Let's start. Welcome, everyone, to the conference call for Q4 for Boule Diagnostics. This is Christina Rubenhag, and I also have Peter, Chairman of the Board here. Can I ask everyone that doesn't have questions to mute their phones, because otherwise there will be an echo. Could you please mute your phones? We start. It would be appreciated if everyone mutes, otherwise we continue here. You can find the presentation on the homepage where it's uploaded, I think that everyone calling in knows pretty much what the company is doing, I think that we skip the first slide.
If we continue a little bit, you will see the updated product portfolio that we have had since end of 2017, beginning of 2018, with an addition of 16 products, which is one of the reasons for the growth during this year. If we go into the details of Q4, which is the slide number five. Q4 was a quarter where we saw all-time high in instruments delivered. The growth continued, and we also had improved profitability. Net sales was SEK 129 million, and this corresponds to growth of 22%. Looking in fixed currencies, it was 18%. We had very strong instrument sales during the quarter, and number of delivered systems increased with approx. 12%, which is a new all-time high. Revenue for instruments increased with 13%, meaning that the ASP was higher compared to previous Q4 last year.
That is mainly impacted by increased prices in Asia. If we look a little bit closer to the delivered systems, you will see that main part of the instrument sales was to Asia, specifically India. For the ones that have followed the company, you know that instrument sales to Asia/India normally takes down the gross margin, and that is also an impact of that in this quarter. Still, with higher ASPs, the revenue increase was 13%, which is quite good. Consumable sales for all instruments continued to increase during this last quarter as well, 31%. Full year, it's a growth of 21%. Specifically in Q4, sales was driven mainly by consumable sales to India. It is very good that we now finally can see that the instruments that we delivered in the big tender to India have started to generate consumables.
Much later than we thought when we did that sale, but now we finally see revenues generated from that one. Can I please, there is a few people that haven't muted. Can you please mute the phone? Okay. In this quarter, we also had the second shipment to the African tender that we had in end of 2017. End of 2017, we delivered instruments and consumables to Africa, and the consumables covered consumption for approx. two years' time, meaning that we haven't delivered so much to Africa since then. This is the second delivery that has happened to Africa. This time it's approx. one year consumption. Of course, it's a big one and probably will cover next year.
If we look at the full year, I think that the main reason for the growth this year is the initiatives that have been taken during the last year and end of 2017. We've broadened the product portfolio, both in the human and veterinary area. We have strengthening the sales and marketing resources, and we have also made changes in the distribution structure, mainly in East Europe and Russia specifically. With high instrument sales and the main part to Asia, gross margins was 44.6%, much higher compared to Q4 last year, but it's slightly lower compared to the full year gross margin. Even though we had high consumable sales, the instrument has an impact, so that's why it's slightly lower. We should remember that instrument sales, it's important because that will lead to increase in consumable sales going forward.
Expenses was slightly above last year's Q4, and mainly driven by investments in sales and marketing. The EBIT margin improved to 11.7% in Q4. Last year was 3.2%. Cash flow was SEK 20 million, mainly impacted by the positive operating profit. Any questions on the financials? We continue to the next one where you can see instrument sales per quarter, the blue ones that is sold, number of instruments. You have the gray one is the rolling 12 sales of the instruments. As you can see, it weakened end of 2017 and beginning of 2018. With the addition of the broadening product portfolio and other changes that has been made, instrument sales has increased over the year, consumable sales has a very healthy growth as you can see on the red/pink line.
The consumables, as I have said, main reason for the growth in Q4 was driven by Asia, but also deliveries to Africa. If we continue to the next one, you will see growth per product line in the different product categories. You have first the Q4, and then you have the year to date. Q4 was driven very much by increase in consumables on instruments, but also increase in instrument sales as such. Year to date, consumable sales increase, that is the main driver, and also instrument sales. Instrument sales is mainly the new five-part systems that was launched in 2018 and the broader product portfolio. Consumable growth is mainly driven by changes in the distribution structure in Eastern Europe that has resulted in increased prices and increased sales, and also a healthy growth in all the regions.
At the top, you can see the percentage and the share of the different product categories, where you can see that consumables on instruments represent 43% of the total product portfolio and the revenues. If we look at sales per region, in Q4, Asia had a very good growth driven by instrument sales and also by reagent sales. Sales to Africa is mainly based on the second delivery on this Africa tender, but also instrument sales. Growth in the Eastern Europe was a little bit declining this quarter, but they have had a fantastic year so far. If we look at year to date, you can see that Eastern Europe is growing compared to last year. The main growth component is Asia, but also U.S.
