Executive Summary

Q4 2023 net revenue rose 27.7% YoY to $109.7M with gross margin at 75.4% (vs. 73.3% LY) and diluted EPS of $0.13; Adjusted EBITDA was $18.9M as operating leverage improved .
Segment strength: SNM revenues grew to $88.5M (+26% YoY) and Bulkamid to $21.2M (+36% YoY), with U.S. demand the primary driver in both categories .
Management-referenced sell-side consensus for Q4 revenue was ~$105M on the Q3 call; actual $109.7M implies a ~4% beat (S&P Global estimates not retrievable via tool) .
FY23 finished at $366.4M revenue (+34% YoY) and $52.3M adjusted EBITDA; no 2024 guidance provided given the pending acquisition by Boston Scientific for $71/share cash (~$3.7B equity value), a key stock catalyst .

What Went Well and What Went Wrong

What Went Well

Strong top-line growth and mix: Q4 revenue +28% YoY to $109.7M; SNM $88.5M (+26%) and Bulkamid $21.2M (+36%) with strength led by U.S. volumes .
Margin expansion: Q4 gross margin improved to 75.4% (vs. 73.3% LY), near the high end of the 74–75% Q4 range telegraphed on the Q3 call; drivers cited previously include higher manufacturing yields and supply chain execution .
Profitability inflection: Q4 adjusted EBITDA $18.9M (vs. $10.1M LY), FY23 adjusted EBITDA $52.3M; management: “Revenue grew 34% in 2023, gross margin expanded to nearly 75% and Axonics generated over $50 million of adjusted EBITDA.” (CEO) .

Selected management quote:

“The continued strong performance of Axonics reflects the physician community’s preference and enthusiasm for our incontinence products.” (CEO) .

What Went Wrong

OpEx step-up: Q4 operating expenses rose to $81.7M (vs. $66.6M LY), including $3.5M in acquisition-related costs; sales & marketing spend also increased YoY .
Limited international contribution: International SNM revenue remained modest at $1.9M in Q4 (vs. $86.6M U.S.), consistent with earlier commentary that reimbursement and regulatory timing temper OUS scaling .
No forward (2024) guidance: With the pending Boston Scientific deal, management did not issue 2024 guidance in Q4 materials; investors lack near-term standalone outlook .

Financial Results

Metric	Q4 2022	Q3 2023	Q4 2023
Net Revenue ($USD Millions)	$85.918	$93.100	$109.735
Diluted EPS ($)	$0.01	$0.08	$0.13
Gross Margin (%)	73.3%	74.2%	75.4%
Operating Expenses ($USD Millions)	$66.576	$69.791	$81.694
Adjusted EBITDA ($USD Millions)	$10.142	$14.037	$18.936
Net Income ($USD Millions)	$0.665	$3.928	$6.574

Segment and Geography Breakdown (Revenue, $USD Millions)

Segment / Geography	Q4 2022	Q3 2023	Q4 2023
SNM – U.S.	$69.068	$72.212	$86.576
SNM – International	$1.236	$1.737	$1.934
SNM – Total	$70.304	$73.949	$88.510
Bulkamid – U.S.	$12.341	$15.579	$17.038
Bulkamid – International	$3.273	$3.572	$4.187
Bulkamid – Total	$15.614	$19.151	$21.225
Total Net Revenue	$85.918	$93.100	$109.735

Selected KPIs and Balance Sheet

KPI	Q4 2022	Q4 2023
Gross Profit ($USD Millions)	$62.967	$82.760
Cash, Cash Equivalents, Short-term Investments & Restricted Cash ($USD Millions)	N/A	~$358
Shares Outstanding (Common, period-end)	49,546,727	50,770,520

Notes: Adjusted EBITDA excludes interest/other income/expense, income taxes, D&A, stock-based comp, acquisition-related costs, acquired IPR&D, loss on disposal, and impairment, per non-GAAP policy .

