This October 31, 2025 report delivers a multifaceted analysis of Vivos Therapeutics, Inc. (VVOS), evaluating the company across five critical areas: Business & Moat, Financial Statement Analysis, Past Performance, Future Growth, and Fair Value. We benchmark VVOS against competitors including Inspire Medical Systems, Inc. (INSP), ResMed Inc. (RMD), and SomnoMed Limited, distilling our takeaways through the proven investment frameworks of Warren Buffett and Charlie Munger.
Negative. Vivos Therapeutics is a speculative medical device company facing severe financial distress. The company is unprofitable, consistently burns cash, and has seen its revenue decline in recent quarters. Its unique oral appliance for sleep apnea has not translated into a successful business, generating very low revenue of around $15 million. Historically, the company has destroyed shareholder value, with its stock price falling over 90% since its debut. Despite the low stock price, the company appears overvalued as it lacks profitability or positive cash flow. Given the significant execution risks and unproven business model, this stock is best avoided.
US: NASDAQ
Vivos Therapeutics operates on a business model centered around treating mild-to-moderate obstructive sleep apnea (OSA) and snoring through its proprietary, non-invasive oral appliances. The company's core product is the Vivos System, which includes custom-fabricated devices designed to address the underlying anatomical issues of the airway. Vivos does not sell directly to patients; instead, it trains and certifies dentists and other healthcare professionals, known as Vivos Integrated Providers (VIPs), who then offer the treatment to their patients. Revenue is primarily generated from the sale of these appliance 'kits' to VIPs, with a smaller portion coming from the training programs and related services required to become a certified provider. This model aims to create a network of advocates who are financially and professionally invested in the success of the treatment.
The primary revenue driver for Vivos is its flagship product, the Vivos System appliances. This product line accounted for approximately 94% of the company's total revenue in 2023. These devices, such as the mRNA and mmRNA appliances, are custom-made for each patient and are intended to be worn for 12 to 24 months, primarily in the evening and overnight, to remodel the airway. The global market for sleep apnea devices was valued at over $4 billion in 2023 and is projected to grow steadily, offering a large target market. However, competition is fierce, with giants like ResMed (CPAP machines), Inspire Medical Systems (implants), and SomnoMed (traditional oral appliances) dominating the space. Vivos' gross margins on its products are around 61%, but the company is not profitable due to extremely high sales and marketing costs needed to build its provider network and educate the market. Compared to competitors, Vivos' key differentiator is its claim to be a restorative solution that may permanently correct the underlying condition, whereas CPAP and traditional oral appliances only manage the symptoms while being used. The end consumer is the sleep apnea patient, who typically pays several thousand dollars out-of-pocket for the treatment, as insurance coverage is not widely established. The stickiness of the model lies with the trained dentists; once they invest time and capital into the Vivos training and protocol, they face switching costs. However, the company's moat is still nascent; it relies heavily on its patents and the specialized training of its provider network, but it lacks the brand recognition, scale, and, most importantly, the established reimbursement pathways of its competitors.
Secondary to its product sales, Vivos generates a small but strategic portion of its revenue from training and services, which constituted about 6% of total revenue in 2023. This includes initial training fees for dentists to become VIPs and revenue from ancillary programs like Vivos-Cares, which helps connect patients with providers. This training-centric model is crucial to the company's go-to-market strategy. The market for dental and medical professional training is broad, but Vivos operates in a highly specialized niche. This model's competitive advantage is the creation of a dedicated, trained network that can act as a leveraged sales force. By embedding its protocol within a dental practice, Vivos creates switching costs and a potential network effect, where a larger network of providers can attract more patients, reinforcing the system's value. However, this moat is vulnerable. The model's success is entirely dependent on the ability of these dentists to successfully sell a high-cost, often unreimbursed, treatment to patients, which is a significant challenge. If dentists find the patient conversion process too difficult or unprofitable, they may abandon the system, undermining the entire network.
Vivos Therapeutics has a business model with the potential for a competitive moat, but it remains largely undeveloped and unproven. The company's strength lies in its patented and FDA-cleared technology that offers a novel approach to a widespread health problem. By building a network of trained dental providers, it has created a scalable, albeit costly, channel to market. This strategy attempts to build switching costs for practitioners and leverage their patient relationships.
However, the company's vulnerabilities are profound and currently overshadow its strengths. The most significant weakness is the lack of widespread and predictable reimbursement from insurance payers, which forces reliance on patients' ability to pay thousands of dollars out-of-pocket. This severely restricts the addressable market and puts Vivos at a major disadvantage compared to competitors whose treatments are widely covered. Furthermore, the company faces an uphill battle to generate the robust, long-term clinical data required to convince the broader medical community to adopt its system as a standard of care over well-established alternatives. Until Vivos can overcome these critical hurdles of reimbursement and clinical validation, its business model will remain fragile and its competitive moat tenuous, despite the innovative nature of its products.
A detailed look at Vivos Therapeutics' financials reveals significant weaknesses across the board. The company is not profitable, posting net losses in its latest annual report (-11.14M) and in the two subsequent quarters (-3.86M and -5.01M). Revenue growth has turned negative recently, with year-over-year declines of -11.79% in Q1 2025 and -5.77% in Q2 2025, indicating struggles in the marketplace. While its gross margins are over 50%, the gross profit generated is insufficient to cover the massive operating expenses, leading to substantial operating losses.
The balance sheet has become notably riskier. Total debt surged from 1.51M at the end of fiscal 2024 to 11.58M by mid-2025, causing the debt-to-equity ratio to skyrocket from 0.19 to 2.53. This sharp increase in leverage puts significant strain on the company's financial stability. At the same time, its liquidity position has weakened, with the current ratio falling to 1.05, which means current assets barely cover short-term liabilities. This thin margin for error is a major red flag for investors.
Cash generation is a critical concern, as Vivos is consistently burning cash. Operating cash flow was negative for the last full year (-12.69M) and continued to be negative in the first half of 2025. This cash burn forces the company to rely on financing activities, such as issuing debt and stock, to fund its operations. This is not a sustainable model in the long run and introduces risks of shareholder dilution and potential default. Overall, the financial foundation of Vivos Therapeutics appears highly unstable and speculative.
An analysis of Vivos Therapeutics' past performance from fiscal year 2020 to 2024 reveals a company struggling with fundamental viability. The historical record is defined by a lack of consistent growth, an inability to generate profits, and a heavy reliance on external financing to fund operations, which has severely diluted existing shareholders. This track record stands in stark contrast to key players in the sleep apnea market, such as the profitable market leader ResMed or the high-growth innovator Inspire Medical, both of which have demonstrated far superior execution and financial stability.
The company's growth and scalability have been highly unreliable. After showing some promise with revenue growth of 29.23% in FY2021, sales contracted for two consecutive years, falling -5.1% in FY2022 and -13.87% in FY2023. This volatility indicates significant challenges in commercial execution and market adoption. Profitability has been non-existent. Gross margins have deteriorated from a high of 79.7% in FY2020 to around 60% in FY2024. More importantly, operating and net margins have been deeply negative every year, with operating margins ranging from -66.65% to a staggering -156.21%. This demonstrates a complete failure to scale operations efficiently.
From a cash flow perspective, Vivos has consistently burned through capital. Operating cash flow has been negative in each of the last five fiscal years, totaling over -$65 million in outflows during the period (FY2020-FY2024). Free cash flow has been even worse. To cover these shortfalls, the company has repeatedly turned to the capital markets, as evidenced by large cash inflows from financing activities, such as +$24.17 million in 2021 and +$17.88 million in 2024. This has resulted in a dramatic increase in shares outstanding, with a +311.68% change in FY2024 alone, severely eroding the value of existing shares. Consequently, total shareholder returns have been disastrous, with the stock price collapsing since its market debut.
In conclusion, the historical record for Vivos Therapeutics offers no basis for investor confidence. The company's past is a story of strategic and financial underperformance across every key metric. It has failed to generate consistent growth, durable profitability, or positive cash flow, all while destroying significant shareholder value. This performance suggests deep-seated issues with its business model and execution capabilities when compared to the demonstrated success of its competitors.
