Good afternoon, everyone, and thank you for waiting. Good afternoon and welcome to the earnings conference call for the third quarter of 2022 of Dasa. We would like to inform you that this event is being recorded. After the company's presentation, there will be a Q&A session for analysts and investors. If you need assistance during the conference call, please press star zero to speak to the operator. The link to access the webcast transmission with audio and slides is available on Dasa's investor relations website. The presentation is also available for download from the website. We would like to highlight that information contained in this presentation and statements that may be made during this conference call regarding the business prospects, projections, operating and financial goals of Dasa constitute the beliefs and assumptions of the company's management, as well as information currently available. Forward-looking statements are not guarantee of performance.
They involve risks, uncertainties, and assumptions as they refer to future events, and therefore depend on circumstances that may or may not occur. Investors should understand that general economic conditions, market conditions, and other operating factors may affect Dasa's future performance. Now, I pass the floor to Mr. Glauco Desidério, who will start the presentation.
Thank you very much. Good afternoon, everyone, and thank you for attending our call. We'll start with the presentation with the remarks of Pedro Bueno, CEO of Dasa, followed by Felipe Guimarães, CFO. Also here with us, we have Andrea Tolabela, Officer of Products, Marketing, and Experience. Emerson Gasparetto, General Officer of Hospitals and Oncology. Rafael Lucchesi, General Officer for Diagnostics. All of us will be available for the Q&A session. Now I turn the floor over to Pedro Bueno to start the presentation.
Thank you, Glauco. It's a pleasure to be here with you.
That was not the best date for this company presentation, but other than that, we're very excited about our numbers in this quarter. We'll make a brief presentation so we can have more time for the Q&A. Let's move on to slide number four. This quarter, we had a consistent quarter in the execution of our strategy. We had a quarter that very strong, especially in hospitals, showing that our integrations are working well, especially the oldest ones that we had been working on for longer. In terms of COVID, is 2% of our revenues coming from COVID runoff only. So, we end this runoff of COVID looking for growth onwards. In terms of platform, we exceeded 5.5 million users at Nav platform. There was a growth of 26% in gross revenue, year- on- year, 17% in diagnosis, 5% year- on- year ex-COVID.
In terms of gross margin, the margin was 32.8% and an evolvement of only 2 percentage points quarter- on- quarter, especially driven by hospitals with a growth of 5 percentage points of gross margin year- on- year. We reached BRL 604 million in adjusted EBITDA, which meant a growth of 11% year -on- year. We also continued to evolve on our NPS, which reached 78.1, which is a very strong NPS, showing the quality of our services. Let's move on to the next slide. We also continue our expansion of the Dasa ecosystem. We had the Luz Dasa Laboratory adding 26 units now. We now have a significant presence in Belo Horizonte, and we also opened the Oncology Centers of Barra, which is a flagship oncology center at Barra in Rio de Janeiro. It's an outstanding unit to position oncology services in Rio. Next slide, please.
We continue to evolve on the ESG. I am not going to comment on everything that is on the slide, just to mention a few. We adopted the commitment to climate from Ethos Institute . We donated almost 1,000 mammographies to the NGO Américas Amigas, and we again participate in ISE B3 cycle. Let us move on to operating performance. Starting on oncology. It is a very strong quarter with a 56% in assets year-on-year driven by M&A. But even so, we had an evolution in the occupancy rate of almost 1 percentage point year-on-year, so from 73.6% - 77.2%. It is interesting because the occupancy rate by itself does not show the entire evolution we had in hospitals, because in addition to the increase in the occupancy rate, we also increased the number of beds by 20% when we compared year-on-year.
More people in hospitals and with a greater turnover, which contributed to our margin. A 9% increase in average ticket and 8% quarter-on-quarter, which proves our conviction in the integration of how certain we are about our policy to integrate the assets as the fastest, easiest way to capture end revenues. Revenues, it takes about 18, it may take even 24 months to mature. That involves improving the quality of assets, increasing the rate with which assets are integrated to capture more complexity. That is taking place, and there are a lot of opportunities to be captured still. When we look ahead to the next quarters, we should see a positive trend in the development of revenues from hospitals and in gross margin as well. Now, moving on to diagnosis. We had a good growth in exams, 5% year-on-year.