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
Total Revenue ($)	FY 2023	$358M (7/27/23)	$362M (10/30/23)	Raised
Q4 Gross Margin (%)	Q4 2023	73–74% 2H guide referenced earlier; updated to 74–75% for Q4 (Q3 call)	Actual 75.4% (reported 2/28/24)	In-line/high end result
2024 Outlook	FY 2024	N/A	Not provided due to pending acquisition	N/A

Earnings Call Themes & Trends

Topic	Previous Mentions (Q2 2023)	Previous Mentions (Q3 2023)	Current Period (Q4 2023)	Trend
Gross Margin trajectory	GM 75.6% in Q2; drivers include higher yields, insourcing, supply chain discipline	Guided Q4 GM to 74–75%; reiterated long-term opportunities above 75%	Actual Q4 GM 75.4%	Improving, near high end of range
Operating leverage / EBITDA	Q2 adj. EBITDA $18.4M; profitability inflecting	Q3 adj. EBITDA $14.0M; sixth straight positive adj. EBITDA quarter; OpEx cadence noted	Q4 adj. EBITDA $18.9M	Positive, sustained
DTC / Demand funnel	Not detailed in Q2 release	>10,000 qualified leads/month; campaign yields measurable ROI; expanding ads to SUI and bowel dysfunction	Press release emphasizes broad clinical adoption; no Q4 call transcript available	Ongoing awareness driver
International SNM	Not highlighted	F15 approval in EU/Australia expected to boost OUS; single-payer budgets limit near-term growth	Q4 OUS SNM $1.9M vs U.S. $86.6M	OUS remains modest; approvals key
Product pipeline	Radian foramen finder mid‑2024; new external trial system planned (shower-safe) late 2024, pending FDA	Same	Same themes reiterated in broader materials	Execution underway
Strategic/Corporate	—	Management open to strategic interest; focus on continence adjacencies	Agreed sale to Boston Scientific for $71/share cash	Acquisition consummation anticipated

Management Commentary

“Revenue grew 34% in 2023, gross margin expanded to nearly 75% and Axonics generated over $50 million of adjusted EBITDA.” – Raymond W. Cohen, CEO .
“In 2023, clinicians used Axonics therapies to treat approximately 100,000 incontinence patients globally.” – CEO .
Non-GAAP policy: Adjusted EBITDA excludes interest/other items, taxes, D&A, stock comp, acquisition-related costs, acquired IPR&D, disposal/impairment; used for strategic and operating planning .

Q&A Highlights

No Q4 2023 earnings call transcript was found in our document set. Notable Q&A themes from the most recent call (Q3 2023) that informed Q4 trends:

Growth drivers: Half of U.S. SNM growth from higher utilization/share of wallet at existing accounts; half from competitive account wins; DTC helps but is “icing,” with long-cycle impact .
Margin outlook: Q4 GM guided to 74–75%, with longer-term path above 75% via yields, supply chain, and production optimization .
Mix dynamics: Recharge-free (F15) ~75% of implants vs ~25% rechargeable; physician guidance largely drives choice .
International: OUS growth contingent on F15 approvals; single-payer budgets constrain near-term growth .

Estimates Context

We were unable to retrieve S&P Global consensus estimates via the tool for AXNX (mapping unavailable).
Management referenced Q4 2023 revenue consensus of ~$105M on the Q3 call; actual Q4 revenue of $109.7M implies a ~4% beat (EPS consensus not cited by management and unavailable via S&P tool) .

Key Takeaways for Investors

Durable growth with operating leverage: Q4 beat on revenue and strong GM (75.4%) underscore a model capable of profitable growth, aided by manufacturing efficiencies and scale .
Broad-based demand: SNM and Bulkamid both accelerated, with U.S. utilization and account penetration driving gains; DTC continues to expand the funnel for future periods .
Guidance and outlook: No 2024 guidance given the pending Boston Scientific acquisition, reducing near-term standalone forecast visibility .
Strategic overhang/catalyst: The $71/share cash deal with Boston Scientific is the principal near-term stock driver pending regulatory and shareholder approvals .
Watch margin execution: Q4 GM at the high end of prior range; further gains hinge on continued yield improvements and supply chain optimization .
International optionality: OUS remains a small base; F15 approvals could unlock incremental growth in 2024+ .
Cross-sell synergy: Bulkamid remains an effective wedge into higher-volume accounts and a differentiator vs. competitors, supporting sustained share gains in SNM over time .

All figures and statements are sourced from Axonics’ SEC filings and earnings materials as cited inline:

Q4 2023 8-K and press release with financials and segment details .
Preliminary Q4/FY23 revenue and acquisition announcement (Jan 8, 2024) .
Q3 2023 8-K and earnings call transcript for prior trends, guidance commentary, and management quotes -.

Axonics, Inc. (AXNX)·Q4 2023 Earnings Summary