Earnings Call Transcript - IQV Q1 2022

Operator, Operator

Ladies and gentlemen, thank you for standing by. At this time, I would like to welcome everyone to the IQVIA First Quarter 2022 Earnings Conference Call. All lines have been placed on mute to prevent any background noise. After the speakers' remarks, there will be a question-and-answer session. As a reminder, this call is being recorded. Thank you. I would now like to turn the call over to Nick Childs, Senior Vice President, Investor Relations and Corporate Communications. Mr. Childs, please begin your conference.

Nick Childs, Senior Vice President, Investor Relations and Corporate Communications

Thank you. Good morning everyone. Thank you for joining our first quarter 2022 earnings call. With me today are Ari Bousbib, Chairman and Chief Executive Officer; Ron Bruehlman, Executive Vice President and Chief Financial Officer; Eric Sherbet, Executive Vice President and General Counsel; Mike Fedock, Senior Vice President, Financial Planning and Analysis; and Bryan Stengel, Associate Director, Investor Relations. Today, we will be referencing a presentation that will be visible during this call for those of you on our webcast. This presentation will also be available following this call in the Events and Presentations section of our IQVIA Investor Relations website at ir.iqvia.com. Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements. Actual results will differ materially from those stated or implied by forward-looking statements due to risks and uncertainties associated with the company's business which are discussed in the company's filings with the Securities and Exchange Commission, including our annual report on Form 10-K and subsequent SEC filings. In addition, we will discuss certain non-GAAP financial measures on this call, which should be considered a supplement to and not a substitute for financial measures prepared in accordance with GAAP. A reconciliation of these non-GAAP measures to the comparable GAAP measures is included in the press release and conference call presentation. I would now like to turn the call over to our Chairman and CEO, Ari Bousbib.

