Pharma IT Enhancing clinical trial diversity - FIRST ANALYSIS QUARTERLY INSIGHTS
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Pharma IT Enhancing clinical trial diversity FIRST ANALYSIS QUARTERLY INSIGHTS Integrative insights on emerging opportunities December 23, 2020 Joseph Munda Main: 312-258-1400 Direct: 312-258-7125 jmunda@firstanalysis.com www.firstanalysis.com
First Analysis
Pharma IT Team
Joseph Munda
Vice President
jmunda@firstanalysis.com
312-258-7125
Matthew Nicklin
Managing Director
mnicklin@firstanalysis.com
312-258-7181
Tracy Marshbanks
Managing Director
tmarshbanks@firstanalysis.com
312-258-7111
Andrew Walsh
Managing Director
awalsh@firstanalysis.com
312-258-7110
About the Author
Joseph Munda
Joseph Munda is a vice president specializing in research and
investment in healthcare technology. He is a thought leader in
his sector, having authored several widely read white papers. He
uses his industry knowledge and expansive network to uncover
promising investment opportunities and help companies navi-
gate their strategic paths and accelerate growth. Prior to joining
First Analysis in 2015, he was an equity research analyst covering medical device
and healthcare services companies at Sidoti & Co. Earlier, he worked in institutional
sales at Bear Stearns/J.P. Morgan. He earned a bachelor’s degree in finance from
Fairleigh Dickinson University.
About First Analysis
First Analysis has a nearly four-decade record of serving emerging growth compa-
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First Analysis and through First Analysis Securities Corp. (FASC), which provides investment banking
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PHARMA IT
Enhancing clinical trial diversity
y Representing population diversity in trials
is important given a review of 167 new NEW GUIDANCE ADDRESSES CRITICAL
molecular entities approved by the FDA
between 2008-2013 showed approximate- CHALLENGE OF TRIAL DIVERSITY ENROLLMENT
ly 20% had racial or ethnic differences in COVID-19 has made patient engagement
safety, efficacy and response. However, a top priority for the life sciences industry,
trial diversity remains a challenge for drug especially when it comes to recruiting, en-
sponsors. rolling and retaining trial participants. Even
y New guidance from the FDA and others prior to COVID-19, recruiting and enrolling
regarding how to broaden eligibility crite- patients into clinical trials required consid-
ria to increase clinical trial enrollment of erable time and expense. Industry estimates
underrepresented populations provides suggest 50% of clinical trials need to extend
a roadmap to addressing this challenge. their recruitment period, resulting in a loss
eClinical technology vendors – companies of up to $1.3 million per day for a given drug
that combine technology, applications, candidate. 11% of trial sites fail to recruit any
and services to automate clinical trial patients while 18% of trial participants drop
data collection, management and analysis out after enrolling.
and to automate other aspects of clinical Additionally, trial diversity remains a chal-
trials – are providing the tools to make it lenge for sponsors despite many trial sites
happen. providing medical care for patients of various
y We highlight a handful of innovative com- ethnicities and socioeconomic backgrounds.
panies whose software and other technol- For example, Black people are about 5% of
ogy promote diversity and accessibility in all patients enrolled in U.S. Food and Drug
clinical trial enrollment and participation. Administration (FDA) registered clinical trials
but represent about 13% of the U.S. popula-
y Digital biomarkers, developed using digital tion. Adequate representation of population
technologies that make it possible to effi- diversity in trials is important given a review
ciently collect and manage large volumes of 167 new molecular entities approved by
of high-quality patient data across dis- the FDA between 2008-2013 showed ap-
persed geographies and expansive time- proximately 20% had racial or ethnic differ-
lines, are particularly important in achiev- ences in safety, efficacy and response. Trial
ing diversity and represent an area seeing diversity becomes particularly important
substantial development, transactions and when it comes to COVID-19, which affects
investment. patients disproportionately relative to ethnic-
ity, age and economic background.
December 23, 2020 1 First AnalysisTABLE 1: Minority underrepresentation in clinical trials
BLACK OR AFRICAN AMERICANS HISPANIC OR LATINO ORIGIN
13.4% 5% 18.1% 1%
of the U.S. of clinical trial of the U.S. of clinical trial
population population population population
(Source: U.S. Census) (Source: FDA) (Source: U.S. Census) (Source: FDA)
Source: Clinical Research Pathways.
