IQVIA Holdings Inc (NYSE: IQV) Q4 2022 earnings call dated Feb. 10, 2023
Corporate Participants:
Nick Childs — Senior Vice President – Investor Relations and Treasury
Ari Bousbib — Chairman and Chief Executive Officer
Ron Bruehlman — IQVIA Holdings, Inc., Executive Vice President and Chief Financial Officer
Analysts:
Dan Leonard — Credit Suisse Group AG — Analyst
Eric Coldwell — Robert W. Baird & Co., Inc. — Analyst
Justin Bowers — Deutsche Bank AG — Analyst
Jack Meehan — Nephron Research LLC — Analyst
Luke Sergott — Barclays Bank PLC — Analyst
Sandy Draper — Guggenheim Securities, LLC — Analyst
Elizabeth Anderson — Evercore ISI International Ltd — Analyst
Charles Rhyee — Cowen and Company, LLC — Analyst
Presentation:
Operator
Ladies and gentlemen, thank you for standing by. At this time, I would like to welcome everyone to the IQVIA Fourth Quarter 2022 Earnings Conference Call. [Operator Instructions]
Thank you. I would now like to turn the call over to Nick Childs, Senior Vice President, Investor Relations and Treasury. Mr. Childs, please begin your conference.
Nick Childs — Senior Vice President – Investor Relations and Treasury
Thank you. Good morning, everyone. Thank you for joining our fourth quarter 2022 earnings call. With me today are Ari Bousbib, Chairman and Chief Executive Officer; Ron Bruehlman, Executive Vice President and Chief Financial Officer; Eric Sherbet, Executive Vice President and General Counsel; Mike Fedock, Senior Vice President, Financial Planning and Analysis; and Gustavo Perrone, Senior Director, Investor Relations.
Today, we will be referencing a presentation that will be visible during this call for those of you on our webcast. This presentation will also be available following this call in the events and presentation section of our IQVIA Investor Relations website at ir.iqvia.com.
Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements. The actual results could differ materially from those stated or implied by forward-looking statements due to risks and uncertainties associated with the company’s business which are discussed in the company’s filings with the Securities and Exchange Commission, including our Annual Report on Form 10-K and subsequent SEC filings.
In addition, we will discuss certain non-GAAP financial measures on this call which should be considered a supplement to and not a substitute for financial measures prepared in accordance with GAAP. A reconciliation of these non-GAAP measures to the comparable GAAP measures is included in the press release and conference call presentation.
I would now like to turn the call over to our Chairman and CEO.
Ari Bousbib — Chairman and Chief Executive Officer
Thank you, Nick, and good morning, everyone. Thanks for joining us today to discuss our fourth quarter and full year results. As we close 2022, we are very proud of what we’ve achieved at IQVIA. It was a record year for our R&DS business. We achieved bookings of $10.8 billion, which was the highest ever. Our backlog stands now at a record $27.2 billion, and the business added over 275 new customers in the year. We improved access to critical research. We’ve expanded our decentralized clinical trial capabilities by launching the first self-collection safety lab panel for U.S. clinical trial participants in collaboration with Tasso. Our DCT program achieved GDPR validation in Europe, marking the first time a DCT offering received this data privacy validation. And our connected devices business added 50 new customers, including wins with two top ten pharma companies.
We made significant advancements as well in our real-world business. We increased the number of our active data sources by more than 30% across more than 50 countries, and we enhanced access to real world data for European and U.S. regulators through our partnerships with the European Medicines Agency and the Real World Alliance. We expanded our digital marketing capabilities with the acquisition of Lasso Marketing, which offers a technology purpose built for healthcare marketers to execute digital campaigns. We deployed capital of $3.7 billion during the year. This included $1.3 billion in acquisitions, $1.2 billion in share repurchase, $0.7 billion in capex, and repayment of $510 million of debt. At the same time, we were able to reduce our net leverage ratio to 3.45 times adjusted EBITDA.