In U.S., we have both sales of own instruments and consumables, but also the OEM business, that has been growing quarter-over-quarter during this year. For the first time, Asia and U.S. is equal in size, 29%. Historically, U.S. has also been furthest in the major region, but Asia is catching up. Now they are equal. If we take the next one, looking a little bit into the gross margin, this is a bit of a busy slide, but what you have is that you have number of sold instruments, that is the blue bars, and then the gray ones are sales of instruments to Asia. You also have in percentage, that is the gray one.
You can kind of see that quarters where we have had high instrument sales and especially high portion of sales to Asia, the gross margin has normally been lower. We have a slight impact of that this quarter, but even though it's extremely high instrument sales, all-time highs, and a very high portion to Asia, gross margin is still 45%, which is historically quite good actually, if you look back in the same numbers. We normally talk about the fact that gross margins are dependent on both geographical and product mix, and especially the instruments. We can have tender sales in the different quarters impacting both instrument sales and gross margin. We have not had any instrument tender sales during this year, and actually the only kind of big chunk of tender-related sales is this sale to Africa this quarter of consumables. Page 10.
Page 10. Yes. FDA. What has happened, as you probably know, third quarter 2019, we completed the warning letter and everything that we had committed towards the FDA. In July, when they conducted on-site audit, we received two new observations. Those observations has also been addressed according to the committed plan and was finalized now in mid-January 2020. Right now we are in dialogue with FDA and positive dialogues, I would say. We will need to wait and see what the next step is. We have done what we have promised and committed, and we have kept everything that has been committed to the FDA. If we take the last page or the next one, at least. Jesper Söderqvist has been appointed as CEO, and he will join Boule, May 11. That we are looking forward to.
Other changes that have been made, both when it comes to organization but also how we organize the company, is that to be able to strengthen production and really focus on further improvements on quality, work, cost efficiency, and also start the preparation for the new five-part platform. We have taken the decision to establish local production of consumables in Russia. We have decided to divide the responsibility between production of instruments and production of consumables. In the U.S., we have one site producing reagents and controls, and Eduardo Pagani is the product manager for that site. He has now also taken on the responsibility for reagents production here in Sweden. At the same time, Mikael Ekholm has recently started and will be responsible for production of instruments here in Sweden.
The reason for this is to increase the pace of this work and really make sure that we drive this in a diligent way. Just to summarize, going forward, we don't give any guidance or any forecast, but what we normally say is just to guide what will happen depending on where the business, in what direction the business goes. Veterinary market and increased growth in that will have a positive impact on revenue and also on gross margins. Distributor products is great when it comes to revenues, but of course, since they are a distributor, the gross margin is not as good as if we have had our own production. That is negative on the gross margin side, when it comes to the percentage. Continue to developing the distributor network that has a positive impact on both revenue growth and gross margins.
We are growing, as you saw in emerging markets, and that we think will continue having a positive impact on revenue, but a slightly negative impact on the gross margin, since instrument prices often are lower in gross margins. Of course, we continue to work with cost reductions and that also includes regional manufacturing that we are working on right now with the new factory and site in Russia. Yes, with that, we open up for questions.
Hi, this is Viktor from ABG.
Hey.
Hey. I'll start with a question regarding your consumable development here, sales development. Could you elaborate a bit more on your five-part systems and the growth you've generated in instruments during this year? What do you foresee for next year in terms of consumables for those systems, how that will support both sales and also margins?
It will, of course, support sales. With a higher installed base, no matter if it's five-part or three-part, that will generate consumables going forward. When it comes to five-part consumables, the new five-part systems that we have launched, we do not produce those consumables on our own, but they are sourced as well. That means that the margin is slightly lower compared to production of our own consumables.
Right. Yeah. Also another question, given the main growth opportunities are still in emerging markets, what do you foresee in terms of gross margin development, given that we perhaps will see a continuously strong sales of instruments to the Asian region or the Latin American region? How is the consumables going to, say, offset that type of growth into next year in terms of margins?
We don't really give forecasts in that detailed level, but I think you can assume that growth will continue in those regions. When it comes to instruments, the margin is different if it's Asian countries or if it's more developed countries. When it comes to the consumables, the difference is not that big because the prices are approximately the same globally on consumables. It can vary how much you use the system. That is the dependency, of course.
Great. One last one on Biosurfit. Do you have any further news there or impressions from recent fairs and congresses? How's that developing for you?
Sales have been slower throughout the year versus what we had expected. If we look at conferences, et cetera, this week we had Medlab, the conference and exhibition in Dubai. As always, attending those conferences and exhibitions, it's a great interest from the distributors and the customers. That, of course, gives hope for the future, at least even though sales have been slightly slower.
Have you seen any attraction for the distributor rights of the CellaVision DC-1?
That was actually launched now for the first time at Medlab in Dubai. Saying that, it was quite good interest. Let's see what will happen with that entering 2020. This was actually the official launch for Boule, at least, with that product.
Okay. That's great. I'll get back into you. Thank you.
Okay, thank you.