In November, the FDA released new industry Manufacturers of America (PhRMA) recently
guidance titled “Enhancing the Diversity of published its first-ever industrywide princi-
Clinical Trial Populations – Eligibility Crite- ples on clinical trial diversity, a new chapter
ria, Enrollment Practices, and Trial Designs.” in the already existing “Principles on Conduct
The guidance documents provide sponsors of Clinical Trials & Communication of Clini-
with a framework on how to broaden eligi- cal Trial Results.” The new chapter focuses
bility criteria to increase trial enrollment of on four key principles: 1) Building Trust and
underrepresented populations. In addition to Acknowledging Past Wrongs, 2) Reducing
the FDA, the Pharmaceutical Research and Barriers to Clinical Trial Access, 3) Using Re-
TABLE 2: Model pathway for trial enrollment process
CANCER DIAGNOSIS
Clinic access Clinical visit
Structural
Demographic and socioeconomic status
Assessment of
Trial available No trial available
trial availability
Assessment of
Clinical patient eligibility Patient eligible Patient ineligible
for available trial
Discussion of trial
participation with Trial discussed Trial not discussed
physician
Attitudinal
(physician)
Trial participation
Trial offered Trial not offered
offered/not offered
Attitudinal Patient agrees to Patient declines to
Patient decision
(patient) participate participate
Source: www.fightcancer.org
December 23, 2020 2 First Analysisal-World Data to Enhance Information on Di- care professionals to dispense investigational
verse Populations Beyond Product Approval, drugs and help ensure medication adherence
and 4) Enhancing Information About Diversity and compliance. In June, the company part-
and Inclusion in Clinical Trial Participation. nered with Thrifty White Pharmacy, whose
central fill pharmacy is accredited and li-
censed in all 50 states, to provide sponsors
TECHNOLOGY VENDORS PROVIDE TOOLS FOR with expanded access to diverse patient pop-
ulations who may be geographically excluded
THE TASK by the traditional trial site model.
Understanding that proactive patient-cen- Matrix Medical Network leverages its net-
tric strategies are needed to identify and work of more than 3,000 clinicians and its
enroll suitable patients expected to benefit fleet of mobile health clinics to remove geo-
from a drug’s approval, eClinical technology graphic barriers by providing mobile trial
vendors – companies that combine technol- access to high-risk and vulnerable popula-
ogy, applications, and services to automate tions. In October, the company announced as
clinical trial data collection, management and part of Operation Warp Speed and in collab-
analysis and to automate other aspects of oration with Fred Hutchinson Cancer Re-
clinical trials – are focused on making sure search Center it would provide 20 academic
their solutions and services promote diversity medical centers with mobile health clinics
and accessibility. For example, one innovative to increase access to the investigational
company providing a differentiated patient COVID-19 vaccine trials with a focus on those
engagement solution aimed at loosening the populations most affected by the virus.
bottleneck of recruit-
ment and enrollment
is Ripple Science. DIGITAL BIOMARKERS PROMOTE INCLUSION AND
Ripple’s CRM-based
platform for starting ENHANCE STUDY QUALITY
up studies trans-
forms site-level data into patient profiles to Digital biomarkers are patient-generat-
help ensure enrollment and retention. In July, ed physiological and behavioral measures
Ripple partnered with Lakeside Life Science collected through connected digital tools
to quickly recruit and track patients from (hardware and software) that can be used
small, underserved communities to clinically to explain diseases, influence fitness be-
validate Medsential’s point-of-care COVID-19 havior, predict drug response and anticipate
antibody test. health-related outcomes. The emergence of
digital technologies including smartphones
RxE2 and Matrix Medical Network are two and connected wearables like the Apple
other notable companies we recently spoke Watch provides clinical trial sponsors with
with that are using unique engagement the means to generate significant amounts of
models to overcome lo- patient-level data measured at frequent inter-
gistical challenges to trial vals between site visits. These technologies
accessibility and diversity. can be applied well beyond the duration of
RxE2 focuses on leveraging the trial itself, spanning the product life cycle
the close relationship be- from research and development to product
tween patients and pharmacists to improve launch to disease management and providing
trial recruitment, retention and outcomes by opportunities to develop novel endpoints and
having pharmacies be trial sites. Accord- supplemental data that may improve the case
ing to the company’s CEO, Gerald Finken, for therapies’ regulatory and reimbursement
pharmacies and pharmacists are significant approvals.