2022 also marked the end of our Vision ’22 three-year strategic plan. No one could have predicted the volatile macroenvironment we would have to operate in during this period. Despite the many headwinds we have faced since 2019 when we set these goals, we in fact exceeded our Vision 2022 goals. I am proud of the resilience, resourcefulness, and creativity that our employees around the world demonstrate every day in support of IQVIA’s mission. It is these attributes that allowed our company to deliver on the commitments we made to you in 2019.
Now as you know, since the beginning of ’22, the industry has been reporting a slowdown in demand for clinical and commercial services caused by reductions in biotech funding as well as the higher interest rate environment and macroeconomic uncertainty. As we’ve discussed before, while we’ve, of course, seen anecdotal evidence of these concerns, we at IQVIA remain confident that the fundamentals of our industry and the demands of our clients remain healthy. And in fact, we remain confident in our ability to deliver on our 2025 goals.
As we begin 2023, there are more molecules in development than at any other time in history. Our RFP flow was up 13% for the full year. We in fact saw acceleration in Q4 to 22% with double-digit growth in all three segments, large, mid-size, and EBP segments. Our net new business reached a record $3.1 billion in Q4, which is up 29% versus prior year. For the full year, we achieved bookings of $10.8 billion, despite the large COVID bookings we had in 2021 that didn’t repeat in 2022. And yes, in our commercial business, while we are seeing some short-term fluctuations in discretionary spend categories, such as, for example, consulting, demand for our commercial services nonetheless remains on a favorable growth trend.
Finally, let me just acknowledge and congratulate our employees around the world for the nice recognition the company received last week. IQVIA was named to Fortune’s list of the World’s Most Admired Companies for the sixth consecutive year. Importantly, once again, we earned the first place ranking within our industry group. We also ranked number one in seven out of nine categories, including innovation, people management, use of corporate assets, social responsibility, quality of products and services, global competitiveness, and long-term investment value.
Turning now to the results for the quarter. Revenue for the fourth quarter grew 2.8% on a reported basis, 7% at constant currency compared to last year, and excluding COVID-related work from both periods, we grew the top line 10% at constant currency on an organic basis. Fourth quarter adjusted EBITDA increased 11.1%, reflecting our strong revenue growth and ongoing cost management discipline. Fourth quarter adjusted diluted EPS of $2.78 grew 9%, driven by our adjusted EBITDA growth.
Few highlights of business activity this quarter. In our technology business, IQVIA recently entered into a milestone agreement with Alibaba Cloud to collaborate in China. Through this collaboration, IQVIA will be the first company to make its Salesforce-based products available on Alibaba Cloud and the only life sciences provider to have a full Salesforce-based ecosystem of products hosted locally and designed to be compliant with China’s data residency and privacy regulations. Through our partnership with Alibaba Cloud and Salesforce, IQVIA will continue to extend the OC suite, delivering innovative capabilities tailored to meet China-specific market needs.
As you know, IQVIA’s Human Data Science Cloud offers clients a combination of extensive data networks, data integration, and embedded intelligence, all of which help our clients deal with the challenge of increased data complexity and volume. A top 10 pharma awarded IQVIA our largest ever commercial managed services deal where we will take responsibility for managing the end-to-end commercial analytics for all their commercial brands globally.
Personalization of care is becoming a focus of our customers’ commercial strategies. This quarter IQVIA was awarded a major patient support program by a top 10 pharma for their cardiology product, displacing the incumbent vendor and once again validating IQVIA’s uniquely differentiated integrated domain expertise, services, and technology platform.
As I previously highlighted, demand from our EBP customers has remained high despite the funding levels returning essentially to pre-pandemic levels. As an example, a U.S. based emerging biopharma company recently selected IQVIA to be their end-to-end clinical to commercial partner. IQVIA was selected due to the breadth of capabilities, our domain expertise, strong resources and technologies such as OCE. IQVIA will support all aspects of their first commercial launch as well as provide clinical trial services for their future indications.
In another example, Biostage, which is a biotech company developing regenerative medicine treatments, selected IQVIA to manage its first clinical trial of their esophageal implant products. Current treatment options for patients diagnosed with esophageal cancer result in only 20% survival at five years. In the first use of the implant, the trial demonstrated that the product was able to successfully regenerate tissue to restore the functionality of the esophagus. IQVIA was selected due to our dedicated gastrointestinal team and our ability and expertise running the most complex cutting-edge cell and gene therapy trials.
