SI-BONE (SIBN) Q4 2024 earnings summary

Executive summary

• Achieved record worldwide revenue of $49 million in Q4 2024, up 26% year-over-year, with U.S. revenue at $46.9 million, up 28%, and full-year revenue reaching $167.2 million, up 20% year-over-year.

• U.S. procedure volume reached 5,300 in Q4 2024, a 27% increase from Q4 2023, and the active U.S. physician base grew 23% to nearly 1,400.

• Delivered positive Adjusted EBITDA of $1.9 million in Q4 2024, a significant turnaround from a $4.8 million loss in Q4 2023, and expect to maintain positive Adjusted EBITDA for full year 2025.

• Ended 2024 with $150 million in cash and equivalents, with minimal net cash usage and strong liquidity.

• Strategic focus for 2025 includes expanding commercial initiatives, increasing procedure density, and preparing for further disruptive product launches.

Financial highlights

• Q4 2024 worldwide revenue grew 26% to $49 million; U.S. revenue up 28% to $46.9 million; international revenue $2.1 million.

• Full year 2024 revenue reached $167.2 million, up 20% year-over-year; U.S. revenue $158.4 million, up 21%; international revenue $8.8 million.

• Q4 gross profit rose 35% to $38.8 million; full year gross profit $132.1 million, up 21%; gross margin was 79% for both Q4 and full year.

• Q4 net loss improved by nearly 60% to $4.5 million; full year net loss improved by 29% to $30.9 million.

• Achieved Q4 Adjusted EBITDA of $1.9 million; full year Adjusted EBITDA loss narrowed to $5.1 million from $17.3 million.

Outlook and guidance

• 2025 worldwide revenue expected at $193.5–$195.5 million, implying 16–17% year-over-year growth.

• 2025 gross margin guidance of 77–78%; operating expenses to grow ~9% at revenue midpoint.

• Expect positive Adjusted EBITDA for full year 2025, with profitability weighted to the second half.

• Guidance incorporates low to mid-single-digit ASP decline due to procedure mix, one less procedure day, and FX headwinds.

• Focus on expanding access, increasing surgeon engagement, and accelerating market penetration for new products.