untapped resources for trial sponsors given
90% of the U.S. popu- As COVID-19 grinds on, demand for digital
lation lives within two biomarkers in clinical research has been
miles of a pharmacy. robust as drug sponsors and clinical research
Finken noted phar- organizations increasingly turn to digital
macies are ideally technology vendors for tools that enable
situated and filled with pharmacists whose them to get trials up and running, keep trials
skills and expertise make them ideal health- going, and keep patients safe despite the
December 23, 2020 3 First AnalysisTABLE 3: COVID-19 decompensation index
Source: PhysIQ.
pandemic’s disruptions. Further, the ubiquity, allows for more representative populations
ease of use, relatively low cost, and broad to be included, which according to the FDA’s
connectivity of the underlying smartphones, Patient Engagement Advisory Committee is
other connected devices, and networks that important as different populations who suffer
collect digital biomarkers make it possible from Parkinson’s disease may exhibit differ-
for bigger, more underrepresented and more ent symptoms. The study is expected to be
remote populations to take part in clinical completed by May 2022. Once validated, the
trials. We believe this creates new opportu- biomarkers are expected to be used to help
nities to increase trial diversity and accessi- assess other movement and mobility disor-
bility with digital biomarkers. For example, in ders.
September the National Cancer Institute and
the National Institute of Biomedical Imaging Overall, the market for
and Bioengineering of the National Institutes digital-biomarker-enabled
of Health awarded PhysIQ companies has been
a contract to develop an strong, encouraging more
artificial-intelligence-based companies to consolidate
COVID-19 Decompensation or raise capital. This is
Index (CDI) digital biomark- evident in a recent wave of
er to address the rapid decline of high-risk M&A and financing activ-
COVID-19 patients. The study is designed to ity in the space, including
capture data from a large, diverse population Medidata’s (a subsidiary of
to investigate CDI performance differences Dassault Systèmes, Paris:
among subgroups based on sex, gender, DSY) recent acquisition
racial and ethnic characteristics. of MC10’s digital biomark-
er business, ArchiMed’s
In another example, Brain Baseline is de- acquisition of Actigraph,
veloping digital biomarkers for Parkinson’s ERT’s acquisition of APDM
disease through the Watch-PD clinical trial and recent merger with
sponsored by the Bioclinica, AliveCor’s $65
University of Roch- million Series E financing,
ester in collabora- Evidation Health’s $45 mil-
tion with Biogen lion Series D financing, and Koneska Health’s
and Takeda. In our view, the observational $16 million Series B financing.
study’s hybrid design (in-clinic and at-home)
December 23, 2020 4 First AnalysisBETTER VALUE FOR ALL
By providing tools that enable therapeutic
companies to efficiently understand and
optimize how their products affect all pos-
sible target populations, eClinical technolo-
gy companies help life science innovations
reach every potential beneficiary, maximizing
the value society and the economy derive
from our rapidly advancing understanding of
human biology.
December 23, 2020 5 First AnalysisCommercialization and eClinical indices
continue recovery
The First Analysis Commercialization Index eClinical index continued to perform more
appreciated 38% between Dec. 20, 2019, and in line with the S&P 500 over the one-year
Dec. 18, 2020, and the First Analysis eClin- period through Dec. 18, the commericializa-
cial Index appreciated 21%. For the one-year tion index performed more in line with the
period ending in June, both indexes per- faster-appreciating Nasdaq over the past
formed similarly to the S&P 500. While the year.