Within RMBS [Phonetic], we also signed a long-term collaboration with Clalit, the largest health services provider in Israel, to launch the first prime site in the region. The collaboration combines IQVIA and Clalit’s capabilities in clinical trial delivery, real-world research, data, and genomics. Clalit operates a network of 14 hospitals and more than 1,600 primary care clinics with special expertise in oncology, pediatric rare disease, and genomics.
In oncology, which remains the largest therapeutic area for R&D outsourcing, we continue to experience strong double-digit year-over-year growth in bookings. As an example, we expanded one of our preferred partnerships with a top global pharma, which awarded IQVIA a large early and late-stage trial in multiple oncology indications. We were selected because of our analytics to optimize protocol development, site selection, and operational planning, including our ability to recruit patients meeting their diversity targets.
So overall the R&DS business continues its strong momentum. You saw we achieved new bookings of $3.1 billion in the quarter, the highest in our history. This translated into a quarterly book-to-bill of 1.51 times, including passthroughs. And excluding passthroughs, the business delivered almost $2 billion of total net new business in the quarter with a book-to-bill of a ratio of 1.30 times. For the full year, our contracted book-to-bill ratio was 1.36 times, including passthroughs and 1.33 times excluding passthroughs.
I will now turn it over to Ron for more details on our financial performance.
Ron Bruehlman — IQVIA Holdings, Inc., Executive Vice President and Chief Financial Officer
Thanks, Ari, and good morning, everyone. Let’s start by reviewing revenue. Fourth quarter revenue of $3.739 billion grew 2.8% on a reported basis and 7% at constant currency. In the quarter, COVID-related revenues were approximately $190 million, which was down about $150 million versus the fourth quarter of 2021. In our base business, that is excluding all COVID-related work from both this year and last, organic growth at constant currency was 10%.
Technology & Analytics Solutions revenue for the fourth quarter was $1.499 billion, up 0.2% reported and 4.7% at constant currency. Excluding all COVID-related work, organic growth at constant currency in TAS was 7%. R&D Solutions’ fourth quarter revenue of $2.058 billion was up 5.9% reported and 9.3% at constant currency. Excluding all COVID-related work, organic growth at constant currency in R&DS was 14%. Finally, Contract Sales & Medical Solutions, or CSMS, fourth quarter revenue of $182 million declined 7.1% reported, but grew 2% at constant currency. Excluding all COVID-related work, organic growth at constant currency in CSMS was also 2%.
For the full year, revenue was $14.410 billion, growing at 3.9% on a reported basis and 7.8% at constant current. COVID-related revenues totaled approximately $1 billion for the year. And our base business, again, that’s excluding all COVID-related work, organic growth at constant currency was 13%. For the full year, Technology & Analytics Solutions revenue was $5.746 billion, up 3.8% reported and 8.7% at constant currency. Excluding all COVID-related work, organic growth at constant currency in TAS was 10% for the year.
Full year revenue in R&D Solutions was $7.921 billion, growing 4.8% reported and 7.7% at constant currency. Excluding all COVID-related work, organic growth at constant currency in R&DS was 17%. Full year CSMS revenue was $743 million, which was down 5.2% reported, but grew 2.7% at constant currency. Excluding all COVID-related work, organic growth at constant currency in CSMS was 4% for the year.
Now let’s move down the P&L. Adjusted EBITDA was $920 million for the fourth quarter, representing growth of 11.1%, while full year adjusted EBITDA was $3.346 billion, which was up 10.7% year over year. Fourth quarter GAAP net income was $227 million and GAAP diluted earnings per share was $1.20. Full year GAAP net income was $1.091 billion or $5.72 of earnings per diluted share. Adjusted net income was $524 million in the fourth quarter and adjusted diluted earnings per share grew 9% to $2.78. For the full year, adjusted net income was $1.937 billion and adjusted diluted earnings per share was $10.16, up 12.5% year over year.
