ShockWave Medical, Inc.

Fourth-quarter 2023 revenue was $203 million, up 41% from $144 million a year ago and up 9% sequentially. Full-year 2023 revenue was $730.2 million, up 49% from $489.7 million in 2022. Q4 US revenue was $158.1 million, up 34%; US coronary revenue was $115.2 million, up 40%; US peripheral revenue was $42.8 million, up 19%; international revenue was $44.8 million, up 74%; international coronary revenue was $37.7 million, up 83%; and Reducer contributed $1.8 million. Gross profit was $177.7 million and gross margin was 88% in Q4, versus 88% a year earlier; full-year gross margin was 87%, also flat year over year. Q4 operating margin was 21%, and full-year operating margin was 22%. Q4 net income was $44.3 million, or $1.16 diluted EPS, versus $140.9 million a year ago; the prior-year quarter included a $99 million tax benefit. Adjusted EBITDA was $68.2 million in Q4, up 20%, and $242.7 million for the full year, up 40%. The company ended Q4 with $990.6 million in cash, cash equivalents, and short-term investments. For 2024, management guided to revenue of $910 million to $930 million, implying 25% to 27% growth, and said full-year operating margin could expand by up to 100 basis points from 2023, with a seasonal Q1 step-down expected. Management also said US peripheral should be modest in the first half and accelerate in the second half, while China is expected to contribute very little in the first half of 2024.

Doug Godshall framed 2023 as a “banner” year and highlighted multiple strategic milestones: new product launches, international expansion, reimbursement wins, the Neovasc/Reducer acquisition, and the convertible debt raise. His tone was upbeat but disciplined; he repeatedly emphasized that topline growth remains the priority and that margin expansion is a byproduct rather than the main objective. He also pointed to a pipeline of launches in peripheral and said 2024 should be another strong year with continued momentum in coronary and international markets.

Renee Gaeta detailed a quarter with $203 million of revenue, $177.7 million of gross profit, and 88% gross margin, alongside $134.4 million of operating expenses. She said full-year 2023 revenue reached $730.2 million, gross margin was 87%, operating expenses were $475.7 million, operating margin was 22%, and adjusted EBITDA was $242.7 million. On 2024 margins, she said full-year operating margin should expand by up to 100 basis points, but Q1 should step down from Q4 due to reset compensation/benefits and the March global sales meeting. She also highlighted $990.6 million in cash, cash equivalents, and short-term investments at quarter-end.

Analysts focused on how much of 2024 guidance assumes ongoing Aetna pressure, China weakness, and possible impacts from coronary outpatient reimbursement changes. Management said the peripheral slowdown was partly due to Aetna and broader softness in late 2023, but that the issue has largely stabilized and they do not see spillover to other payers; they expect low-single-digit peripheral growth in the first half before stepping up later in the year. Questions also centered on the path to the $51.94 coronary payment level and the new CPT/complexity adjustment; management said they have already met with CMS, expect the proposed rule in early July, and remain confident the facts support the payment change. Analysts also asked about cash deployment, and management said they are open to smart M&A but will not spend just because they have cash.