LivaNova - Q3 2023
November 1, 2023
Transcript
Operator (participant)
Good day, ladies and gentlemen, and welcome to the LivaNova PLC third quarter of 2023 earnings conference call. If you'd like to ask a question at the end of the presentation, you can press star followed by one on your telephone keypad. If you'd like to remove your question, you may press star followed by two. As a reminder, this conference call is being recorded. I'd now like to introduce your host for today's call, Mr. Matthew Dodds, LivaNova's Senior Vice President of Corporate Development and IT. Please go ahead.
Matthew Dodds (Senior VP of Corporate Development and IT)
Thank you, Alex, and welcome to our conference call and webcast discussing LivaNova's financial results for the third quarter of 2023. Joining me on today's call are Bill Kozy, our Chairman of the Board of Directors and Interim Chief Executive Officer; Alex Shvartsburg, our Chief Financial Officer; Stephanie Bolton, President of Global Epilepsy; and Briana Gotlin, Director of Investor Relations. Before we begin, I would like to remind you that the discussions during this call will include forward-looking statements. Factors that could cause actual results to differ materially are discussed in the company's most recent filings and documents furnished to the SEC, including today's press release that is available on our website. We do not undertake to update any forward-looking statement.
Also, the discussions will include certain non-GAAP financial measures with respect to our performance, including but not limited to sales results, which will all be stated on a constant currency basis. Reconciliations to the most directly comparable GAAP financial measures can be found in today's press release, which is available on our website. We have also posted a presentation to our website that summarizes the points of today's call. This presentation is complementary to the other call materials and should be used as an enhanced communication tool. You can find the presentation and press release in the Investors section of our website under News, Events, and Presentations at investor.livanova.com. With that, I will now turn the call over to Bill.
Bill Kozy (Chairman and Interim CEO)
Hey, thank you, Matt, and thank you everyone for joining us. Welcome to LivaNova's conference call for the third quarter of 2023. Before turning to results for the quarter, allow me to provide a brief update on the CEO search. Our process remains on track, and the board and I are currently interviewing select candidates. We are encouraged by our progress and are committed to selecting the right individual to lead the company. For the remainder of the call, I'll discuss our third quarter results and then turn to our strategic portfolio initiatives. After my comments, Alex will provide additional details on our performance and updates to 2023 guidance. I'll wrap up with closing remarks before moving on to Q&A. In the quarter, we achieved 12% revenue growth versus the prior year, marked by double-digit growth across all regions and improved profitability.
Our performance reflects strong execution throughout the organization, as demonstrated by the growth in all three business units. Notably, we maintained our commitment to modest leverage, achieving adjusted operating income growth of 23%, contributing to value creation in the quarter. Now, turning to segment results. For the cardiopulmonary segment, revenue was $145 million in the quarter, an increase of 18% versus the third quarter of 2022. Oxygenator revenue grew in the mid-teens, driven globally by higher than expected demand again, and I'd like to acknowledge our cardiopulmonary manufacturing and supply chain team on their excellent performance in the quarter. Heart-lung machine revenue increased more than 25%, driven by Essenz installations in the U.S. and Europe, and S5 placements in the Rest of World region.
At the end of August, we received U.S. FDA 510(k) clearance and CE mark for the Essenz In-Line Blood Monitor in the U.S. and Europe, respectively. These clearances are important product milestones that enable increased customer adoption of Essenz. Accordingly, our commercial rollout is now fully underway, and we have been successful in both evaluations and placements, including shipments to highly prestigious hospital systems in the U.S. While we continue to anticipate increased contribution from Essenz through year end, we should see a more meaningful benefit in 2024 and beyond. We now expect cardiopulmonary revenue to grow 12%-14% for full year 2023. Our revised forecast incorporates the strong performance through the first nine months of the year in HLMs and oxygenators, with our current oxygenator production capacity running at its limit.
As previously stated, we continue to expect a modest ramp in Essenz revenue through year end. Epilepsy revenue increased 6% versus the third quarter of 2022. U.S. epilepsy revenue increased 7% year-over-year, driven by higher realized price and favorable product mix. We achieved 815 new patient implants in the quarter, representing 1% growth versus the prior year, but well aligned with our expectations after the 13% growth experienced in the second quarter. We achieved 1,827 replacements, representing a decline of 1% versus the prior year. Again, though, very much in line with our phasing expectations. Epilepsy revenue in Europe grew 7% versus prior year, led by the U.K. Epilepsy revenue in the Rest of World region decreased 3%, primarily due to uneven distributor ordering patterns and the sanctions.