Now as Ari reviewed, R&D Solutions delivered another outstanding quarter of bookings. Our backlog at December 31 stood at a record $27.2 billion, which was up 9.6% year-over-year on a reported basis and 11.6% adjusting for the impact of foreign exchange. Without that impact of foreign exchange, year-over-year backlog would have been about $500 million higher. Full year net new business increased $10.8 billion growing 6.2% year over year on a reported basis. It increased to $10.8 billion, I should say, growing 6.2% year over year on a reported basis, despite the significant amount of COVID bookings we had in 2021 that didn’t repeat in 2022.
Reviewing the balance sheet. As of December 31, cash and cash equivalents totaled $1.216 billion, and gross debt was $12.747 billion, and that resulted in a net debt of $11.531 billion. Our net leverage ratio ended the year at 3.45 times trailing 12-month adjusted EBITDA. Fourth quarter cash flow from operations was $560 million and capex was $171 million, which resulted in free cash flow of $389 million for the quarter.
Now as we shared on the last earnings call, early in the fourth quarter we retired $510 million of variable rate U.S. dollar term loan that was scheduled to mature in early 2024. At the end of the year, we entered into a $1 billion of floating to fixed interest rate swaps to further limit our exposure to changes in interest rates. And with these changes, our debt structure at year end was 66% fixed, and we expect this to drop to about 58% fixed at the end of Q1 when, as you know, we have a $1 billion swap expiring.
December 31 marked the end of our Vision 2022 three-year plan and, as Ari mentioned, we exceeded our commitments and here are a few highlights. We achieved a compound average growth rate to revenue of 9.1% reported and 10.2% adjusted for the impact of foreign exchange. This achievement exceeded the high end of our goal range of 7% to 10%. Our three-year CAGR for adjusted EBITDA was 11.7%, exceeding our goal of 8% to 11%. And for adjusted diluted earnings per share, the average growth rate was 16.7%, consistent with our goal of double-digit growth. Finally, our net leverage ratio exiting 2022 of 3.4 times trailing 12-month adjusted EBITDA compared favorably to our goal of 3.4 to 4 times.
Okay. Let’s turn now to 2023 guidance. For the full year 2023, we expect total revenue to be between $15.150 billion and $15.400 billion, representing year-over-year growth of 5.1% to 6.9%. This revenue growth includes about 100 basis points contribution from M&A activity and a very slight FX tailwind of approximately 10 basis points versus the prior year. Adjusting for the COVID-related work stepdown, which we anticipate to be approximately $600 million, the contribution of acquisitions and the FX tailwind, our guidance implies 9% to 11% underlying organic revenue growth at constant currency.
Our adjusted EBITDA guidance is $3.625 billion to $3.695 billion, a growth of 8.3% to 10.4%. Our adjusted dilutive EPS guidance is $10.26 to $10.56, representing year-over-year growth of 1% to 3.9%. Our EPS guidance includes about $615 million of interest expense, just under $550 million of operational D&A, an effective income tax rate of approximately 21%, which is about 1 point higher than it otherwise would have been because of the increase in the U.K. corporate tax rate from 19% to 25%. And finally, our EPS guidance assumes an average diluted share count slightly above 190 million shares.
Adjusting for the year-over-year impact of the onetime step up in interest rates and the higher U.K. tax rate, our guidance implies adjusted EPS growth of 11% to 14%. This guidance assumes about $2 billion of cash deployment split evenly between acquisitions and debt retirement. And regarding the latter, we expect to retire remaining term debt maturing in March 2024 towards the end of the year, that is the end of ’23. Based on these assumptions and our guidance, our net leverage ratio should drop to below 3 times adjusted EBITDA by the end of 2023. Finally, our guidance assumes that foreign currency rates, as of February 8th, continue for the balance of the year.
Now I know there are a lot of moving pieces in our guidance, so let me share some additional color on the revenue and adjusted EPS dynamics in 2023. As I mentioned earlier, we anticipate that COVID-related revenue will step down by approximately $600 million versus 2022. And I should highlight that about 40% of this stepdown will occur in the first quarter. Now, we’ll more than compensate for this headwind during the course of the year as we project revenue to grow between 9% and 11% organically at constant currency, excluding COVID-related work. As I also mentioned previously, our full year guidance includes about 100 basis points of M&A contribution and a very slight tailwind from foreign exchange of 10 basis points. Now that said, it’s important to point out that we’ll actually experience a headwind from FX in the first half.
