Vapotherm Reports Fourth Quarter and Fiscal Year 2020 Financial Results

EXETER, N.H.–(BUSINESS WIRE)–Feb 24, 2021–
Vapotherm, Inc. (NYSE: VAPO), (“Vapotherm” or the “Company”), a global medical technology company focused on the development and commercialization of its proprietary Vapotherm high velocity therapy® products, which are used to treat Patients of all ages suffering from respiratory distress, today announced fourth quarter and fiscal year 2020 financial results.
Fourth Quarter 2020 Summary

  • Net revenue for the fourth quarter of 2020 was $40.9 million, representing a 214.4% increase over the prior year period
  • Gross margin was 50.6% in comparison to gross margin of 45.1% in the fourth quarter of 2019

Fiscal Year 2020 Summary

  • Net revenue for 2020 was $125.7 million, 161.4% growth over 2019
  • Disposable revenue in 2020 was $56.7 million, 61.8% growth over 2019
  • Gross margin was 50.1% in comparison to gross margin of 44.3% in 2019
  • Worldwide installed base of Precision Flow Hi-VNI systems grew by 72.8% in 2020

“We are pleased with our progress in 2020, which has positioned us well for continued long-term growth beyond the COVID pandemic. During 2020, we saw increased worldwide awareness of High Velocity Therapy, significant growth in the number of new ED Gold and Silver accounts in the U.S., and 72.8% growth in our worldwide installed base of Precision Flow systems,” said Joe Army, President and CEO of Vapotherm. “In 2021, we will focus on educating our Customers on how to use High Velocity Therapy for Patients experiencing Type II respiratory distress, increasing our worldwide installed base, and launching new products worldwide.”
Results for the Three Months Ended December 31, 2020
The following table reflects the Company’s net revenue for the three months ended December 31, 2020 and 2019:

    Three Months Ended December 31,                  
    2020     2019     Change  
    (in thousands, except percentages)  
    Amount     % of Revenue     Amount     % of Revenue     $     %  
Revenue                                                
Capital (product & lease revenue)   $ 21,582       52.8 %   $ 2,920       22.4 %   $ 18,662       639.1 %
Disposable     18,074       44.2 %     9,679       74.4 %     8,395       86.7 %
Service and Other     1,251       3.0 %     411       3.2 %     840       204.4 %
Total net revenue   $ 40,907       100.0 %   $ 13,010       100.0 %   $ 27,897       214.4 %

Net revenue for the fourth quarter of 2020 was $40.9 million as compared to $13.0 million for the fourth quarter of 2019, a 214.4% increase over the fourth quarter of 2019. Total capital equipment revenue, including product and lease revenue, increased by $18.7 million or 639.1% over the fourth quarter of 2019. This increase was due to increased sales of our Precision Flow units as a result of demand related to the COVID-19 pandemic and increased average selling prices in the United States. Total disposable revenue increased 86.7% over the fourth quarter of 2019, primarily driven by an increase in the worldwide installed base of Precision Flow units and increased utilization to treat the respiratory distress experienced by many COVID-19 patients and higher average selling prices in the United States.
Revenue information by geography is summarized as follows:

    Three Months Ended December 31,                  
    2020     2019     Change  
    (in thousands, except percentages)  
    Amount     % of Revenue     Amount     % of Revenue     $     %  
United States   $ 33,612       82.2 %   $ 9,821       75.5 %   $ 23,791       242.2 %
International     7,295       17.8 %     3,189       24.5 %     4,106       128.8 %
Total net revenue   $ 40,907       100.0 %   $ 13,010       100.0 %   $ 27,897       214.4 %