Also, exams by direct users, and also growth in average ticket. There is a distortion because of COVID. When we look at revenue per direct users, we have grown 8% year-on-year and 10% quarter-on-quarter. But even so, we are not pleased with the growth of revenue in this business unit. We are very focused on resuming organic growth and gaining share for the next quarters throughout 2023. Three main points of focus. Commercial fronts, new registrations, adjustment of prices with insurance companies. Most of the insurance that provides lab services takes place in September, so that will be shown as of the fourth quarter. We had new company registered. Also, the use of our assets.
That involves the increase of revenue per square meter, new exams, new procedures, the growth of new units, especially in the premiums segment of Alta Lab, which is a brand that grows above market rate, and also Salomão Zoppi in São Paulo and a flagship of São Marcos in Belo Horizonte. All of these will drive organic growth. Finally, the more transformational fronts that we can work because these are leverages of an integrated systems, if we can find fair gaps, winning gaps, and convert these users to our diagnoses using our hospitals, oncology, and other assets we have to direct patients that need to make exams for our own brands. We are working on that front as well, and that will probably have a more relevant impact in the mid-terms . Sales and usage of assets more quickly.
We should expect a healthy growth in our business of diagnostics moving forward, especially considering that now our basis is ex-COVID. Now, finally, the Nav platform that shows an exponential growth, six times the number of user patients, 5.5 million users that are enrolled with Nav. In medical users, the growth was three times 34.5 thousand physicians. We are uploading new features to generate more engagement and recurrent use at the platform, and also to accelerate our digitization initiatives. Teleconsultations is growing almost 50% year-on-year. We can move on. Now I turn the floor over to Felipe, our CFO, to talk about the financial performance.
Thank you, Pedro. Starting on slide 12, showing that we had again, a record growth, BRL 3.7 billion revenue, 26% growth compared to 2021.
This result reflects the operational advances mentioned and shows how the maturity of our ecosystem has been evolving. Revenue from hospitals oncology business continues to grow 72% year-on-year, reaching BRL 1.9 billion in the quarter, and becomes the business unit with most relevant 51% of revenue. Some factors contributed to this result. First, the integration of new hospitals generated an increase of 1,056 active beds in the third quarter compared to the third quarter of 2021. Another factor was the 9% increase in the unit's average ticket, which ended the quarter at BRL 8,969 compared to BRL 8,265 in the previous quarter. This reflects the higher volume of highly complex procedures, mainly surgeries, with the resumption of elective surgeries offsetting the reduction in demands for ICU beds due to COVID-19. In diagnostics, disregarding the effects of COVID-19, revenue grew 5%, closing the quarter at BRL 1.8 billion.
This result, when compared to the same period last year, reflects the higher number of exams in the period with an increase of 5% and 8% increase in the average ticket, reflecting better mix of use. Dasa's gross profit increased by 22% compared to the third quarter of 2021, reaching BRL 1.1 billion. The adjusted gross margin in the period was 32.8%, an increase of 1.7 percentage points compared to the second quarter of 2022. The reduction in the consolidated margin. We had a reduction in the margin because of higher profitability of hospitals and oncology that has a lower margin than diagnostics. With that mixed effect, we have expanded it by more than one point when compared to last quarter.
The gross profit in hospitals and oncology, when compared to 3Q 2022, advanced 106% in the third quarter, closing the period at BRL 498 million and a margin of 29.1%, reflecting the advances in the hospital integration processes and better asset management. Contributing to this result, the increase of 72% in operating revenue supported by last year's acquisitions, gains of efficiency compared to 2021 due to the execution strategy and the acquiring of hospitals. Adjusted gross profit for diagnostics decreased 8%, totaling BRL 626 million in the third quarter of 2022 on a margin of 36.6%. This result mainly reflects the effects of COVID-19 throughout 2022, which makes the comparative basis stronger. When we compare with 2Q 2022, we have a gain of approximately 1 percentage point. Slide 14.