Now at the segment level, we expect TAS revenue growth to be 6% to 8% reported. This includes a year-over-year stepdown in COVID-related work, underlying organic growth for TAS, that is adjusting for the step down in COVID work, FX, and acquisition impacts will be 7% to 9%. R&DS revenue will grow 5% to 7% reported. This reflects an even more significant year-over-year stepdown in COVID-related work, underlying organic growth for R&DS, again, adjusting for COVID-related work, FX, and acquisition impacts, will be 10% to 12%. And finally, in CSMS revenue growth is expected to be flat reported and approximately 2 percentage points organic, excluding COVID-related work and FX impacts.
On adjusted EPS, we will experience the year-over-year impact of the step up in interest rates and an increase in the U.K. corporate tax rate that I mentioned. Together these nonoperational items are expected to impact growth by approximately 10 percentage points year over year. Excluding these items, we expect to deliver strong results with 11% to 14% adjusted EPS growth. It’s important to note that the year-over-year increase in interest expense step-up will be most pronounced in the first half, while the operational tailwind from our cost-cutting and productivity initiatives will be skewed towards the second half of the year, and these timing issues are relevant to our first quarter guidance.
The first quarter will be the toughest comparison versus the prior year, primarily due to four factors: Number one, the largest headwind from FX, despite FX being a tailwind for the year; number two, the largest year-over-year COVID-related stepdown; third, the toughest interest expense comparison; and finally fourth, the phase in during the year of the benefits of our productivity initiatives which will increase as we progress through the year.
So as a result in Q1, we expect revenues to be between $3.570 billion and $3.640 billion, a growth of 2.4% to 4.3% on a constant currency basis and 0.1% to 2% on a reported basis. Excluding COVID-related work, we expect organic revenue growth at constant currency to be between 9% and 11%. Adjusted EBITDA is expected to be between $835 million and $860 million, which is up 2.8% to 5.9%. And finally, adjusted diluted EPS is expected to be between $2.35 and $2.46, declining 4.9% to 0.4%. Excluding the step up of interest expense and the tax rate in the U.K., we expect adjusted diluted EPS to grow between 6 and 10% in the first quarter. Again, our guidance assumes that foreign currency rates as of February 8th continue for the balance of the year.
So to summarize, Q4 was another strong quarter capping a successful year. The full year revenue grew 13% organic at constant currency, excluding COVID-related work. And adjusted EPS was up 13%. Underlying demand in the industry and our business remain healthy with RFP growth accelerating in Q4 and record bookings in R&DS. During 2022, we repurchased almost $1.2 billion of our shares and retired $500 million of a variable rate term debt while reducing our net debt leverage ratio to 3.4 times. We exceeded our Vision 2022 commitments despite the volatile macroenvironment. And lastly, we’re projecting strong operating performance again in 2023 with 9% to 11% organic revenue growth at constant currency, excluding COVID-related work, and 11% to 14% adjusted EPS growth, excluding nonoperational headwinds.
And with that, let me hand it back over to the operator for Q&A.
Questions and Answers:
Operator
[Operator Instructions] Your first question comes from the line of Dan Leonard with Credit Suisse. Your line is open.
Dan Leonard — Credit Suisse Group AG — Analyst
Thank you. So I’ll just start off. Ari, you mentioned continued confidence in the 2025 goals. You’re guiding 5% to 7% of revenue growth in ’23. I think the CAGR through ’25 was a double-digit number. So could you bridge from the 2023 result to the acceleration anticipated thereafter? Thank you.
Ari Bousbib — Chairman and Chief Executive Officer
Yeah. Thank you very much, Dan. Look, when we say we are on the same trajectory we were on when we set our ’25 goals, it continues to be true. Operationally, obviously, we assumed foreign currency rates that were different. I think we lost — I don’t know the exact number any longer, but we probably lost $0.5 billion in revenue just in 2022 to FX. So look, I don’t know about revenue. It’ll be close maybe not 20 but it’ll be close. On EBITDA and on earnings per share, we’re very confident that we will achieve those goals.