Worldwide revenue growth in the fourth quarter of 2020 was driven by an increase in the number of Precision Flow units sold over the prior year period and to a lesser extent an increase in single-use disposable sales due to higher installed bases of Precision Flow units worldwide.
Gross profit for the fourth quarter of 2020 was $20.7 million, an increase of $14.8 million over the fourth quarter of 2019. Gross margin was 50.6% in the fourth quarter of 2020 compared to 45.1% in the fourth quarter of 2019. Gross margin was positively impacted by improved overhead absorption due to higher production volumes and a higher mix of U.S. revenue.
Operating expenses were $33.0 million in the fourth quarter of 2020, an increase of $14.4 million as compared to $18.6 million in the same period last year. The increase in operating expenses was primarily due to higher sales and marketing expenses as a result of an increase in sales commissions, and increased sales and marketing headcount, and to a lesser extent increased general and administrative expenses as well as research and development expenses.
Net loss for the fourth quarter of 2020 was $17.2 million, or $0.67 per share, compared to net loss of $12.5 million, or $0.60 per share, in the fourth quarter of 2019. Net loss for the fourth quarter of 2020 includes a loss on debt extinguishment of $4.2 million recorded as a result of the Company’s debt refinancing. Net loss per share was based on 25,682,098 and 20,830,169 weighted average shares outstanding for the fourth quarter of 2020 and 2019, respectively.
Adjusted EBITDA was negative $9.1 million for the fourth quarter of 2020 as compared to negative $10.8 million for the fourth quarter of 2019. The $1.7 million improvement in Adjusted EBITDA in the fourth quarter of 2020 was primarily due to higher revenue and gross profit, partially offset by increased operating expenses resulting from higher levels of sales and marketing expenses, primarily sales commissions and increased headcount. Reconciliations of all historical non-GAAP financial measures used in this release to the most comparable GAAP measures can be found in the attached financial tables.
Results for the Twelve Months Ended December 31, 2020
The following table reflects the Company’s net revenue for the twelve months ended December 31, 2020 and 2019:

    Year Ended December 31,                  
    2020     2019     Change  
    (in thousands, except percentages)  
    Amount     % of Revenue     Amount     % of Revenue     $     %  
Revenue                                                
Capital (product & lease revenue)   $ 65,964       52.5 %   $ 11,045       22.9 %   $ 54,919       497.2 %
Disposable     56,711       45.1 %     35,055       72.9 %     21,656       61.8 %
Service and Other     3,058       2.4 %     2,004       4.2 %     1,054       52.6 %
Total net revenue   $ 125,733       100.0 %   $ 48,104       100.0 %   $ 77,629       161.4 %

Net revenue for 2020 was $125.7 million, representing a 161.4% increase over 2019. Total capital equipment revenue, including product and lease revenue, increased 497.2% year over year. This increase was due to increased sales of our Precision Flow units as a result of demand related to the COVID-19 pandemic and increased average selling prices in the United States. Total disposable revenue increased 61.8% year over year, primarily driven by an increase in the worldwide installed base of Precision Flow units and increased utilization to treat the respiratory distress experienced by many COVID-19 patients and higher average selling prices in the United States.
Revenue information by geography is summarized as follows:

    Year Ended December 31,                  
    2020     2019     Change  
    (in thousands, except percentages)  
    Amount     % of Revenue     Amount     % of Revenue     $     %  
United States   $ 99,161       78.9 %   $ 36,583       76.0 %   $ 62,578       171.1 %
International     26,572       21.1 %     11,521       24.0 %     15,051       130.6 %
Total net revenue   $ 125,733       100.0 %   $ 48,104       100.0 %   $ 77,629       161.4 %