The sleep apnea device market, valued at over $4 billion and projected to grow at a CAGR of ~6%, is undergoing a significant shift. A key driver of this change is patient demand for more comfortable and convenient alternatives to the long-standing gold standard, Continuous Positive Airway Pressure (CPAP) therapy, which suffers from notoriously low compliance rates, often cited as low as 50%. This creates a substantial opportunity for innovative solutions. Over the next 3–5 years, the industry is expected to see increased adoption of oral appliances, neurostimulation implants, and other less invasive technologies. Catalysts for this shift include an aging population and rising obesity rates, both of which increase the prevalence of obstructive sleep apnea (OSA). Furthermore, growing awareness of the links between untreated sleep apnea and serious comorbidities like heart disease and diabetes is pushing more patients to seek treatment.
Despite the opportunity, the competitive landscape is intense and entry barriers are high. The market is dominated by large, well-capitalized companies. For new entrants, the path to market is steep, requiring significant investment in clinical trials to generate efficacy data, navigating the complex FDA approval process, and, most critically, securing reimbursement codes from payers like Medicare and private insurers. This final hurdle—reimbursement—is often the most difficult and is becoming a primary determinant of commercial success. Without it, even a technologically superior product can fail. Therefore, competitive intensity is expected to remain high, with success favoring companies that can demonstrate not only clinical efficacy but also cost-effectiveness to payers, and who possess the financial resources to fund extensive marketing and sales efforts to educate both physicians and patients.
The core of Vivos's future growth potential rests on its primary product, the Vivos System of oral appliances. Currently, consumption is limited to a small niche of the total sleep apnea market. Its customers are typically those who have failed or are intolerant to CPAP therapy and have the financial means to pay several thousand dollars out-of-pocket, as the treatment is not widely covered by insurance. This lack of reimbursement is the single greatest constraint on consumption. Other limiting factors include a relatively small network of trained providers (approximately 1,800 as of recent reports), low brand awareness among the general medical community and patients, and a treatment protocol that requires 12-24 months of patient compliance. The addressable market for oral appliances is estimated to be around $300-$400 million annually, but Vivos's ~$17.3 million in 2023 revenue shows it has captured only a tiny fraction of even this sub-segment.
Over the next 3–5 years, a significant increase in consumption of the Vivos System is almost entirely dependent on one catalyst: securing broad insurance reimbursement. If Vivos achieves this, its potential customer base would expand dramatically from a small group of affluent individuals to a large portion of the millions of mild-to-moderate OSA sufferers. This would shift the purchasing decision from one of affordability to one of clinical preference. Conversely, if reimbursement efforts fail, consumption growth will likely stagnate, limited by the constraints of the out-of-pocket model. Competitors are chosen based on a clear hierarchy: insurance coverage, physician recommendation, and clinical evidence. CPAP (ResMed) is the first line of therapy due to its established efficacy and full reimbursement. Hypoglossal nerve stimulators (Inspire Medical) are a reimbursed option for those who fail CPAP. Other oral appliances (SomnoMed) also have established reimbursement pathways. Vivos can only outperform these entrenched players if it proves its unique 'restorative' claim with robust long-term data AND gets on a level playing field with reimbursement. Until then, established competitors will continue to win the vast majority of patients.
The secondary pillar of Vivos's growth strategy is its Vivos Integrated Provider (VIP) training model. Current consumption involves dentists paying for training to be certified to offer the Vivos System. The primary constraint here is the provider's perceived return on investment. Dentists are hesitant to invest significant time and money into a program if they cannot successfully convert their patients into paying customers, a task made difficult by the high out-of-pocket cost. The network's growth could increase substantially if reimbursement makes the Vivos System an easy and profitable service for dentists to offer. However, the network could also experience high churn if providers find the model unsustainable. The key risk is that dentists abandon the system due to low patient acceptance, which would cripple Vivos's only distribution channel. This risk is medium-to-high in the current non-reimbursed environment.
Looking forward, the number of companies in the specialized therapeutic device space for sleep apnea is likely to remain relatively stable or consolidate. The high costs of clinical research, regulatory approval, and commercialization serve as formidable barriers to entry, favoring existing players with scale and access to capital. For Vivos, the most critical forward-looking risk is financial viability. The company is currently unprofitable, with a very high cash burn rate; its selling, general, and administrative expenses alone were 170% of its revenue in 2023. Its future growth plans are entirely contingent on its ability to raise additional capital to fund operations until it can achieve profitability. There is a high probability that if the company cannot secure reimbursement within the next 2-3 years, it will struggle to continue financing its operations, posing an existential risk to the business. A secondary risk is the potential for negative or inconclusive results from ongoing and future clinical trials (medium probability), which would permanently derail its efforts to gain mainstream medical acceptance and insurance coverage.
Based on the available financial data as of October 30, 2025, Vivos Therapeutics presents a challenging case for fair value. The company's persistent unprofitability and negative cash flow render most standard valuation methods ineffective. The stock closed at $2.67, and a careful analysis suggests this price is not justified by the company's financial performance, indicating it is significantly overvalued. With negative EPS of -$1.78 and negative EBITDA, both P/E and EV/EBITDA ratios are not meaningful for VVOS. The only applicable multiple is the Enterprise Value-to-Sales (EV/Sales) ratio, which stands at 1.84. While the median EV/Revenue multiple for the broader Medical Devices industry is 4.7, applying such a multiple to a company with declining revenue (-5.77% in the most recent quarter) and deeply negative margins would be misleading. A more reasonable valuation using a discounted 0.5x to 1.0x EV/Sales multiple implies an equity value between $0.00 to $0.96 per share after adjusting for net debt. The asset-based approach also paints a grim picture. The company's book value per share as of June 30, 2025, was $0.63, but more critically, the tangible book value per share was negative at -$0.83. A negative tangible book value means that after subtracting intangible assets and all liabilities, the value of physical assets is negative, indicating a complete lack of a safety net for shareholders and high financial risk. In a triangulation of these methods, the asset-based valuation suggests a value near zero and the multiples approach points to a value below $1.00. Therefore, a consolidated fair value range of $0.50–$1.00 seems appropriate, with the most weight given to the tangible book value and a heavily discounted sales multiple due to the high operational risk and cash burn.
Bill Ackman would categorize Vivos Therapeutics as a highly speculative venture that falls far outside his investment framework of owning simple, predictable, free-cash-flow-generative businesses. He would be immediately deterred by the company's financial profile, particularly its negligible revenue of ~$15 million against a significant operating cash burn of over -$20 million, funded by dilutive equity offerings that destroy shareholder value. Ackman seeks either high-quality, dominant platforms or underperforming large companies with clear turnaround catalysts; Vivos is neither, possessing no discernible moat against giants like ResMed or better-capitalized innovators like Inspire Medical. For retail investors, Ackman's takeaway would be to avoid such a capital-intensive, unproven business where the probability of total loss is high. His decision would only change if Vivos demonstrated multi-year, profitable growth and secured a fortress-like balance sheet, an unlikely near-term scenario.
Warren Buffett's investment thesis in the medical device sector would mirror his overall philosophy: seeking simple, predictable businesses with durable competitive advantages, strong pricing power, and consistent earnings. Vivos Therapeutics, with its unproven business model, negative operating margins of over -100%, and consistent cash burn requiring dilutive financing, represents the antithesis of a Buffett-style investment. Management's use of cash is entirely focused on funding operating losses, primarily through issuing new shares, which destroys shareholder value. Buffett would be highly concerned by the fragile balance sheet and the lack of a discernible 'moat' against much larger, profitable competitors like ResMed. For retail investors, the takeaway is clear: Buffett would view Vivos as a speculation with a high probability of permanent capital loss, not a value investment. If forced to choose leaders in this broader space, he would favor established, profitable franchises like ResMed (RMD) for its market dominance, Medtronic (MDT) for its diversified cash flows, and perhaps Inspire Medical (INSP) for its powerful regulatory moat. A change in his decision would require Vivos to achieve multiple years of consistent profitability and positive free cash flow, fundamentally transforming it into a different kind of company.
Charlie Munger would likely view Vivos Therapeutics as a speculative venture rather than a serious investment, placing it firmly in his 'too hard' pile. He would prioritize businesses with proven, durable moats and predictable profitability, characteristics Vivos sorely lacks. The company's ongoing cash burn, with operating cash flow at -$20 million on roughly ~$15 million in revenue, and its reliance on dilutive share offerings to fund operations would be seen as cardinal sins. While its oral appliance technology is interesting, its competitive moat appears weak, relying on a lower-bar 510(k) clearance and a therapeutic claim that is not yet the standard of care, unlike the fortress-like positions of competitors. For Munger, the extreme financial fragility and unproven business model present an unacceptable risk of permanent capital loss. The key takeaway for retail investors is that this is a high-risk bet on a technology that may or may not succeed, a far cry from the high-quality compounders Munger prefers.
