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 worldwide 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 active U.S. physician base grew 23% to 1,400.

• Positive Adjusted EBITDA of $1.9 million in Q4 2024, a significant turnaround from a $4.8 million loss in Q4 2023.

• Net loss narrowed to $4.5 million in Q4 and $30.9 million for the year, both showing substantial improvement year-over-year.

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

Financial highlights

• Q4 2024 gross profit increased 35% to $38.8 million; full-year gross profit up 21% to $132.1 million.

• Gross margin was 79% for both Q4 and full-year 2024, exceeding original guidance by 100 basis points.

• Q4 net loss improved by nearly 60% to $4.5 million ($0.11 per share); full-year net loss improved by 29% to $30.9 million ($0.75 per share).

• Q4 Adjusted EBITDA was $1.9 million (vs. a $4.8 million loss in Q4 2023); full-year Adjusted EBITDA loss narrowed to $5.1 million from $17.3 million.

• Operating expenses increased 8% in Q4 and 7% for the year, driven by commercial activity and R&D investments.

Outlook and guidance

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

• 2025 gross margin guidance is 77%–78%; operating expenses expected to grow ~9%.

• Positive Adjusted EBITDA expected for full-year 2025, with profitability weighted toward 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.