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Consolidated Statements of Cash Flows - USD ($) | 12 Months Ended
--- | ---
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018
Cash flows from operating activities: |  |  |
Net income (loss) | $ 7,028,000 | $ (33,226,000) | $ (95,304,000)
Adjustments to reconcile net income (loss) to net cash (used in) provided by operating activities: |  |  |
Depreciation and amortization | 1,690,000 | 2,486,000 | 7,430,000
Impairment of intangible asset | 0 | 0 | 66,087,000
Remeasurement of acquisition-related contingent consideration | 3,327,000 | 845,000 | (22,731,000)
Remeasurement of financing-related contingent consideration | 435,000 | 378,000 | (1,899,000)
Amortization of debt discount and debt issuance costs | 6,524,000 | 5,995,000 | 4,830,000
Changes in deferred tax | (7,431,000) | (6,334,000) | (19,152,000)
Share-based compensation expense | 2,999,000 | 519,000 | 7,852,000
Gain on sale of Hospital Products | (45,760,000) | 0 | 0
Loss on deconsolidation of subsidiary | 0 | 1,750,000 | 0
Gain from release of certain liabilities | (3,364,000) | 0 | 0
Other adjustments | 142,000 | (254,000) | 4,188,000
Net changes in assets and liabilities |  |  |
Accounts receivable | 8,281,000 | 2,471,000 | 3,452,000
Inventories, net | (1,352,000) | 1,155,000 | 711,000
Prepaid expenses and other current assets | 1,863,000 | (1,187,000) | 3,577,000
Research and development tax credit receivable | 2,213,000 | (1,014,000) | (2,545,000)
Accounts payable & other current liabilities | (2,788,000) | 4,641,000 | (2,032,000)
Deferred revenue | 0 | (114,000) | (1,892,000)
Accrued expenses | (13,226,000) | 357,000 | (10,640,000)
Earn-out payments for contingent consideration in excess of acquisition-date fair value | (5,323,000) | (10,988,000) | (19,468,000)
Royalty payments for contingent consideration payable in excess of original fair value | (866,000) | (1,748,000) | (2,838,000)
Other assets and liabilities | (3,126,000) | (4,057,000) | (2,342,000)
Net cash used in operating activities | (48,734,000) | (38,325,000) | (82,716,000)
Cash flows from investing activities: |  |  |
Purchases of property and equipment | (98,000) | (29,000) | (178,000)
Proceeds from disposal of property and equipment | 0 | 154,000 | 0
Proceeds from the disposition of the Hospital Products | 25,500,000 | 0 | 0
Purchase of intangible assets | 0 | 0 | (20,000,000)
Proceeds from sales of marketable securities | 36,284,000 | 63,246,000 | 359,507,000
Purchases of marketable securities | (131,407,000) | (24,648,000) | (376,310,000)
Net cash (used in) provided by investing activities | (69,721,000) | 38,723,000 | (36,981,000)
Cash flows from financing activities: |  |  |
Proceeds from debt issuance | 0 | 0 | 143,750,000
Payments for debt issuance costs | 0 | 0 | (6,190,000)
Exercise of warrants | 0 | 0 | 2,911,000
Proceeds from the February 2020 private placement | 60,570,000 | 0 | 0
Proceeds from the May 2020 public offering | 116,924,000 | 0 | 0
Proceeds from issuance of ordinary shares | 2,189,000 | 118,000 | 577,000
Share repurchases | 0 | 0 | (27,637,000)
Other financing activities, net | 0 | (145,000) | (752,000)
Net cash provided by (used in) financing activities | 179,683,000 | (27,000) | 112,659,000
Effect of foreign currency exchange rate changes on cash and cash equivalents | 720,000 | 78,000 | (201,000)
Net change in cash and cash equivalents | 61,948,000 | 449,000 | (7,239,000)
Cash and cash equivalents at January 1 | 9,774,000 | 9,325,000 | 16,564,000
Cash and cash equivalents at December 31 | 71,722,000 | 9,774,000 | 9,325,000
Supplemental disclosures of cash flow information: |  |  |
Income taxes (refund) paid, net | (1,701,000) | 140,000 | 776,000
Interest paid | $ 6,469,000 | $ 6,469,000 | $ 3,359,000

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