Vivos Therapeutics operates in the competitive market for sleep-disordered breathing, a field dominated by large, well-capitalized companies. Its primary distinction is its technology—the Vivos System—an oral appliance therapy intended not just to manage symptoms, but to remodel and enhance the airway. This treatment-oriented approach sets it apart from competitors whose products, like CPAP machines or mandibular advancement devices, primarily manage symptoms while the device is in use. This unique value proposition is the core of the company's growth story, targeting a segment of patients and practitioners looking for non-invasive, long-term solutions.
However, this innovative approach comes with significant challenges. As a micro-cap company, Vivos lacks the financial resources, brand recognition, and extensive distribution networks of industry leaders such as ResMed. Its business model relies on training and certifying independent dentists to prescribe and fit its devices, which can be a slower and less predictable path to market penetration than direct sales or traditional distribution. This strategy requires substantial investment in education and marketing to build a critical mass of practitioners, a process that consumes capital without guaranteeing widespread adoption.
The company's financial performance reflects its early stage of commercialization. Vivos is not profitable and has a history of generating negative cash flows, relying on equity financing to fund its operations. This contrasts sharply with established peers who generate stable profits and cash flow. Therefore, an investment in Vivos is a bet on its technology gaining significant traction and disrupting a well-established market. Its success hinges on its ability to demonstrate superior clinical outcomes, secure broader insurance reimbursement, and effectively scale its network of providers before its financial runway runs out.
Inspire Medical Systems offers a fundamentally different solution for obstructive sleep apnea (OSA) compared to Vivos Therapeutics. Inspire's product is an implantable neurostimulation device that actively opens the airway during sleep, representing a high-tech, surgical alternative for patients who cannot tolerate CPAP. This positions Inspire in a premium market segment, distinct from Vivos's non-invasive, dentist-prescribed oral appliance. While both companies target the same underlying condition, their technologies, patient profiles, and business models are vastly different, with Inspire being a much larger, more established growth company with significantly higher revenue and market capitalization.
Winner: Inspire Medical Systems, Inc. over Vivos Therapeutics, Inc.
Inspire possesses a stronger business moat primarily due to significant regulatory barriers and high switching costs. Its technology is protected by extensive patents and requires FDA pre-market approval (PMA), a much higher bar than the 510(k) clearance held by Vivos's devices. Switching costs are extremely high for patients, as the device is surgically implanted. In contrast, Vivos's moat relies on its proprietary treatment protocol and practitioner training, but switching from one oral appliance to another is far less difficult. Inspire's established network of surgeons and ENT specialists (over 1,100 centers in the U.S.) provides a scale and network effect that Vivos's dentist network (over 1,800 trained dentists) is still working to match in terms of revenue generation. Winner: Inspire Medical Systems, Inc. due to higher regulatory hurdles and patient lock-in.
From a financial standpoint, Inspire is in a vastly superior position. Inspire's trailing twelve-month (TTM) revenue is over $780 million, dwarfing Vivos's TTM revenue of approximately $15 million. While both companies are not yet consistently profitable as they invest in growth, Inspire's gross margins are robust at around 85%, whereas Vivos's are lower at approximately 58%. Inspire has a much stronger balance sheet with over $350 million in cash and minimal debt, providing significant liquidity. Vivos, on the other hand, operates with a small cash balance and has historically relied on equity sales to fund its cash burn (-$20 million in operating cash flow TTM). Winner: Inspire Medical Systems, Inc. due to its massive revenue scale, stronger margins, and far superior balance sheet health.
Reviewing past performance, Inspire has demonstrated explosive and consistent growth. Its 3-year revenue CAGR has been over 60%, a testament to the successful commercialization of its implantable device. Vivos's revenue growth has been volatile and from a much smaller base. In terms of shareholder returns, INSP has delivered significant value since its IPO, despite recent volatility, whereas VVOS stock has experienced a substantial and prolonged decline since its market debut. Inspire's stock volatility (beta around 1.5) is high for a medical device company but reflects its growth nature; Vivos's volatility is characteristic of a speculative micro-cap stock with much higher downside risk. Winner: Inspire Medical Systems, Inc. based on a proven track record of hyper-growth and superior shareholder returns.
Looking at future growth, both companies operate in the large and underserved sleep apnea market. Inspire's growth is driven by expanding insurance coverage, international expansion, and increasing patient awareness of CPAP alternatives. Its main challenge is scaling its surgical capacity to meet demand. Vivos's growth depends on its ability to convert dentists into active prescribers and convince patients of its unique long-term treatment claims. Consensus estimates project continued strong double-digit revenue growth for Inspire. Vivos's path is less certain and carries higher execution risk. Inspire has a clearer, more predictable path to continued expansion. Winner: Inspire Medical Systems, Inc. due to its established momentum, broader reimbursement, and clearer growth trajectory.
In terms of valuation, both companies trade at a premium based on future potential rather than current earnings. Inspire trades at a high price-to-sales (P/S) ratio of around 6.5x, reflecting investor optimism about its large market opportunity and proven growth. Vivos trades at a P/S ratio of around 1.0x. While Vivos appears cheaper on a relative sales basis, this reflects its massive risk profile, negative cash flow, and unproven business model. Inspire's premium is supported by its market leadership in its niche and tangible growth metrics. Vivos is a high-risk, low-priced bet, while Inspire is a high-price, high-growth story. Winner: Inspire Medical Systems, Inc. as its premium valuation is better justified by its demonstrated performance and market position.
Winner: Inspire Medical Systems, Inc. over Vivos Therapeutics, Inc. The verdict is decisively in favor of Inspire. It is a market leader with a highly differentiated, FDA-PMA approved product that has achieved significant commercial traction, evidenced by its >$780 million revenue run rate and 85% gross margins. Its primary weakness is its current lack of profitability, but this is a result of aggressive investment in growth. Vivos, by contrast, is a speculative, early-stage company with a fraction of the revenue (~$15 million), weaker margins, and a business model that is yet to be proven at scale. The primary risk for Inspire is maintaining its growth trajectory and reaching profitability, while the risks for Vivos are existential, hinging on market adoption and its ability to secure funding. This comprehensive outperformance makes Inspire the clear winner.
ResMed is the global market leader in treating sleep-disordered breathing, primarily through its portfolio of CPAP machines, masks, and connected software solutions. This makes it a formidable, albeit indirect, competitor to Vivos. While Vivos offers a non-invasive oral appliance aimed at treating the condition's underlying anatomy, ResMed provides the standard of care for symptom management. The comparison is one of a dominant, highly profitable incumbent versus a tiny, disruptive challenger with an unproven technology and business model.
Winner: ResMed Inc. over Vivos Therapeutics, Inc.
ResMed's business moat is exceptionally wide and deep, built on decades of leadership. Its brand is synonymous with CPAP therapy, creating immense trust among physicians and patients. Economies of scale are massive; its global manufacturing and distribution capabilities are unparalleled, allowing it to produce devices at a low cost. Switching costs are moderate but supported by a powerful network effect through its AirView software platform, which connects millions of devices and allows remote patient monitoring. Its moat is further protected by a vast patent portfolio and deep-rooted relationships with sleep labs and durable medical equipment (DME) providers. Vivos has none of these advantages; its brand is nascent, it has no scale, and its network of dentists is small. Winner: ResMed Inc. due to its commanding brand, massive scale, and entrenched network.
Financially, there is no comparison. ResMed is a financial powerhouse, generating over $4.5 billion in annual revenue with consistent profitability. Its operating margin is strong at approximately 28%, and it produces substantial free cash flow (over $800 million TTM). The company has a solid balance sheet, a manageable net debt/EBITDA ratio of ~1.2x, and a history of returning capital to shareholders through dividends and buybacks. Vivos, with its ~$15 million in revenue, negative operating margins (<-100%), and ongoing cash burn, is at the opposite end of the financial spectrum. Vivos's survival depends on external financing, while ResMed self-funds its growth and shareholder returns. Winner: ResMed Inc. based on overwhelming superiority in every financial metric.