Worldwide revenue growth in 2020 was driven by an increase in the number of Precision Flow units sold year over year and to a lesser extent an increase in single-use disposable sales due to higher installed bases of Precision Flow units.
Gross profit for the twelve months of 2020 was $63.0 million, an increase of $41.7 million over 2019. Gross margin was 50.1% in comparison to 44.3% in 2019. Gross margin was positively impacted by improved overhead absorption due to higher production volumes and a higher mix of U.S. revenue partially offset by higher labor costs, increased supplier freight and expediting fees to meet the rapid increase in production capacity.
Operating expenses were $106.1 million for the year ended December 31, 2020, an increase of $36.6 million as compared to $69.5 million in 2019. The increase in operating expenses was primarily due to higher sales and marketing expenses as a result of an increase in sales commissions and increased sales and marketing headcount and, to a lesser extent, general and administrative expenses as well as research and development costs.
Net loss for the year ended December 31, 2020 was $51.5 million or $2.16 per share compared to a net loss of $51.1 million or $2.74 per share in 2019. Net loss for 2020 includes a loss on debt extinguishment of $4.2 million recorded as a result of the Company’s debt refinancing in the fourth quarter of 2020. Net loss per share was based on 23,818,447 and 18,604,707 weighted average shares outstanding for the year ended December 31, 2020 and 2019, respectively.
Adjusted EBITDA was negative $31.8 million for the year ended December 31, 2020 as compared to negative $41.3 million for 2019. The improvement in Adjusted EBITDA in 2020 was primarily due to higher revenue and gross profit, partially offset by increased operating expenses resulting from higher levels of sales and marketing expenses, primarily sales commissions and increased headcount, and to a lesser extent general and administrative expenses and research and development costs.
Cash Position
Cash and cash equivalents were $113.7 million as of December 31, 2020 compared to $139.0 million as of September 30, 2020 and $71.7 million as of December 31, 2019.
Fiscal 2021 Outlook
COVID-19 has driven dramatic increases in our installed base and awareness of the benefits our technology, which will enable us to produce long-term growth post pandemic. Due to the significant and rapid changes in COVID-19 related hospitalizations, forecasting the demand for both our capital and disposables in the near term remains challenging. From an overall business standpoint, we are addressing this variability by positioning ourselves to respond quickly to changes in demand. This was a significant focus during 2020, and we believe we are positioned well to respond quickly to COVID-19 driven increases or decreases in demand. From a financial outlook standpoint, we are providing a range of outcomes based on a set of assumptions derived from the best information available to us at this time.
To start 2021, we saw near peak COVID-19 related hospitalizations across the U.S. and Europe resulting in demand for our capital and disposables at levels we experienced in late 2020. Beginning in mid-January of 2021, we saw a decrease in U.S. hospitalizations from the peak experienced in early January and reduced COVID-19 related demand for our products. In addition, we have not seen meaningful flu related cases or hospitalizations in the U.S. quarter to date which is a trend we expect to continue throughout 2021. Typically, U.S. disposable utilization rates are the highest in the first quarter each year due to the impact of the flu.
Beginning in the second quarter of 2021, we expect that there will be very limited budget dollars available for capital equipment and, as a result, we expect capital sales to decrease significantly year over year given the COVID-19 driven demand we experienced in 2020. In addition, our current expectations are that vaccination efforts will be successful and will result in a declining number of COVID-19 cases and hospitalizations over the last three quarters of the year thereby reducing COVID-19 related demand for our disposables as well. Despite this, we expect that disposables will show year over year growth in the U.S due to an increased installed base and greater awareness of our ability to treat the symptoms of respiratory distress in all patients, including those in Type II respiratory distress. Lastly, given the significant expected year over year decrease in sales and production volumes, especially related to capital equipment, we expect gross margins to decrease in 2021 before improving again in 2022 to levels above 2020.
For fiscal 2021, we expect revenue in the range of $82 million to $88 million, which represents a two-year compound annual growth rate of 33% at the mid-point of this range.
For the first quarter of 2021, we expect revenue in the range of $30 million to $33 million.
For fiscal 2021, we expect gross margin to be in the range of 46% and 48%.
For fiscal 2021, we expect operating expenses to be in the range of $97 million to $99 million.
We are still in a highly dynamic environment given the impact of COVID-19 and should our expectations regarding COVID-19 or other aspects of our operating results not play out as anticipated, it could result in materially different financial results than what we are currently expecting.
Conference Call
Management will host a conference call at 4:30 p.m. Eastern Time on February 24 th to discuss the results of the quarter and the year with a question and answer session. To listen to the conference call on your telephone, please dial (833) 714-0922 for U.S. callers, or +1 (778) 560-2684 for international callers, approximately ten minutes prior to the start time and reference conference code 5693622. To listen to a live webcast, please visit the Investors section of the Vapotherm website at: http://investors.vapotherm.com/events-and-presentations/events . The webcast replay will be available on the Vapotherm website for 12 months following completion of the call. A replay of this conference call will be available by telephone through March 3, 2021 by dialing (800) 585-8367 in the U.S. or (416) 621-4642 outside of the U.S. The replay access code is 5693622.
Website Information
Vapotherm routinely posts important information for investors on the Investor Relations section of its website, http://investors.vapotherm.com/. Vapotherm intends to use this website as a means of disclosing material, non-public information and for complying with Vapotherm’s disclosure obligations under Regulation FD. Accordingly, investors should monitor the Investor Relations section of Vapotherm’s website, in addition to following Vapotherm’s press releases, Securities and Exchange Commission filings, public conference calls, presentations and webcasts. The information contained on, or that may be accessed through, Vapotherm’s website is not incorporated by reference into, and is not a part of, this document.
