M&A Announcement

Feb 3, 2021

Good morning, ladies and gentlemen, and welcome to Veracyte's conference call regarding its agreement to acquire Decipher Biosciences. As a reminder, today's conference call is being recorded. I'd now like to hand the conference over to Traci Morris, Veracyte's Vice President of Corporate Communications and Investor Relations. You may begin. Thank you, Ashley. Good morning, everyone, and thanks for joining us today for a discussion of our agreement to acquire Decipher Biosciences, which we announced earlier this morning. We expect to close the acquisition by May 2021 subject to regulatory approval and the satisfaction of other customary conditions. In conjunction with today's announcement, Veracyte announced our preliminary financial results for the Q4 full year ended December 31, 2020. This information may be found on our website. With me today are Bonnie Anderson, Veracyte's Chairman and Chief Officer Keith Kennedy, our Chief Operating Officer and Chief Financial Officer and Doctor. Tina Nova, DeCipher Biosciences' President and Chief Executive Officer. Before we begin, I'd like to remind you that various statements that we may make during this call will include forward looking statements as defined under the applicable securities laws. Forward looking statements include those regarding our pending acquisition of Decipher, results, as well as our future plans, prospects and strategy, financial results as well as our future plans, prospects and strategy, financial goals and guidance, product attributes and pipeline, drivers of growth, expectations regarding reimbursement and other statements that are not historical fact. It also includes statements regarding the the potential impacts to our business resulting from the COVID-nineteen pandemic and the potential timing for a recovery of our business. Management's assumptions, expectations and opinions reflected in these forward looking statements are subject to risks and uncertainties that may cause actual results and or performance to differ materially from any future results, performance or achievements discussed in or implied by such forward looking statements, and the company can give no assurance that they will prove to be correct and will not provide any further guidance or updates on our performance during the quarter unless we do so in a public forum. Please refer to our February 3, 2021 press release and the risk factors including sorry, February 3, 2021 press releases and the risk factors included in the company's filings with the Securities and Exchange Commission for discussion of important factors that may cause actual events or results to differ materially from those contained in our forward looking statements. In addition to today's announcements, which are available on our website at veracyte.com under Press Releases in the Investor Relations section, we published a presentation regarding the Decipher Biosciences in the Investor Relations section. I will now turn the call over to Bonnie Anderson, Veracyte's Chairman and CEO. Thanks, Tracy. Welcome, everyone, and thanks for joining us this morning. I am thrilled to discuss our agreement to acquire Decipher Biosciences, which will uniquely advance our vision of improving outcomes for patients all over the world at every step of their journey. I'll reference a presentation that Tracy referred to and as you can see on Slide 4, today we offer tested and form diagnosis and treatment decisions along the care continuum in 4 major cancers and other diseases with a near term market opportunity of approximately $10,000,000,000 And on slide, as you can see Slide 5, in addition to offering our tests through our centralized CLIA lab in South San Francisco, California through our best in class nCounter platform, we are positioned to potentially reach patients globally with a broad menu of advanced genomic diagnostic tests. As Slide 6 shows the powerful combination of Veracyte and Decipher Biosciences, which we announced today, will create a comprehensive portfolio of novel genomic tests that expand our reach across 7 of the top 10 cancers and positions us to drive market, menu and global expansion, while also accelerating our near term revenue growth. As we turn to Slide 7, I'm delighted to introduce Doctor. Tina Nova, President and CEO of Decipher Biosciences to tell you firsthand about the amazing company she and her team have built. Tina? Thanks, Bonnie. We at Decipher Biosciences are thrilled to join forces with Veracyte to become part of a global brand that is transforming patient care across the clinical continuum in cancer and other diseases. We believe Veracyte provides a compelling opportunity to accelerate commercial expansion of our current and pipeline tests. First, a little about us. We are a commercial stage precision oncology company focused on the $2,000,000,000 urologic cancer market. We have about 100 full time employees and we're based in San Diego, California, where we have a state of the art CLIA and CAP certified lab. Our lead indication is prostate cancer, where we've created a unique portfolio of tests that span the patient continuum of localized disease. We've