ResMed's past performance is a model of consistency. It has delivered steady revenue and earnings growth for over a decade, with a 5-year revenue CAGR of around 10%. This stability has translated into strong, long-term shareholder returns, albeit with some recent volatility due to competitive and market shifts (e.g., GLP-1 drugs). Vivos's performance history is short, marked by revenue volatility and a catastrophic decline in its stock price (>90% since its IPO). ResMed has proven its ability to navigate market cycles and competitive threats while delivering consistent results. Winner: ResMed Inc. for its long track record of profitable growth and value creation.
Both companies face different future growth pathways. ResMed's growth is driven by increasing diagnosis rates for sleep apnea globally, expansion into new geographies, and innovation in digital health and home care. Its growth is mature but reliable. A key risk is the potential impact of weight-loss drugs on the OSA population, though the extent is still debated. Vivos's future is entirely dependent on its ability to disrupt the market and prove its technology is a viable alternative to CPAP. Its potential growth is theoretically much higher, but so is the probability of failure. ResMed's growth is an extension of its current success; Vivos's is a bet on a paradigm shift. Winner: ResMed Inc. for its highly probable, lower-risk growth path.
From a valuation perspective, ResMed trades at a reasonable valuation for a market-leading healthcare company. Its forward P/E ratio is typically in the 20-25x range, and its EV/EBITDA is around 15x, supported by strong profitability and cash flow. It also offers a dividend yield of around 1%. Vivos has a market cap below its annual revenue, but this isn't a sign of value; it's a reflection of extreme risk, unprofitability, and shareholder dilution. An investor in ResMed is paying a fair price for a high-quality, profitable business. An investor in Vivos is buying a speculative option on future success. Winner: ResMed Inc. as it offers quality at a reasonable price, representing far better risk-adjusted value.
Winner: ResMed Inc. over Vivos Therapeutics, Inc. This is a clear victory for the incumbent, ResMed. It is a global leader with a fortress-like moat, exceptional financials ($4.5B+ revenue, 28% operating margin), and a long history of profitable growth. Its primary risks are related to macro market shifts, such as the impact of new obesity treatments, but its core business is robust. Vivos is a speculative micro-cap with an interesting but unproven technology, negligible revenue, and a precarious financial position that makes its future highly uncertain. While Vivos offers a potentially disruptive technology, it lacks any of the fundamental strengths that define a durable investment. The comparison highlights the immense gap between an established market leader and an early-stage challenger.
SomnoMed is a more direct competitor to Vivos Therapeutics, as both companies specialize in oral appliance therapy for obstructive sleep apnea. Based in Australia, SomnoMed is one of the leading global players in mandibular advancement devices, which manage OSA by repositioning the jaw. This makes for a much closer comparison than a CPAP giant or a surgical implant company. SomnoMed is more mature than Vivos, with a longer operating history, higher revenue, and a broader international footprint, though it too has faced challenges in achieving consistent profitability.
Winner: SomnoMed Limited over Vivos Therapeutics, Inc.
SomnoMed has a more established business moat based on its brand recognition among sleep physicians and dentists, particularly outside the U.S. Its core product, SomnoDent, has been on the market for years and is supported by significant clinical data. The company has a direct sales force and manufacturing facilities in multiple regions, giving it a modest scale advantage. Vivos's moat is centered on its unique therapeutic claim of remodeling the airway, which is a key differentiator but one that requires more clinical validation to be widely accepted. While both companies rely on dental professional networks, SomnoMed's is more established in key markets (sales in 28 countries). Winner: SomnoMed Limited due to its longer track record, broader brand recognition, and larger international sales infrastructure.
Financially, SomnoMed is in a stronger, though not perfect, position. Its TTM revenue is approximately AUD $85 million (around USD $56 million), roughly four times that of Vivos. While SomnoMed has also struggled with profitability, it has periodically reached positive EBITDA and operates closer to breakeven than Vivos. Its gross margin is around 65%, slightly better than Vivos's ~58%. SomnoMed maintains a healthier balance sheet with a manageable debt load and a more stable cash position compared to Vivos's constant need for financing to cover its significant operating losses (-133% operating margin TTM). Winner: SomnoMed Limited due to its higher revenue scale, better margins, and more stable financial footing.
In terms of past performance, SomnoMed has delivered steady, if not spectacular, revenue growth over the last decade, with a 5-year CAGR in the high single digits. This demonstrates a resilient business model, though its share price performance has been lackluster, reflecting its struggles to achieve sustainable profitability. Vivos, in its short public history, has shown erratic revenue growth and a share price that has been almost completely wiped out. SomnoMed represents a story of slow, grinding progress, whereas Vivos represents a story of high hopes followed by deep disappointment for early investors. Winner: SomnoMed Limited for demonstrating more consistent, albeit modest, business growth and greater capital preservation.
For future growth, both companies are targeting the large number of OSA patients who are non-compliant with CPAP. SomnoMed's growth strategy involves technological innovation (e.g., connected devices with its Rest-Assure technology), geographic expansion, and deepening its relationships with sleep specialists. Vivos's growth is a higher-risk, higher-reward proposition based on convincing the medical community of its unique therapeutic approach. SomnoMed's path is more incremental and predictable. Given its existing infrastructure and product acceptance, SomnoMed has a clearer line of sight to continued growth, while Vivos must first overcome fundamental adoption hurdles. Winner: SomnoMed Limited for its more proven and less speculative growth strategy.
Valuation-wise, SomnoMed trades at a P/S ratio of approximately 1.0x on the Australian Securities Exchange. This is similar to Vivos's P/S ratio, but for a company with four times the revenue and a much more stable operating history. This suggests that, on a relative basis, SomnoMed offers better value. An investor is buying a more established business with a similar sales multiple. The market is pricing significant risk into both stocks, but the risk associated with Vivos—related to its cash burn and unproven model—is arguably much higher. Winner: SomnoMed Limited as it represents a more fundamentally sound business for a similar valuation multiple.
Winner: SomnoMed Limited over Vivos Therapeutics, Inc. SomnoMed is the clear winner in this head-to-head comparison of oral appliance specialists. It has a more mature business with significantly higher revenue (~$56M vs ~$15M), a global footprint, and a product that is already an established option in the sleep medicine community. While it shares Vivos's challenge of achieving profitability, its operational and financial footing is far more solid. Vivos's key potential advantage is its disruptive technology, but this remains largely unproven in the marketplace. SomnoMed's primary risk is getting squeezed between low-cost competitors and high-tech solutions, while Vivos faces the more immediate risk of business model failure and running out of cash. SomnoMed is a struggling but established niche player, while Vivos is a speculative startup.
ProSomnus is another direct and highly relevant competitor to Vivos Therapeutics, as both are U.S.-based, publicly traded micro-cap companies developing precision oral appliances for obstructive sleep apnea. ProSomnus differentiates itself through its use of advanced manufacturing (robotics and 3D printing) to create highly accurate, patient-specific devices. This comparison pits Vivos's unique therapeutic approach against ProSomnus's focus on technological precision, product quality, and manufacturing efficiency. Both companies are in the early stages of commercialization and face similar financial and market adoption challenges.
Winner: ProSomnus, Inc. over Vivos Therapeutics, Inc.
Both companies possess narrow moats. Vivos's moat is its patented Vivos System and the associated treatment protocol. ProSomnus's moat is derived from its proprietary manufacturing process, material science, and a growing body of clinical data supporting its device efficacy. ProSomnus emphasizes its devices are FDA-cleared for severe OSA and are backed by data showing equivalency to CPAP in some patients, a strong clinical claim. Vivos's claims of airway remodeling are more ambitious but less substantiated by mainstream clinical evidence. ProSomnus's focus on precision and data may provide a more defensible, albeit small, moat than Vivos's harder-to-prove therapeutic claims. Winner: ProSomnus, Inc. for its more evidence-based and technologically-focused competitive advantage.
Financially, ProSomnus is slightly ahead of Vivos, though both are in a precarious position. ProSomnus's TTM revenue is around $30 million, approximately double that of Vivos. Its gross margins are also stronger, typically in the 65-70% range compared to Vivos's ~58%, reflecting its efficient manufacturing process. However, like Vivos, ProSomnus is deeply unprofitable, with significant operating losses and negative cash flow (-$25 million operating cash flow TTM). Both companies are highly dependent on capital markets for survival. ProSomnus's higher revenue base and better gross margin give it a slight edge. Winner: ProSomnus, Inc. due to its larger revenue scale and superior unit economics.