Ari Bousbib, Chairman and Chief Executive Officer

Thank you, Nick and good morning everyone. Thank you for joining today to discuss our first quarter results. IQVIA has very strong financial results in the quarter despite the broader macro environment. On this note, regarding first the tragic situation in Ukraine, our thoughts and concerns from the beginning have been around the safety and well-being of our employees, the patients we support, and all those affected by the ongoing events. We've been actively supporting our employees and their families on the ground with evacuation support, relocation services and financial assistance. For example, we accelerated bonus payments and actually we continue to pay our employees there, regardless of their ability to perform any work. In addition, IQVIA capabilities are being utilized to help support the resulting refugee crisis. For example, Ukrainian refugees are entering surrounding countries with medicines and prescriptions and medical professionals in those countries are seeking to identify and convert product information on these prescriptions into their local equivalent. To help, we've established a free online service for medical professionals to search a product name, active ingredients, and strength, and the tool generates a list of matching products in whichever local country around Ukraine is. Also, we've been working very closely with our customers, suppliers and clinical sites across the region to ensure continuity of our in-flight clinical trials and ensure, of course, that our clients are able to continue to support the effective delivery of medicines to vulnerable patients in the region who depend on these medicines. In Ukraine, we are providing support to ensure that trial patients who have begun receiving treatment remain on their treatment protocols. We have established direct-to-patient shipments of investigational medical products and patient call centers to ensure patient care can continue. In Russia, we are guided by ethical concerns to ensure the safety of patients already enrolled in clinical trials. We are utilizing our global logistics and procurement infrastructure to facilitate the movement of investigational medical products, lab kits, and samples into and out of the country to minimize potential adverse impacts to patient care. For studies that are in startup or early phase in both countries, we are redirecting patient recruitment to other countries based on consultations with our customers. Even though a little less than 1% of our overall revenue and approximately 3% of our global patient recruitment come from Ukraine and Russia, the operational disruptions I just described will have some financial impact which we have incorporated into our updated guidance. Another key focus area for investors in the quarter has been the emerging biopharma funding environment. We received a number of questions on this topic since our earnings release in February and we have addressed those in multiple forums. However, there have been some lingering questions on the same topic and I want to take this opportunity once again to reiterate our comments with a specific focus on the funding environment and our own company's exposure to this EBP segment. I'll start by stating that the concern about the EBP funding environment is overstated. I want to support this assertion with four key points. First, the industry has observed a slowdown in public funding compared to the record levels in 2020 and 2021, but the private venture capital markets have continued to be strong and funding in the first quarter of 2022 was the third highest ever according to the National Venture Capital Association. I will also observe that these EBP firms are seeking large amounts of cash from the very strong funding cycles in 2020 and 2021. Second, when there is a reduction in EBP funding or the IPO market contracts, mid and large pharma companies often step up their acquisition activities of EBP companies and frankly, that benefits us as we have long-standing relationships with these customers. In fact, you may have seen the recent acquisition of Checkmate Pharmaceuticals by Regeneron, which illustrates this very point. Third, history tells us that when EBP funding slows, it does not have a significant effect on our business. For example, following the last EBP funding slowdown in 2015, 2016, our IQVIA biotech unit saw no interruption in net new business and revenue growth, nor any unusual increase in cancellations. Finally, when we look at either our pipeline or RFP activity, we have simply not seen any slowdown, no unusual cancellation activity, no unusual delays in decision-making. In fact, in the quarter our overall R&DS RFP dollars were up 13% year-over-year, and RFP dollars from EBP were up over 16%. The broader industry continues to show strength. We're seeing clinical trials start up 7% in the first quarter compared to last year, with a 14% increase in oncology trial starts, which is a therapeutic area that's predominantly sponsored by EBP. Now let me focus on our own exposure to the same, specifically three commercial EBPs, which are those EBPs that have zero revenue, and are the most vulnerable and exposed to the funding environment. And here I want to make another four points. First, as of March 31, pre-commercial EBPs represented just over 10% of our total R&DS backlog. Second, less than 7% of our overall RFP dollars in the quarter came from pre-commercial EBP. Third, this exposure to pre-commercial EBP for IQVIA is not only minimal but also, I want to underline that our vetting process for taking on a pre-commercial EBP is extremely rigorous and thorough. The process includes, for example, a review of the client's cash balances, payment history, viability, quality of their science, and of course, progress with clinical developments. So, again, said differently, not every EBP who knocks at our door with a molecule that they think is interesting makes it into our battle. Finally, I will simply remind you that this exposure primarily impacts our R&DS segment. Approximately 45% of IQVIA's total company revenue comes from our commercial businesses and as you know, there