Guardant Health's Q4 2024: Unpacking Contradictions in Reveal and Shield Strategies

These are the key contradictions discussed in Guardant Health's latest 2024Q4 earnings call, specifically including: Reveal volume expectations, Shield ASP guidance, Shield's sales force expansion, Reveal's strategy post-reimbursement, and Shield's commercial expansion assumptions:



Strong Financial Performance in 2024:
- Guardant Health reported Q4 revenue of $202 million, up 30% year-over-year, and total full-year revenue of $739 million, an increase of 31% year-over-year.
- Growth was driven by strong clinical revenue growth and improved reimbursement trends.

Strong Clinical Revenue and Volume Growth:
- Clinical revenue grew 34% year-over-year, supported by ASP improvements and reimbursement tailwinds.
- Total oncology clinical volumes in the fourth quarter increased 24% year-over-year, attributed to double-digit volume growth in Guardant360.

Reimbursement Tailwinds and ASP Improvements:
- Guardant Health achieved an ASP of $3,000 for Guardant360, exceeding its target due to reimbursement wins and improved reimbursement rates.
- The increase in ASP was driven by the increase of Guardant360 LDT Medicare rate from $3,500 to $5,000 and Tissue Medicare pricing increase from $3,100 to $3,500.

Smart Liquid Biopsy Platform and Product Upgrades:
- The transition to the smart liquid biopsy platform led to significant upgrades in Guardant360 Liquid, which expanded the number of genes and improved sensitivity for tumor burden detection.
- This upgrade resonated well among physicians, leading to greater order depths and frequency, contributing to the growth in clinical volumes.

Expansion into Screening Market with Shield:
- Shield, Guardant's screening blood test for CRC, received FDA approval and Medicare coverage, becoming the first blood test for primary CRC screening.
- The company delivered $4.1 million of Shield testing revenue in Q4, driven by a majority of samples from covered Medicare beneficiaries, achieving gross margin breakeven.