Building on our commitment to invest in our core businesses, we had a very successful go live in Houston with our first manufacturing execution systems, widely known as MES, and we now have 15 super users in the LivaNova organization. This initiative represents a meaningful operating upgrade to fully digitized manufacturing quality systems. For the full year 2023, we now expect global epilepsy revenue to grow 7%-9%. Our revised forecast incorporates the performance during the first nine months of the year. ACS revenue was $11 million in the quarter, an increase of 27% versus the third quarter of 2022, reflecting growth in cardiac and respiratory case volumes, partially offset by product mix. For 2023, we continue to expect ACS to be flat year-over-year. Turning now to the strategic portfolio initiatives. DTD revenue for the third quarter was $2 million.
For 2023, we continue to anticipate DTD revenue of approximately $6 million-$8 million, primarily from the RECOVER study. The RECOVER study continues to advance. As a reminder, enrollment for the unipolar cohort of the study has been completed. Upon receipt of the 12-month follow-up data for the 500 unipolar patients in June of 2024, we will conduct a final analysis. We continue to expect the publication of that study results by late 2024. The bipolar cohort continues to enroll as expected, and we're pleased with the success we had in refocusing our recruitment efforts from unipolar to bipolar patients. As a reminder, the bipolar cohort is similar to the unipolar cohort in that the randomized controlled study is designed with frequent interim analyses that assess if predictive probability of success or futility was reached, or if the study should continue enrolling.
Moving to OSA, the OSPREY trial continues to progress with all 25 sites actively recruiting patients. In heart failure, the closeout of the ANTHEM clinical study is progressing. We continue to expand the overall R&D spend related to heart failure this year to be approximately $24 million, the majority of which occurred in the first half of the year. With that, I will turn the call over to Alex.
Alex Shvartsburg (CFO)
Thanks, Bill. During my portion of the call, I'll share a brief recap of the third quarter results and provide commentary on 2023 guidance. Turning to results, revenue in the quarter was $286 million, an increase of 12% versus 2022. Foreign exchange in the quarter had a favorable year-over-year impact of approximately $3 million or 1% of revenue. Adjusted gross margin as a percent of net revenue was 71%, compared to 70% in the third quarter of 2022. Adjusted gross margin was impacted favorably by realized price, higher volume, which drove favorable fixed overhead absorption, as well as lower inbound freight costs, which offset component cost inflation. Adjusted R&D expense in the third quarter was $42 million, in line with third quarter of 2022.
R&D as a percent of net revenue was 15%, down from 16% in the third quarter of 2022. While flat on a dollar basis versus the prior year, R&D expense declined sequentially, largely driven by lower costs associated with closing out the ANTHEM trial. Including the costs related to ANTHEM, our R&D investment increased 4% versus the prior year. Adjusted SG&A expense for the third quarter was $115 million, compared to $98 million in the third quarter of 2022. SG&A, as a percent of net revenue, was 40% as compared to 39% in the third quarter of 2022. The year-over-year increase was driven by targeted investments supporting the Essenz launch, legal expenses, and variable costs such as freight and commissions associated with increased revenue.
Adjusted operating income was $45 million, compared to $37 million in the third quarter of last year. Adjusted operating income margin was 16%, compared to 15% in the third quarter of 2022. Adjusted operating income was driven by improved gross margin and operating expense leverage. Adjusted effective tax rate in the quarter was 10%, versus 8% in the third quarter of 2022. The higher tax rate is primarily attributable to changes in geographic mix. The global tax landscape continues to evolve and will impact our effective tax rate in 2024. We will share more details as they become available, but we anticipate the raise to be consistent with our previous long-range plan, as described during our 2021 Investor Day. Adjusted diluted earnings per share was $0.73, compared to $0.58 in the third quarter of 2022.
Our cash balance at September 30th was $234 million, up from $214 million at year-end 2022. Total debt at September 30th was $587 million, up from $542 million at year-end 2022. The increase in total debt was driven by the delayed draw of the $50 million on the Term Loan A facility that we put in place in July 2022. Net debt, including restricted cash at September 30th, was $98 million. Adjusted free cash flow for the quarter was $26 million, down from $41 million in the prior year period. The year-over-year decrease was driven by higher working capital, which was a function of higher revenue, as well as investments in inventory, supporting the launch of Essenz and capital spend phasing.