Non-GAAP Financial Measures
This press release includes non-GAAP financial measures of EBITDA and Adjusted EBITDA, which differ from financial measures calculated in accordance with U.S. generally accepted accounting principles (“GAAP”). EBITDA in this press release represents net loss less interest expense, net, taxes and depreciation and amortization. Adjusted EBITDA in this release represents EBITDA as adjusted for the impact of foreign currency loss or gain, stock-based compensation expense, loss on debt extinguishment and gain on legal settlement. The Company has reconciled all historical non-GAAP financial measures with the most directly comparable GAAP financial measures in tables accompanying this release.
These non-GAAP financial measures are presented because the Company believes they are useful indicators of its operating performance. Management uses Adjusted EBITDA principally as a measure of the Company’s operating performance and for planning purposes, including the preparation of the Company’s annual operating budget and financial projections. The Company believes this measure is useful to investors as supplemental information because it is frequently used by analysts, investors and other interested parties to evaluate companies in its industry. The Company believes Adjusted EBITDA is useful to its management and investors as a measure of comparative operating performance from period to period.
These non-GAAP financial measures should not be considered as alternatives to, or superior to, net income or loss as a measure of financial performance or cash flows from operations as a measure of liquidity, or any other performance measure derived in accordance with GAAP. They should not be construed to imply that the Company’s future results will be unaffected by unusual or non-recurring items. In addition, Adjusted EBITDA is not intended to be a measure of free cash flow for management’s discretionary use, as it does not reflect certain cash requirements such as tax payments, debt service requirements, capital expenditures and certain other cash costs that may recur in the future. Adjusted EBITDA contains certain other limitations, including the failure to reflect our capital expenditures, cash requirements for working capital needs and cash costs to replace assets being depreciated and amortized. In evaluating Adjusted EBITDA, you should be aware that in the future the Company may incur expenses that are the same as or similar to some of the adjustments in this presentation. The Company’s presentation of Adjusted EBITDA should not be construed to imply that its future results will be unaffected by any such adjustments. Management compensates for these limitations by primarily relying on the Company’s GAAP results in addition to using Adjusted EBITDA and other non-GAAP financial measures on a supplemental basis. The Company’s definition of Adjusted EBITDA is not necessarily comparable to other similarly titled captions of other companies due to different methods of calculation.
About Vapotherm
Vapotherm, Inc. is a publicly traded developer and manufacturer of advanced respiratory technology based in Exeter, New Hampshire, USA. The Company develops innovative, comfortable, non-invasive technologies for respiratory support of patients with chronic or acute breathing disorders. Over 2.6 million patients have been treated with Vapotherm high velocity therapy. High velocity therapy is mask-free noninvasive ventilatory support for spontaneously breathing patients and is a front-line tool for relieving respiratory distress—including hypercapnia, hypoxemia, and dyspnea. It allows for the fast, safe treatment of undifferentiated respiratory distress with one tool. The Precision Flow system’s mask-free interface delivers optimally conditioned breathing gases, making it comfortable for patients and reducing the risks associated with mask therapies. While being treated, patients can talk, eat, drink and take oral medication. For more information, visit www.vapotherm.com.
Legal Notice Regarding Forward-Looking Statements
This press release contains forward-looking statements, including statements about our ability to grow our installed base, our ability to educate new customers on the use of Vapotherm’s High Velocity Therapy, especially on hypercapnic patients, increasing our production and our installed base, expanding the limited release of our Oxygen Assist Module, improving our gross margins and expected revenue for the first quarter of 2021 and expected revenue, gross margin and operating expenses for fiscal year 2021. In some cases, you can identify forward-looking statements by terms such as ‘‘expect,’’ “guide” or “typically” or the negative of these terms or other similar expressions, although not all forward-looking statements contain these words. Each forward-looking statement is subject to risks and uncertainties that could cause actual results to differ materially from those expressed or implied in such statement. Applicable risks and uncertainties include, but are not limited to the following: Vapotherm has incurred losses in the past and may be unable to achieve or sustain profitability in the future, Vapotherm may need to raise additional capital to fund its existing commercial operations, develop and commercialize new products, and expand its operations, Vapotherm’s dependence on sales generated from its Precision Flow systems, competition from multi-national corporations who have significantly greater resources than Vapotherm and are more established in the respiratory market, the ability for Precision Flow systems to gain increased market acceptance, its inexperience directly marketing and selling its products, the potential loss of one or more suppliers, Vapotherm’s susceptibility to seasonal fluctuations, Vapotherm’s failure to comply with applicable United States and foreign regulatory requirements, the failure to obtain U.S. Food and Drug Administration or other regulatory authorization to market and sell future products or its inability to secure, maintain, or enforce patent or other intellectual property protection for its products, the impact of the COVID-19 pandemic on its business, including its supply chain, and the other risks and uncertainties included under the heading “Risk Factors” in Vapotherm’s Annual Report on Form 10-K for the fiscal year ended December, 31, 2020, as filed with the Securities and Exchange Commission on February 24, 2021, and in any subsequent filings with the Securities and Exchange Commission. The forward-looking statements contained in this press release reflect Vapotherm’s views as of the date hereof, and Vapotherm does not assume and specifically disclaims any obligation to update any forward-looking statements whether as a result of new information, future events or otherwise, except as required by law.
Financial Statements:

VAPOTHERM, INC.
CONSOLIDATED BALANCE SHEETS
(In thousands, except share amounts)
 
    December 31,  
    2020     2019  
Assets                
Current assets                
Cash and cash equivalents   $ 113,683     $ 71,655  
Accounts receivable, net     23,488       8,243  
Inventories     19,873       9,137  
Prepaid expenses and other current assets     5,041       4,066  
Total current assets     162,085       93,101  
Property and equipment, net     20,573       15,086  
Operating lease right-of-use assets     8,260        
Restricted cash     1,853       1,852  
Goodwill     16,226       588  
Intangible assets, net     5,694       353  
Deferred income tax assets           66  
Other long-term assets     967       844  
Total assets   $ 215,658     $ 111,890  
Liabilities and Stockholders’ Equity                
Current liabilities                
Accounts payable   $ 4,967     $ 3,375  
Contract liabilities     459       137  
Accrued expenses and other liabilities     36,551       9,187  
Short-term line of credit           3,491  
Total current liabilities     41,977       16,190  
Long-term loans payable, net     39,653       41,787  
Revolving loan facility     4,888        
Deferred income tax liabilities     6        
Other long-term liabilities     15,229       174  
Total liabilities     101,753       58,151  
Commitments and contingencies                
Stockholders’ equity                
Preferred stock ($.001 par value) 25,000,000 shares authorized; no shares
issued and outstanding as of December 31, 2020 and 2019
           
Common stock ($.001 par value) 175,000,000 shares authorized as of
December 31, 2020 and 2019; 25,722,984 and 20,851,531 shares issued
and outstanding as of December 31, 2020 and 2019, respectively
    26       21  
Additional paid-in capital     430,781       319,115  
Accumulated other comprehensive income     41       44  
Accumulated deficit     (316,943 )     (265,441 )
Total stockholders’ equity     113,905       53,739  
Total liabilities and stockholders’ equity   $ 215,658     $ 111,890  
Vapotherm, Inc.
UNAUDITED CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except share and per share amounts)
 