experienced strong growth in the last couple of years with 2020 revenue of approximately $39,000,000 to $40,000,000 an increase of more than 130% over 2019, all while achieving cash flow positive status in 2020. Turning to Slide 8, DeCiper Biosciences has made significant progress traction over the last few years. As you can see, our vision has been to develop and offer our proprietary genomic tests across the entire prostate cancer care continuum, culminating in 9 Medicare approvals for our commercialized test. We've developed tests and localized disease using either a sample from a prostate biopsy or from the entire prostate following surgical removal to predict the patient's risk of progressing to metastatic disease. This is the most important clinical dilemma for physicians who are treating these patients. We have an industry leading pipeline of very promising products, which moves us into more advanced disease and to other urologic cancers, including our bladder test, which we plan to launch later this year and into kidney cancer in the future. All of these tests represent a $2,000,000,000 total available market. DECIPRI has the strongest clinical validity of any prostate test on the market as evidenced by our NCCN support. For example, our post surgery test is the only NCCN recommended test on the market today. Our test has been included in over 220 scientific publications and the DECIPR test is an integral biomarker in 7 prospective randomized controlled global clinical trials. As you can see on Slide 9, prior to the utilization of genomics, clinicians relied solely on clinical parameters such as PSA level, prostate specific antigen and pathology to determine the appropriate treatment per patient. But those factors were only accurate on average 60% of the time, which led to over treatment of some and under treatment of others. DECIPRIS test results dramatically improve the physician's ability to personalize therapy for each patient and to make the appropriate treatment decision, better patient care with improved outcomes. So how does the DECIPR test improve patient care? Know that clinicians have many options to choose from in regard to treatment. DECIPR has shown that if you over treat a patient who should not have been treated, for example, with radiation and hormones, the patient's survival can be even worse than if you had not treated the patient at all. So how do you know who to treat? The DECIPRE biopsy test informs the physician to either decide to not treat patient initially, but rather to weigh and monitor the patient over time or tells them they need to intensify treatment right away to decrease the patient's probability of becoming metastatic. The same following surgery, here the DECIPR test guides the physician to either take a more proactive approach and intensify treatment through the use of radiation plus or minus hormones or alternatively to identify patients who can forego further treatment. Looking at Slide 10, what further separates us from the competition is our unique and proprietary database, which we've branded GRID. It is comprised of whole transcriptome profiles from over 90,000 patient tumors. We believe that this is the largest urologic database in the world. This database fuels both our pharmaceutical partnerships and aids a new biomarker discovery for future product development. The research database contains over 300 proprietary signatures that are run on each patient's tumor data, analyzed and stored as part of our daily commercial operations. This provides valuable information for our pharma partners. In addition, we've matched banked samples as part of our database initiative and over 15,000 of these patient profiles have extensive follow ups, clinical characterization and outcomes. With that, I'll now turn the call back to Bonnie. Thank you, Tina. I'm sure everyone can see why we're so excited about the Veracyte and DeCypher combination. To provide further color, I'll direct you to Slide 11. The addition of DECIPHER's tests in prostate, bladder and kidney cancers to our tests in lung, breast and thyroid cancers along with lymphoma means that our comprehensive test menu will address 7 of the top 10 cancers by incidence in the United States. Our combined test will enable us to potentially reach 60% more patients in the U. S. Alone, increasing our near term total addressable market by over $2,000,000,000 We are not aware of any other company in the genomic testing space with such breadth and depth of coverage in cancer. And looking at Slide 12, even more significantly, we believe that the combination will further solidify our global leadership in differentiated genomics driven cancer diagnostics with a comprehensive testing menu and our exclusive access to the nCounter analysis system and a total addressable market of more than $50,000,000,000 This best in class diagnostic instrument enables us to deliver our advanced genomic test to physicians and patients in global markets where hospitals and laboratories can perform them locally, which is key to ensuring their adoption and reimbursement. As we've mentioned before, the combination of our centralized CLIA lab in South