Capital spend was $22 million in the first nine months of the year, compared to $17 million in the prior year. The increase was driven by CP manufacturing infrastructure investments. Now, turning to our revised 2023 guidance. As Bill mentioned, based on our performance through the third quarter, we're increasing our full year 2023 revenue and adjusted diluted earnings per share guidance, while narrowing the range on the adjusted free cash flow. We now expect 2023 revenue growth on a constant currency basis between 9% and 11%, and continue to assume approximately a 1% tailwind from exchange rates. We now expect adjusted diluted earnings per share in the range of $2.60-$2.80, with adjusted diluted weighted average shares outstanding to be 54 million for the full year.
Adjusted free cash flow is now expected to be in the range of $85 million-$95 million. In summary, I'm encouraged by the company's execution and financial performance in the first nine months of the year. We remain positioned to drive improved operating leverage by year-end, having achieved 14% adjusted operating margin and 23% adjusted operating income growth through the first nine months of the year. I'm pleased that we have achieved this while investing in critical capabilities for the company, including innovation, manufacturing infrastructure, and IT modernization. And with that, I'll turn the call back over to Bill.
Bill Kozy (Chairman and Interim CEO)
Hey, thank you, Alex. As a company, we have executed against our targets through the first nine months of 2023. We're well positioned to deliver on our full year guidance, including operating leverage by year-end, as well as pipeline commitments. Achieving these communicated goals and creating shareholder value are top priorities of the executive leadership team and our colleagues around the globe. Let me take a minute to thank our entire organization for their focus on patients, innovation, and value creation. We look forward to building on this level of performance through the remainder of the year and into 2024. With that, Alex, we are ready to open the call for questions.
Operator (participant)
Thank you. As a reminder, if you'd like to ask a question, you can press star, followed by one on your telephone keypad. If you'd like to remove your question, you may press star followed by two. Please ensure you're unmuted locally when asking your question. Please also limit yourself to one question and one follow-up before reentering the queue. Thank you. Our first question for today comes from Rick Wise of Stifel. Rick, your line is now open. Please go ahead.
Rick Wise (Managing Director)
Good morning, everybody. Thanks. Bill, let me, first of all, it's great to see the solid quarter overall. Clearly, a lot of good things happening, and you make a bunch of encouraging comments. And I said ahead, before I start off with, I just wanna touch on the fourth quarter. When if I, if I'm looking at it correctly, your current guide, even though it's stepped up a bit, implies a bit lower growth in EPS than I might have thought and that we had modeled. And just wanted to better understand, is this just, you know, thoughtful, prudent conservatism? Is there something I'm not understanding? Is this something related to, tax rate? If you could just give us a little more color there and understand.
Bill Kozy (Chairman and Interim CEO)
Sure, Rick. Thanks, thanks for the question. Getting right at the, the EPS range. We have been, all throughout the year, really paying close attention to not only sales and profitability performance, but also this balance of supporting some well-known needs we have infrastructurally, manufacturing, innovation, and some strategic investments. We have notably been cautious on the latter set of choices that we've made to ensure that we put the first three quarters of the year into a strong position. We do have some targeted investments in the core business around growth and profitability, and we're gonna support some of those investments in the fourth quarter.
Additionally, we can't predict this ongoing competitor supply situation, particularly in the CP business, and very much focused on oxygenators and the impact it's gonna have on volume and our ability to achieve the same amount of sales and the corresponding EPS benefit we get from that. We got a few ongoing inflationary pressures we've got our eyes on, particularly on components. But hopefully, that'll give you a little better picture of where we're sitting right now.
Rick Wise (Managing Director)
Gotcha. And just, and again, it's always, management's favorite question this time of year. Maybe you'll talk a little bit about the 2024 setup. You, you made some encouraging comments there at the end, you know, maybe you could expand on that a little bit, just, key drivers for next year or things the organization and you are focused on. But maybe it, it most particularly, you know, given the strong cardiopulmonary, performance, you know, how much more, how long should we anticipate, that running, that benefit lasting? What inning are we in there, as we look ahead to the year ahead? Thank you very much.