    Three Months Ended December 31,  
    2020     2019  
Net revenue   $ 40,907     $ 13,010  
Cost of goods sold     20,196       7,147  
Gross profit     20,711       5,863  
Operating expenses                
Research and development     4,954       3,656  
Sales and marketing     20,958       9,903  
General and administrative     7,114       5,021  
Total operating expenses     33,026       18,580  
Loss from operations     (12,315 )     (12,717 )
Other (expense) income                
Foreign currency gain     77       81  
Interest income     30       202  
Gain on litigation settlement           1,151  
Interest expense     (813 )     (1,313 )
Loss on extinguishment of debt     (4,163 )      
Net loss before income taxes   $ (17,184 )   $ (12,596 )
Benefit for income taxes           (146 )
Net loss   $ (17,184 )   $ (12,450 )
Other comprehensive income                
Foreign currency translation adjustments     38       114  
Total other comprehensive income   $ 38       114  
Total comprehensive loss   $ (17,146 )   $ (12,336 )
                 
Net loss per share – basic and diluted   $ (0.67 )   $ (0.60 )
Weighted-average number of shares used in calculating net loss per share,
basic and diluted
    25,682,098       20,830,169  
Vapotherm, Inc.
CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except share and per share amounts)
 
    Year Ended December 31,  
    2020     2019  
Net revenue   $ 125,733     $ 48,104  
Cost of revenue     62,687       26,793  
Gross profit     63,046       21,311  
Operating expenses                
Research and development     16,956       13,376  
Sales and marketing     65,065       37,689  
General and administrative     24,039       18,410  
Total operating expenses     106,060       69,475  
Loss from operations     (43,014 )     (48,164 )
Other (expense) income                
Foreign currency gain     114       44  
Interest income     257       860  
Gain on litigation settlement     15       1,151  
Interest expense     (4,711 )     (5,096 )
Loss on extinguishment of debt     (4,163 )      
Net loss before income taxes     (51,502 )     (51,205 )
Benefit for income taxes           (146 )
Net loss     (51,502 )     (51,059 )
Other comprehensive income (loss)                
Foreign currency translation adjustments     (3 )     44  
Total other comprehensive income (loss)     (3 )     44  
Total comprehensive loss   $ (51,505 )   $ (51,015 )
                 
Net loss per share – basic and diluted   $ (2.16 )   $ (2.74 )
Weighted-average number of shares used in calculating net loss per share,
basic and diluted
    23,818,447       18,604,707  
Vapotherm, Inc.      
CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)
  Year Ended December 31,
    2020     2019  
Cash flows from operating activities                
Net loss   $ (51,502 )   $ (51,059 )
Adjustments to reconcile net loss to net cash used in operating activities                
Stock-based compensation expense     6,430       3,836  
Depreciation and amortization     4,769       3,078  
Loss on extinguishment of debt     4,163        
Non-cash lease expense     1,140        
Loss on disposal of property and equipment     250       101  
Amortization of discount on debt     222       234  
Provision for bad debts     72       104  
Deferred income taxes     70       (147 )
Provision for inventory valuation     (534 )     (543 )
Gain on litigation settlement           (1,151 )
Changes in operating assets and liabilities:                
Accounts receivable     (14,810 )     (833 )
Inventories     (10,157 )     5,606  
Prepaid expenses and other assets     (483 )     (1,218 )
Accounts payable     1,461       720  
Contract liabilities     322       58  
Accrued expenses and other liabilities     20,273       1,552  
Operating lease liabilities, current and long-term     (1,154 )      
Net cash used in operating activities     (39,468 )     (39,662 )
Cash flows from investing activities                
Purchases of property and equipment     (9,797 )     (4,747 )
Acquisition of business, net of cash acquired     (8,372 )     (1,560 )
Net cash used in investing activities     (18,169 )     (6,307 )
Cash flows from financing activities                
Proceeds from issuance of common stock in connection with public offering, net     94,155       48,669  
Proceeds from issuance of common stock in connection with at-the-market offering,
net
    9,927        
Proceeds from issuance of common stock under Employee Stock Purchase Plan     824        
Proceeds from exercise of stock options and purchase of restricted stock awards     593       386  
Common stock offering costs     (471 )     (393 )
Proceeds from loans     40,000       10,500  
Repayment of loans     (42,500 )      
Payments of debt extinguishment costs     (3,765 )      
Debt issuance costs     (475 )     (29 )
Proceeds from short-term line of credit and revolving loan facility     5,883       7,500  
Repayments on short-term line of credit     (4,495 )     (7,184 )
Net cash provided by financing activities     99,676       59,449  
Effect of exchange rate changes on cash, cash equivalents and restricted cash     (10 )     5  
Net increase in cash, cash equivalents, and restricted cash     42,029       13,485  
Cash, cash equivalents and restricted cash                
Beginning of year     73,507       60,022  
End of year   $ 115,536     $ 73,507  
Supplemental disclosures of cash flow information                
Interest paid during the period   $ 4,439     $ 4,793  
Property and equipment purchases in accrued expenses   $ 145     $ 135  
Issuance of common stock upon vesting of restricted stock units and awards   $ 213     $ 402  
Issuance of warrants in conjunction with debt draw down   $     $ 293  