Starting with the graph in the upper left corner, we show our adjusted general administrative expenses, total BRL 498 million in this quarter versus BRL 376 million in 3Q 2021. The increase between the periods can be explained mainly by the expense brought by the acquired companies in BRL 91 million and by the increase in expenses with third-party services to support the company's growth and digitization strategy, BRL 30 million. In the analysis versus the second quarter of this year, we can identify dilution of expenses compared to the company's net revenue, reflecting Dasa's current strategy to control expenses and consequent gain efficiency. It's important to emphasize that we have been showing a constant growth in our expenses in line with our strategy investments for the future.
Today, we can already see a stabilization trend at this level, and we understand that there is still several actions to gain productivity efficiency to be captured over the next quarters. Moving on to the chart on the lower left corner of the slide, we have the evolution of adjusted EBITDA, which increased by 11% compared to the third quarter of 2021 from BRL 544 million -BRL 604 million. The adjusted EBITDA margin was 17.6% in the quarter. Compared to the second quarter of 2022, adjusted EBITDA grew by 8% and showed a margin increase of 0.5 percentage points. Adjusted EBITDA mainly reflects the growth in gross profit under the effects of higher net revenue in the period and the points now highlighted.
Non-recurring items and remuneration in stock options did not have an impact in the quarter when compared to the positive effect of BRL 37 million in 2021. It's important to note that as of the third quarter of 2022, we started to adjust only expenses related to M&A and stock options processes. Going to slide 15, we closed the quarter with leverage for the purpose of covenants of 3.75 x the value of net debt over the pro forma EBITDA in the last 12 months. We had a substantial reduction of the amount to be paid in M&A by almost BRL 1 billion versus December 2022. Our net debt closed the quarter at BRL 7.8 billion, and it's important to point out two recent transactions that reinforced the cash of Dasa and that guarantee fulfillment of company's obligations.
In October, we carried out the 18th issuance of debentures in the amount of BRL 1 billion. In November, we completed the issuance of real safe deposit certificates, also in the amount of BRL 1 billion. Both operations are part of an ongoing debt management process to optimize the company's capital structure. Today, the average cost is CDI + 1.5%, and the average term is 3.6 - 3.8 years. We'll continue to work to optimize our capital structure in order to take advantage of organic and inorganic opportunities in the future. Thank you, and let's start the Q&A session.
We'll now open the Q&A session. To ask a question, please press star one. You can also send your question through the webcast platform. Our first question comes from Vinicius Figueiredo from Itaú BBA.
Good afternoon, everyone. Thank you for the question. If you could address two topics.
First, about the increase in ticket in the hospital segment. You mentioned that there was an impact regarding the increase in complexity of procedures. If you could comment on how this breaks down between the older hospitals in the portfolio and those that are recently acquired, whether the increase in complexity was more due to the integration process. The other point is about BU, whether there was an increase in the oncology costs. Could you comment on this increase, the nature of it, whether it is temporary, maybe, or should we look into that towards the future. Thank you.
Vinicius, thank you for your question. About your first question on the average ticket, obviously, the acquired hospitals are less mature, and the management of complexity, of the teams, of having to invest in technology due to the increase in complexity, that happens in the acquired hospitals more strongly.
It also takes place in the hospitals of the network that are more mature. Because what we noticed is a reduction when compared to last year of CDI patients, because we had a strong impact of ICU last year. So, this increase in ticket is slightly higher in acquired hospital. As for your second question, there are two leverages. When we look at the average cost versus the net revenues, 50% in oncology. This is how the business works. So essential costs are very much lower. When you look at indirect cost, it is much lower. At the end, the margin is similar.
So when the medical materials cost in oncology is higher, this is good news because oncology is growing well, and this is a business that is doing fine, and it brings complexity to the hospital, and it brings care in the entire journey of the oncology patients. When we look at average materials, more than our revenue from hospitals, it is a daily hospital space. So it is relevant. It is a part of expense that is not part of the package of the hospital stay fee. So when we look at average net, mat/med is a cost that is carrying a revenue, so it does not necessarily have to be proportionally reduced. So there are these two leverages in this line that are significant.