Again, what we are facing — first of all, you’re seeing the EBITDA is certainly clearly on that trajectory unchanged despite everything else and EPS, just as we said in our introductory remarks, a onetime step up that hopefully won’t replicate. If anything, I think the world expects rates to either stabilize or start declining afterwards [Phonetic] in ’24 and ’25, so that would be even a tailwind. But certainly the step up is onetime and after that we fully expect to resume very strong double digit as we experience. I’ll remind you, we delivered over 16% compound earnings per share rate — growth rate over the 2022 period — three-year period. Thank you.
Operator
Your next question is from the line of Eric Coldwell with Baird. Your line is open.
Eric Coldwell — Robert W. Baird & Co., Inc. — Analyst
Thank you. Good morning. So I wanted to hit on R&DS bookings first. Difficult to ask the question in a way that’s easy to answer, but I’d like you to step back and think about your fourth quarter strong bookings, your ’22 bookings. Do you have a sense how much was, if you will, normal opportunities versus say competitive takeaways, rescue wins or incremental share capture that you might have gained through higher hit rates through the year? Just trying to get a sense of where the market was versus what IQV did additionally on top of that, if that makes sense.
Ari Bousbib — Chairman and Chief Executive Officer
Yeah. It’s really hard because we don’t have the perspective of time and clear data from competitors yet. We would know a little bit more after we read your report on how CROs did when everyone has reported, so I’m looking forward to that read. But look, we’ve been on a momentum certainly since the merger to gain market share. And I think it’s clear that we have been gaining market share. We know we are gaining market share because we are displacing competitors.
I don’t think rescue studies played a role. Of course, we have the anecdotal here and there, but not more or less than in history and things happen and the study doesn’t go well with a certain approach, and at some point in time the sponsor decides that they want to switch CROs. It’s a very difficult and cumbersome exercise, and no one wants to do that. But it does happen. I don’t think it’s happened more than in the past, unless you include the investigator studies, studies that were at the beginning, and that for a reason or another sponsor decided to switch CROs, that I would include in the category of market share gains.
The market continues to be strong, the underlying demand, all the indicators that we see, and we kept repeating it ad nauseam during 2022 despite everyone else being on the other side and suggesting that the world was falling apart because of biotech funding levels returning to, what I consider, be very strong levels, but nevertheless lower levels than they were during the pandemic. We haven’t seen any delays in decision making. We haven’t seen any signs that demand was slowing down. Quite the opposite, I mentioned that our RFP flow is very strong, I can give you even more — I’ve got some more data here on if you’d like…
Eric Coldwell — Robert W. Baird & Co., Inc. — Analyst
Yes. The answer would always be yes. I’ll take more data.
Ari Bousbib — Chairman and Chief Executive Officer
So I guessed that. Again, overall RFP flow was very strong. We said 13% for the full year and over 20% in the fourth quarter. So if anything, accelerating. Our qualified pipeline at the end of the year was up over 20%. But that is really the pipeline that we consider real.
The awards, by the way, which is an early indicator of what will happen in the future. Awards, I’ll also remind you, is stuff that we have essentially won, but we have not yet contracted for and not booked for. The awards were up. Actually, the absolute number in Q4 was the highest ever, and it was up 9% year-over-year.
So we mentioned the book-to-bill ratios, the backlog, which itself is up just under 10% year-over-year and 11.6%, excluding FX. So I don’t know what else to share. We’ve got hard solid numbers here that support healthy demand for clinical trial services. And then on top of that, you can add our market share gains, and I think that explains it.
Eric Coldwell — Robert W. Baird & Co., Inc. — Analyst
And Ron, if I could just have one quick technical item here. Can you confirm that there are no share repurchases built into the guidance? And I know you’ve talked about the $2 billion capital deployment and the split between debt and M&A. But is there any current thinking on taking some advantage of that authorization that you have on the repurchase side?