San Francisco and the ENCOUNTER system for decentralized testing gives us increased flexibility for delivering our tests to patients in the U. S. And globally. We plan to maintain Decipher Biosciences state of the art facilities and its talented team in San Diego for further increased operational flexibility. Next, let's look at Slide 13 to further understand why this acquisition is such a strong strategic fit for Veracyte and will accelerate our growth pathway. Like Veracyte, Decipher is focused on answering the key questions doctors have so that they can best treat patients across the continuum in specific diseases. Notably, in prostate cancer, DECIPHER began with a test that's further downstream to guide patients therapy following surgery. As they've launched tests for earlier stages of disease, they've increasingly become a one stop shop for doctors treating prostate cancer patients. And by establishing relationships and trust with physicians with one clinically valuable test, they have been able to facilitate adoption of subsequent tests in the same clinical arena. DECIPHER also puts a premium on rigorous science. Their whole transcriptome approach to test development has enabled them to build large comprehensive biorepositories that are fueling biopharmaceutical partnerships with companies like Janssen, Dendreon and Astellas and are serving as their engine for further product innovation. This is an approach that has served Veracyte very well and we are thrilled to join forces with such a like minded team. Finally, in addition to accelerating our near term revenue and genomic volume growth, we believe Decipher's market leading genomic tests in urologic cancers will give us a powerful menu for driving global growth on the nCounter instrument. We are excited once the transaction closes to dig in and determine the best pathway forward towards capturing a global total addressable market of approximately $50,000,000,000 And now to speak about terms and other financial details, I'll turn the call over to Keith. Thank you, Bonnie. As illustrated on Slide 14, Veracyte will pay $600,000,000 in total consideration to Zecipher's security holders, consisting of $250,000,000 in cash and up to $350,000,000 in stock consideration, subject to customary purchase price adjustments. The number of Veracyte shares issued at the closing will be based on a fixed price of $54.30 per share, resulting in a maximum issuance of 6,400,000 common shares. However, without changing the total consideration paid at closing, Veracyte has the option at its sole discretion until the earlier of March 15, 2021 and the 4th business day following the closing of any potential equity financing to substitute cash in lieu of shares in any amount up to the entire stock consideration of $350,000,000 The transaction, which has been unanimously approved by Veracyte's Board of Directors and by an independent special committee appointed by the Decipher Biosciences Board of Directors is expected to close by May 2021, subject to regulatory approval and the satisfaction of other customary conditions. At December 31, 2020, we had approximately $345,000,000 to $350,000,000 in cash on hand. Turning to Slide 15. We expect the acquisition to accelerate our revenue growth and pathway to profitability. Despite the impact of COVID-nineteen, based on Decipher's preliminary 2020 revenue of $39,000,000 to $40,000,000 The company generated over 130 percent top line growth compared to the prior year period. As evidenced by the annualized results shown on the right hand side of this slide, we believe there is significant momentum in the combined business. Based on preliminary results, Decipher reported positive operating cash flow for 2020. In addition, we also expect the acquisition to be gross margin accretive. I will now turn the call back over to Bonnie. Thank you, Keith. And finally, I'm delighted that Decipher's world class team will be joining us. This includes Doctor. Tina Nova, the company's President and CEO, who will continue to run the business as the General Manager of Veracyte's urologic cancer business unit once the transaction closes. Tina is already very knowledgeable about Veracyte having served as a will further solidify our global leadership in the genomic cancer diagnostics market, while accelerating revenue growth. Moreover, it marries 2 highly aligned businesses with world class teams and products in our efforts to improve outcomes for as many patients as possible in the United States and around the world. That we believe is a good deal for patients, physicians, payers and for our respective employees and shareholders. I will now ask Ashley to open up the call for questions. And your first question comes from Puneet Souda with SVB Leerink. Great. Thanks, Bonnie, and congratulations and congrats, Tina. So this is great to see excellent TAM expansion and menu coming to Veracyte. So my first question is, 130% growth that you're seeing in 2021. Could you maybe elaborate and give us a view into what sort of what could that mean in terms of coming out of COVID in terms of volume growth and revenue growth, given the strong growth that you've seen over between 