eClinical/commercialization public comparables*
($ in millions) Revenue growth Enterprise value /
LTM LTM
Revenue EBITDA1
LTM 2019A- 2020E gross EBITDA
Company revenue 2020E -2021E margin margin 2020E 2021E 2020E 2021E
Commercialization
Clarivate (CCC) $1,053.5 30.8% 41.7% 67.0% 31.2% 15.73x 11.10x 41.1x 24.8x
Informa (INF) $3,099.6 (42.5%) 25.7% 38.9% 24.9% 6.10x 4.86x 29.5x 16.1x
Model N (MODN) $161.1 13.0% 8.1% 59.3% (0.7%) 7.36x 6.81x NMF NMF
OptimizeRx Corp. (OPRX) $34.3 54.4% 27.7% 58.3% (6.7%) 11.28x 8.83x NMF NMF
PaySign (PAYS) $26.6 (30.1%) 78.7% 40.0% (14.3%) 10.41x 5.83x NMF 29.5x
Phreesia (PHR) $139.7 17.4% 23.3% 65.1% (8.9%) 14.96x 12.14x NMF NMF
UDG Healthcare (UDG) $1,279.2 (2.4%) 2.8% 31.1% 14.5% 2.21x 2.15x 13.5x 12.3x
Veeva Systems (VEEV) $1,379.8 31.2% 18.6% 71.8% 26.9% 27.77x 23.41x NMF NMF
Wolters Kluwer (WKL) $5,750.3 0.8% 1.5% 70.5% 29.6% 4.41x 4.35x 15.0x 14.6x
Average $1,436.0 8.1% 25.3% 55.8% 10.7% 11.14x 8.83x 24.8x 19.5x
Median $1,053.5 13.0% 23.3% 59.3% 14.5% 10.41x 6.81x 22.2x 16.1x
eClinical
Certara (CERT) $232.7 0.0% 0.0% 62.3% 31.7% 0.00x 0.00x NMF 0.0x
Cogstate (CGS) $23.7 0.0% 0.0% 42.6% (4.4%) 0.00x 0.00x NMF 0.0x
Dassault Systèmes (DSY) $5,400.6 10.8% 9.1% 82.8% 22.6% 9.96x 9.13x 30.9x 27.4x
ICON (ICLR) $2,762.5 (0.5%) 12.6% 30.4% 17.0% 3.57x 3.18x 21.2x 18.0x
IQVIA Holdings (IQV) $10,956.0 1.0% 11.7% 34.0% 16.2% 4.14x 3.71x 19.8x 16.8x
PPD (PPD) $4,364.1 13.8% 10.6% 63.5% 16.7% 3.52x 3.19x 18.6x 16.5x
PRA Health Sciences (PRAH) $3,110.1 2.3% 11.3% 48.6% 13.4% 2.87x 2.58x 18.5x 15.2x
Schrödinger (SDGR) $100.9 31.4% 55.7% 59.5% (48.2%) 44.18x 28.37x NMF NMF
Simulations Plus (SLP) $41.6 19.6% 21.0% 74.4% 34.7% 28.01x 23.16x NMF NMF
Syneos Health (SYNH) $4,488.7 (5.2%) 15.8% 22.5% 12.6% 2.20x 1.90x 15.6x 13.1x
Average $3,148.1 7.3% 14.8% 52.1% 11.2% 9.85x 7.52x 20.7x 13.4x
Median $2,936.3 1.7% 11.5% 54.1% 16.5% 3.55x 3.18x 19.2x 15.9x
Source: Capital IQ, First Analysis.
Notes: * Public comparable company data shown above is as of Dec. 20, 2020.
(1) EBITDA multiples less than 0 and greater than 50 labeled “NMF”.
December 23, 2020 6 First AnalysisFirst Analysis eClinical/Commercialization Index 1-year performance
eClinical Commercialization NASDAQ S&P 500
Index price1
Overall performance, %
50%
Hundreds
40% 42.92%
36.54%
30%
20% 20.92%
15.16%
10%
0%
-10%
-20%
-30%
-40%
Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20
Enterprise value / LTM revenue1
10x
9x
8.68x
8x
7x
6x
5.05x
5x 4.87x
4x
3x 3.04x
2x
1x
0x
Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20
Source: Capital IQ.
Notes: (1) eClinical/commercialization index performance is based on market cap weighted constituents. For
the period from Dec. 20, 2019, through Dec. 18, 2020.
All but two of the commercialization stocks The increase in stock prices helped drive the
were up over the period. The two largest commercialization index’s enterprise value
gainers were OptimizeRX (OPRX), up 173%, multiple of trailing-12-month revenue to 8.7,
and Phreesia (PHR), up 110%. Veeva (VEEV), close to its high of 8.9 on Nov. 5 and up from
which accounted for about 23% of the com- 6.3 the last time we reported the value of this
mercialization index’s total market capitaliza- index in June. The eClinical index’s multiple
tion on Dec. 20, 2019, and was up 94% in the increased to 5.1 from 4.2 in June.