is virtually zero pre-commercial exposure on the commercial side. With that background, let me now delve into the first quarter results. Revenue for the first quarter grew 4.7% on a reported basis and 6.8% at constant currency. The $23 million beat above the midpoint of our guidance range was driven by strong operational performance across all three segments and was, of course, partially offset by foreign exchange headwinds. Compared to the prior year and excluding COVID-related work for both years, our core businesses grew about 13% at constant currency on an organic basis. First quarter adjusted EBITDA grew 9.1% reflecting our revenue growth, as well as ongoing productivity initiatives. First quarter adjusted diluted EPS of $2.47 grew 13.3%, that was 4% above the midpoint of our guidance, with about $0.03 of the beat coming from operational improvements. I'll now provide an update on the business and let's start with the commercial and technology side. We've spoken before and you're familiar with IQVIA's connected intelligence framework, which leverages our advanced analytics technology and domain expertise across the entire clinical and commercial portfolio and has been critical in supporting the emerging needs of the pharma industry. I want to give a recent example of how these capabilities are being deployed. In the quarter, we entered into a multiyear agreement with Argenx for the development and commercialization of new indications for their rare disease product currently approved for treatments of a rare autoimmune disorder affecting the muscles. Our collaboration with Argenx incorporates IQVIA's Connected Intelligence to support clinical development, real-world evidence, regulatory and commercial support to accelerate the development of this product for potential treatment of other severe autoimmune diseases and to expand globally. This is an exciting product with a lot of upside potential. It's currently approved for six indications, with the potential for up to 15 indications. Plus this drug has already been launched in the U.S. and has plans to launch in Europe and in Japan in the next year. Another example of a client selecting IQVIA's integrated capabilities to solve complex problems is a European pharma client recently selecting IQVIA's Vigilance Platform and Regulatory Information Management Technology. This is an area that's a real headache for our clients, and our technology solutions simplify and streamline our processes. This client will benefit from our technology's integrated AI ML capabilities, automation of labor-heavy activities, and easy implementation. To date, over 150 clients have adopted one or more solutions within our safety, regulatory, and various technology suites. In the real world evidence space, I'm sure you've seen that we were selected to support DARWIN, or Data Analysis and Real World Interrogation Network. DARWIN is a strategic initiative of the EMA. This is a major win for IQVIA, as it draws on our proprietary technologies, methods and deep scientific and operational expertise. It will help us deepen our relationship with healthcare providers and sites across Europe. Moving to Clinical Technology, IQVIA continues to lead the industry in decentralized clinical trials. Our end-to-end solution of integrated technology and services capabilities are being utilized on just over one-third of our full service trials globally. Today, we've recruited over 300,000 patients across 80 countries, covering over 30 indications. Now, whether for traditional or decentralized trials, demand for our suite of digital clinical technology offerings continued to increase during the first quarter. To date, over 400 clients have adopted one or more modules within our Orchestrated Clinical Technology suite since launch. One of these key modules, for example, is our clinical trial payments solution. This technology ensures accurate, timely and transparent investigator payment processing. It is a key driver of both site and sponsor satisfaction. Four of the top 10 and 25 of the top 30 pharma clients have now selected IQVIA's payment technology solution for their trials. This includes a major award in the quarter with a top 10 sponsor to migrate their entire payment ecosystem across several legacy platforms to our technology. The scale of this technology migration is the largest of its kind in the industry and it encompasses 120 clinical studies across all phases, with over 6000 sites globally. Beyond these client highlights, our overall R&DS businesses continued to see strong momentum in the quarter, delivering over $2.5 billion of net new business, including pass-throughs. This included a record quarter of over $1.9 billion of services bookings, resulting in the first quarter of contracted net book-to-bill ratio of 1.32, excluding pass-throughs and 1.31 including pass-throughs. Over the last 12 months, our contracted net book-to-bill ratio was 1.33 excluding pass-throughs and 1.32 including pass-throughs. Our contracted backlog in R&DS grew 9.1% year-over-year to a record $25.3 billion as of March 31, 2022. As a result, our next 12 months revenue from backlog increased to over $7 billion growing 8% from a year ago. As you can see, there is a lot of strong positive momentum across the business, regardless of the choppy macro environment. On a final note, IQVIA was named the top CRO in overall reputation by clinical trial sites around the world in the 2021 CenterWatch's Global Site Benchmark Survey. This is a big deal for us. This is a rigorous and independent survey, that is highly respected in the industry. Over 60,000 investigators, trial coordinators, research nurses, and other clinical professionals representing clinical trial sites from around the world were asked to rank and score 29 CROs across 35 performance-related attributes. We are proud to have been selected and named the top CRO in overall reputation, and specifically, we received high marks, especially high marks for our comprehensive decentralized trials, direct-to-patient recruitment, and therapeutic clinical regulatory and technology expertise. I will now turn it over to Ron for more details on our financial performance.

