SI-BONE, Inc. Q4 FY2024 earnings call

• Fourth quarter performance: Record $49 million worldwide revenue, 26% growth; U.S. revenue $46.9 million, 28% growth. Full year 2024 worldwide revenue $167.2 million, over 20% growth.
• Growth priorities: First, implement targeted commercial initiatives to fuel adoption of expanded portfolio and grow physician base. Second, increase procedure density by focusing on multimodality physician engagement. Third, lay groundwork for commercialization of disruptive new products.
• Commercial infrastructure and productivity: Closed 2024 with 87 quota-carrying U.S. territory managers; territory productivity nearly doubled to $1.8 million in 2024; plan to selectively expand direct sales force in 2025.
• Physician engagement: Record number of physicians trained in 2024; nearly 2,000 U.S. physicians performed at least 1 procedure in 2024; 1,400 active physicians in fourth quarter, 23% growth; number of physicians performing multiple procedure types grew by nearly 40% in fourth quarter.
• Innovation: Transformed into high-growth medical device platform; four product families targeting multiple indications; Granite 9.5 successful since launch; TNT launched, interest from surgeons; awarded breakthrough device designation for another novel implant system; expect clinical publications in 2025.

In the fourth quarter, SI-BONE achieved a record $49 million in worldwide revenue, representing growth exceeding 26%. U.S. revenue increased by 28% to $46.9 million, with international revenue at $2.1 million. For the full year 2024, worldwide revenue was $167.2 million, reflecting over 20% growth. U.S. revenue grew over 21% to $158.4 million, and international revenue was $8.8 million. Gross profit in the fourth quarter increased 35% to $38.8 million, and for the full year 2024, it increased 21% to $132.1 million. Gross margin was 79% for both the quarter and the full year 2024.

• 2025 worldwide revenue expected to be $193.5 million to $195.5 million, implying year-over-year growth of approximately 16% to 17%.
• Expect 2025 annual gross margin between 77% and 78%, and annual operating expenses to grow approximately 9% at the midpoint of revenue range.
• Expect to deliver positive adjusted EBITDA in the second half of 2025 and full year 2025.

• SI-BONE’s ability to introduce and commercialize new products and indications.
• SI-BONE’s ability to maintain favorable reimbursement for its products and procedures.
• Changes in payer requirements for authorization of procedures involving SI-BONE’s products.
• Impact of potential economic weakness on the ability and desire of patients to undergo elective procedures.
• SI-BONE’s ability to manage risks to its supply chain.
• Impact of future capital requirements driven by new product introductions.
• Risks to the continued renormalization of the healthcare operating environment.

Q: Craig Bijou from Bank of America asked about growth drivers and guidance.

A: Laura Francis mentioned strong momentum across procedure types and call points, with 2024 growth drivers likely stronger in 2025. Anshul Maheshwari discussed guidance assumptions including ASP, procedure day, and FX headwind.

Q: David Turkaly from Citizens JMP asked about competitive landscape and physician use of multiple products.

A: Laura Francis stated SI-BONE is market leader in sacral-pelvic solutions. Anshul Maheshwari talked about active physician growth and number of docs doing multiple procedures.

Q: Unidentified Analyst from Piper Sandler asked about gross margins and OpEx.

A: Anshul Maheshwari explained gross margin assumptions and OpEx growth factors including R&D investment and sales force expansion.

Q: Caitlin Cronin from Canaccord Genuity asked about Globus’ acquisition and novel implant product timeline.

A: Laura Francis said Globus’ deal doesn’t impact SI-BONE’s strategy; novel implant product is in early development stages.

Q: David Saxon from Needham & Company asked about guidance cadence and Granite NTAP.

A: Anshul Maheshwari discussed seasonality and revenue cadence; Laura Francis provided update on Granite NTAP application to CMS.

Q: Felipe Lamar from Truist Securities asked about profit ramp cadence and free cash flow.

A: Anshul Maheshwari talked about focus on revenue growth and operating leverage.

Q: Kallum Titchmarsh from Morgan Stanley asked about sales reps and DOJ investigation.

A: Laura Francis discussed sales force expansion and cooperation with DOJ; Anshul Maheshwari talked about physician engagement and density.