Bill Kozy (Chairman and Interim CEO)
Yeah, Rick, thank you. Let me take the latter part of that question first. Just to be clear, our manufacturing organization on the cardiopulmonary side, focused on oxygenators, are running flat out right now. We don't have any more available capacity. Everything that we make, we sell. We were surprised that our competitors have not yet seemingly put much greater volume back into the marketplace. And so I have given up trying to predict if and when that's going to happen, because we just don't know, you know? We mentioned to you guys last quarter that we were pretty sure they were gonna be back. Clearly, the numbers we just showed you, they've not popped back. I actually have been asking a lot of the same questions you're asking about the upcoming year. We can't project that, and we won't.
As it relates to 2024, we really are looking forward to covering that in much greater detail, Rick, with you and, and all others, when we do our fourth quarter call. We had an encouraging and successful board meeting in October, where we took our strategic business plan for the coming year. Let us just defer that discussion until we get to the fourth quarter results.
Rick Wise (Managing Director)
Thanks very much, Bill.
Bill Kozy (Chairman and Interim CEO)
Hey, Rick. Thanks.
Operator (participant)
Thank you. Our next question comes from Mike Polark of Wolfe Research. Your line is now open, please go ahead.
Mike Polark (Senior Equity Research Analyst)
Hey, good morning. Thank you for the question. One, one more on cardiopulmonary, and I'm specifically looking at the implied fourth quarter guidance. If I'm doing the math right, segment revenue down sequentially and year on year, it just strikes me as very conservative. The question is, on the oxygenator disruptions at competitors, can you remind us on the timing of that over the last year or 18 months? Was that primarily a 2023 phenomenon, or, or are there some tough comps in the back half of 2022 that we're coming up upon?
Bill Kozy (Chairman and Interim CEO)
Hey, Mike. Yeah, thanks. Thanks for the question. You're on to a really important topic. And by the way, this is our math and our math only. But we did start to see the first escalation in the oxygenator revenue uptake in the fourth quarter of 2022. So number one, we know that we're up against a little bit of a tougher comp as we go into that quarter. Number two, and please excuse me, I'm not trying to be repetitive here, but we're just running flat out in the plants. I can't, and our organization can't produce any more oxys. So when we do our projections based on those two critical factors, we're having a really hard time seeing how we could sustain the double-digit growth.
So once we're in the fourth quarter of 2023, against that tougher comp, and as we look forward on oxys, we can't see the sustainability. Now, of course, we're looking at everything we can do in the short term to optimize our production capabilities, but you guys know well, we've got molding, assembly, packaging, and sterilization here. There's just no magic wand where we can, in a very short term, create a notable recovery scenario. And by the way, we are operating well within all the quality boundaries of our quality management system to make sure that we're not just optimizing volume, but everything that's going out of that facility is at the quality levels we expect. So by the way, I'm not in any way complaining about all that.
I'm just sharing that we're doing the absolute best that we can in the situation that we have.
Mike Polark (Senior Equity Research Analyst)
Helpful. For my follow-up, I'll ask on the CEO search. Appreciate the comments. I guess as I look at LivaNova, you know, but my question is, is it difficult to find the right fit before you know, you know, what happens with depression and sleep as examples? Those are potentially transformative opportunities. Still have to clear clinical data risk, and I just-- is it-- I roll this forward, Bill, and kind of wonder if, you know, a better timing for somebody new would be middle or back half of next year, when you maybe know a little bit more about these pipeline programs and how the data is gonna turn out, and therefore, the potential commercial prospects. Any color on this would be great. Thank you so much.
Bill Kozy (Chairman and Interim CEO)
Yeah, thanks for the question. Actually, we have been pleasantly encouraged by the number of people who want to be a CEO. The same questions that you have asked, we have been getting asked in our process, but I see no hint that it's dampened candidate interest in people coming to the company. As I mentioned in my earlier remarks, the board and myself are in, and have been in some active interviewing now since late August, early September. All our attention is on finding the right person. We said initially, it would more likely take six-nine months. We kind of moved a little past the six-month window, but we'll continue to do two things: Keep the process at the level of quality that we have it, and we're not flexing on our spec.
When we say we're gonna find the right person, we've described over the last couple of calls, you know, those things that are really important to us in terms of getting the right candidate, and we're just, we're just staying connected to that.
Mike Polark (Senior Equity Research Analyst)
Thank you.
Bill Kozy (Chairman and Interim CEO)
Sure. Thank you for the question.
Operator (participant)
Thank you. Our next question comes from Adam Maeder of Piper Sandler. Your line is now open. Please go ahead.