Thank you. That is clear.
Our next question comes from Gustavo Miele from Goldman Sachs.
Good afternoon. Thank you for the question. I have two quick questions.
First, I would like to explore the growth of the company in the premium segment. Pedro mentioned the performance of Alta brand that had an interesting growth in the quarter. Does this mean a gain of share? If you could give us some color on that, it would be nice. The second question is more related to COVID-19, and that would apply to both BUs. You mentioned that the third quarter, in fact, was lower, but do you see an impact of that in the end? Now looking at the beginning of the fourth quarter, the number of cases of COVID has increased significantly recently. Do you see something significant that you could share with us in any of the two BUs regarding COVID? Thank you.
Hello, Gustavo. Thank you for your questions. Well, first, about Alta, the answer is yes.
We continue to grow way above the market levels with Alta, both in existing units with increase in occupancy as well as in new units that will continue to grow. There is one in Alphaville, there is two under construction in São Paulo and Rio. So our growth in Alta remains strong, and we continue with room for growth in that segment. So it continues to be an important pillar in our strategy. As for COVID-19, it is like we said, last year was very strong. We captured an important volume. This year, there is a downward curve. In the third quarter, it was reduced less than 3% of our revenue, and there are all the impacts from that reduction, as said before.
From now on, what I can say is that in last week, mainly, we again had a growth in volume, but much, much lower than the previous peaks in growth, but with an upward trend. It is true. For diagnosis, specifically, we don't think there will be that huge volume we had in the past. But these are initial projections. Depending on the slope of this curve and the acceleration, we are ready to capture this growth. We are able to capture whatever curve comes forward. Emerson will answer the hospitals.
In hospitals, that is very small because at Omicron, the number of inpatients was very low. So some people coming to the hospital, but not inpatients. So for hospital, it is neutral and some impact for diagnosis.
Thank you. Very clear.
Next questions comes from Fred Mendes from Bank of America.
Good afternoon. Thank you for the call.
I have two questions. One on diagnostics, year two. The growth of COVID-19 was 5%, when considering inflation, 10% year-on-year, though historically transfer 5%. So this 5%, if everything remains constant according to history, that represents a transfer of prices. I know at the end of the quarter, as Pedro said, but I would like to understand, we saw in the release that there was an increase in the number of exams. I would like to reconcile this growth with these two factors. And the second question in diagnostics, when I look at the gross margin year-on-year, it decreased. Less COVID-19. I would like to understand if maybe this is some operational leverage, and what can be done for margins to go up to historical levels of a gross margin close to 40%. Thank you.
Thank you for your questions. Now starting with the ticket.
When there is a change in the mix, as happened now, and that explains a bit both questions. Per user, whenever COVID-19 cases decrease, we increase our average user ticket. That has happened because of the change in the mix. That is what is shown in the chart. As the growth of 5% organic ex-COVID-19, you are right, there is a price transfer inside that figure. In addition to the reduction in the number of COVID-19 tests, for some operations, that also reduced additional exams, especially at hospital operations that we have diagnosis in our hospitals, and in support that had a level of exams that was driven from COVID-19 that was very high. So we saw a deceleration in growth, mainly due to COVID-19.
And from now on, there are these three blocks of actions, very strong, as Pedro explained, to go back to having a stronger organic growth, regardless of this drop in COVID-19 cases from one quarter to the other. As for the increase in the number of exams, that is a lot due to the mix change. When COVID-19 goes down, which is almost one exam per user, the direct user ex-COVID-19 makes more exams. So when you see when COVID-19 goes down to zero, we will go back to the regular course of increment in exams per user as we had last year. That will be gradual, but not so steep as we had lately. Thank you very much. Go ahead, Fred.
If I could just make a follow-up. I am sorry to interrupt. Just to understand.
COVID-19 has an impact on exams, and when we talk about COVID-19 margin, is that related to the gross margin?