Ron Bruehlman, Executive Vice President and Chief Financial Officer

Thanks, Ari, and good morning, everyone. Let's start by reviewing revenue. First quarter revenue of $3,568 million grew 4.7% on a reported basis and 6.8% at constant currency. In the quarter, COVID-related revenues were approximately $375 million which was down about 35% versus the first quarter of 2021. In our base business, that is excluding all COVID-related work from both this year and last, organic growth at constant currency was about 13%. Technology and Analytic Solutions revenue for the first quarter was $1,439 million, which was up 6.8% reported and 9.8% at constant currency. Excluding all COVID-related work, organic growth at constant currency in Tech and Analytic Solutions was just over 10%. R&D Solutions first quarter revenue of $1,934 million was up 3.5% at actual FX rates and 4.7% at constant currency. Again, excluding all COVID-related work, organic growth at constant currency in R&DS was approximately 17% which was consistent with our expectations. Contract Sales and Medical Solutions or CSMS first quarter revenue of $195 million grew 1% reported and 5.7% at constant currency. Excluding all COVID-related work, organic growth at constant currency in CSMS was mid single digits. And let's move down the P&L now. Adjusted EBITDA was $812 million for the first quarter, which represented growth of 9.1% on a reported basis. First quarter GAAP net income was $325 million, that was up 53.3% year-over-year and GAAP diluted earnings per share was $1.68 up 54.1% year-over-year. Adjusted net income was $477 million for the quarter, up 12.2% year-over-year and adjusted diluted earnings per share grew 13.3% to $2.47. Now as already reviewed, R&D Solutions delivered yet another outstanding quarter of net new business. Our backlog at March 31 stood at a record $25.3 billion, an increase of 9.1% year-over-year. Next 12 months revenue from backlog increased 8% year-over-year to just over $7 billion and I would note that both the backlog and next 12 months revenue numbers I just quoted were affected by FX rates at quarter end, and that is to say they were lower than they otherwise would have been due to the strengthening of the dollar during the quarter. Okay, moving now to the balance sheet, first quarter cash flow from operations was $508 million and CapEx was $177 million. That resulted in free cash flow of $331 million and as a reminder, our free cash flow in the first quarter of each year is affected by the timing of annual bonus payments. At March 31, cash and cash equivalents totaled $1,387 million and gross debt was $12,637 million which resulted in net debt of $11,250 million. Our net leverage ratio at March 31 was 3.64 times trailing 12 months adjusted EBITDA. In the quarter, we repurchased $403 million of our shares, which leaves us with slightly over $2.1 billion of share repurchase authorization remaining under the current program. Now let's move to guidance. For the full year 2022, our expectation remains unchanged that organic revenue growth excluding COVID-related work will be low to mid-teens at constant currency. Since February, FX fluctuations have caused an incremental full year revenue headwind of over $200 million as of yesterday's rates. In addition, we currently estimate the revenue disruption from the Russia-Ukraine crisis to be in the $40 million to $50 million range. Accordingly, we are updating our revenue guidance range to reflect these two factors. For the full year, we now expect revenue to be between $14,450 million and $14,750 million, which represents year-over-year growth of 6.9 to 9%, at constant currency and 4.2% to 6.3% reported, both compared to 2021. Now as a reminder, in the revenue guidance we've provided in our Q4 call in February, we absorbed a $70 million FX headwind versus the initial guidance we provided at Analysts and Investor Conference in November. Objective revenue growth includes just over 150 basis points of contribution from M&A activity. Now, despite the macro factors that affected our revenue guidance, we're reaffirming our full year 2022 adjusted EBITDA and adjusted EPS guidance ranges that we provided on our fourth quarter 2021 earnings call. This includes absorbing the earnings impact of lost revenue in Russia and Ukraine as well as the costs that remain there such as salaries and assistance provided to employees. Accordingly, we continue to expect adjusted EBITDA to be between $3,330 million and $3,405 million representing year-over-year growth of 10.2% to 12.7% and we continue to expect adjusted diluted EPS to be between $9.95 and $10.25 or year-over-year growth of 10.2% to 13.5%. Now, our full year 2022 guidance ranges assume that foreign currency rates as of yesterday, April 26, remain in effect for the balance of the year. Moving on to second quarter guidance, I'll remind you that the first half of last year represented our peak for COVID-related revenues, and as a result of that, the second quarter should be the toughest year-over-year compare in terms of revenues. So for the second quarter, revenue is expected to be between $3,470 million and $3,520 million representing growth of 4.6% to 6% on a constant currency basis and 0.9% to 2.4% on a reported basis. Excluding COVID-related work we expect organic revenue growth at constant currency to be in the low to mid-teens, consistent with what we had in Q1 actuals and our projected full year revenue growth. Adjusted EBITDA is expected to be between $790 million and $805 million, up 9.4% to 11.5% and adjusted diluted EPS is expected to be between $2.35 and $2.42, growing 10.3% to 13.6%. So to summarize, we delivered very strong first quarter results on both the top and bottom line against what had been a very strong first quarter of 2021. Our base business maintained low teens organic growth at constant currency, excluding COVID-related work with double-digit growth on this basis in both TAS and R&DS. Our R&DS bookings for business recorded its largest ever quarter of service bookings, contracted backlog exceeded $25 billion for the first time rising over 9% year-over-year with over $7 billion expected to convert to revenue over the next 12 months. We maintained our net leverage ratio at 3.6 times 12-month adjusted EBITDA on a trailing basis and finally most importantly, despite the turmoil around us, we remain very confident in our outlook and accordingly have maintained a full year 2022 profit guidance. So with that, let me hand it back over to the operator for our Q&A session.

Operator, Operator

Your first question comes from Eric Coldwell from Baird. Your line is open, please ask a question.

Eric Coldwell, Analyst

Thanks very much. Good morning. Two quick ones, both on geography. First, with Russia-Ukraine, I'm sorry if I missed it, but could you tell us the impact in Q1 and then how the $40 million to $50 million of annual impact is phased throughout the year? I guess, I would assume the majority of that or a significant portion is in 2Q, but I'd love to get your sense on how you phase that $40 million to $50 million projected impact? And then secondarily, early in the pandemic, IQVIA was the first and perhaps most vocal company to talk about the impact of China in Asia-Pac when COVID first broke out. Obviously, a lot of conversation these days on the rolling lockdowns in China, I'd love to get an update on what you're seeing from the impact in that market and how you're operating across that region, given the governmental actions ongoing today? Thanks very much.