Ron Bruehlman — IQVIA Holdings, Inc., Executive Vice President and Chief Financial Officer
I can confirm that there is no share repurchase baked into our guidance. We’re right now assuming $2 billion of capital deployment, split evenly between M&A and debt reduction. Look, might we repurchase some shares during the year? Sure. Our assumption going in and the guidance that we gave is that we’re not, and we’ll devote the capital to debt reduction instead, but that could always change with circumstances.
Eric Coldwell — Robert W. Baird & Co., Inc. — Analyst
Okay. Thank you.
Operator
Your next question is from the line of Anne Samuel with JPMorgan. Your line is open. Anne Samuel with JPMorgan, your line is open.
Ari Bousbib — Chairman and Chief Executive Officer
Okay, next question, please.
Operator
Your next question is from Justin Bowers with Deutsche Bank. Your line is open.
Justin Bowers — Deutsche Bank AG — Analyst
Hi, good morning, everyone. Just pivoting from R&DS. Ari, you talked a lot about some strong momentum in commercial managed services. Just wondering if you could expand about some of the strength there. And also, is that isolated just in TAS? Or is that also in the CTMS [Phonetic] business?
Ari Bousbib — Chairman and Chief Executive Officer
You mean CSMS, right?
Justin Bowers — Deutsche Bank AG — Analyst
Sorry, CSMS. That’s right.
Ari Bousbib — Chairman and Chief Executive Officer
No. CSMS is a relatively slow grower. So I’ll put that aside. The TAS growth has been consistent. We’re pleased, obviously, to see that it continues to grow. You saw that excluding the COVID stepdown, and we had a fair, I would say, a large share of COVID work during the pandemic, so that’s stepping down. And excluding that, we had growth of 7% in Q4 and 10% for the full year.
Quarter-to-quarter, it could vary. I think the first half was more or less around 10% growth. Third quarter was 12%. We had activity that was — that came in earlier than we thought. And the fourth quarter was 7%. So overall, very good growth in Q4. We guided 7% to 9% for next year. Again, this is consistent — again, excluding COVID, acquisitions, and FX, it is consistent with the underlying operating momentum that we’ve had in TAS and that we’ve guided to, which is high-single digit.
So the real — the fast growers in this business are technology and real world, and that’s where I mentioned a few very significant achievements and a few significant awards with clients. Both continue to be strong drivers of growth as we continue to find innovative ways to utilize real-world evidence for clients and deploy more of our technology solutions.
The piece of the business that is perhaps more exposed to the economic whims and budget expansions or restrictions by clients is the more discretionary spend, like analytics and consulting work. We saw — usually, at the end, just to share a little bit more color, we usually have at the end of the year an acceleration in this business, and we didn’t see that in December. And the reason for that is historically clients like to spend more towards the end of the year, and they do last-minute purchases, and they utilize their budgets, if you will. And we didn’t see that so much this year. And again, I don’t know whether people are being more cautious or anything. And mostly, again, it was in the consulting area and analytics, which tends to be short cycle, short term, and more discretionary.
But the underlying growth is driven by real world and technology, both of which are longer-term decisions and are not so subject to cyclical economic changes. And then, of course, the last piece is the data business, which is flat and continues — or flat to low-single digits, 1-ish percent. And that continues where it is. And when you do the math, basically, that’s what yields you high-single-digit growth for the segment. Thank you for your questions.
Operator
Your next question is from the line of Jack Meehan with Nephron. Your line is open.
Jack Meehan — Nephron Research LLC — Analyst
Thank you. Good morning. Ari, so I know you sound bullish around the funding trends that you’ve seen over the last year. I wanted to ask about funding in a different way. Just what were you seeing in terms of cancellations around year-end? Was there anything notable about that relative to the last couple years?
Ari Bousbib — Chairman and Chief Executive Officer
Nothing.
Jack Meehan — Nephron Research LLC — Analyst
Short and sweet. Yes, has there been any rumbling around restructuring in any of your important clients? I guess, just like how are you building just the macro into your outlook for the R&D segment this year?