Analyzing past performance for these two micro-caps shows a story of struggle. ProSomnus has achieved a higher level of revenue and has shown a more consistent, albeit still early-stage, growth ramp since it went public via a SPAC. Vivos's revenue has been more erratic. Both stocks have performed exceptionally poorly since their public debuts, with share prices declining more than 90%, reflecting the market's skepticism about their ability to achieve profitability. Neither has a track record that would inspire confidence, but ProSomnus's ability to generate more revenue gives it a marginal lead. Winner: ProSomnus, Inc. based on achieving a higher revenue base in a similar timeframe.
Future growth for both companies hinges on displacing CPAP and other oral appliances. ProSomnus's strategy is to win over clinicians with data on precision and efficacy, and it is pursuing broader medical insurance reimbursement, including a recent Medicare code approval (E0486). This is a major milestone that Vivos has not yet achieved and could significantly accelerate adoption. Vivos's growth relies on the appeal of its 'cure' narrative, which may attract a certain type of patient and dentist but could face skepticism from the broader medical community. The Medicare approval gives ProSomnus a more concrete and immediate growth catalyst. Winner: ProSomnus, Inc. due to its significant progress on the critical front of medical reimbursement.
Valuation for both companies is deep in distressed territory. Both trade at P/S ratios well below 1.0x. ProSomnus's market cap is around $10 million on $30 million of revenue, while Vivos's is around $15 million on $15 million of revenue. Both valuations signal a high probability of failure or significant future dilution. However, given ProSomnus's higher revenue, better margins, and the key Medicare reimbursement milestone, its stock arguably offers a better risk/reward profile. An investor is paying less for each dollar of sales for a business with more tangible progress. Winner: ProSomnus, Inc. as it appears to be the more de-risked of two highly speculative assets, offering better value on a relative basis.
Winner: ProSomnus, Inc. over Vivos Therapeutics, Inc. In this matchup of struggling micro-caps, ProSomnus emerges as the narrow winner. It has built a larger revenue business (~$30M vs ~$15M), achieves better gross margins, and has secured a critical Medicare reimbursement code that provides a clearer path to commercial scaling. Both companies are in a fight for survival, plagued by massive cash burn and decimated stock prices. The primary risk for both is running out of money before their technology gains widespread adoption. However, ProSomnus's focus on manufacturing precision and its recent reimbursement success provide more tangible evidence of progress than Vivos's ambitious but less validated therapeutic claims. This makes ProSomnus a slightly more compelling, though still exceptionally high-risk, proposition.
Nyxoah SA is a European medical technology company focused on developing a unique, leadless, and battery-free hypoglossal nerve stimulation (HGNS) system called Genio for the treatment of Obstructive Sleep Apnea. This places it in the same high-tech, implantable category as Inspire Medical, making it an indirect competitor to Vivos's non-invasive oral appliance. The comparison highlights the different capital-intensive, high-reward paths being taken to solve the OSA problem, with Nyxoah representing another venture-backed, clinical-stage innovator against the commercial-stage but struggling Vivos.
Winner: Nyxoah SA over Vivos Therapeutics, Inc.
Nyxoah's business moat is rooted in its highly innovative and patent-protected technology. The Genio system's key differentiators are its bilateral stimulation capability and its patient-centric design, featuring a small, single implant activated by a disposable patch. This technology required extensive R&D and is protected by significant regulatory hurdles, including CE Mark approval in Europe and ongoing FDA pivotal studies in the U.S. Vivos's moat, based on its 510(k) cleared device and treatment method, is lower-tech and faces fewer regulatory barriers, making it potentially easier to replicate. The complexity and clinical validation required for Nyxoah's product create a stronger, more durable moat. Winner: Nyxoah SA due to its advanced technology and higher regulatory barriers to entry.
From a financial perspective, both companies are in the pre-profitability, cash-burn phase, but Nyxoah is better capitalized to execute its strategy. Nyxoah has generated minimal revenue to date (~€2 million TTM) as it is still primarily in the clinical and early commercialization stage, but it holds a substantial cash position of over €80 million from recent financing rounds. This provides a multi-year runway to fund its critical FDA trials and U.S. market launch. Vivos, while generating more revenue (~$15 million TTM), has a much smaller cash balance (<$5 million) and is constantly facing a funding crunch. Nyxoah's financial strength allows it to focus on execution, while Vivos's financial weakness is a constant strategic distraction. Winner: Nyxoah SA due to its vastly superior balance sheet and funding runway.
Past performance is difficult to compare meaningfully as both are early-stage. Nyxoah's focus has been on clinical development and regulatory milestones, which it has been successfully achieving, including positive results from its DREAM U.S. pivotal study. Vivos has been focused on a slow commercial rollout, with disappointing revenue growth and a collapsing stock price. Nyxoah's stock has also been volatile, but it has maintained a much higher market capitalization (>$200 million) than Vivos, reflecting investor confidence in its technology's potential. Nyxoah has hit its stated clinical milestones more effectively than Vivos has hit its commercial ones. Winner: Nyxoah SA for its successful execution on its clinical and regulatory strategy.
Future growth potential for Nyxoah is immense but contingent on FDA approval in the U.S., the world's largest OSA market. A successful launch would position it as a primary competitor to Inspire Medical, tapping into a multi-billion dollar market. Its growth is binary— FDA approval would unlock massive value. Vivos's growth is more linear and uncertain, depending on the slow process of training dentists and achieving wider acceptance. The potential upside for Nyxoah, should it succeed, is arguably much greater than for Vivos, even if the risk is also high. Winner: Nyxoah SA for its higher potential market impact and 'blockbuster' upside.
Valuation reflects their different stages and perceived potential. Nyxoah has a market capitalization over $200 million with very little revenue, giving it an extremely high valuation based on its future promise. Vivos's market cap is around $15 million. Investors in Nyxoah are paying a significant premium for a de-risked clinical asset with a clear path to a large market. Investors in Vivos are paying a small absolute amount for a commercial business with a highly uncertain future. While Nyxoah is 'expensive', its valuation is supported by its strong balance sheet and late-stage clinical progress. Vivos is 'cheap' for a reason. Winner: Nyxoah SA as its valuation, though high, is better aligned with its tangible progress and future potential.
Winner: Nyxoah SA over Vivos Therapeutics, Inc. Nyxoah is the clear winner, despite being earlier in its commercial journey. Its strength lies in its novel, well-differentiated technology, its successful execution of a rigorous clinical and regulatory strategy, and most importantly, its robust balance sheet (>€80 million in cash), which provides the necessary fuel to reach the lucrative U.S. market. The primary risk for Nyxoah is a negative FDA decision or a flawed commercial launch. Vivos, while already on the market, is hampered by a weak financial position, slow adoption, and a technology whose therapeutic claims are not yet widely accepted by the medical mainstream. Nyxoah is a well-funded, late-stage venture bet, while Vivos is a struggling commercial entity fighting for survival.
Acurable is a private, UK-based medical technology company that competes in the broader sleep apnea ecosystem, but on the diagnostic front. Its flagship product, AcuPebble, is a wearable sensor that simplifies the diagnosis of sleep apnea at home. This makes it an indirect competitor to Vivos; while Vivos provides the treatment, Acurable provides the diagnosis that feeds patients into the treatment funnel. Acurable's success could benefit all treatment providers, but its business model and technology are fundamentally different, focusing on accessible, medical-grade diagnostics rather than therapy.
Winner: Acurable over Vivos Therapeutics, Inc.
As a venture-backed private company, Acurable's business moat is built on its proprietary acoustic sensing technology and algorithms, which are protected by patents. The device has received CE mark in Europe and FDA clearance in the U.S., validating its accuracy and creating a significant regulatory barrier to entry. The simplicity of the device (a small sensor worn on the neck) creates a strong user-experience advantage over complex home sleep tests. Vivos's moat is in its treatment protocol, but Acurable's is in core, patented technology that solves a major bottleneck in the patient journey—diagnosis. Acurable's tech-first moat appears more scalable and defensible. Winner: Acurable for its strong, technology-based moat in the critical area of diagnostics.
Since Acurable is private, detailed financial information is not public. However, it has successfully raised significant venture capital funding, including a notable £9.4 million round, indicating investor confidence in its technology and business plan. This funding provides it with a solid runway to scale its commercial operations in Europe and the U.S. This contrasts sharply with Vivos's public struggles to maintain adequate funding for its operations through dilutive secondary offerings. While we cannot compare revenue or margins directly, a well-funded private company is often in a stronger financial position than a publicly-traded micro-cap facing a liquidity crisis. Winner: Acurable based on its demonstrated ability to attract substantial private investment, implying a healthier financial position.