Ari Bousbib, Chairman and Chief Executive Officer

Thank you. Good morning, Eric, and I appreciate your questions. Regarding Ukraine, it represents a small portion of our revenue, around $130 million to $140 million. The ongoing situation has significantly disrupted operations, particularly in R&D. Some activities may resume, but trials will face delays due to these disruptions. In terms of quarterly impact, we estimate it at $40 million to $50 million for the year, with less impact in Q1 since the conflict began late in February. We experienced only a few million dollars in Q1, which was not substantial. That estimated amount is likely to be more concentrated at the beginning of the year, as we anticipate some recovery later in the year as we adjust our work. However, such shifts often take more time than expected. We don't foresee a significant recovery in 2022, but as we enroll new patients and relocate clinical trial activities outside of Russia and Ukraine, we do expect to regain much of that revenue possibly late this year or early next year. Now, regarding China, it accounts for about 2.5% of our global revenues, split evenly between U.S. and commercial. On the commercial side, we felt minimal impacts even during the peak of the COVID crisis when everything was shut down. While some aspects, like PMR consulting, saw a complete halt, other sectors, including technology and analytics services, remained largely unaffected. We have no concerns in those areas. For R&D, our main worry is accessing sites due to lockdowns. The situation is fluid, and we’re closely monitoring developments on the ground. We've experienced some disruptions to site access and patient visits, particularly in Shanghai, as that region has been the most affected by lockdowns. It is difficult to predict if these closures will last long or expand across China, but for now, we haven't observed significant effects elsewhere, and we haven’t adjusted forecasts for China. Overall, we are confident in our ability to navigate these challenges with our remote capabilities and decentralized trial approaches. If the situation in China worsens, we believe we can adapt, as we have successfully done elsewhere. Any other comments, guys? Thank you, Eric.

Eric Coldwell, Analyst

Thank you very much.

Operator, Operator

Your next question comes from the line of Shlomo Rosenbaum from Stifel. Your line is open, please ask your question.

Shlomo Rosenbaum, Analyst

Hi, thank you very much for taking my questions. A quick question, just is the year's revenue and profitability pacing the way that you expected as you entered the year? I mean obviously a little bit of change with Russia and stuff like that, just the second quarter guidance is a little bit lower than what the Street expected. Obviously, the Street does not have the insight into the pacing that you guys have at that level of detail and it could be that we just didn’t get the same kind of COVID headwind roll off year-over-year and I just want to kind of start with that question and then I have one follow-up.

Ari Bousbib, Chairman and Chief Executive Officer

Well, Shlomo thank you for your question, good morning. Look, I think Ron mentioned in his introductory remarks that last year's first half included the highest, the peak revenues from COVID. The second quarter will be the toughest compared year-over-year with COVID in. Right? The biggest step down, year-over-year in COVID revenue will be in the second quarter. That's one factor. Secondly, on a reported basis, if you look at, again, assuming FX rates remain where they are for the balance of the year, the worst comparisons year-over-year in terms of FX impact are in the second quarter, okay? But the underlying businesses when you take these out, COVID and FX, you guys help me out with the numbers, yes second quarter is consistent with the rest of…

Ron Bruehlman, Executive Vice President and Chief Financial Officer

Yes, very consistent. And that's why we're giving you ex-COVID constant currency organic, because that cleans out a lot of the items that cause the volatility that you're seeing. And really across the quarters of 2022, when you look at it on that basis, very consistent growth rate.

Ari Bousbib, Chairman and Chief Executive Officer

So again, I mean, in TAS, I can tell you the what's built in our forecast and reflected in our guidance is due to constant currency organic growth, excluding COVID-related work that will be high single digits, so very consistent again with the first quarter. R&DS due to constant currency organic growth, excluding COVID will be upper teens. And CSMS will be low single digits, excluding COVID-related work at again constant currency organic growth. So you're right on a reported basis the number with the actual COVID work included it looks a little choppy sequentially. But the reality is the underlying business is pretty consistent and pretty strong.

Shlomo Rosenbaum, Analyst

Okay, great.

Ron Bruehlman, Executive Vice President and Chief Financial Officer

Yes, and the other thing I would say, Shlomo, is that that's pretty much in line with our guidance that we gave. I mean the linearity and how it's progressing over the quarter is exactly what we were expecting.