past year, accounted for nearly a fourth the
index’s gain. Looking at enterprise value multiples of es-
timated full-year 2020 revenue, the average
All the eClinical stocks in the group were up and median multiples for the commercializa-
over the period. The two largest gainers were tion group as of Dec. 20 were 11.1 and 10.4,
Cogstate (CGS), up 181%, and Simulations up from 7.2 and 5.6 as of June 9, despite the
Plus (SLP), up 87%. The largest eClinical average 2020 estimated growth rate decreas-
index contributor was IQVIA, which account- ing from 9.3% to 8.1%. The largest multiple
ed for about 30% of the eClinical index’s total increases were OptimizeRx, from 5.6 to 11.3,
market capitalization on Dec. 20, 2019, and and Phreesia (PHR), from 8.1 to 15.0. For the
was up 16% in the past year. eClinical group, the average and median mul-
tiples were 9.9 and 3.6, up from 6.5 and 3.2 as
of June 9, with the average estimated 2020
growth rate increasing from 2.6% to 7.3%.
December 23, 2020 7 First AnalysisPharma IT M&A rebounds in Q4
With 16 notable pharma IT transactions in the tise in imaging with ERT’s expertise in elec-
fourth quarter through Dec. 20, M&A activity tronic clinical outcome assessment, cardiac
has rebounded from the two-year quarterly safety, respiratory and wearables.
low of six transactions in the third quarter but
remains well below the two-year high of 32 Advarra acquired Longboat in late November
transactions in the 2019 second quarter. We for an undisclosed amount. Longboat pro-
highlight the following transactions with rel- vides clinical trial technologies focused on
evance to our discussion of tools to achieve site training, protocol compliance, and pa-
diversity in clinical trial participation. tient engagement. The addition of Longboat
broadens Advarra’s suite of technology solu-
In December, ERT, a leader in clinical end- tions for sites, biopharmaceutical companies,
point data solutions, agreed to merge with and clinical research organizations.
Bioclinica, a technological and scientific
leader in clinical imaging, for an undisclosed Medidata acquired MC10’s digital biomarker
amount. Bioclinica was a portfolio compa- business in late October for an undisclosed
ny of private equity firm Cinven, which will amount. The addition of this business brings
become a minority shareholder of ERT. The novel clinical analytics and biosensor capa-
transaction will integrate Bioclinica’s exper- bilities to Medidata and enhances Medidata’s
ability to integrate data from wearable sen-
sors and help customers successfully virtual-
ize clinical trials.
237 230
Pharma services M&A 1Q19 - 4Q201
205 206 202 198 ($ in millions)
182
151 # of transactions
32
29 28
$18.0 Avg. transaction size
$13.3
$15.9 $15.8
$14.1$13.7 $1,143 26
$10.0
22
$9.6
$952 $901
17 16
$469
$411
6
$250
$77
$0
1Q19 2Q19 3Q19 4Q19 1Q20 2Q20 3Q20 4Q20
Total transaction size $538 $5,713 $1,233 $3,809 $1,876 $501 $0 $4,503
Source: Capital IQ, Pitchbook, First Analysis.
Notes: (1) Average and total deal size only consider those deals with reported enterprise values. 4Q20 includes
reported deals through Dec. 20.
December 23, 2020 8 First AnalysisSelect recent M&A transactions (sorted by date of announcement)
($ in millions)
Enterprise EV/
Date Target Target business description Buyer value (EV) revenue
12/21/2020 Cytel Software and solutions for design, analysis, and imple- Astorg Partners; $1,000.0 NA
mentation of clinical trials Nordic Capital
12/18/2020 BioTelemetry Provides monitoring services and digital population Philips (AMS: $2,842.7 6.64x
(BEAT) health management for healthcare providers, medical PHIA)
device manufacturing, and centralized core laboratory
services for clinical research
12/14/2020 MS Clinical Offers clinical trials with specialization in oncology, Ergomed (LON: $25.0 0.80x
Services neurology and rare diseases that support biopharma- ERGO)
ceutical clients who conduct complex clinical trials
in the most challenging disease states and patient
populations
12/10/2020 Bioclinica Provider of technology-enabled services to contract Ares Capital $5,900.0 NA
research organizations and pharmaceutical compa- (ARCC); Astorg;
nies, supporting the development of new medical eResearch Tech-
therapies globally nology; Nordic
Capital; Novo
12/10/2020 Synteract Offers a complete range of clinical development and Syneos Health $400.0 8.07x
consulting services in clinical operations, safety sur- (NAS: SYNH)
veillance, bio-statistics, data management, medical
monitoring and medical writing
12/7/2020 Everest Clinical Services include biostatistics and statistical program- Arlington Capital Undisclosed NA
Research ming, clinical data management, medical coding, trial Partners
subject randomization using interactive web-based
response system, trial drug dispensing and inventory
management, enabling clients to achieve drug and
medical device development goals and maintain a high
level of ethical and professional standards
12/3/2020 Trifecta Clinical Provider of a fully integrated training, safety and com- Annox; Arsenal; Undisclosed NA
munication platform for pharmaceutical, biotech and Leonard Green
clinical research organizations & Partners; MSD
Capital; Novo;
WIRB-Copernicus
12/1/2020 PCI Pharma Provider of integrated pharmaceutical development Kohlberg & Com- Undisclosed NA
Services services to healthcare companies pany; Mubadala
Development Co.
