Good morning and welcome, and thank you for joining us today. My name is Jesper Söderqvist and I'm the CEO of Boule Diagnostics. With me here today at our headquarters in Stockholm, I have our CFO, Christina Rubenhag. Today we have the pleasure to present our results for the fourth quarter of 2021. Before we jump into our great achievement in this quarter, I would like to make a short introduction to Boule for anyone that is new to us. Boule is a global niche player that provides solutions for decentralized blood testing that allow physicians to inform and make treatment decisions, without the need to wait for central laboratory test results. Blood diagnostics in general is an essential tool to discover diseases, monitor treatments, and also a screening tool in health checkups.
We sell instruments and consumables used for both human and veterinary diagnostics in over 100 countries that we serve through a strong and loyal distributor network. In addition, we sell white label consumables to other hematology manufacturer that we refer to as our OEM business. We have built strong brands offering user-friendly and reliable systems. We use a multi-brand product strategy with products using the same technology platform. This means that we have parallel sales channels in many important markets. A value drive of Boule is the attractive business model where we place instruments that thereafter generate sales of high margin consumables for many years. Thanks to our large installed base of close to 29,000 instruments and our OEM business, more than 60% of our sales are recurring revenue during a normal year.
In the beginning of the pandemic in 2020, we experienced a big drop in testing due to restrictions. Last year, we have seen a gradual recovery in all markets, thanks to increased vaccination rates. Thanks to the vaccines, eased restrictions, and also hard work from our side, we ended last year with an all-time high sales records. I thought we'll start to look at our how our sales has developed before and during the pandemic. For the fourth consecutive quarter, we see the rolling 12 months revenue growth for both instruments and consumables, which is a clear sign of recovery in the market. Total revenue this quarter was all-time high, SEK 40 million. Very important is that the consumables sales is now above the pre-pandemic levels. Sales are up 47% versus last year and also 23% versus the previous quarter.
In the fourth quarter, we also shipped a record number of instruments, and we continue to report strong sales in the U.S., driven by our OEM business. All this during a period with a lot of disturbances in the supply chain that unfortunately impact our profitability. Despite the many challenges with supplies and logistics, we have continued to progress with our strategic development projects, and I will come back to that progress later in this presentation. Let us have a look at our financial results. I must say, I'm very pleased that we have delivered a record quarter for sales, and we have increased our profitability significantly. Sales landed at SEK 140 million, which is 51% more than the same period last year, and it's also up 25% compared to the third quarter last year.
The all-time high revenue is SEK 9 million or 7% above our best previous quarter, which was the third quarter of 2019. Gross margin was 41%, impacted by extra costs related to supply chain disturbances and an unfavorable region mix. We generate an EBIT margin of 9.9% and an operating cash flow of SEK 11.8 million. The development of our new product platform has continued with full speed, and we have invested SEK 50 million in this quarter. I am both grateful and proud how my colleagues and our partners have managed the supply chain and the sales channels during the last year in a very turbulent market environment. I think the outcome in the end is a fantastic result, and in a more normal market, we will deliver higher profits.
Let us look at how the drivers for our sales growth look like. For the first time since the pandemic hit us, we deliver growth for all product lines and all regions in the same quarter. Growth in the U.S. was driven by the OEM business that continued develop very positively and grow by 110% compared to 2020. The biggest contribution to this growth are the ramp up of sales and production of the products related to the 10-year supply agreement we signed in third quarter 2020. Instrument growth are mainly driven by more sales to India, whereas other parts of Asia is still much affected by the pandemic restrictions and lower vaccination rates.
Overall, we saw strong growth of consumables in all regions, and in particular, growth in Eastern Europe was helped by a new production site in Russia. The increased activity with our new sales organization in the Middle East and Africa also start to show results. All in all, we grow sales by SEK 48 million, equivalent to 51% growth compared to the same period last year. Let's now turn to the next slide and look at our profitability. Operating profits was SEK 13.8 million, corresponding to a margin of 9.9%. Last year, we did a write-down on some technology assets. Without this write-down, the EBIT was -SEK 1.6 million in 2020.
We deliver an EBIT improvement greater than SEK 50 million in this quarter. As I already mentioned, during the quarter, the shortages of electronic and other components have created significant challenges for our development products and our production, negatively impacting both sales, expenses, and progress in projects. To maintain production in this volatile market has required a lot of attention, extra work related redesigns, and we had to pay more, in particular, for electronic components and transports. In total, we have taken approximately SEK 6 million in extra cost to mitigate these issues during this quarter. Also, the product mix with higher portion of instruments to India and more OEM sales with slightly lower gross margin is also putting pressure on our gross margin. Operating expenses have increased, you know, due to supply chain mitigations, but we have also increased our marketing activities.