Shlomo Rosenbaum, Analyst

Okay, perfect. Then this is another one for you Ari, just you have a really good history of being aggressive on share repurchases when the stock dips, and the stock has pulled back a lot. I mean, you know, at the Analysts Day you communicated being, and just, you know, actually more recently of having a lower leverage target for a longer period of time. But would you consider taking up the leverage to take advantage of the stock price, given the fact that it seems like our trends in the business really haven't changed despite the changes in the stock price?

Ari Bousbib, Chairman and Chief Executive Officer

My first inclination will be to do that, but very frankly, we're not going to do that. We can buy, you know, thankfully, there's a third factor you are articulating, which is our cash flow generation. And as you've seen, it's been pretty strong. And that allows us more flexibility and affords us the ability to do both, that is to maintain a lower leverage ratio and aggressively pursue share repurchases. You saw we bought for over $400 million in the first quarter. You know, frankly, there are time windows where we cannot buy. We reported earnings, I think in February 15, and we be in the markets as we leverage a lot at any level of time. So again, the answer to your question is, yes we will do aggressive share repurchases, but no we will not increase the leverage ratio.

Shlomo Rosenbaum, Analyst

Okay, thank you.

Operator, Operator

Your next question comes from the line of Jack Meehan from Nephron Research. Your line is open, please ask your question.

Jack Meehan, Analyst

Thank you, and good morning. You know, one of the big debates for this year in the industry has also been labor. How did your wage and turnover trends compare to prior periods? Can you just comment on how you're managing through that?

Ari Bousbib, Chairman and Chief Executive Officer

Yes, it's interesting to note that we are seeing the same trend we have discussed previously regarding the competitive landscape for talent due to the strong industry backdrop. We are actively recruiting and hiring to address the increased demand. Like others in the industry, we experienced a rise in attrition towards the end, but I believe it has stabilized over the past few weeks. We monitor this closely on a weekly basis, and it appears to have plateaued or even decreased slightly. We hire thousands of employees each year, so our talent acquisition capabilities are robust enough to meet this heightened demand. In light of the situation in Ukraine, we are considering relocating individuals from Russia and Ukraine to different geographic locations to utilize their skills elsewhere. Our global presence provides us with more flexibility in this regard. We are facing some margin pressure from rising labor costs, but our global footprint allows us to manage costs more effectively through various strategies and adjustments. We continuously engage in productivity initiatives and cost optimization actions as part of our core practices. Additionally, we have raised rates on existing requests for proposals and are exploring ways to integrate some of these cost increases into our pricing where applicable. This adjustment is easier for short-cycle business compared to longer-cycle projects, which may not fully capture the wage inflation we see in the market. However, we have various strategies to effectively manage these challenges, and all these cost pressures are already included in our guidance. It's worth mentioning that we paid a record dollar amount in bonuses to our employees for 2021, and we continue to provide substantial bonuses even during the pandemic's most challenging times. Our employee satisfaction and loyalty have been increasing, as reflected in our regular surveys. While some competitors have not maintained similar bonus levels, leading to employee turnover at those firms, we are capitalizing on this situation. The landscape is complex, with rising wages and attrition, but we are confident in our ability to navigate these issues without altering our guidance. Thank you for your question.

Jack Meehan, Analyst

Thanks.

Operator, Operator

Your next question comes from the line of John Sourbeer from UBS. Your line is open, please ask your question.

John Sourbeer, Analyst

Hi, thank you for taking my questions. Could you discuss the growth of the real world evidence business this quarter? Is it still expected to achieve double-digit growth this year, especially with some of the COVID-related work declining throughout the year?

Ari Bousbib, Chairman and Chief Executive Officer

Okay. Well look, real world evidence, we saw strong growth. You saw that in TAS in general, organic constant currency revenue growth, excluding COVID was just over 10% in aggregate. And the high growth segments, as you pointed out, are real world evidence and of course, as you all know, Commercial Tech which continued to be strong drivers of growth. And I gave several examples, specific client examples of how in the commercial world and technology space, and real world evidence we are utilizing our unique capabilities. So real world evidence is doing disclose the numbers here or not?

Ron Bruehlman, Executive Vice President and Chief Financial Officer

I mean, there continues to be high teen growth driver excluding any COVID impacts. So the numbers we've been giving for real world have excluded that from the beginning. So that business has been consistently in the high to upper teens growth rates and we see that continue.