12/1/2020 PDCI Market Provides assistance to its clients regarding price reg- McKesson Can- Undisclosed NA
Access ulations, public and private reimbursement strategies ada
and submission as well as pharmaceutical policy and
economic research projects
11/23/2020 Longboat Clinical trial software platform spanning patient recruit- Advarra Undisclosed NA
ment through to study closeout. It serves investigators,
site staff, patient, caregivers, and CRAs.
11/12/2020 Two Labs Provider of consultancy services for the pharmaceuti- Envision Pharma; $280.0 NA
cal and biotechnology sectors GHO Capital;
HarbourVest;
Mubadala Invest-
ment Company
11/11/2020 eStudySite Provider of outsourced clinical research services NaviMed Capital; Undisclosed NA
intended to improve the process for bringing new med- Velocity Clinical
icines to the global community Research
10/27/2020 Digital biomark- Wearable medical sensors Medidata Solu- Undisclosed NA
er biz of MC10 tions
10/13/2020 Agnitio Digital sales tools intended to empower the life science BigTinCan (ASX: $3.6 2.23x
sales force BTH)
10/2/2020 snapIoT Self-service clinical science platform designed to de- Covance Undisclosed NA
centralize clinical trials
10/1/2020 ProPharma Provider of medical information, pharmacovigilance Odyssey Invest- Undisclosed NA
Group and compliance consulting services ment Partners
Average 4.43x
Median 4.43x
Source: Capital IQ, First Analysis.
December 23, 2020 9 First AnalysisQ4 pharma IT private placements continue
trend downward
With 15 pharma IT private placements in the clinical trials, replacing siloed systems with
fourth quarter through Dec. 20, the quarterly integrated digital tools, data and interfaces to
pace of transactions in the sector appears accelerate trial execution. In connection with
on track to hit a two-year low. Private place- the transaction, David Hartwig from Sapphire
ment activity has trended downward since Ventures has joined the company’s board of
the two-year high of 39 transactions in the directors.
second quarter. We highlight two noteworthy
fourth-quarter transactions involving technol- In December, Elligo Health Research re-
ogies useful in ensuring clinical trial partici- ceived an undisclosed amount of Series D
pant diversity. funding led by new investor Cerner (CERN).
Elligo uses electronic health records and
Medable raised $91 million in a Series C patient-physician relationships to help ensure
round in mid-November led by new investor patients have access to clinical research as a
Sapphire Ventures and including existing care option, engaging physicians and pa-
investors GSR Ventures, PPD (PPD) and tients who otherwise would not participate in
Streamlined Ventures. Medable’s digital clinical research and helping accelerate ther-
platform streamlines design, recruitment, apeutic and diagnostic product development.
retention and data quality for decentralized
237 230
Pharma services private placements 1Q19 - 4Q201
205 206 202 198 ($ in millions)
182 $95.0
151 # of transactions
39 39
$18.0 Avg. transaction size 37
$15.9 $15.8
$13.3 $14.1$13.7
$9.6 $10.0
$67.5
24 25
23 23
15
$23.9
$20.4
$17.1 $14.7 $15.4
$4.8
1Q19 2Q19 3Q19 4Q19 1Q20 2Q20 3Q20 4Q20
Total transaction size $273 $265 $76 $432 $2,659 $789 $408 $743
Source: Capital IQ, Pitchbook, First Analysis.