Adam Maeder (Senior Research Analyst)
Hi, good morning, guys. Thank you for taking the questions, and congrats on the next quarter. I wanted to start on-
Bill Kozy (Chairman and Interim CEO)
Thanks. Good morning.
Adam Maeder (Senior Research Analyst)
Good morning. Wanted to start on specifically CP and heart-lung machines, and I think you said that segment grew 25%, HLM did in Q3. I'm curious if you can just talk a little bit more about the Essenz rollout. What was the contribution in the quarter from Essenz? How many systems did you place? Kinda how you foresee that evolving going forward. And then also just remind us on the pricing strategy relative to S5, and then I had a follow-up. Thanks.
Bill Kozy (Chairman and Interim CEO)
Sure. Thanks for the question. We did move, as I mentioned in my earlier comments, to a, you know, kind of a full launch. And for sure, our HLM revenue growth was driven primarily by Essenz installations in U.S. and Europe, with just some S5 placements in Rest of World. All of our Essenz orders to date are achieving the expected price target. We have talked in the past that we were expecting to, because of the quality advancements in technology in Essenz, we were hoping to get round about a 30% price premium above traditional S5. At this very early stage, all of that expectation is being achieved. We're not yet at a point where we're gonna start talking about units placed.
What we actually are enthused about is the quality of our pipeline and funnel, and the customer interest that we're seeing in both U.S. and Europe. So what we'd hope to do is prove ourselves even to the next level, if you would, in the fourth quarter, and then we can circle back some more on Essenz performance as 2024 starts to roll out.
Adam Maeder (Senior Research Analyst)
That's great color, Bill. Thank you for that. For the follow-up, you know, realize you're not a little bit limited in terms of what you can say on 2024, but I did wanna ask about the heart failure program closure. You know, I think that's $24 million of spend this year. You know, any updated thoughts, even just broad strokes on how you think about that spend as it relates to next year, letting that flow through to investors versus reinvestment in the business? And then I guess I'll test my luck and also ask about associated spend with depression and OSA next year as well. Thank you.
Bill Kozy (Chairman and Interim CEO)
Okay, sure. Let me, I'm gonna, you know, I'm gonna have Alex comment on our heart failure. He's got his, a real tight handle on our game plan there.
Alex Shvartsburg (CFO)
Hi, Adam. So look, our heart failure program. We continued down the path of closing that out by the end of the year. We expect some residual costs into next year. You know, we're looking at our capital deployment as part of our budgeting process. We'll update you guys, you know, as we end Q4 and on all of our expectations for performance in next year.
Bill Kozy (Chairman and Interim CEO)
And to close out on your DTD, OSA questions, what we did, as you would expect in our business planning, is the best we can do, given the little bit of uncertainty that resides, particularly on DTD, is do scenario planning. We have completed scenario planning for a possible launch of that product, obviously not until we get into 25, but we would have to start to prepare our homework for late 2024 commercial activity. That's what we'll talk about when we get into our fourth quarter review, and we'll actually be prepared to give you quite a bit of insight, I think, in both of what we're going to try and do, why we're going to do it, and what that spend will be. As you would already guess, there are more than a few moving parts there.
So we're gonna take the benefit of the next couple of months to really button that down, but we have a really good kickoff on that planning effort. Of course, the scenario has to operate under the financial premise that depression has a chance to be a goer, and more details to follow.
Adam Maeder (Senior Research Analyst)
All right. We'll stay tuned. Thanks again.
Bill Kozy (Chairman and Interim CEO)
Hey, thank you.
Operator (participant)
Thank you. Our next question comes from Matt Taylor of Jefferies. Your line is now open. Please go ahead.
Matt Taylor (Managing Director)
Hi, thank you for taking the question. I guess I was wondering if you could talk a little bit more about the epilepsy dynamics, you know, under the hood, and give us some color on trends in new patient starts, you know, the replacements. Also, the things that you've been doing with your sales force, you know, how the landscape's been with the centers opening, and maybe carry that forward and talk at least at a high level about what to expect with those dynamics next year.
Bill Kozy (Chairman and Interim CEO)
Hey, Matt. Thanks. We've got the benefit of having Steph here, and she has been spending inordinate amounts of time on these two topics, so I'm gonna just turn that question right over to, to Stephanie Bolton.