2019 2021 in both prostate and RP? Thanks, Puneet. I appreciate that. As we said on the call, despite COVID-nineteen, the Cipher's estimated revenue grew in excess of 130%. We expect the acquisition to accelerate our revenue growth and the pathway to profitability. We also believe the company's products are less than 15% penetrated by test volume and the urological target markets that they address. So we're really excited about the momentum this means for us on a combined basis. That's all I can say in terms of the forecast. Yes. Your next question comes from Brian Weinstein with William Blair. Hey guys, thanks for taking the questions. A couple of them I'll just kind of ask upfront. So I appreciate the answer to the last one. Can you be a little bit more specific on what drove the 130 percent? I know that, Tina, you were looking at doing some pretty significant sales force expansion in 2020. Was it sales force expansion? Was it a single product that was driving that? Can you just talk about what the drivers were that really drove that outsized growth last year? And then a question on the data generation and the biorepository here. Can you talk about just a little bit more about the success that you've had there? And is there anything gone in the Veracyte biorepository here when you combine these things, which would be helpful recognizing, of course, these are different patient types, but when you combine these biorepositories, is there anything that you'll be able to glean from one Thanks. So, Tino, why don't you address the question around what drove the growth? I think there were considering COVID and everything that happened in 2020. Considering COVID and everything that happened in 2020. So yes, part of it was expanding the sales force. Intermediate range for prostate cancer. So acquired 2 LCDs in the intermediate range for prostate cancer and then near the end of 2020, which really didn't affect our overall growth for the year because they were so late in the year, but we gained the high and very high lymph node positive LCDs as well and expanded our current LCDs, for coverage. We also were able to acquire more managed care contracts last year. And we also with the NCCN recommendations that we received last year, it certainly put us in a great position to have that overall growth that we did. Thanks, Tina. As we've always said, volume and evidence that drives coverage decisions, drives reimbursement and Decipher has certainly played that out well. I'd like to comment on the grid and the data, the biorepositories and then certainly Tina can add any color she wants. But as you know, we have been focused in our own business of expanding the results and information that we provide not only to answer the questions around the diagnostic dilemmas and decision making on surgery and treatment, but to be able to use the vast amount of data we collect in our whole transcriptome sequencing assay to inform further untargeted treatment therapies by identifying broad base of variants that are interesting and novel and need to know. DECIPHER has done with their GRID product. That might be a branding opportunity because it's very, very similar to us where you're able to build out a biorepository of extensive cancer cases, collect follow-up data, pathology data, other clinical data, demographic data and then build a database that has more data than anyone knows today what they'll do with. But over time, there will be value created. And some of the partnerships that they have gleaned in biopharma out of this work will overlap with us. And we think together, we could advance a whole new area of defining what diagnostic test results can do. Tina, anything specific you want to add around grid? I just think that you've hit on all the major points, but I think the fact that both companies do whole transcriptome analysis of every patient sample they receive really puts us in a position to explore that database together at a level that IGA is very dictating from any other competitors. Your next question comes from Taha Sabet with Morgan Stanley. Hey guys, good morning. Hi, Taha. Congrats on the deal. So on prostate, Tina, can you just help us think through how does your the biopsy test compare to something like genomic health GPS? And are there any important points of differentiation to understand? And second, this LCD expansion that you mentioned at year end, how much of an ASP tailwind do you expect from that in 2021? And then on the bladder side, I know you mentioned it's predominantly self pay, but there is a draft LCD that you expect to be finalized. Maybe can you just elaborate on that a little bit in terms of whether that's sort of a first half of this year event or do you expect that to be in the back half of the year? Yes. Thank you for the question. Yes, we expect the bladder test, of course, it's all dependent on Medicare. But looking at the past and how long it takes to get things approved and what have you, yes, we already have the draft LCD And so we do expect that mid-twenty 21. And on the prostate side, sorry. The competitive positioning. So with our competitors, of course, are extremely good companies that have