Notes: (1) Average and total deal size only consider those deals with reported enterprise values. 4Q20 includes
reported deals through Dec. 20.
December 23, 2020 10 First AnalysisSelect recent private placements (sorted by date of announcement)
($ in millions) Total
Amount amount
Date Company Business description Investors Raise type raised raised
12/18/2020 Pear Software-based digital therapeutics 5AM Ventures; Arbo- Later Stage $112.0 $251.0
Therapeutics platform designed to treat disease and retum; CrimsoNox; VC
enhance the efficacy via prescription EDBI; Forth Manage-
digital therapeutics ment; JAZZ Venture;
Novartis
12/10/2020 Tempus Labs Health care data analytics platform Baillie Gifford; Franklin Later Stage $450.0 $1,070.0
designed to improve patient outcomes Templeton; GV; Novo; VC
T. Rowe Price
12/8/2020 Elligo Health Clinical research platform designed to Cerner (CERN) Later Stage Undis- $41.0
Research revolutionize research by eliminating VC closed
the barriers that contribute to study
delays and budget overruns
12/4/2020 Circuit Clinical Integrated research organization that KMG Capital; Launch Later Stage $4.7 $12.9
optimizes the clinical research experi- NY; Western New VC
ence York Venture Associ-
ation
12/3/2020 Clinical Ink eSource technology designed to revo- McKesson Ventures PE Growth/ Undis- $17.5
lutionize clinical research by eliminat- Expansion closed
ing paper source documents
12/2/2020 Kayentis Electronic clinical outcome assess- Bpifrance; Extens; Later Stage $8.3 $25.8
ment (eCOA) technology designed to LBO France VC
offer new perspectives to speed up
clinical trials
11/20/2020 Precision Clinical research organization special- Berkshire Partners; PE Growth/ Undis- $350.0
Medicine Group ized in the field of precision medicine Oak HC/FT; The Expansion closed
Blackstone Group;
TPG Growth; Vida
Ventures
11/19/2020 Medable Decentralized trial platform designed GSR Ventures; Phar- Later Stage $91.0 $142.6
to get effective therapies to patients maceutical Product VC
faster Development (PPD);
Sapphire Ventures;
Streamlined Ventures
11/10/2020 COTA Healthcare informatics and precision Baptist Health South PE Growth/ $44.0 $115.7
analytics software designed to improve Florida; Boston Mil- Expansion
the lives of cancer patients lennia Partners; EW
Healthcare Partners;
Horizon Blue Cross
Blue Shield of New
Jersey; ONC Capital
11/6/2020 ArborMetrix Provides clinical performance analytics Invest Detroit Ven- Later Stage $12.8 $30.3
tools designed to improve the delivery tures VC
of healthcare outcomes through data
science
11/5/2020 Unlearn Platform designed to accelerate clinical 8VC; Alumni Ven- Early Stage $15.0 $20.0
trials with artificial intelligence tures Group; Data VC
Collective; DCVC Bio;
Eisai Ventures; EPIC
Ventures; Mubadala
Capital-Ventures
10/26/2020 MD Biosciences Provider of preclinical, translational and Great Point Partners; Buyout/ Undis- Undis-
clinical-phase contract research ser- MLM Medical Labs LBO closed closed
vices for the development of pharma-
ceutical and diagnostic assets
10/23/2020 Subjectwell Patient recruitment platform designed Geekdom Fund Later Stage $1.8 $17.5
to deliver highly qualified referrals for VC
clinical trials
10/22/2020 Jeeva Biotechnology platform intended to Center for Innovative Seed Round $0.2 $0.4
Informatics transform thinking about research, de- Technology
velopment, and commercialization
December 23, 2020 11 First AnalysisSelect recent private placements (sorted by date of announcement)
($ in millions) Total
Amount amount
Date Company Business description Investors Raise type raised raised
10/13/2020 rMark Bio Business intelligence software de- CerraCap Ventures Early Stage $2.8 $4.5
signed to accelerate innovation, collab- VC
oration and scientific discovery for life
sciences
Source: Capital IQ, Pitchbook, First Analysis.
