incredible market. Now, I can see the skeptics in the room saying, "This is a static epidemiology model.
What you need is the kinetics," right? Will there be an air pocket? Will there be a change in the rate of growth in the short to medium term because of this? And I'm gonna address that in the next slide. But the bottom line here is, there is a huge addressable market for ResMed now and over the next three decades and beyond. So this is my last slide, on the clinical side, but I, I think this is really important. I've been challenged a lot to start putting out a whole bunch of information on GLP-1s. Put out a whole pack. Put out a whole bunch of information. I, I don't think so. I think we need to focus on science and real-world evidence and large Ns. So the N of, this study is 529,000 patients.
So we took 529,000 patients and looked at patients who are on GLP-1s, patients who are not on GLP-1s, and then overlapped them, age, gender, complete matched pair set with our database, and looked longitudinally at these patients. So I want to address three myths on GLP-1s. The first myth is that there will be less patients in the funnel, right? That's what the share price correction said. That's actually completely not true. We are seeing more patients in the funnel. People are being activated and engaged. You saw it in our last quarter's growth. I'm not here to talk. I'm not gonna preannounce December quarter or March or June, but you're gonna see growth. More patients are coming into the funnel. So myth one is just untrue. There won't be less patients; there are more patients.
Of the $1 billion I need to get to, a bunch of them are coming in for these pills. They're seeing PCPs. If they have an AHI over five or 15 with no symptoms, they're getting a prescription, so there's more patients in the funnel. Myth number two is that the patients in the funnel are less likely to start CPAP, right? That was the myth. They're gonna come in, but they're gonna be using a GLP-1. They're not gonna start CPAP. The purple square there. There's actually a 10% absolute higher start rate for a patient on a GLP-1 versus a patient not on a GLP-1 after that prescription is written. This is absolute, this is not relative.
So if it was 70% of patients who got a script that showed up for that patient set up on the PAP in general market, it becomes 80% for a patient who's also on a GLP-1. So they're not only more in the system, they're more activated, they're more motivated, and they start that PAP at a 10% higher rate, a thousand basis points higher. The third myth, which is broken by the next two dot points there, is the myth three, is that patients with the latest generation of GLP-1s will be more likely to quit the therapy than those not on GLP-1s. That's not true.
These data, 529,000 patients, T=12 months, that one year post set up, they're 3% higher, not just in adherence, in their resupply rates, that they actually order another mask and accessory. So if the average adherence. Again, if the average adherence rate and resupply rate was 70%, it's three absolute percentage points. It's 73% high. So, 73% for a GLP-1 patient at that 12-month rate. And then, of course, at 24 months, it'll get worse is the myth. No, it actually gets better! So if it was 75% on the general market, a patient using a GLP-1, latest gen, is 75% adherence. 5% higher in terms of actually purchasing a mask, not just being adherent, but making that decision to purchase a mask.
So what we've been saying is, this isn't a headwind for us, we think it's a tailwind. I've got only 529,000 reasons of that, and by the way, we'll update this every quarter. It'll be in the appendix on our quarterly updates, the epidemiology slide, and this T = zero, T = 12 months, T = 24 months, to keep proving you through science and data, that we're actually seeing these class of drugs bring patients through. And just to cover the question before I get asked, 90%, greater than 90% of these are the latest gen GLP-1s, so semaglutide and tirzepatide. I know we want to get to Q&A, but this is my last slide.
I think the financials, I won't go through in detail because we'll be releasing those in a couple of weeks when we do our earnings call. But the bottom line is ResMed is positioned to win. We're the number one provider. That doesn't give you the right to win, but it gives you a great starting point. We are growing the market. We're not going to accept single-digit growth for devices and high single-digit, you know, mid-single-digit growth in devices and high single-digit growth in masks. Now that we're the market leader in all 140 countries, I have a very big incentive to start turning on the demand gen capabilities that we have through social media and other methods to get patients into the funnel.