very high quality tests as well. So, we're just very different than the competitors in the fact that, 1, as compared to one of our competitors, we have more LCDs approved than one of our competitors, and so we cover the whole localized prostate cancer care continuum. In addition, we do have the highest rated, as I mentioned, NCCN for our radical prostatectomy, test, which has a recommended, and there is no other prostate cancer, test that has a recommended. So I think that puts us in a different position than our competitors. And the other thing is that just the endpoints that they have developed their test to as compared to the endpoint that we developed our test to, we've taken different approaches. And the And so therefore, with different endpoints, the physician can use these differently. But this seems to be something from our discussions that physicians really are about and it's very difficult with some of these intermediate patients to decide exactly what to do with them. It's very confusing data actually because prostate cancer is such a heterogeneous disease. So having genomic information to tell you which your patient has high or low risk of getting metastatic disease is really something that they find extremely useful. Got it. Very helpful, Tina. Thank you. Your next question comes from Thomas Flaten with Lake Street Capital. Hi, good morning. Thanks for taking the questions. Bonnie, I know you said you were going to dig in and kind of lay out a plan, but I was wondering if you could just provide some color around your thoughts around transitioning maybe some of the Cypress products onto the nCounter platform and how we might think about that at least from a temporal perspective? Is this 3, 4 years out or is it sooner than that you think you might have some strategic direction to help us with? Yes. Well, we're certainly super excited that their tests are all developed on whole transcriptome. We know that these RNA tests transfer relatively easy from both array and sequencing over to the nCounter platform. We've done significant work there ourselves. And obviously, our vision is to build a global enterprise that can touch as many patients around the world. We know in order to do that, we need to build out menu. The menu is the value driver to drive installed base of encounters. And then once you proliferate that installed base, the menu gets pulled through. So it becomes much more of a razor razorblade approach than sending samples back to a single lab in the U. S. So it's a key part of our strategy. I certainly don't have any dates yet on when this might happen, but you can imagine after this deal closes, we'll be collaborating across our teams to see how we can accelerate this important dynamic for the company to really drive and remain leaders in the global markets. Thanks for the question. Absolutely. And then Keith, just one quick one for you. Is there anything you can comment on the middle of the P and L? What kind of impact we might see from an R and D and SG and A perspective? They Decipher operates in the same target ranges that we operate. And recently, as you can see from their S-one that's on file, their R and D cost, SG and A is in line with where we expect to be. And they've generated positive cash flow for the 1st 9 months of the year and margins of around 69 percent. Your next question comes from Sandy Draper with Truist Securities. Thanks so much and definitely echo my congratulations on the transaction. Maybe just two questions. First, in terms of the commercial payers, not as familiar in terms of the balance between the number of patients here that are going to be covered by Medicare versus commercial, do you have that number? And then you have the checks for commercial, but a sense of like how broad are you at 20%, 50%, 90% coverage for commercial? That would be helpful. And then the follow-up probably for on the operational synergy. You said you're going to keep the lab, but just trying to think about sales force, other synergies. Clearly you're focused on the top line, but are there operational synergies besides and you've addressed the nCounter opportunity? Would just love any thoughts on that. Thanks. Yes. I'll answer the latter question and then, talk it to Tina to elaborate a little bit more on the reimbursement. We are thrilled to combine DECIPHER with us. It's not driven by synergies. We'll be looking for opportunities to invest in accelerating and driving the growth. Not only will we keep the entire that could be beneficial to us. As that could be beneficial to us. As you know, we're launching 4 new products this year as well. So I think together the companies are going to be looking for the best places to grow and accelerate the pathway to achieve our goals. So sales force, we are excited that there's been recent expansion in the sales force to help drive 2020 revenue growth. And that's what we'll be looking for out of this deal, growth, margin expansion and long term access to global markets. Tina, do you want to speak a little bit to the Medicare and the timing? It always takes obviously time to get the commercial payers all on board. I think the Cypher is on that journey