Maybe the lower volume of COVID-19 tests would result in a lower gross margin, or the margin tends to be more similar to ex-COVID-19. What happened is that since our business has a very high fixed cost basis, last year with that peak of volume, both ex-COVID-19 and COVID-19, we optimized the usage of our structures that dilutes our fixed cost, and we had a peak of margins, especially in the third quarter. Now we go back to the regular level, and as of the second part of this year, we grew our percentage of margins. So it is closer to the world ex-COVID-19 with the possibility of increasing.
And we are going after that, both in terms of resuming growth as well as in productivity, usage of assets, and being more efficient in our operations. So these are the leverages to continue to grow our margins.
Thank you very much. That is clear. I do not know if Pedro will say something.
No, Lucchesi mentioned what I had to say. Thank you, Fred Mendes.
Thank you all. It is very clear.
The next question is from Samuel Alves from BTG Pactual.
I have two questions. First, about the balance sheet. To understand the evaluation of the net debt, we saw that it had a growth of almost BRL 500 million quarter-on-quarter. When we see the cash generation from the company, it was quite positive. Operating cash after CapEx totaled more than BRL 600 million, according to our calculations.
So the first question is try to understand the reasons for this increase in the net debt, even after the debt service, because we see the cash flow generation from the company. There is a line that is not very clear, acquisition of interest from non-controlling shareholders. Maybe there is some item there that is not understood. We would like to understand the reasons for this increase in the net debt. The second question, in line with the other person's question about oncology, if you could give us some idea of how big is the development of oncology revenue, maybe infusions, so that we can understand a little bit the operational leverage and leverage in margins that you were explaining. Thank you.
Good afternoon. I will answer the leverage one. You made a good comment.
The reason why we have a leverage of 3.75, slightly above the second quarter, is basically the fact that we are having a high concentration, both of payment of M&As already carried out in the past, as well as CapEx. The third quarter was more concentrated in terms of CapEx investments and in terms of concentration of payments of some M&As that happened throughout this entire year. As you may see, an important reduction of M&A amounts to payable throughout this year, and now it becomes more residual. We expect that we will have organic deleverage of our business during 2023. I will let Emerson answer the question about oncology.
Samuel, regarding oncology is a business that we started to accelerate recently, and second, it is a business that we made a major acquisition that accounts for slightly less our revenue in oncology. It is significant.
The metric that is most important is the overall revenue generated the entire oncology journey. It comes from inpatients, consultations, even AMO, all the outpatient labs of general specialties are under the P&L of AMO, because that is when the oncology patient is captured. Because we have outpatient oncology services and this model that we had in the acquired companies, now for the next release, we are preparing a specific report on oncology according to market metrics of infusions and so on. Starting with the next release, you will have information more in detail about oncology. That is undoubtedly a business that is significantly growing in the company. That is important for your comment, and taking into account what Vinicius said about the average ticket, our business is a seasonal business. The fourth quarter is historically weaker, especially in hospitals.
That will have an impact, but oncology is having a significant growth in our business.
Okay, thank you all very much and good afternoon.
Ladies and gentlemen, I would like to remind you that if you would like to ask a question, please press star one. The Q&A session has now ended. I turn the floor over to Mr. Pedro Bueno for his final remarks.
Thank you very much for participating in our call. Looking forward, we have some important areas we will focus on. For hospitals, to continue to integrate the companies we acquired, taking them to the maturity level of our older hospitals. For diagnostics, resuming accelerated organic growth and top-line revenue, and more efficiency with digitization, productivity, controlling costs. The platform, as we expand and increase the capacity of navigating these patients inside our core business, increasing efficiency, revenue, and margins for the company.
Finally, the G&A that we did not talk much about, but we have a higher than our competitors' G&A for two reasons. One, because we invest more in platform technology and innovation than our competitors by design. But we also know that there are deficiencies due to so many integrations, Dasa within, and all the other acquisitions we made in the last two, three years. So we are now focusing on efficiencies in G&A, and we expect to capture that next year. The combination of these two factors should generate very healthy growth and top line for the company and an important growth in margin for the next quarters. Thank you all very much and have a good week.
The earnings conference call for the third quarter of 2022 of Dasa has ended. The investor relations area is available to answer any other questions you may have.
Thank you all for attending and have a good afternoon.