Past performance for Acurable is measured by milestones rather than stock price. It has successfully developed its product from concept to a commercially available, FDA-cleared device. It has won numerous awards and has published data validating its technology against the gold standard, polysomnography. This is a track record of successful execution on the R&D and regulatory fronts. Vivos's track record is one of struggling commercialization and value destruction for public shareholders. Acurable has consistently hit its development goals, which is the key performance indicator for a company at its stage. Winner: Acurable for its strong track record of product development and regulatory success.
Future growth for Acurable is substantial. The market for home sleep testing is large and growing as diagnosis moves from expensive sleep labs to the home. Acurable's ease of use could allow it to capture a significant share of this market, and it can sell its devices to sleep clinics, hospitals, and potentially directly to consumers. Its growth is tied to the expansion of the diagnostic funnel. Vivos's growth depends on converting those diagnosed patients to its specific therapy. Acurable operates at a less competitive, higher-volume part of the patient journey, giving it a potentially larger and more accessible market. Winner: Acurable for its position in the high-growth diagnostics space, a natural bottleneck and opportunity in the overall market.
Valuation is not publicly available for Acurable. Its valuation is set by private funding rounds. However, successful med-tech diagnostics companies can command high valuations. Given the public market's valuation of Vivos (market cap around $15 million), it is highly likely that Acurable's last private funding round valued it at a significantly higher figure. Investors in Acurable are betting on a focused, tech-driven solution to a clear market need. Vivos offers a more complex and unproven treatment solution that the public market has valued very pessimistically. The implied private valuation of Acurable likely represents a better quality asset. Winner: Acurable on the assumption its private valuation reflects stronger fundamentals and growth prospects than Vivos's public market valuation.
Winner: Acurable over Vivos Therapeutics, Inc. Acurable wins this comparison by focusing on and effectively solving a critical, underserved part of the sleep apnea care pathway: diagnosis. Its innovative, FDA-cleared technology, backed by significant venture funding, gives it a clear and defensible business model. The primary risk for Acurable is commercial execution and competing with other home sleep test providers. Vivos, on the other hand, is trying to sell a complex therapeutic solution from a position of financial weakness. Its risks are more fundamental, related to clinical acceptance and business model viability. Acurable is a focused, well-funded innovator in diagnostics, making it a stronger entity than the struggling therapeutic provider, Vivos.
Based on industry classification and performance score:
Vivos Therapeutics offers a unique, FDA-cleared oral appliance system for sleep apnea, protected by a solid patent portfolio. This gives it a potential technological edge over traditional treatments. However, the company's business moat is weak and unproven, facing intense competition from established standards of care like CPAP machines. Vivos struggles with a lack of widespread insurance reimbursement and has yet to build the body of clinical evidence needed to drive broad physician adoption. The investor takeaway is negative, as the company's significant execution risks in marketing and reimbursement currently outweigh the promise of its technology.
The company's intellectual property is a key asset, with a portfolio of over 50 patents providing a legal barrier against direct competitors copying its unique device designs.
For a medical device company with a novel technology, a strong patent portfolio is a critical component of its competitive moat. Vivos reports having over 50 patents issued or pending globally, covering its core oral appliance technology and treatment protocols. This intellectual property provides a significant barrier to entry for any company looking to create a bio-mimetic device that functions in the same way. The company's commitment to protecting its technology is further demonstrated by its R&D spending, which was approximately 20% of its revenue in 2023. This investment is aimed at refining its products and strengthening its IP fortress. While patents do not protect against different therapeutic approaches like CPAP or surgical implants, they are essential for defending its niche and allowing the company to operate without direct imitation.
The lack of widespread and consistent insurance coverage for the Vivos System is a critical weakness that severely limits patient access and makes it difficult to compete with fully reimbursed treatments.
While Vivos's devices are FDA-cleared, this does not guarantee insurance reimbursement. This is currently the company's single greatest commercial challenge. The treatment is not consistently covered by Medicare or major private insurance payers, meaning many patients must pay the multi-thousand-dollar cost out-of-pocket. This dramatically shrinks the addressable market to only those who can afford it, creating a major headwind to widespread adoption. Competitors like ResMed (CPAP) and Inspire Medical (implants) have well-established reimbursement codes and extensive coverage, making their treatments far more accessible. Vivos is actively working to secure favorable coverage decisions and billing codes, but this is a slow and arduous process with an uncertain outcome. Until this reimbursement barrier is broken, the company's revenue growth potential will remain severely constrained.
Vivos' revenue model is based on one-time sales of its appliance kits for each new patient, lacking the predictable, recurring revenue streams that make a business more resilient.
Unlike companies that sell devices with high-margin disposable components or software subscriptions, Vivos' business model does not have a significant recurring revenue component. The vast majority of its revenue comes from the sale of an appliance kit to a provider for a specific patient's course of treatment. This is essentially a one-time transaction per patient. While a successful dental practice will treat multiple patients over time, creating repeat business, this is not the same as a contractual, predictable recurring revenue stream. The company's revenue is therefore dependent on the continuous generation of new patient leads and treatment starts, which can be volatile and difficult to forecast. The lack of a true recurring revenue model makes the business less stable and more capital-intensive, as it must constantly spend on marketing to acquire new customers.
Vivos is investing heavily in marketing and training to drive physician adoption, but it lacks the large-scale clinical evidence needed to become a standard of care, making its high spending an inefficient path to growth.
Vivos has secured a growing network of over 1,800 trained dentists, indicating some success in physician adoption. However, this growth has come at a tremendous cost. The company's Selling, General & Administrative (SG&A) expenses were $29.5 million in 2023, representing a staggering 170% of its $17.3 million revenue. This level of spending, which is far above industry norms, highlights the immense difficulty and cost of marketing a new treatment paradigm without a foundation of robust, long-term clinical data comparable to the decades of evidence supporting CPAP. While Vivos has published peer-reviewed studies, it has not yet produced the landmark clinical trials needed to change medical practice on a large scale. Its Research & Development (R&D) spending of $3.4 million is substantial for its size but pales in comparison to the R&D budgets of competitors, limiting its ability to generate this evidence quickly.
Vivos has successfully obtained FDA 510(k) clearance for its key devices, creating a significant regulatory moat that any direct competitor would have to overcome.
Gaining clearance from the U.S. Food and Drug Administration (FDA) is a non-trivial, expensive, and time-consuming barrier to entry in the medical device industry. Vivos has achieved this critical milestone, securing 510(k) clearance to market its mRNA Appliance and mmRNA Appliance for the treatment of mild-to-moderate obstructive sleep apnea and snoring in adults. This approval is a tangible asset that forms a key part of its competitive moat. It provides commercial legitimacy and prevents competitors from legally marketing a similar device for the same indication without undergoing their own lengthy and uncertain regulatory review. This moat is a foundational element that enables the company to legally operate and market its products in the largest healthcare market in the world.
Vivos Therapeutics' recent financial statements show a company in a precarious position. The company is consistently unprofitable, with a trailing twelve-month net loss of -14.32M, and it burns through more cash than it generates from operations. While it recently took on significant debt, increasing its total debt to 11.58M, its cash reserves are dwindling and revenues have been declining in the last two quarters. For investors, the company's current financial health presents a high-risk profile, heavily reliant on external funding to sustain its operations.
The company's balance sheet has weakened dramatically due to a massive increase in debt and declining liquidity, signaling high financial risk.
Vivos Therapeutics' balance sheet shows serious signs of strain. The most alarming change is the explosion in leverage. The company's debt-to-equity ratio jumped from a manageable 0.19 at the end of fiscal 2024 to 2.53 by the second quarter of 2025. This indicates that the company is now financed more by debt than by equity, which significantly increases financial risk for shareholders. This was driven by total debt increasing from 1.51M to 11.58M in just six months.
Liquidity has also deteriorated. The current ratio, which measures the ability to pay short-term obligations, fell from 1.5 to 1.05 over the same period. A ratio this close to 1.0 is a red flag, as it suggests the company may struggle to meet its immediate financial commitments. With cash and equivalents dropping from 6.26M to 4.4M, the company's financial cushion is shrinking while its obligations grow. This combination of high debt and low liquidity results in a very weak balance sheet.
The company reports no spending on Research and Development (R&D), a critical red flag for a medical device firm that needs innovation to compete and grow.