I think that the tidal wave of patients, the $1 trillion worth of market cap from these large pharmas coming in, is gonna drive, for their own benefit, patients into the funnel, and we're gonna be a big beneficiary of that. I think Big Tech coming in and putting sleep wellness across all their devices is gonna drive patients into our funnel. But we're gonna take it on our own to, to not only continue to drive with those big megatrends, but also to capture that patient in our digital end-to-end ecosystem. And obviously, in the middle, we're driving digital innovation with a digital health leader in our space, but we want to go beyond that.
And the bottom line is we want to transform care delivered preferably in the home, but definitely in an out-of-hospital care setting, faster and better than anyone on the planet, to drive better outcomes, lower costs, and improve quality of life for the patients. So, with that, I'll close with, you know, in the last 12 months, we helped over three million people get a CPAP, an APAP, a bilevel, or a ventilator. We helped over 25 million people get a full mask system, and we helped over 140 million people get a digital health solution for outside hospital care. And our goal is to grow that double digits, 2024, 2025, and help over 250 million lives in the year 2025. So with that, I'll hand back to Dave, and we can.
I'll sit down here, and we can do some questions.
Perfect. Great. Thanks, Mick. I'll—I might start with a couple of questions, and then we'll certainly throw it to the audience as well. So, Mick, you hit the GLP-1 question head on and with more data, and I think that will probably take us a little bit of time to digest. But just one question that you sort of addressed, but just to make it clear, the patients in that 500,000 patient set, they're using the latest GLP-1, so they'd largely be diabetes patients then, given obesity indications more recent?
Yes, we've got. Look, my team who do this research didn't even want me to say, you know, greater than 90%, so I'm stretching the envelope. We actually know exactly by drug what that is. You look, you guys know, I mean, those of you who are following the pharma side, you guys know how many of those are in each of those classes and even the brand names of them. But yeah, it's the Wegovys, it's the Mounjaros, and all of the above, Ozempic and all of the above. It's the latest and greatest of all those. And look, as you know, more varieties come to market, and we see more, we'll continue to track those data. I think the most important thing is people obviously bet last year this is a headwind. It's a tailwind.
It really is, in terms of the patients coming in, and they're sticking on therapy and driving therapy more. And whether you're using it for diabetes or you're using it for a different indication, weight loss, it's still gonna have the same effect of engaging you, and, and physiologically, it's the same, chemical compound.
Okay. Now, look, that is a great data set, and definitely we look forward to those updates and probably something that I need to absorb a little bit. But one more question on GLP-1s before I let you move on. So we've got a pretty important clinical trial result coming probably this quarter, certainly this half. Does ResMed have expectations for this Surmount trial and what it will show?
Yeah, look, I think the investigators of that trial are the best to ask the question. But, I mean, look, I've read the data, and you have. We've run scenarios around it. I think what's programmed in there is, you know, three arms, a GLP-1 alone arm, a CPAP alone arm, and a combination arm. You know, I look to the primary investigator, one of the primary investigators on that is Professor Atul Malhotra from University of California, San Diego, and he was on a podcast recently with our chief medical officer, and he was asked the question, "You know, how do you think about weight loss treatment and CPAP treatment for sleep apnea?
You know, like, is it A or is it B?" And he sort of stepped back and said, "Well, why, why would you ask this question? I've been in this field for 30 years, and it's always been weight loss treatment and CPAP treatment for sleep apnea, A plus B." So there are three arms in that study. You know, treatment A alone, treatment B alone, and combination. It's pretty obvious that the best outcome is gonna be a combination therapy, and it always has been. A, a physician before these drugs were available, diet, exercise, and sleep apnea. A 30% weight loss... You know, and the bariatric surgery before that, with 50% weight loss, patients still needing it, 95% probability rates, post-bariatric surgery, positive airway pressure treatment.