Ari Bousbib, Chairman and Chief Executive Officer

Yes, exactly John. We see that continuing. To your last question, with respect to that COVID step down in revenue, which we've been talking about for a while now, we've always said during the height of the pandemic that, and this is true for real world, is true for commercial, and certainly is extremely true for the R&DS business. COVID work essentially crowded out the rest of the business, because our clients understandably refocused their dollars on COVID, whether it's vaccines, or therapeutics, or what have you. But on the commercial side, government works to track and monitor COVID patients, etc. and they turned to us. As you know, we had a very strong share of that market appropriately. And the concerns that some of you had expressed at that time is, well, when that goes away then what happens? Well, we told you that that time that when that would go away, the base business would come back, because we knew that there were a lot of projects that had been essentially put on hold and that there was a lot of pent-up demand that needed to be addressed and that's exactly what is happening. Exactly what is happening. Now that's true with real world evidence, it's true on the commercial side, and it is true certainly in R&DS. Thank you.

John Sourbeer, Analyst

Thanks, I appreciate the color there and then just maybe one follow-up. As you are approaching around that 3.5 times leverage, any thoughts on M&A and what areas or potential type of businesses would you be looking at if there were to do those?

Ari Bousbib, Chairman and Chief Executive Officer

We have consistently provided guidance and maintained a track record of 1 to 2 points of top-line revenue growth, supplementing our organic growth. We pursue acquisitions within our core businesses when they fit strategically and enhance our capabilities or allow us to enter adjacent markets where we can add value. However, we tend to walk away from over 90 percent of the companies we evaluate, as we believe valuations have been quite high, and we prefer not to overpay for assets. Unfortunately for others who did, the current environment has seen valuations decline, making many private equity-owned businesses attractive to us, though acquisition prices at the time were elevated. Thus, we will remain cautious going forward. Nevertheless, we are prepared to act when we find acquisitions that are highly attractive and beneficial to our operations and financials. In fact, we made a significant acquisition of a lab business recently, which aligns well with our strategy. Our lab business has been performing exceptionally, and we also keep an eye on CROs, though their high valuations have kept them out of reach for us. On the commercial front, we are actively purchasing technology companies and will continue to pursue opportunities in the digital space. Our interest in growing on the commercial side remains strong, especially as our clients' go-to-market strategies become more sophisticated. Our OCE suite is designed with advanced AI analytics, distinguishing it from simpler CRM solutions offered by competitors. We will explore anything that enhances our position in the U.S. and European digital commercial markets, as they are the most developed areas. This summarizes our strategic approach to acquisitions.

John Sourbeer, Analyst

Thanks for taking the questions.

Operator, Operator

Your next question comes from the line of Luke Sergott from Barclays. Your line is open, please ask your question.

Luke Sergott, Analyst

Good morning. Thanks for the question here. Just a couple of cleanups. On the COVID step down into 2Q, remind us, I might have missed this one, can you remind us what you guys did in 2Q last year, and by the segments, just so we have an idea how that paces out?

Ron Bruehlman, Executive Vice President and Chief Financial Officer

We have a combination of projects in the TAS segment, you'll recall, we did a lot of government work, which is stepping down as we go through this year. In the R&DS segment, we are working on some mega COVID vaccine studies and safety monitoring work and also therapeutics. But you know, we were involved in hundreds of different COVID-related projects. So are you asking what type of work were we doing or revenue numbers?

Luke Sergott, Analyst

No, just the revenue. I was just trying to get a sense, I meant the numbers.

Ron Bruehlman, Executive Vice President and Chief Financial Officer

The numbers, like I told you was, we did about $375 million and now are you talking in Q2 or Q1 now?

Luke Sergott, Analyst

Q2 last, I'm just trying to get a sense of the step down what you have the whole billion rolling off right?

Ron Bruehlman, Executive Vice President and Chief Financial Officer

And you can infer from the numbers we gave you on the conference call what Q1 was last year, which was over $550 million and in Q2 it was slightly larger than that last year.

Luke Sergott, Analyst

That's helpful. That's exactly what I was looking for. All right. So and there's something here a little more strategic as you think about it. So, I mean, when you guys came on after the merger, you started going after the fat tails of biotech, right and going after all the bookings. And so now when you're getting up to record booking levels 1.9 plus, are you guys at capacity of what your business can handle? And I guess it's more of a sense of, I understand it's hard just to add additional bodies given the tight labor market. So give us a sense of the type of work you're now taking on how that's changed. And if we should expect the overall bookings to continue to climb or if this is kind of peak at your capacity right now?