For a medical device company, consistent investment in Research and Development (R&D) is the lifeblood of future growth. It is essential for improving existing products and developing new ones to maintain a competitive edge. However, in Vivos Therapeutics' income statements for the last full year and the last two quarters, the line item for 'researchAndDevelopment' is reported as null or zero. This lack of investment is a major concern.
Without any reported R&D spending, it is impossible to assess the company's productivity in this area. More importantly, it raises questions about the company's long-term strategy and its ability to innovate. A medical device company that is not investing in its future product pipeline is likely to fall behind competitors and may struggle to generate sustainable revenue growth over time. This lack of investment is a critical failure.
Although the company's gross margin is over 50%, it has been declining and the gross profit is completely inadequate to cover its high operating costs.
Vivos reported a gross margin of 60% for fiscal year 2024, which on the surface appears healthy. However, this figure has shown signs of weakness recently, dropping to 50.03% in Q1 2025 before a slight recovery to 55.24% in Q2 2025. While these margins are not disastrous in isolation, they are meaningless when the gross profit is dwarfed by operating expenses.
In the most recent quarter, Vivos generated a gross profit of 2.11M. However, its operating expenses for the same period were 6.98M. This means for every dollar of gross profit, the company spent more than three dollars on running the business, leading to a substantial operating loss of -4.87M. The core profitability from selling its devices is nowhere near sufficient to support the company's operational structure, making the business model fundamentally unprofitable at its current scale.
The company's spending on sales, general, and administrative (SG&A) expenses is extremely high compared to its revenue, indicating a highly inefficient and unsustainable cost structure.
Vivos Therapeutics demonstrates a severe lack of sales and marketing efficiency. Its Selling, General & Administrative (SG&A) expenses consistently exceed its total revenue. In fiscal year 2024, SG&A was 19.61M on revenue of 15.03M, meaning SG&A expenses were 130% of sales. The situation worsened in the most recent quarter, where SG&A of 6.67M was 175% of the 3.82M in revenue. This means the company spent $1.75 on SG&A for every $1.00 of sales it generated.
This is the opposite of operating leverage. Instead of revenue growing faster than expenses, the company's cost structure is consuming all of its gross profit and more, leading to significant operating losses. This level of spending is unsustainable and shows that the current business model is not scalable. Without a drastic reduction in costs or a massive increase in sales, the path to profitability is not visible.
The company consistently burns through cash in its daily operations and relies on outside financing to stay afloat, indicating an unsustainable business model.
Vivos Therapeutics fails to generate positive cash flow from its core business operations. For the full fiscal year 2024, the company had a negative operating cash flow of -12.69M. This trend continued into 2025, with negative operating cash flows of -3.8M in Q1 and -3.49M in Q2. Free cash flow, which accounts for capital expenditures, is also deeply negative, coming in at -13.26M for the last fiscal year. A company that cannot generate cash from its operations cannot self-fund its growth or even its day-to-day activities.
Instead of generating cash, Vivos relies on financing activities to survive. In the latest quarter, it raised 11.46M from financing, primarily by issuing 9.64M in new debt. This dependency on external capital is a major risk, as it cannot continue indefinitely and often leads to shareholder dilution or an overwhelming debt burden. The negative free cash flow margin, which was over -100% in the last two quarters, highlights the severe cash burn relative to its sales.
Vivos Therapeutics' past performance has been extremely poor, characterized by volatile revenue, consistent and significant net losses, and high cash consumption. Over the last five years, the company has failed to achieve profitability, with operating margins consistently below -60% and negative free cash flow each year. Unlike successful competitors such as Inspire Medical or ResMed, Vivos has not demonstrated a viable path to scalable growth, leading to massive shareholder dilution and a stock price decline of over 90% since its debut. The historical record presents a clear negative takeaway for investors, showing a business that has consistently destroyed value.
The company has consistently destroyed capital, evidenced by deeply negative returns on equity (ROE) and invested capital (ROIC) every year for the past five years.
Vivos Therapeutics has a track record of profoundly ineffective capital use. Key metrics like Return on Equity (ROE) have been consistently and extremely negative, with figures such as '-92.31%' in FY2021 and '-521.22%' in FY2023. Similarly, Return on Invested Capital (ROIC) has been poor, ranging from '-49.96%' to '-224.74%' over the last five years. These figures indicate that for every dollar invested in the business, a significant portion has been lost rather than used to generate profits.
Furthermore, the company's capital allocation strategy has been detrimental to shareholders. Instead of returning capital via dividends or buybacks, Vivos has relied on issuing new stock to fund its cash-burning operations. This has led to massive shareholder dilution, with the share count increasing by 65% in 2021 and a staggering 311.68% in 2024. This continuous destruction of capital and dilution of ownership is a clear sign of a struggling business model.
While specific guidance figures are not available, the company's persistent net losses, negative cash flows, and catastrophic stock performance strongly indicate a consistent failure to execute on its strategic and financial objectives.
A company's ability to meet its own forecasts and Wall Street's expectations is a key indicator of management credibility and operational control. In the case of Vivos, the financial results speak for themselves. The company has posted significant net losses each year, including -$20.29 million in FY2021 and -$23.85 million in FY2022, on relatively small revenues. The stock price has collapsed by over 90% since its public debut, which is a clear market verdict on the company's performance versus expectations.
This pattern of value destruction suggests a profound gap between the company's plans and its ability to deliver. Consistently burning cash and failing to achieve profitability points to fundamental flaws in execution. This performance record has understandably eroded investor confidence, as the company has not demonstrated an ability to manage its business toward stated or implied financial goals.
The stock has delivered catastrophic losses to shareholders since going public, with its value declining over 90% amid extreme volatility and significant underperformance versus its peers and the market.
Past stock performance is a direct reflection of the market's judgment on a company's execution and future prospects. For Vivos, that judgment has been overwhelmingly negative. As noted in competitor comparisons, the stock has lost more than 90% of its value since its IPO. The market capitalization has shrunk from over 100 million in 2020 to under 20 million currently, representing a massive destruction of shareholder wealth. The stock's beta of 6.87 indicates extreme volatility, which in this case has been almost entirely to the downside.
This performance stands in stark contrast to more successful peers in the sleep apnea space. While all stocks have periods of volatility, the near-total loss of value in VVOS stock points to fundamental issues with the business that have caused investors to lose confidence. The historical return for anyone who invested in the company has been profoundly negative.
Vivos has never achieved profitability, and its key margins have either stagnated at deeply negative levels or worsened over the last five years, showing no signs of improvement.
An analysis of Vivos's profitability trends reveals a business that is fundamentally unprofitable. Over the past five fiscal years, the company has not had a single profitable year, with net losses ranging from -$11.14 million to -$23.85 million. The trend in margins offers no encouragement. Gross margin, a measure of basic product profitability, has declined from a peak of 79.7% in FY2020 to 60% in FY2024.
Operating margin, which shows the profitability of the core business, has been extremely poor, ranging between '-66.65%' and '-156.21%'. This indicates that operating expenses have consistently dwarfed the gross profit generated from sales. Because earnings per share (EPS) have always been negative, there is no positive growth trend to analyze. The complete absence of profitability and the lack of any positive momentum in margins is a critical weakness.
Revenue growth has been highly erratic and unreliable, featuring two consecutive years of decline within the last five years, which is a major concern for an early-stage company.
For a small medical device company, consistent and strong revenue growth is essential to prove market adoption. Vivos has failed to deliver this. Its growth has been choppy and unpredictable, with annual revenue growth of +29.23% in FY2021 followed by two years of contraction (-5.1% in FY2022 and -13.87% in FY2023). This lack of a steady upward trajectory suggests the company is struggling to expand its market share and commercialize its products effectively.
This performance is significantly weaker than its competitors. For instance, Inspire Medical has demonstrated a multi-year track record of hyper-growth, while ResMed has delivered steady, reliable growth for years. Vivos's inability to establish a consistent growth pattern from its small revenue base raises serious questions about the long-term demand for its products and its go-to-market strategy.
Vivos Therapeutics presents a high-risk, high-reward growth scenario centered on its novel sleep apnea treatment. The primary tailwind is the large and underserved market of patients dissatisfied with traditional CPAP therapy. However, this potential is completely overshadowed by formidable headwinds, most notably the lack of widespread insurance reimbursement, which severely limits its addressable market. Compared to established competitors like ResMed and Inspire Medical, who benefit from full reimbursement and extensive clinical validation, Vivos is a speculative niche player. The investor takeaway is negative, as the company's path to profitable growth is exceptionally challenging and dependent on overcoming critical reimbursement and market adoption hurdles that are far from certain.