The challenge is to make sure through that journey, patients are fully engaged in both their—and it's not just weight loss, it's diet, it's cardiovascular exercise. I mean, if you take a pill that shrinks your stomach, and you have a shot of bourbon and a bite of a burger, that's not good. And so it's really making sure that the diet, combined with cardiovascular exercise, combined with the sleep apnea therapy and others, are gonna be good. But what we're seeing is that these are bringing patients into the funnel. I really do hope the combination therapy is strong because that means a company with a market cap of $500 billion is gonna be wanting to drive patients in-
Yeah.
For sleep apnea care and into the funnel. And, yeah, the likely case scenario is the combination therapy is the best. So they have an incentive not only to drive for their pill, but then to say, "And while you're there, you should also get this 'cause it'll make your and my outcomes better." And a primary care physician is always gonna follow the Hippocratic Oath or beyond, to just do the right thing by the patient and make sure that if they have HI north of five or north of 15, which vast majority of patients at the end of that study still will have an HI above five and certainly 15 with or without symptoms. And they're gonna need CPAP. And the combination therapy has been something we've done with Pharma before. Lunesta, right?
When a patient has insomnia, they're often prescribed a hypnotic like Lunesta or one of the other brand names out there. That's been used in combination with CPAP therapy for decades, and so it's not new to us. And I just think the myths, turning them around to say headwinds are actually tailwinds is something that the market needs to catch up with, where the science is, where we are, and where the data are as we go forward.
Given we've hit that topic, yeah, there are questions in the audience. If we could get a microphone. If I could get you to wait for a microphone one, two, three, please. Down the front here, please.
There's one, two, three, four , I see.
What's this?
Sorry about that. Working? Okay, yeah. Let's do the GLP-1. More than 5,000 patients, you said 90% of them are on the newer GLP-1s. Did you see the difference if, like, separate the newer GLP-1s versus older GLP-1s, when they drive, like, more, I would say, patient adherence or patient awareness? Do you see the difference between the older GLP-1 users and newer GLP-1 users?
Yeah, so it was 529,000 patients, and it was more than 90% the latest generation, so I'm not sure. We didn't do the breakdown analysis. I mean, we all know the data that the older gen had less than, like, 10% or less weight reduction, and the newer gen are more like 10, 20, 30. So my assumption would be the latest generation are the ones that drive more engagement because... and more adherence, 'cause the patient's actually getting a benefit. So I think the data will be stronger, but we can absolutely look at that. But, over time, I think the older gen will start to go down to be less and less a percentage of that pool, and it'll be more the patients on the latest gen.
But what we're seeing is that these patients are far more engaged, and I think that'll only increase with time as the drugs get better.
Hey, Mick, Cody, I appreciate you being one of our biggest cheerleaders. I think sleep apnea is a huge issue. Reading between the lines, it sounds like you're alluding to possibly a focus on insomnia, digital therapeutics, and maybe an end-to-end platform. Was that kind of the thought process in the Somnoware acquisition? Can you share a little bit more on the strategy behind it? And then I have a, I have a follow-up to that.
Yeah, so, the acquisition that's most applicable to our work in insomnia is actually Mementor, a company from Hildesheim in Germany. And so it was a bunch of MD PhDs in the field of psychiatry, psychology, who were treating insomnia through CBT, one patient at a time, cognitive behavior therapy, and they really successfully, actually, so much better than, frankly, the hypnotics and other pharmaceutical therapies. And what they wanted to do was do it at scale, and so they wrote the software to do that. And so Mementor, the product is called somnio. Somnio is available all across Europe, all across Germany, and it's part of DiGA, so it's government-driven. The government's actually paying for it already in market.
We have to prove at month 24 the clinical and economic outcomes, and so we'll do that. And when we get that, we'll get clearance to then market across Germany, and we think that'll expand across European Union. We're also doing a trial on the somnio product in Australia and New Zealand. We just got clearance from TGA, and we're gonna do a trial through there, where we've got an omni-channel market. And yeah, we're going it as a pure play on treating insomnia as a psychologic neurological disease disorder. But then we're also looking at that overlap, obviously, with our core market and saying, COMISA, comorbid sleep apnea and insomnia, it's gotta be of the 13% we can't quite get there. How many, how many of them?