December 23, 2020 12 First AnalysisDecember 23, 2020
eClinical/commercialization public comparables appendix*
($ in millions) Revenue growth Enterprise value /
LTM LTM
Revenue EBITDA1
Market Enterprise LTM 2019A- 2020E gross EBITDA
Company cap value revenue 2020E -2021E margin margin 2020E 2021E 2020E 2021E
Commercialization
Clarivate (CCC) $18,615.0 $20,049.0 $1,053.5 30.8% 41.7% 67.0% 31.2% 15.73x 11.10x 41.1x 24.8x
Informa (INF) $10,798.1 $13,686.8 $3,099.6 (42.5%) 25.7% 38.9% 24.9% 6.10x 4.86x 29.5x 16.1x
Model N (MODN) $1,284.9 $1,202.4 $161.1 13.0% 8.1% 59.3% (0.7%) 7.36x 6.81x NMF NMF
OptimizeRx Corp. (OPRX) $440.0 $428.4 $34.3 54.4% 27.7% 58.3% (6.7%) 11.28x 8.83x NMF NMF
PaySign (PAYS) $255.6 $252.5 $26.6 (30.1%) 78.7% 40.0% (14.3%) 10.41x 5.83x NMF 29.5x
Phreesia (PHR) $2,413.9 $2,192.4 $139.7 17.4% 23.3% 65.1% (8.9%) 14.96x 12.14x NMF NMF
UDG Healthcare (UDG) $2,707.1 $2,846.2 $1,279.2 (2.4%) 2.8% 31.1% 14.5% 2.21x 2.15x 13.5x 12.3x
Veeva Systems (VEEV) $41,760.6 $40,229.2 $1,379.8 31.2% 18.6% 71.8% 26.9% 27.77x 23.41x NMF NMF
Wolters Kluwer (WKL) $22,334.4 $25,090.9 $5,750.3 0.8% 1.5% 70.5% 29.6% 4.41x 4.35x 15.0x 14.6x
Average $11,178.8 $11,775.3 $1,436.0 8.1% 25.3% 55.8% 10.7% 11.14x 8.83x 24.8x 19.5x
Median $2,707.1 $2,846.2 $1,053.5 13.0% 23.3% 59.3% 14.5% 10.41x 6.81x 22.2x 16.1x
eClinical
Certara (CERT) $5,582.8 $5,977.9 $232.7 0.0% 0.0% 62.3% 31.7% 0.00x 0.00x NMF 0.0x
Cogstate (CGS) $148.9 $143.1 $23.7 0.0% 0.0% 42.6% (4.4%) 0.00x 0.00x NMF 0.0x
13
Dassault Systèmes (DSY) $51,623.5 $54,232.0 $5,400.6 10.8% 9.1% 82.8% 22.6% 9.96x 9.13x 30.9x 27.4x
ICON (ICLR) $10,248.4 $9,975.4 $2,762.5 (0.5%) 12.6% 30.4% 17.0% 3.57x 3.18x 21.2x 18.0x
IQVIA Holdings (IQV) $34,585.4 $46,363.4 10,956.0 1.0% 11.7% 34.0% 16.2% 4.14x 3.71x 19.8x 16.8x
PPD (PPD) $12,346.3 $16,163.4 $4,364.1 13.8% 10.6% 63.5% 16.7% 3.52x 3.19x 18.6x 16.5x
PRA Health Sciences (PRAH) $7,860.9 $9,007.0 $3,110.1 2.3% 11.3% 48.6% 13.4% 2.87x 2.58x 18.5x 15.2x
Schrödinger (SDGR) $5,549.2 $4,962.5 $100.9 31.4% 55.7% 59.5% (48.2%) 44.18x 28.37x NMF NMF
Simulations Plus (SLP) $1,314.6 $1,199.5 $41.6 19.6% 21.0% 74.4% 34.7% 28.01x 23.16x NMF NMF
Syneos Health (SYNH) $7,175.7 $9,772.8 $4,488.7 (5.2%) 15.8% 22.5% 12.6% 2.20x 1.90x 15.6x 13.1x
Average $13,643.6 $15,779.7 $3,148.1 7.3% 14.8% 52.1% 11.2% 9.85x 7.52x 20.7x 13.4x
Median $7,518.3 $9,389.9 $2,936.3 1.7% 11.5% 54.1% 16.5% 3.55x 3.18x 19.2x 15.9x
Source: Capital IQ.
Notes: * Public comparable company data shown above is as of Dec. 20, 2020.
(1) EBITDA multiples less than 0 and greater than 50 labeled “NMF”.
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