Non-GAAP Financial Measures
The following tables contain a reconciliation of net loss to Adjusted EBITDA for the three and twelve months ended December 31, 2020 and 2019, respectively.

    Three Months Ended December 31,  
    Amount  
    2020     2019  
    (in thousands)  
Net loss   $ (17,184 )   $ (12,450 )
Interest expense, net     783       1,111  
Benefit for income taxes           (146 )
Depreciation and amortization     1,398       859  
EBITDA   $ (15,003 )   $ (10,626 )
Foreign currency     (77 )     (81 )
Loss on extinguishment of debt     4,163        
Gain on litigation settlement           (1,151 )
Stock-based compensation     1,850       1,081  
Adjusted EBITDA   $ (9,067 )   $ (10,777 )
    Year Ended December 31,  
    Amount  
    2020     2019  
    (in thousands)  
Net loss   $ (51,502 )   $ (51,059 )
Interest expense, net     4,454       4,236  
Benefit for income taxes           (146 )
Depreciation and amortization     4,769       3,078  
EBITDA   $ (42,279 )   $ (43,891 )
Foreign currency     (114 )     (44 )
Loss on extinguishment of debt     4,163        
Gain on litigation settlement     (15 )     (1,151 )
Stock based compensation     6,430       3,836  
Adjusted EBITDA   $ (31,815 )   $ (41,250 )

Supplemental Operating Metrics

  December 31,                  
  2020     2019     Change  
  Amount     Amount     Amount     %  
Precision Flow Units Installed Base                              
United States   19,884       11,882       8,002       67.3 %
International   8,766       4,698       4,068       86.6 %
Total   28,650       16,580       12,070       72.8 %
                               
  Three Months Ended December 31,                  
  2020     2019     Change  
  Amount     Amount     Amount     %  
Precision Flow Units Sold and Leased                              
United States   2,406       353       2,053       581.6 %
International   1,114       251       863       343.8 %
Total   3,520       604       2,916       482.8 %
                               
Disposable Patient Circuits Sold                              
United States   136,106       73,276       62,830       85.7 %
International   40,386       22,975       17,411       75.8 %
Total   176,492       96,251       80,241       83.4 %
                               
  Twelve Months Ended December 31,                  
  2020     2019     Change  
  Amount     Amount     Amount     %  
Precision Flow Units Sold and Leased                              
United States   7,706       1,311       6,395       487.8 %
International   3,475       843       2,632       312.2 %
Total   11,181       2,154       9,027       419.1 %
                               
Disposable Patient Circuits Sold                              
United States   414,068       263,092       150,976       57.4 %
International   157,173       88,944       68,229       76.7 %
Total   571,241       352,036       219,205       62.3 %
                               

 
View source version on businesswire.com:https://www.businesswire.com/news/home/20210224005370/en/
CONTACT: Investor Relations:
Mark Klausner or Mike Vallie, Westwicke, an ICR Company,ir@vtherm.com, +1 (603) 658-0011
KEYWORD: UNITED STATES NORTH AMERICA NEW HAMPSHIRE
INDUSTRY KEYWORD: BIOTECHNOLOGY GENERAL HEALTH MEDICAL DEVICES HEALTH MEDICAL SUPPLIES
SOURCE: Vapotherm, Inc.
Copyright Business Wire 2021.
PUB: 02/24/2021 04:01 PM/DISC: 02/24/2021 04:01 PM
http://www.businesswire.com/news/home/20210224005370/en