It's the stress of the day, it's the standard insomnia, "I can't sleep" issue, combined with "I can't breathe" issue. If you just treat the breathing and not the "I can't sleep," you're gonna miss out on some. So I think there's an opportunity alone in sleep apnea, 800 million people. There's a big overlap with 1 billion on OSA as well. But Somnoware can help us with that. Somnoware is more a patient management software for pulmonary and sleep physicians in the U.S., used by the VA and Kaiser and others, and incredible. It was moving upstream on that end-to-end digital concierge to help sort of the physicians a little bit further up the channel.
So there will be a potential product in the U.S.? And what are your thoughts on digital therapeutics around that? It sounds like you're gonna bring Narval back into the U.S., or is that? Did I read into that too much?
Yeah, there's a lot in that. I'll just go the digital therapeutics. I think our digital therapeutic is good. I think obviously the field, we saw with Teladoc and the $14 billion. I think digital health itself went on a little bit of a hype curve and has come back. We'd always said that. You've got to produce and provide value every time. That's why I like Compliance Coach. Just show you save costs. Save costs on the respiratory therapist and the sleep physician practice, improve outcomes, get them to compliance quicker, have an economic outcome that's more than you charge, and then it's a sustainable business model. If you overhype it and charge too much or say it's worth this when it's worth that, it's only gonna last one fiscal year, then you're out, and we play the long game in digital health.
I think there's a lot to go there. On the dental slide, on dental side, we're focused on Western Northern Europe for Narval right now. I think someone back there has the mic. Sorry.
Yes.
The lady up here is next, I think.
Mick, great to see you again. How large a share do you expect Inspire Medical to take longer term in sleep apnea for those people who use CPAP? And related, what would you tell a patient who uses CPAP? What would you recommend to them if they were considering the Inspire device?
Look, I think, hypoglossal nerve stim as a field is a great sort of third-line therapy, right? After you've tried CPAP, APAP, bilevel, after you've tried dental, and probably after you've tried pharmaceutical, then you go to the highest cost, most invasive care. I think total to date, that category as a whole has treated 50,000 patients, lifetime to date, over seven years. We took care of 50,000 patients in the last three business days. And so it's just a different scale. I think it's a great niche therapy. I think it's really useful for patients who just cannot comply with CPAP, APAP, bilevel, right? That we get to 87% adherence, that's amazing.
But if it's two million plus patients a year, that 13% is not a small number, and we do currently refer over to dental, where we have a play and even where we don't. Like in the U.S., we'll still refer over there. And then I think pharmaceutical and products like Apnimed has, which is a pharmaceutical aimed at tongue stim, would probably be next. Certainly, GLP-1s will wanna get in, I think, on that third tier. And then I think an implant is further down the road. So I... That's-- And we're an investor in a hypoglossal nerve stim company as well. We think the category is interesting. It's a niche play at the... I think it's third tier, though. I think you have to try the lowest cost, lowest security.
Healthcare insurance is gonna make you, but actually, the clinical data say you should walk through the highest efficacy, lowest cost, as well, first.
Just a quick,
Thank you.
All right. This will be our last question.
Okay, sure.
Yeah, just quick clarification for the adherence with GLP-1. Did you track the adherence with the loss of weight? Like, if people started losing weight, did they continue to comply and use
Yes. I mean, it was from prescription, but those patients, you know, we know from the clinical data, do lose weight 10, 20, and 30% on those, those latest gen. And so-
The loss of weight didn't make too much of a difference in the adherence?
Well, we just looked across the category, and we saw increase in usage. So it had some effect of increase in usage. I don't know what, you know, correlation versus causality. All we know is there's a correlation. If they're using GLP-1s, they use CPAP more, and they order more masks at one year and two years.
Thank you very much, Mick, for your time.
Thanks, all.