with prostate having just gained recent Medicare expansion LCDs. It will take some time for us to get those. But Veracyte has a lot of contracts out there across the payer world and it could be an opportunity to bring products together under common contracts and we'll be exploring that. I guess I may have answered most of that. Tina, do you want to add anything to that? No, no, that's fine. Yes, I just want to reiterate that our mix has continued to be at 50% Medicare and Medicare Advantage together, comprising 50% 50% commercial. We have been working very hard on continuing to add managed care contracts and we have right now about a north of about 100,000,000 covered lives in our commercial side. Okay, great. That's really helpful. Thanks a lot. Congrats again. Thank you. Thank you. Your next question comes from Paul Knight with KeyBanc. Hi, Bonnie. Congratulations on the deal. With the number of salespeople now, what was the number of salespeople planned at the company? I think that Decipher has you mean a broad company. Decipher has I think about 25. Tina, can you confirm? That is correct, 25. And we'll be looking at that as we move through the year. Veracyte is around just over 100 this year as we move through the year and think about the launch of our portfolio of tests, we may grow that a bit, so that we're all teed up by the end of the year and have people trained to accelerate the growth we're looking for in 2022, which we think will be significant. So very nice position to achieve that growth. And then you had gone over 50 are commercial pay on your tests and then the remaining is Medicare? Yes. That's what Tina just said, about a fifty-fifty mix on the prostate products. Okay. And typical pricing on product? I believe the Medicare rate, Tina, is what around $4,000 Yes, to be exact, $3,873. Very good. What a nice round number. Sorry. I know it well. Yes. Their average revenue for 20 22 is about $2,400 to $2,500 on a blended basis. You just take revenue and divide volume. Perfect. What was that number, Keith? It's between $2,400 $2,500 per test when you blend all test volume, so revenue over volume. Okay. And then lastly, what CMS decisions are you looking to in 2021? I think bladder is the key test that's teed up for a final decision. As Tina said earlier, we have a draft LCD on the bladder cancer test. And what I like about the Cipher is they follow very much the Veracyte playbook and that is we don't expand and drive commercial growth of test revenue until there is a coverage decision. So we'll look forward to getting that to a final stage sometime this year and being ready to commercialize and ramp the launch of bladder cancer as well. Same call point, which is phenomenal and as well as kidney when that advances in the pipeline. And that's on top of the 7 finals already at the company, right Bonnie? Yes, that's correct. And we have a nice slide in the deck that lays out the coverage, the evidence map and the coverage decisions for each of those indications and you can take a look at that in the deck that's on our website. Okay, thanks. All right. Thanks, Paul. And your next question comes from Puneet Souda with SVB Leerink. Yes. Hi, Bonnie. Thanks for the follow-up. So on so on I wanted to get a better sense from you and Tina on the urologist call point, given the maturity of the market so far and then obviously the competition in the market and what you have done so far with LCDs, number of LCDs and indication expansion, maybe could you provide how does the strategy change under Veracyte in order to drive that essentially that leadership position in urology, just given the competition that you have in the market? And if you could maybe just help us also Tina, if you could help us understand recurring sales in the urologist, what makes them switch to different products? Just help us understand how the urologists are thinking about the prostate products? So I'll speak to structure and then Tina can answer the details around why we're so well positioned to capture Veracyte structure back in December. We announced that we brought on a new general manager and a verticalized all of our businesses under general management structure, so that we can bring the clinical focus, the training, the expertise and the line of focus to our end customers in each of our segment. We have a General Manager, John Hanna, who now leads our endocrinology and global breast cancer franchise, will also run the lymphoma business when that test launches. We have Morton Frost who joined us in January from Agilent, tremendous leader, who is now leading our entire pulmonology franchise. Again, common call point there across all of our lung cancer products as well as IPF, both launching IPF in the international markets on eCounter toward the end of this year. And we'll launch the 2 exciting products in lung cancer, our nasal swab test for earlier detection and Percepta Atlas, our version of Frid. And so having Tina stay on just a veteran world class experienced leader to continue to run the urologic cancer business was just a key part of our excitement around bringing this business into Veracyte. So Tina will run the operation and