Stephanie Bolton (President of Global Epilepsy)
Thanks, Matt. As mentioned during the last call that we had, we've really been focusing on producing consistent performance and having a consistent execution. I continue to be encouraged by what that looks like with the team, particularly in the U.S. We keep leaning into our consistent operating mechanism and focusing on the fundamentals of the collaboration between the different groups. Our Q3 was another sort of consistent execution quarter, and our NPI, entirely in line with our expectations, given how we exited Q2. I'm really pleased that we'll continue to anticipate that normal run rate as we move through towards the end of the year.
In terms of the sales teams, they are very much focused on our customers that have the most amount of opportunity to treat our DRE population. We continue with our CEC strategy, with our CAMs in the field. Everything is moving in a very nice direction, and we continue to work on our consistent execution.
Matt Taylor (Managing Director)
Very good. Anything notable to call out in terms of changing dynamics next year in the business?
Stephanie Bolton (President of Global Epilepsy)
No, no notable changes as it stands now. We have full and appropriate coverage in the U.S. of our CECs, and they remain our firm priority moving forward.
Matt Taylor (Managing Director)
Okay, great. Thank you very much.
Stephanie Bolton (President of Global Epilepsy)
Thank you.
Bill Kozy (Chairman and Interim CEO)
Thank you, Matt.
Operator (participant)
Thank you. Our next question comes from Mike Matson of Needham & Company. Your line is now open. Please go ahead.
Mike Matson (Senior Analyst)
Yeah, thanks. I guess just, you know, good to see the strong growth in ACS. So, you know, is that-- do you think that's back to kind of steady, strong, double-digit growth now?
Bill Kozy (Chairman and Interim CEO)
Well, we continue to keep our eyes on that. When we had, let me give you just a little bit of color on the ACS side. I mentioned just briefly that, you know, we had some case volume benefit. In fairness, we had a couple of other smaller tailwind events that happened in the quarter, and that related to some backorder clearance, a few minor catch-ups in purchases in Europe, and a one-time adjustment in service revenue. And so it was the combination of those three things that kind of elevated that year-on-year growth for ACS. We're maintaining kind of our full-year guidance, continuing to work closely with our ACS leadership team to look at how we can further grow and improve profitability in the year ahead.
But our guidance remains pretty much the what we mentioned to you last time.
Mike Matson (Senior Analyst)
Okay, thanks. Then just as far as OSPREY goes, you know, good to hear that you've got the, all the sites up and running. You, can you give us any sort of update on the, where enrollment is and, you know, what your expectation is in terms of when the data could be released? Is it possible we could see in 2024, or is it really gonna be more 2025?
Bill Kozy (Chairman and Interim CEO)
Yeah, I'm gonna flip that one right to Matt.
Matthew Dodds (Senior VP of Corporate Development and IT)
Sure. Thanks, Mike. So OSPREY, as Bill said, was on track. You know, we've talked about getting the enrollment completed in 2024, six-month follow-up. To your point, you know, it looks right now like kinda late 2024, early 2025, we'd get the data, you know, a little bit of time to analyze it. And then that's why we've talked about a filing in 2025.
Mike Matson (Senior Analyst)
Okay. Got it. Thank you.
Operator (participant)
Thank you. Our next question comes from Anthony Petrone of Mizuho Group. Your line is now open. Please go ahead.
Anthony Petrone (Managing Director)
Thanks. Maybe one on epilepsy, and then I'll ask a little bit about margins. Maybe just a little bit more on end of service.
I know the company is actually tracking those patients. Just wondering where you guys are in terms of how many patients are still in the queue for end of service. And would assume that most of those would be, if they choose to upgrade, they would upgrade at SenTiva. And then I'll have a follow-up on margins.
Bill Kozy (Chairman and Interim CEO)
Hey, thanks, Anthony. I'm going to flip that one over to Steph.
Stephanie Bolton (President of Global Epilepsy)
Sure. Hi, Anthony. Nice to speak to you. So each quarter we have an overview of our identification for both end of service and NPI, and I continue to be encouraged by what that looks like. For sure, you're absolutely right. The end of service patients that we have coming through now are opting to move to our SenTiva platform. So again, we're seeing incremental improvement, and that's the piece that you see around the mix and the change. That's with end of service patients opting to move to our latest platform.
Anthony Petrone (Managing Director)
And again, in terms of the tailwind, I mean, can that last all the way through 2024 into 2025, or are you ending the end of the queue there on End of Service? And then just quickly on margins, just to recap on the amount of R&D spend on RECOVER, and then under a scenario where you don't get an ideal readout there, I'm wondering, will those R&D dollars be redeployed elsewhere in the business, or would you let those fall to the bottom line? Thanks again. Congrats on a good quarter here.