While Vivos targets a massive potential market for sleep apnea, its actual accessible market is severely restricted by the lack of insurance coverage, rendering its expansion plans largely ineffective at present.
On paper, Vivos has enormous market expansion opportunities within the multi-billion dollar sleep apnea market, including early-stage efforts to enter international markets like Canada. However, the company's ability to penetrate this market is fundamentally crippled by its failure to secure widespread reimbursement. Without insurance coverage, its target customer is not the broad population of OSA sufferers, but a very small subset who can afford to pay thousands of dollars out-of-pocket. Until this primary barrier is removed, both domestic and international expansion strategies are unlikely to generate meaningful revenue growth. The large total addressable market is currently more theoretical than practical for Vivos.
The company does not provide specific revenue or earnings guidance, leaving investors with significant uncertainty about its near-term growth trajectory and financial performance.
As is common for many early-stage, pre-profitability companies, Vivos Therapeutics does not issue specific, quantitative financial guidance for upcoming quarters or the full year. Management's forward-looking statements are typically qualitative, focusing on strategic goals such as expanding their provider network, advancing clinical trials, and pursuing reimbursement. While the long-term vision may be compelling, the absence of concrete financial targets for revenue or EPS makes it difficult for investors to benchmark the company's progress and hold management accountable for near-term execution. This lack of clear guidance translates to higher investment risk and uncertainty.
Vivos's future is entirely dependent on the success of its existing product line, as there is no disclosed pipeline of new products to drive future growth.
The company's growth prospects for the next 3-5 years are wholly tied to the market adoption of its current Vivos System. There is no publicly available information on a pipeline of next-generation devices or therapies for new medical conditions. The company's R&D spending, which was substantial at ~20% of revenue in 2023, is focused on generating clinical evidence to support its existing products rather than developing new ones. This single-product focus creates a significant concentration risk; if the Vivos System fails to gain widespread adoption and reimbursement, the company has no other products in development to fall back on.
Vivos is a cash-constrained company focused on organic growth and has no history or financial capacity for acquisitions, meaning this is not a viable growth lever.
As an early-stage company with significant operating losses and negative cash flow, Vivos Therapeutics is not in a financial position to acquire other companies. Its capital is fully dedicated to funding its internal operations, primarily sales and marketing expenses and clinical research. The company has no history of mergers and acquisitions, and this strategy is not part of its stated plan for future growth. Therefore, investors cannot expect tuck-in acquisitions to contribute to revenue or technology expansion in the foreseeable future.
Vivos operates a capital-light model by outsourcing manufacturing, so its minimal capital spending is not a meaningful indicator of its future growth ambitions.
Vivos Therapeutics' business model is asset-light, meaning it does not own or operate manufacturing facilities and instead relies on third parties to produce its oral appliances. As a result, its capital expenditures (CapEx) are consistently very low, related primarily to minor investments in office equipment or software. Because the company's growth is driven by investments in intangible assets like its provider network and clinical data (reflected in SG&A and R&D spending), traditional CapEx metrics are not relevant for assessing management's expectations for future demand. While an asset-light model can be efficient, in this context, it provides no positive signal about proactive investment to support anticipated sales growth.
As of October 30, 2025, with a closing price of $2.67, Vivos Therapeutics, Inc. (VVOS) appears significantly overvalued based on its current fundamentals. The company is unprofitable, with a negative EPS (TTM) of -$1.78 and negative free cash flow, making traditional valuation metrics like P/E and FCF yield meaningless for establishing value. Its current EV/Sales ratio of 1.84 is the primary metric available, and while it might seem low in isolation, it's attached to a company with declining revenue and substantial cash burn. The stock is trading in the lower third of its 52-week range ($1.98–$7.95), which may attract some attention, but the underlying financial health is poor. The investor takeaway is negative, as the valuation is not supported by profitability or cash flow, and the company's financial stability is a major concern.
The EV/Sales ratio of 1.84 appears unjustifiably high for a company with declining revenues and deeply negative margins.
The company's current EV/Sales ratio is 1.84. While this is below the medical device industry median of 4.7x, it does not represent good value. Vivos's revenue growth is negative (-5.77% in Q2 2025), and its gross margin is 55.24%, which is eroded by massive operating expenses leading to an operating margin of -127.36%. A company destroying value at this rate does not warrant a premium. For a business that is not profitable and shrinking, even a seemingly low EV/Sales ratio is a sign of overvaluation, as the market is still assigning a positive enterprise value to sales that generate significant losses.
The company has a significant negative free cash flow yield, indicating it is burning through cash rapidly relative to its market size.
Vivos Therapeutics has a highly negative free cash flow yield, reported as "-80.91%" for the current period. In the last two quarters alone, the company burned through over $8M in free cash flow (-$4.27M and -$3.92M). This metric shows how much cash the company generates compared to its market value. A deeply negative figure like this is a major red flag, suggesting the business is unsustainable without continuous external financing. This rapid cash burn increases the risk of shareholder dilution through future equity offerings.
The company's negative EBITDA makes the EV/EBITDA ratio meaningless for valuation and highlights severe unprofitability.
Vivos Therapeutics has a negative EBITDA, with a reported -$4.56M in its most recent quarter and -$10.59M in the last fiscal year. A negative EBITDA means the company's core operations are not generating any profit before accounting for interest, taxes, depreciation, and amortization. Consequently, the EV/EBITDA multiple cannot be calculated and is not a useful tool for valuation. The median EV/EBITDA for the Medical Devices industry is around 20x. VVOS's inability to generate positive EBITDA places it far outside the norms of its industry and signals significant operational and financial distress.
Despite weak fundamentals, analyst price targets suggest significant potential upside from the current price, although these targets appear highly optimistic.
The consensus analyst price target for Vivos Therapeutics is $5.25, with forecasts ranging from a low of $2.25 to a high of $6.50. This represents a substantial upside of over 90% from the current price of $2.67. While analysts are split between Buy, Hold, and Sell ratings, the average target provides a "Pass" for this factor as it points to potential for appreciation. However, investors should be extremely cautious. These targets may be based on future potential and technology adoption rather than current financial health. The company's recent performance includes downward EPS revisions and revenue misses, which conflicts with the bullish price targets.
With negative earnings per share of -$1.78, the P/E ratio is not applicable and underscores the company's lack of profitability.
The P/E ratio compares a company's stock price to its earnings per share. Since Vivos Therapeutics is not profitable, its P/E ratio is 0, rendering this metric useless for valuation. The average P/E for the Medical Devices industry is approximately 37x to 54x, highlighting how VVOS lags far behind its peers in terms of profitability. A company with no earnings cannot be considered undervalued on a P/E basis, and the ongoing losses represent a fundamental failure in its business model to date.
Vivos operates in a challenging environment shaped by macroeconomic pressures and fierce industry competition. As a company that is not yet profitable, a high-interest-rate environment makes it more expensive and difficult to raise the capital needed to fund its growth and operations. Economically, since the Vivos System may not be fully covered by all insurance plans, a downturn could lead patients to delay or avoid the out-of-pocket expense. Within the sleep apnea market, Vivos is a very small company competing against giants like ResMed, whose CPAP machines are the established standard of care. It must fight for market share not only with these incumbents but also with a growing number of other oral appliance makers and surgical solutions.
The most critical risk for Vivos is its financial instability. The company has a history of significant net losses, reporting a loss of over -$19 million in the first nine months of 2023 on revenue of less than $12 million. This high cash burn rate, combined with a low cash balance that has often been below $2 million, creates a constant need to raise more money. This is typically done by issuing new shares, which dilutes the ownership stake of existing investors and can put downward pressure on the stock price. The company's ability to simply continue its operations is entirely dependent on its ability to secure new funding, posing a substantial risk to its long-term survival.
Beyond financials, Vivos' future success depends on executing its go-to-market strategy and clearing crucial reimbursement hurdles. Its business model relies on training and equipping dentists to offer the Vivos System, which can be a slow and expensive way to scale the business. The largest long-term obstacle is securing widespread insurance coverage. While Vivos has FDA clearance, its treatment will remain a niche product for affluent patients until major insurance carriers agree to cover the costs. Without broad reimbursement, the Vivos System cannot effectively compete with CPAP machines and other treatments that are already covered, severely limiting its addressable market and path to profitability.
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