Boston Scientific Corporation (BSX) Q4 2025 Earnings Call Transcript
Access earnings results, analyst expectations, report, slides, earnings call, and transcript.
Overview
The earnings call reveals strong financial performance with high growth in key segments, increased guidance, and optimistic long-term targets. The Q&A section supports this with management's confidence in overcoming challenges and sustaining growth, despite some vague responses. The raised guidance, strong cash flow, and strategic product launches further support a positive outlook. Although there are concerns about competition and market dynamics, the overall sentiment is positive, suggesting a likely stock price increase of 2% to 8%.
Key Financial Performance
Total Company Operational Sales (Q4 2025) Grew 14%, organic sales grew 13%, achieving the high end of guidance range of 11% to 13%. This growth was driven by continued strength across many business units, including EP, WATCHMAN, IO, endo, and ICTx.
Full Year Operational Sales (2025) Grew 19%, while organic sales grew 16%, exceeding guidance of approximately 15.5%. This was fueled by innovation and execution across business units and the global team.
Q4 Adjusted EPS (2025) $0.80, grew 15%, exceeding the high end of guidance range of $0.77 to $0.79. Outperformance was driven primarily by favorable adjusted tax rate in the quarter.
Full Year Adjusted EPS (2025) $3.06, grew 22%, exceeding the high end of guidance range of $3.02 to $3.04. This growth was supported by strong revenue performance and reinvestment into the business.
Adjusted Operating Margins (2025) Expanded by 100 basis points to 28%. This was achieved by balancing strong revenue performance with reinvestment into the business for long-term growth.
Urology Sales (Q4 2025) Grew 13% operationally and 3% organic on a full year basis. Full year operational growth was 23% and organic growth was 5%. Performance was below expectations due to supply chain issues, but recovery is expected in 2026.
Endoscopy Organic Growth (2025) 8% in both Q4 and full year. Growth was driven by endoluminal surgery, imaging systems, and endobariatric franchises, with positive reimbursement support for ESG procedures.
Neuromodulation Growth (2025) 10% in Q4 and 8% organic growth for the full year. Growth was driven by brain and pain franchises, supported by new product launches and expanded reimbursement coverage.
Cardiovascular Segment Growth (2025) 16% operational and organic growth in Q4, 22% operational and 21% organic growth for the full year. Growth was driven by coronary therapies and drug-eluting technology.
Interventional Oncology & Embolization Growth (2025) 17% operational and 12% organic growth in Q4, nearly $1 billion in full year sales with 16% operational and 12% organic growth. Growth was driven by embolization and cancer therapies portfolio.
WATCHMAN Business Growth (2025) 29% growth in Q4 and strong double-digit growth for the full year. Growth was driven by strong adoption of concomitant procedures and global market expansion.
Electrophysiology (EP) Growth (2025) 35% organic growth in Q4, 73% growth for the full year. Growth was driven by PFA catheter utilization and OPAL placements, supported by a high-performing commercial organization.
Free Cash Flow (2025) $3.659 billion, reflecting 38% growth versus 2024 and 80% free cash flow conversion. Growth was driven by strong operating activities and efficient capital expenditures.
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Operating Highlights
WATCHMAN: Strong adoption of concomitant procedures, with over 25,000 patients treated concomitantly. Strategic partnership with Siemens Healthineers to develop next-gen 4D ICE catheter. Enrollment completed in SIMPLAAFY clinical trial for post-procedural alternatives to dual antiplatelet therapy. CHAMPION trial data to be presented in March 2026, potentially expanding indicated patients globally from 5 million to 20 million.
EP (Electrophysiology): Global organic growth of 35% in Q4 and 73% for the full year. PFA technology adoption with 70% of U.S. AF ablations using PFA. Approval and limited market release of FARAPOINT PFA Catheter for atrial flutter. Initiated OPTIMIZE trial for Cortex OPTIMAP Mapping Technology with FARAPULSE PFA system.
Neuromodulation: 10% growth in Q4 and 8% organic growth for the full year. Brain franchise grew low double digits, driven by Cartesia X and Illumina 3D offerings. Pain franchise grew high single digits, supported by Nalu acquisition and expanded reimbursement for Intracept procedure.
Cardiovascular: 16% growth operationally in Q4 and 22% for the full year. Penumbra acquisition announced, adding mechanical thrombectomy and neurovascular offerings. AGENT DCB technology achieved over 20% growth for the year. FRACTURE trial enrollment completed for SEISMIQ IVL System.
Regional Growth: U.S. grew 17% in Q4 and 26% for the full year, driven by EP, WATCHMAN, and ICTx. Europe, Middle East, Africa grew 5% in Q4 and 3% for the full year, with higher growth expected in H2 2026. Asia Pacific grew 15% in Q4 and 14% for the full year, led by Japan and China.
