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Product / Company Performance

SI-BONE reports 4Q18 revenue of $15.6MM, +13% vs. 4Q17 -


SI-BONE reports 4Q18 revenue of USD $15.6MM, +13% vs. 4Q17, with 2018 full year revenue of $55.4MM, +15.4% vs. 2017. Growth was driven by salesforce expansion, surgeon education and increased case volume from improved reimbursement coverage. The company provided 2019 revenue guidance of $65MM (+17%) to $66.5MM (+20%).

At the end of 4Q18, SI-BONE employed 45 U.S. sales reps and 22 clinical support specialists, who can cover cases and capture new sales opportunities from exclusive payor coverage decisions. In 2019, the company plans to hire another 10 to 15 reps for large or unpenetrated territories, as well as 25 to 30 clinical support specialists. To support these expansion efforts, the company increased its number of U.S. sales regions from seven to 10 while promoting three top direct reps to regional sales leader positions.

International sales were hampered by revenue issues in Germany, where the company hired a new head of sales in early January to improve results there. A French branch was also opened to take advantage of an exclusive coverage decision by the French Public Health System in December 2018.

SI-BONE continues to build upon an impressive library of clinical evidence and, in March 2019, added its 68th peer reviewed study for iFuse. The Journal of Bone and Joint Surgery published two-year results that demonstrated rapid and sustained improvements in pain, patient function and quality of life from SI joint fusion with the iFuse implant system.

This growing library of clinical evidence is a key driver of SI-BONE’s improving reimbursement coverage. At the end of 2018, the company received coverage from BlueCross BlueShield of Arizona, Excellus BlueCross BlueShield in western New York and CareFirst in the mid-Atlantic region. Within 1Q19, the company added Premera Blue Cross in the Pacific Northwest and Highmark in the Pittsburgh area. Total coverage for SI-BONE stands at 263 million lives, with 62 million covered exclusively for iFuse. In early January 2019 the company hired Jeff Zigler, a veteran of Zimmer Biomet, LDR Spine and St. Jude Medical Abbott, as Vice President of Market Access and Reimbursement.

SI-BONE has also focused on increasing their market through surgeon training. In addition to targeting surgeons, the company’s medical affairs team also engages with nurse practitioners and physician assistants, who are often the first providers to see patients suffering from back pain. During 4Q18, the company had 450 active surgeons and expects that number to increase to 550 by the end of 2019.

Expanding into adjacent markets has also helped incrementally drive revenue and exposure. In 4Q18, the FDA cleared SI-BONE’s iFuse Bedrock technique that allows a surgeon to place an iFuse implant on each side of the sacrum from the posterior approach. The company estimates that there are about 35,000 multilevel fusions that extend down to the sacrum performed annually to treat adult spinal deformities. Importantly, many of these fusions are performed at leading academic institutions, giving SI-BONE recognition from key opinion leaders.

Segment sales and growth on an as-reported basis:

  4Q18 4Q17 % Chg % Chg
Spine $15.6 $13.8 $1.8 13.0%
  FY18 FY17 % Chg % Chg
Spine $55.4 $48.0 $7.4 15.4%

Revenue by geographic region:

Geographic Region 4Q18 4Q17 % Chg % Chg
US $14.5 $12.6 $1.9 15.5%
Ex-US $1.1 $1.2 -$0.1 -11.4%
Total  $15.6 $13.8 $1.8 13.0%

Net earnings:

4Q18 Amount ($MM) % of Sales
Sales $15.6  
Cost of Sales -$1.4 8.8%
General and Admin -$4.4 28.4%
Sales and Marketing -$12.6 80.7%
R & D -$1.5 9.6%
Other -$1.0 6.4%
Net Earnings  -$5.3 -34.0%


Sources: SI-BONE

Mike Evers is ORTHOWORLD’s Market Analyst. He can be reached by email.

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