continue to lead the business, drive the growth in the field and it will be run-in a vertical way, a little more of autonomy and all the functions reporting into Tiena at least through the 1st year and then we'll assess. But the cool thing is Veracyte doesn't have to make any decisions now on integrating the people and functions into our business. We've got the leadership structure in place to continue to drive growth. And Tina will be such an asset on our leadership team. We're thrilled with that both she and her other key senior leaders have all agreed to be part of this new team and we're hoping every play in the company comes over with a smile on your face. Tina, do you want to speak to the reason why these urologists? Right. So in the beginning, when we had the earlier stage test approved, in other words, in the biopsy low, for example, we were really selling to urologists 100%. And then as we gained more LCDs across the spectrum and especially the ones at the end of the year, we now start also selling to radiation oncologists because they become a very important part of the decision, especially after the removal of the prostate, after radical prostatectomy on whether to treat the patient or not. And they become involved with the radiation plus or minus hormone step. So we've not only expanded our offering, but we also expanded our customer base by having more LCDs. And 2021 will be the 1st year that we've had all of the tests from the very beginning of the year that we can offer, as a package. I think the other thing is that docs really like it to be as easy as possible working with a company. I think the fact that we have all of the localized prostate cancer now makes it much easier. You just send the sample to us and no matter what stage it is, that makes a big difference. It makes it a lot easier. And also, I think that physicians decide who to use based on the strength of the clinical evidence. And I think that is where we really make a difference. So for example, last year, we presented an abstract at leading meetings, where we showed that DECIPRE predicts overall survival and that publication will be out shortly. And it was a prospective randomized trial. And in addition to that, just recently, we had a systematic review, which was a review of all of our data. If they looked at 42 studies, they looked at over 30,000 patients and they showed that DECIPRE every time beat the standard of care that's currently used. And so I think between those that clinical evidence that has really made a difference in the usage and keeps the physicians using our test. Thank you, Tina. That's very helpful. Thanks, Tina. And last one, if I could squeeze in for Keith. Great to see the volume in the quarter. Just wanted to get a sense on Percepta because obviously that's an important question in terms of volume growth that you were seeing. I know pandemic has gated some of this. Maybe just give us anything you can provide on the quarterly numbers that you printed and the volume there? Thank you. Thanks, Puneet. We're consistent with the prior quarter. We're seeing Afirma continue to do very, very well on a rebound. And as pulmonologists are spending time with COVID patients, that has lagged behind what we originally thought at the beginning of the year pre COVID. But overall, results have been really strong. And our product business has done very, very well. Your next question comes from Sandy Draper with Truist Securities. Thanks for letting me squeeze one more in. We'd love to hear, Tina, I can certainly understand, Bonnie, your enthusiasm and the opportunity here. We'd love to hear, Tina, your thought process. You had an S1 on file, potential to raise capital that way. When you looked at that avenue versus pairing up with somebody, the thought process and then why specifically Veracyte? Would just love your perspective on that. Thanks. Thank you for the question. I mean, there's several reasons. And one is our cultures are very much alike in the way we approach the market and the way we manage our businesses. I think the other thing that's really important for us is scale. It gives us an opportunity to scale at a whole different level much quicker than we would have been able to do on our own because we're just not at the same place obviously that Veracyte is. I'm very excited about the nCounter and our test potentially being part of that. And that really opens up an international market for us in a very short period of time, which we would not have been able to access quickly. It would have taken us a lot of time and strategy for us to think about how to approach those markets, which as you know are very complex. And so I think those things really make a difference, scale and time, access. Great. That's really helpful. Thanks, Tina. Thanks, Sandy. All right. And I think there are no further questions. I'll hand the call back for closing remarks. Thank you everyone for joining us. We're super thrilled to make this announcement Q1, which seems to be coming quite fast. So stay safe and healthy and thanks for joining us. Ladies and gentlemen, this concludes our call today. Thank you for joining us. You may now disconnect.