Operational Revenue: Q4 operational sales grew 14%, organic sales grew 13%. Full year operational sales grew 19%, organic sales grew 16%, exceeding guidance.
Adjusted Operating Margins: Expanded by 100 basis points to 28% for the full year. Expected to expand by 50-75 basis points in 2026.
Free Cash Flow: Full year free cash flow of $3.659 billion, 38% growth versus 2024. Expected to reach $4.2 billion in 2026.
Acquisitions: Announced acquisitions of Valencia Technologies and Penumbra, expected to close in 2026. Valencia to expand pelvic health portfolio; Penumbra to add mechanical thrombectomy and neurovascular offerings.
Portfolio Expansion: Focused on expanding high-growth markets, including WATCHMAN, PFA technology, and AGENT DCB. Strategic partnership with Siemens Healthineers for imaging innovation.
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Risk or Challenges
ACURATE discontinuation impact: The discontinuation of the ACURATE product line has negatively impacted growth in the Europe, Middle East, and Africa (EMEA) region. This is expected to continue affecting growth in the first half of 2026 until the impact is annualized.
AXIOS device product removal: A product removal for certain sizes of the AXIOS device due to a manufacturing variation is anticipated to result in lower growth in the endoscopy business in the first half of 2026.
Supply chain issues in urology: Supply chain challenges in the urology business have led to underperformance in 2025. While improvements are expected in 2026, these issues have impacted the company's ability to meet market growth expectations.
Litigation charge: A $194 million litigation charge related to a legacy intellectual property matter has impacted financial performance.
Foreign exchange fluctuations: Foreign exchange fluctuations have created variability in reported revenue growth, with a 160 basis point tailwind in Q4 2025 and a 70 basis point tailwind for the full year.
Regulatory and acquisition risks: The acquisitions of Valencia Technologies and Penumbra, expected to close in 2026, are subject to customary closing conditions and regulatory approvals, which could pose risks to strategic execution.
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Guidance & Outlook
2026 Organic Growth: Guidance for organic growth is 8.5% to 10% for Q1 and 10% to 11% for the full year.
2026 Adjusted EPS: Guidance for adjusted EPS is $0.78 to $0.80 for Q1 and $3.43 to $3.49 for the full year, representing leveraged double-digit EPS growth of 12% to 14%.
Regional Growth Outlook: Momentum in EP and WATCHMAN is expected to continue in Europe, with higher growth anticipated in the second half of the year. In Asia Pacific, EP momentum is expected to continue, supported by recent NMPA approval of FARAWAVE NAV device and indication expansion into the persistent AF population.
Urology Business: The overall business is expected to return to market growth in 2026 with supply chain issues resolved, new product launches, and strengthening of the sacral neuromodulation franchise.
Endoscopy Business: Lower growth is anticipated in the first half of 2026 due to the product removal of certain sizes of the AXIOS device, but the devices are expected to return to market by midyear.
Neuromodulation Business: Growth is expected to continue, supported by expanded reimbursement coverage for the Intracept procedure and the full market launch of the Intracept EDGE Stylet.
Cardiovascular Segment: Continued growth is expected, supported by the acquisition of Penumbra and new product offerings such as the SEISMIQ IVL System, with data from the FRACTURE trial expected later in the year.
WATCHMAN Business: Strong growth is anticipated, supported by clinical trials and strategic partnerships, including the CHAMPION trial and collaboration with Siemens Healthineers.
Electrophysiology (EP) Market: The EP market is expected to grow approximately 15% in 2026, with Boston Scientific anticipated to outpace market growth due to its differentiated PFA portfolio and global expansion.
2026 Financial Goals: Sales growth of 10%+, adjusted operating margin expansion of 150 basis points, and leveraged double-digit EPS growth are targeted for 2026 to 2028.
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Shareholder Return Plan
The selected topic was not discussed during the call.
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Key Q&A
Q:What happened with U.S. EP and U.S. WATCHMAN in the quarter versus expectations?
A:Michael Mahoney explained that U.S. EP results exceeded internal targets, growing 35%, while U.S. WATCHMAN grew 29%, similar to the third quarter. He noted that the EP market growth was closer to 18%-20% rather than 25% as claimed by others. WATCHMAN's growth was attributed to strong market performance and concomitant reimbursement.
Q:Is there any impact from the three recent trials (CLOSURE, ALONE-AF, and OCEAN) on WATCHMAN?
A:Ken Stein confirmed that there was no impact from the trials on WATCHMAN. He emphasized robust uptake of WATCHMAN and concomitant procedures.
Q:Why was U.S. EP flat sequentially, and what does the Q1 guide of 8.5%-10% mean for EP in early 2026?