Stephanie Bolton (President of Global Epilepsy)
I think what I'd like to say in terms of end of service, we keep updating our models every single quarter. So we should have more information on that towards the beginning part of next year. Due to the fact that a number of our patients are opting for SenTiva, and we launched in 2017, so we're starting to see the first replacements of those. We'll continue to see a slightly higher end of service identification because of that reason. But we'll keep you updated with that.
Alex Shvartsburg (CFO)
Anthony, on depression, the RECOVER study burn is approximately, call it $30 million on an annual basis. And so, you know, to answer your question about how we think about capital deployment for next year, again, as I said, you know, we'll update you guys, you know, early in 2024 about how we're thinking about our budget and guidance for next year. Obviously, there's multiple scenarios as they relate to depression.
Bill Kozy (Chairman and Interim CEO)
But that depression will be fully funded throughout 2024, unless we get some kind of unexpected news in June of 2024.
Alex Shvartsburg (CFO)
Correct.
Anthony Petrone (Managing Director)
Thank you.
Bill Kozy (Chairman and Interim CEO)
Hey, thanks for the question.
Operator (participant)
Thank you. Our next question comes from Matt Miksic of Barclays. Your line is now open. Please go ahead.
Matt Miksic (Equity Research Analyst)
Thanks so much. Can you hear me okay?
Bill Kozy (Chairman and Interim CEO)
We can. Good morning.
Matt Miksic (Equity Research Analyst)
Great. Terrific. Good morning. Thanks, and, and congrats on the quarter.
Bill Kozy (Chairman and Interim CEO)
You bet.
Matt Miksic (Equity Research Analyst)
So, yeah, just, one question, following up on some of the work that you're doing with, in, in the epilepsy business, and I guess maybe this is for Stephanie or for the team. You know, is this something that, you know, given the, sort of, new implants in the quarter, you know, seemed like they maybe dipped a bit, you said it was in line with your expectations. Just to get us a sense of the cadence for the year and how we should think about, you know, Q4, now you're entering 2024. Is that something we should expect to kind of sequentially improve, or is there another quarter or two of, of, I'm sorry, internalizing some of the new, the new programs and, and, a pipeline concept that would put the improvement in, in trends into 2024?
I had one follow-up.
Stephanie Bolton (President of Global Epilepsy)
Yeah. Hi, Matt. So as I look specifically at Q3, and the reason why I say I'm continued, or I continue to be encouraged by that sort of consistent execution, is when we look back towards Q2, we had a 13% increase in our NPI for that quarter. So it is entirely in line with my expectation that we saw what we did in Q3. In fact, because I was, you know, I, I continue to be encouraged due to the fact that we didn't see a dip. Now, when we look towards the fourth quarter, I'll refer you back to the original full year guidance that we gave in terms of mid-single digit for NPI and end of service. So we anticipate a normal run rate for the fourth quarter.
Matt Miksic (Equity Research Analyst)
Okay. Thanks for that. And then just to follow up on sort of, you know, cash flows and maybe the ability to sort of reinvest your priorities for reinvesting some of the R&D spend that you're unwinding, you know, into the end of this year. You know, if you could provide any color on your most recent thought, and I understand there's a stock plan underway, and there's a new CEO, you know, potentially coming on board soon, and you want to get ahead of that. But you know, your latest thoughts on how to think about that adding back to the P&L and maybe being redeployed, you know, for what kinds of investments? Thanks.
Alex Shvartsburg (CFO)
Matt, this is Alex. I'll take the free cash flow and then. We, you know, our target for this year is $85 million-$95 million of adjusted free cash flow. Our goal is to continue to drive cash conversion. That's what the organization is focused on. That is assuming an expectation that we continue to see improvements in profitability and working capital management. As far as, you know, capital deployment for next year, you know, we're not ready to talk about that at this point. Obviously, there are multiple scenarios in terms of success with depression and getting us ready for a potential launch there.
We'll update you guys as we get into 2024, early in the first quarter.
Matt Miksic (Equity Research Analyst)
Okay, fair enough. Thanks.
Bill Kozy (Chairman and Interim CEO)
Thank you.
Operator (participant)
Thank you. Our next question comes from David Rescott of Baird. David, your line is now open. Please go ahead.