Ari Bousbib, Chairman and Chief Executive Officer

First of all, our capacity is always driven by our people in this business, as you know. However, I would say that since the merger, our ability to take on more work with the same number of people has significantly increased due to our decentralized clinical trials capabilities. The advancements in technology, data analytics, and process improvements we have made since the merger are quite dramatic. Our capacity to handle more work with the same workforce is greatly enhanced. Therefore, I do not foresee us turning away work due to a lack of capacity; we simply do not operate that way. The only minor exception would be in the case of pre-commercial EBPs seeking assistance that do not meet our stringent vetting criteria. Aside from that, we are ready and eager to take on any and all work. I certainly hope that as long as the underlying dynamics of the market continue to grow, which I believe is a reasonable and conservative expectation, and assuming we continue to gain market share, you can expect our bookings to keep growing over the long term, without a doubt.

Luke Sergott, Analyst

Okay, thanks.

Ari Bousbib, Chairman and Chief Executive Officer

Thank you.

Operator, Operator

Your next question comes from the line of Patrick Donnelly from Citi. Your line is open, please ask your question.

Patrick Donnelly, Analyst

Hey, guys, thanks for the questions. Ari, I just wanted to circle back on EBP really helpful commentary during the script. I mean, it sounds like even if you did see some softening your business is diversified enough where the impact would be pretty negligible. But to date, you haven't seen anything. And just to clean up, I guess why you wouldn't be seeing it versus some competitors, like one yesterday, who called it out? Then coming down to your vetting process, you're maybe not taking on higher risk trials that others are and you think it comes down to kind of that process internally?

Ari Bousbib, Chairman and Chief Executive Officer

I cannot comment on what other competitors are doing. People in the industry are aware of their peers' market segment focuses. From the start of this merger, we committed to being more thorough about what we include in our backlog. We transitioned from 'awarded business' to 'contracted business' and have become more rigorous in our booking analytics. I hope you will never hear us say we are adjusting our bookings due to unexpected issues; that has not happened and is not our practice. We report our numbers that are meticulously verified. We do not engage with clients seeking to use our support for fundraising; that is simply not our business model. It is common for early-stage biotech companies to claim they have a CRO involved that has validated their scientific basis, and the credibility of that CRO can influence their fundraising chances, but we don't participate in that. There is a clear distinction in our approach compared to others. Someone earlier asked about capacity, but I reaffirm it's not a concern for us. We are not in a position where we feel desperate for business; we have sufficient projects lined up, so we can choose not to take on just anyone. This could be one of our differentiating factors. Mike, do you have any additional comments?

Mike Fedock, Senior Vice President, Financial Planning and Analysis

Just to build on those comments. You know, in addition to the vetting on both the financial and scientific basis, the nature of work that we typically take in is in the later stage clinical timeframe, whereby there's a lot more, I think, you know, historical data versus whether you're down feeling an EBP is mainly in the pre-clinical or first in human space. So I think that's another benefit to the decision.

Ari Bousbib, Chairman and Chief Executive Officer

Thank you, and very important.

Patrick Donnelly, Analyst

Yep, now that's really helpful. I appreciate it.

Ari Bousbib, Chairman and Chief Executive Officer

And then your first comment, frankly, was the right one, which is it's a very small part of our overall business, our company.

Patrick Donnelly, Analyst

Right, yes, understood. And then just a quick one, Ari on the pricing environment. You know, what do you see in there? I know that's a concern and biotech falls off, maybe pricing softens and it sounds like you guys still have nice power there. And on the back of that, any delay in terms of getting reimbursed on some of the shifting trials in Russia-Ukraine, just wondering, as you put in a change order, is there near-term margin pressure that then alleviates as you go through the year and get reimbursed? Just trying to figure that piece out as well? Thank you.

Ari Bousbib, Chairman and Chief Executive Officer

Yes, yes, of course. But again, it's a small, small piece of the overall, and we are absorbing that cost. So we haven't changed our profit outlook and we are not planning to do that for now. There's no reason to do that. We can absorb it. We have enough initiatives. We are large enough, diversified enough that we can handle the Russia, Ukraine situation and disruption on clinical trials normal, so longer that's what, that it is what it is now. Okay?

Nick Childs, Senior Vice President, Investor Relations and Corporate Communications

Thank you, Patrick. Thank you all for joining us today. We look forward to speaking to you again on our next earnings call. Myself and the team will be available for the rest of the day for any follow-up questions, so feel free to reach out. I look forward to talking to everyone again soon. Thank you.

Operator, Operator

This concludes today's conference call. Thank you for participating. You may now disconnect.