A:Michael Mahoney stated that U.S. EP was flat due to anticipated share loss from new competitors and high market share position. The Q1 guide reflects tough comparisons and impacts from ACURATE discontinuation and AXIOS withdrawal, which will ease in the second half of the year.
Q:What are the expectations for EP growth in 2026 and beyond?
A:Michael Mahoney expects EP to grow faster than the 15% market growth rate in 2026, with continued market leadership in PFA. Growth drivers include geographic expansion, new product launches, and investments in the portfolio.
Q:What other products or business units are expected to drive growth in the second half of 2026 and into 2027?
A:Michael Mahoney highlighted stronger performance expected in PI, uro, neuromod, and CRM businesses. He also mentioned growth in endoscopy, interventional oncology, and coronary businesses, supported by new product launches and investments.
Q:What steps are being taken to ensure consistent performance in non-EP and WATCHMAN businesses?
A:Michael Mahoney mentioned addressing supply chain issues in urology, new product launches, and investments in neuromod, endoscopy, and ICTx businesses. He emphasized organic R&D and tuck-in M&A to fuel growth.
Q:How will the partnership with Siemens for 4D ICE and the 2D ICE product coexist?
A:Michael Mahoney explained that the Siemens 4D ICE product will target premium markets, while the 2D ICE product will serve as a portfolio addition at a different price point.
Q:What are the expectations for the CHAMPION trial and its potential impact?
A:Ken Stein stated that the CHAMPION trial aims to show non-inferiority for stroke and superiority for bleeding. A positive result could strengthen current indications and sustain WATCHMAN growth over the long term.
Q:What is the confidence level in achieving long-range plan (LRP) targets through 2028?
A:Michael Mahoney expressed confidence in achieving 10%+ organic revenue growth and 150 bps margin improvement through 2028, supported by investments and market growth.
Q:What is the remaining potential for PFA penetration and its application in other procedure categories?
A:Ken Stein noted that 30% of the U.S. AFib market remains to be penetrated by PFA. He highlighted potential applications in atrial tachycardias and ventricular tachycardia, supported by ongoing studies and new catheter developments.
Q:Review of Unclear Management Responses
A:Management avoided directly addressing the question about potential share changes in U.S. EP due to sequential flat performance, providing general market growth explanations instead. Additionally, they used vague language when discussing the impact of new competitors and the timeline for addressing product discontinuations.
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Earnings Word Cloud
The most frequently occurring keywords in this quarter's earning call
ACC Saturday
Cardiology Therapies
EKOS
ICTx
IVL System
Interventional Cardiology
Mapping
Oncology Embolization
Penumbra Boston
SEISMIQ IVL
Technologies Penumbra
Valencia Technologies
agreement Penumbra
agreement Valencia
alternative
breaker ACC
catheter utilization
discontinuation
ecosystem approach
efficiency
end share
matter
offering
point tailwind
product removal
reimbursement support
removal size
sale basis
size device
solicitation
structure
tailwind exchange
today basis
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Boston Scientific Corporation (BSX) Q4 2025 Earnings Call Transcript
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The earnings call reveals strong financial performance with high growth in key segments, increased guidance, and optimistic long-term targets. The Q&A section supports this with management's confidence in overcoming challenges and sustaining growth, despite some vague responses. The raised guidance, strong cash flow, and strategic product launches further support a positive outlook. Although there are concerns about competition and market dynamics, the overall sentiment is positive, suggesting a likely stock price increase of 2% to 8%.
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Frequently Asked Questions
Where does this earnings call transcript come from?
All transcripts are sourced directly from the official live webcast or the company’s official investor relations website. We use the exact words spoken during the call with no paraphrasing of the core discussion.
How soon is the transcript available after the earnings call ends?
Full verbatim transcripts are typically published within 4–12 hours after the call ends. Same-day availability is guaranteed for all S&P 500 and most mid-cap companies.
Is the transcript edited or altered in any way?
No material content is ever changed or summarized in the “Full Transcript” section. We only correct obvious spoken typos (e.g., “um”, “ah”, repeated 10 times”, or clear misspoken ticker symbols) and add speaker names/titles for readability. Every substantive sentence remains 100% as spoken.
Why do some answers appear as “Unclear” or “Inaudible”?
When audio quality is poor or multiple speakers talk over each other, we mark the section instead of guessing. This ensures complete accuracy rather than introducing potential errors.
Who creates the AI Summary and Key Q&A highlights shown above the transcript?
They are generated by a specialized financial-language model trained exclusively on 15+ years of earnings transcripts. The model extracts financial figures, guidance, and tone with 97%+ accuracy and is regularly validated against human analysts. The full raw transcript always remains available for verification.