We have started to travel, and we also participated in a large stage of MEDICA in November, and we have continued to strengthen our organization. Let's have a look at what the result is in terms of cash flow. Operating cash flow was SEK -11.8 million, and where SEK 15 million was invested in our new product platform during the quarter. The total cash flow was SEK 1.6 million, despite the investments and the large sales growth towards the end of the year. We continued to maintain a strong liquidity position with SEK 89 million available at the year-end. Let's zoom out and look at our other accomplishments. How have we delivered to the plans that we set out to do in Q4?
We entered the fourth quarter with large order book, and we managed to convert a major part of that order book to revenue, not all. Our sales were limited by supplies, and we take some of the orders with us into this year. I must say that overall, I think we have managed the challenge in the supply chain very well. This is something that will continue, and I think the situation will prevail also during the coming year. In the quarter, we also passed a major milestone for our implementation of the new European regulatory framework, IVDR. We had an audit in November that we passed without any observations. That was a very welcome and well-deserved recognition for the work the organization has done to adapt to IVDR during a long period, you know, time.
Of course, very important, you know, the progress with our new product platform progressed very well. I'm particularly very happy with how our connectivity solution has developed lately. We have seen some delays in prototype deliveries, which is affecting our overall time schedule for the instruments that is shifted from, like, late this year to early 2023, a slight delay. The good news is that we will do a first release of our connectivity solutions to select customers that will use it to service our current installed base. Then we have continued to strengthen our installed base on our updated strategy, and that's both in terms of tools, it's about improving processes, and we also have hired new talent to the organization.
Overall, I think a very good quarter for us with a also very good financial result. Since we closed the year, I think it's appropriate to also take a look at, the full-year highlights. During the year, we have seen a gradual recovery of demand with greater uptakes towards the end of the year. Our total sales, for the year was SEK 463 million, which is a growth of 16% versus the previous year, and in constant currency, that is 21% growth. The gross margin of 42.9% and EBIT of 7.8% for the full year is below our potential. Given the many challenges with supplies and logistics, I think the organization has done very well. A few very important milestones during the year is that we have updated our strategy. We have expanded our commercial organization, in particular in the Middle East, Africa, and Russia.
We started local production of consumables in Russia. We have also ramped up our production of new products to one of our OEM clients successfully. As I mentioned, we have made good progress with the IVDR implementation, where IVDR will be mandatory in the European market from May of this year. We have also increased our focus on innovation. We have made progress on a new platform, which now includes connectivity, instruments, and consumables. In total, we have invested SEK 53 million in that program this year. The board is also happy with our performance and will propose a dividend of 0.55 SEK to the AGM in May, which is the same level as last year. To summarize and look ahead into 2022, you do a bit of a market outlook.
What we see for the U.S. market is that we see strong performance, and we have positive outlook, in particular for our OEM business. In Asia, we have seen that India is starting to recover, whereas other part of Southeast Asia is still waiting for easing restrictions. As those markets open up, we expect to see increased testing that will drive our consumable sales further, and we will also increase instrument sales. Also in Eastern Europe, we have a very positive momentum, and particularly thanks to our start of a local production in Russia.
However, as we all know, there are some political risks with the political situation in Russia, and we'll see how that play out for us. In the Middle East and Africa, it's looking very positive, and last week we participated in a big trade show in Dubai where we met many of our loyal distributors from those regions. We also met a number of new distributors that really want to take on our products and open up new markets. I think we can see continued good growth in that region. You know, very, you know, positive outlook, very good. However, you know, globally we have this continued disturbance in the supply chains that we have to live with and overcome.
We expect that it will limit our sales in the beginning of the year, and maybe also implying higher cost, but you know, we expect that things will be more normalized in the later part of this year. Our plans for the coming year remains intact and the key priorities, you know, going into this year is, of course, to you know, take the strong order book and convert that to revenue, which is very much limited by how much product we can supply given you know, what supplies we can get from our suppliers. We're also working with price adjustments according to agreements, to increase our prices to compensate for the higher operating cost that we see.
We did some price adjustments now in January, and we will continue to implement price adjustments in all regions during the year, as much as the agreements allow. As I mentioned, that we have to continue to work with the supply chain situation. Some of that work will be unexpected, you know, given the situation. We also have some plans to increase our production capacity, in particular in the U.S. site, to serve the demand from our OEM clients. Of course, very importantly is that the new regulatory framework in Europe, IVDR, is coming into effect in May. You know, what's ahead for us now is to update the technical file for some lower-risk products that are CE self-certified, where there's new requirements with IVDR.
That's an intense work ongoing the coming months. Then, of course, the most important, and I think the most, you know, inspiring, is that we are, you know, working towards a launch of our new product platform, starting with the connectivity launch of this year, and the first instrument, an advanced five-part instruments, the development will be ready in early 2023. We will continue to strengthen Boule based on our updated strategy. We want to leverage our local presence. We are also increasing activity in Boule Academy, where we train our distributors and also end users, and that has been very well received by our distributors. I had very good conversations with many of our distributors in Dubai just last week about those efforts that we're doing.