David Rescott (Senior Research Analyst)
Hey, guys. Thanks for taking the question. I wanted to start on Essenz and kind of the margin contribution from that segment. I appreciate the, you know, comments around the pricing premium. I know it's really in the early days here, still of just getting underway, but just wondering how we should think about maybe the contribution or leverage from that product as that ramps and as you move into 2024 and beyond, just relative to the rest of the portfolio.
Alex Shvartsburg (CFO)
So this is as far as Essenz margins are concerned, you know, we expect sort of some margin improvement as we scale the volumes there. The cost base is slightly higher, and we obviously compensate for that with our price premium at this point. Essenz, as it continues to ramp into 2024, will have a margin improvement for the cardiopulmonary business. Our capital business has a higher margin base than our consumable business. So slightly different perhaps from other companies, but that's the way we think about the business, that Essenz will have a strong contribution to our gross margin improvement in 2024.
David Rescott (Senior Research Analyst)
Okay, that's helpful. And then just two, two quick follow-ups on, on I think some prior comments that you made actually at our conference. Just wondering, one, I think the prior expectation maybe had been to have a CEO replacement, in place by January of 2024. So wondering if that's still the, expected timeline. And, and then second, I, I think we had asked, in the past just about whether or not any of this concern or anything you're seeing around GLP-1s are impacting the enrollment of the OSPREY trial. So just wondering if there's any, updated thoughts on, on both of those. Thank you.
Bill Kozy (Chairman and Interim CEO)
Hey, thank you. I'll take the first one. You're exactly right. We had talked back in April, at the time of my arrival, about a six-nine-month window, and of course, that 9-month window would take us into the January timeframe. We're not. I, as you would guess, you know, we're not operating under any deadline. We're gonna find the right person. We'll know that right person when we see them. Every effort is being made to get that person in sooner. I want to make sure that that commitment is clear. At the same time, we'll find that right person, and we won't be pushed by any time frames or calendars or anything.
So, the board is very sincerely committed to the spec, as I mentioned just a few minutes ago, and I don't think we're gonna see us waver from that. Now, Matt, would you comment on the GLP-1, please?
Alex Shvartsburg (CFO)
Sure. On the GLP-1s, we don't believe we're seeing any impact on the enrollment of OSPREY. And also, you know, that trial is relatively small, 125-150 patients. Those are expectations, so, we're not seeing anything.
David Rescott (Senior Research Analyst)
Okay, great. Thanks.
Bill Kozy (Chairman and Interim CEO)
Hey, thank you.
Operator (participant)
Thank you. Our next question is a follow-up question from Mike Polark of Wolfe Research. Your line is now open. Please go ahead.
Mike Polark (Senior Equity Research Analyst)
Hey, thank you for taking the follow-up. Just one. Alex, I thought in your prepared remark, you said something about the tax rate. What did you say? What, what's a good input in 2024, 2025?
Alex Shvartsburg (CFO)
Yeah, thanks, Mike. Recall from our Investor Day in December 2021, we kind of foreshadowed an increased tax rate. At that time, we were saying that over the course of 2022-2024, we'd expect a tax rate to be in the range of 15%-20%. We're gonna see that happen in 2024. So that's what I would recommend that you guys start modeling.
Mike Polark (Senior Equity Research Analyst)
So I just want to be clear there. This is for your adjusted reporting. The adjusted tax rate goes from something like 10% this year to 15% or 20% next year? And, and-
Alex Shvartsburg (CFO)
That is-
Mike Polark (Senior Equity Research Analyst)
If that's true, what's driving it? I mean, what are the changes?
Alex Shvartsburg (CFO)
Yeah, that's correct. The changes are we're enjoying a very low tax rate today. It's very different versus if you look at some of our competitors. And you know, we expect that to kind of normalize as some of our tax planning. We lose the benefits of some of the tax planning that we've enjoyed over the last few years.
Mike Polark (Senior Equity Research Analyst)
Okay. It's just that feels. Yeah, it feels like a big step up. So okay, appreciate the comments. Thank you.
Bill Kozy (Chairman and Interim CEO)
Hey, thank you.
Operator (participant)
Thank you. At this time, we currently have no further questions, so I'll hand it back to Bill Kozy for any further remarks.
Bill Kozy (Chairman and Interim CEO)
Thank you, everyone, for joining us on today's call. On behalf of the entire team, we appreciate your support and your interest in LivaNova. Thank you.
Operator (participant)
Thank you for joining today's call. You may now disconnect your lines.