Intuitive Surgical, Inc. (NASDAQ:ISRG) Q3 2023 Earnings Call Transcript

Jamie Samath: Yes. And I want to make sure I got it right, Matt. So come back to me if I have the wrong questions. But our total bariatric business represents about 4% to 5% of global procedures. What you saw in Q2 was in the U.S., which is where the majority of our bariatric procedure volumes are, in the U.S., the growth rate declined to about the U.S. average. And then what we saw in Q3 was it modestly decline a little further in Q3. Were those your questions?

Matthew Miksic: Yes. No, that’s very helpful. And then I guess, just your expectation – you framed out in terms of your guidance, but I mean, is this – I mentioned it just because one of the other competitors actually saw a decline, I guess, in laparoscopic bariatric or some combination a lot been open in the third quarter, single-digit decline. But it doesn’t seem like you’re in that zone, right? You’re still at or slightly below your average growth rate in the U.S. Is that – am I hearing your answer correctly?

Jamie Samath: Well, if you take our procedure growth in bariatrics relative to market, we’re taking share and have been for some time. So the fact that we had double-digit growth in Q3 relative to another company that had a decline, that’s just a reflection in part of the fact that we are taking share in bariatrics and continue to do so, even though there’s an impact to overall bariatric surgery, because of GLP-1s.

Matthew Miksic: Got it. That’s very helpful. And then the other – just ASP, I understand system ASP you give is not – does not – as your U.S. leasing goes up, as I understand it, those leased systems in the U.S. are not included in that ASP calculation. So if you could maybe just speak to – I don’t know, the way in which the increased leases have affected ASP or whether this is straight up year-over-year decline that suggested in sort of the overall numbers that you provide, if that’s a clear question?

Jamie Samath: So everything you described is correct. Generally, although there can be exceptions for mix effect, generally U.S. system ASPs when purchased are accretive to the global average. So in effect, as leasing has grown significantly in the U.S., that in and of itself has an adverse effect for calculated system ASP. The other thing that you see then with now a greater proportion of systems used to calculate that system ASP being international FX can have an effect. If you look on a two-year horizon. So for example, the exchange rate in Japan based on how the U.S. dollar has strengthened, there’s a 30% to 40% impact over a two-year basis on system ASP in Japan as translated. So, there is a geographical effect. And if you look at a long enough horizon, there’s an FX effect in what we described in Q3 was in terms of the year-over-year decline in ASP, also a dynamic relative to pricing.

And that’s really just as we expand our existing customers who are looking for a third, fourth, fifth system, those tend to be slightly lower ASPs than you’ve seen previously when they were greenfield accounts, I would say that in China, we do see some competitive dynamics with respect to pricing just given the number of lower local players. And so, there’s been some competitive effect on system ASPs in China specifically. We don’t really see that in other markets to this point.

Matthew Miksic: Thanks so much for the color.

Operator: And we’ll go to the next one, Jayson Bedford, Raymond James. Please go ahead.

Jayson Bedford: Hi, good afternoon. Gary, I think you’ve expressed your views on the role of bariatric surgery in a GLP world. I’m just wondering if these views have changed in any way over the last quarter or two? I know it’s not a lot of time, but the adoption of this class of drugs is obviously ramping quickly. And then just as kind of a related follow-up, getting back to Robbie’s question on the potential impact of GLPs beyond bariatrics. Do you expect an impact from some of your other procedure categories as GLPs get adopted?