You know, to summarize, we continue to see a market recovery. We are executing on our strategy. We are increasing value for our distributors and also our users. We are investing in product development to renew our entire product portfolio in the coming two-five years, and we're growing the number of tests done with Boule Solutions by entering new market segments and new geographies. We will see some challenges in the supply chain in the coming year. Overall, I must say we are very, very happy with the results that we take with us last year, and now we enter this year with a strong order book. We are very, very positive about the outlook for this coming year. With that, I would like to thank you for your attention and open up for questions.
Thank you very much. Jacob, do you want to start?
Yeah, sure. First of all, congrats on a very strong quarter.
Yeah. Thank you.
I was a bit late here into the presentation, so I'm sorry if I'm asking something you have covered. If we start with the price increases, is this sort of a reflection of you expecting these higher costs to be, let's say, over the full next year?
Yeah. Yes. I think to some extent, some of this, of the additional costs are related, you know, are temporary, you know, related to this, you know, specific situation we're right in, right now. We do expect that material cost, in particular electronic components, will have a permanent price increase, which will affect our standard cost for our products.
Eventually should you be able to get the gross margins back up towards more the 45%-46% level?
That is our aim, and that's what we're working towards. Of course, it's, you know, I think the situation we are in right now is unpredictable, and I think that's kind of the you know the core issue here. We're working towards that as a, at least as a first step.
Okay. On the OEM and the CDS sales, which in my opinion was very strong here in the quarter. Is this sort of a sustainable level you can continue on? Or is there any one-offs here?
I see no one-offs. A sustainable level with a very positive outlook for further growth.
Okay. As well, your expansion strategy into the Middle East and Africa delivered quite strong results here. Is this also something we can sort of expect to continue going forward?
Yeah. I mean, I see very positive signals. I said, I mean, we were in Dubai just last week, and we had many of our distributors from that region, and I think there's a lot of opportunities in that region. Then it's, you know, it's a bit difficult to predict, you know, how much of that potential can be materialized, you know, in near term. But, at least longer term, we expect to see, you know, Middle East and Africa contributing to our overall revenue.
Okay. Then my final question just on the cash flow and investments, quite high investment level in the quarter. I know this is you investing for your new line of products, but how should we think about the sort of capital expenditure going forward when you are approaching launch and maybe also after you have launched the new product line?
I mean, I think, you know, what we have ahead of us is now that we also in the next year until launch, we are investing in, you know, the product development, but also in production equipment and, you know, new tooling and all of that. In this level will remain until launch, and then we will adjust it down slightly, depending on, you know, how fast we plan to bring other products to market based on this platform.
Okay. That was all the question I had. Thank you very much, Jesper.
Thank you, Jacob. Any more questions? No more questions?
I can take another question if there.
Yeah, you're welcome.
Yeah. Just thinking about your installed base, I saw you've done some efforts to sort of audit and get a better understanding of how it's done, how it's looking.
Mm-hmm.
How should we think about you entering a potential replacement cycle in the installed base now when there's quite a lot of instruments that were delivered, let's say seven, eight years ago? Is this an opportunity for you to drive sort of easy sales of new instruments going forward?
I think you could say that we, you know, apart from the new geographies, the new market segments we're entering, we're already in the replacement cycle. I think it's you know I would see it as a kind quite stable business going forward. And since we know we have a growing installed base, I think it's you know the new sales should really compensate instruments that is taken out of service. I think you can see that if you look at Boule you know a bit longer term, our consumable sales has grown year by year, and I think this pandemic was just a bump in the road. Now we see that we also you know getting you know beyond that bump and we deliver a record quarter.
I think it's stable going forward.
Do you expect the new product line to sort of benefit to this end towards sort of existing Boule customers or users?
No, I didn't quite get the question. What was the question?
Now, do you expect that the sort of existing users of Boule instruments will be eager to upgrade to your new product line?
Yes, I would say so. First, I mean, the first release will be a five-part instrument, and clearly that is a market that is growing faster than the three-part market where we have the majority of our sales. Some of our customers are waiting to switch from three-part to five-part. Those are easy sales, you know, in the beginning for us. We, you know, the new platform will also address new market segments. I think part of our installed base is we will also wait for that we also, you know, release a three-part version of this new platform, you know, later.
Overall, I think we have a plan to, you know, to convert all our loyal customers and we know that we have, you know, both our distributors are, you know, scoring us very high as a high quality provider, but also we have a very good brand in the market. I think there are many, you know, our users are looking forward for us to bring new products to market and will then convert to new instruments from Boule.
Okay. Thank you.
No further questions? Well, thank you very much then, and thanks for taking time to listen to us, and have a great day. We are very happy here at Boule about our achievements, and we look forward to, you know, meeting you at another point in time. Have a great day. Take care. Bye-bye.