Ari Bousbib — Chairman and Chief Executive Officer
Okay. Once again, in terms of the demand, no signs that we can see that our clients are somehow delaying, canceling, postponing clinical trial development work that was planned before. So we don’t see anything. No unusual cancellation activity, no unusual postponements, nothing. We’ve been saying this essentially for 12 months exactly.
In terms of factoring the macroenvironment, if you want to expand your question, then that’s a different discussion. We got — we are a large, powerful ship navigating extremely stormy waters. The engine continues to be very strong; that’s the demand. And certainly, our operating momentum in our organization, but the winds in the form of interest expense, in the form of wage inflation, in the form of wars in foreign theaters that affect our ability to do work in certain sites, in the form of continued COVID issues in China which are expected delays our return to normal operating mode in clinical sites, all of those and more are these winds and stormy waters that I’m referring to that are macro factors, some of which we can do something about.
For example, wage inflation, we are addressing by trying to manage our workforce more tightly, by increasing and accelerating our productivity initiatives, by looking at maintaining and accelerating our cost-cutting discipline, and we’ve launched to that effect towards the end of last year a new program to, again, bring forward many field overheads, rationalizations, and economies of scope and outsourcing and offshoring decisions that were scheduled to occur over the ’22 to ’25 planning period. And we are accelerating all of that into 2023. So as Ron mentioned, the benefits of those will begin showing towards the latter part of the year, but the work is ongoing. So that’s how we are trying to address those macro factors that are not — that are somehow — that we can offset with action on our side.
With respect to interest shortage [Phonetic], the onetime step-up in the interest expense, were limited in what we can do. But we certainly, as you saw, started reducing our debt levels, and we entered into swaps. We are trying to address that in capital markets. We’ll probably, towards the end of the year, retire another $1 billion of debt, a tranche that would normally term out in 2024. We’ll do that in the latter part of the year. And for now, as Eric reminded us, we do not have any share repurchase plan this year because we are diverting our cash flow. Now if our cash flow is very strong and circumstances were to change, obviously, we will adjust those decisions. But that’s what we’re doing to adjust the macro factor. Thank you very much, Jack, for your question.
Jack Meehan — Nephron Research LLC — Analyst
Thank you.
Operator
Your next question is from the line of Luke Sergott with Barclays. Your line is open.
Luke Sergott — Barclays Bank PLC — Analyst
Hey, guys. Thanks. Can you — one cleanup here on the COVID. Can you give us a sense of how you’re expecting that to roll off in 1Q between TAS and RDS, just from a modeling perspective?
Ron Bruehlman — IQVIA Holdings, Inc., Executive Vice President and Chief Financial Officer
Yeah. Jack, it’s — I think I said overall of the $600 million COVID stepdown year-over-year, about 40% of it would be in Q1. There will be fairly substantial impacts in both of the segments there.
Unidentified Speaker —
Yeah. I would say about a third of the impact will be in TAS, Jack, and about two-third in R&D. That’s how you should think about it by quarter and for the full year. It’s about that, roughly.
Luke Sergott — Barclays Bank PLC — Analyst
All right. Great. Thanks. That’s really helpful. And then lastly here [Indecipherable] on the free cash flow. So I understand a ton of moving parts here for the year. But can you give us a sense of what you’re targeting for ’23 and as a percentage of EBITDA conversion?
Ron Bruehlman — IQVIA Holdings, Inc., Executive Vice President and Chief Financial Officer
We always talk about it as a percentage of adjusted net income, and we target typically between 80% and 90% free cash flow to adjusted net income. That’s where we were for the full year 2022. And look, the only thing I would caution on that is that in any given year, it could vary from that because cash flow is based on point to point of the balance sheet. It’s not like an accrual concept or anything like that. So, of course, you could be higher or lower. We were substantially higher than that in 2021, and we’re right in the range in 2022. And I would say just as a target, you should think of us being in the 80% to 90% of adjusted net income range but recognizing that we could deviate from that in any given year.
Luke Sergott — Barclays Bank PLC — Analyst
All right, thank you.
Operator
Your next question is from the line of Sandy Draper with Guggenheim. Your line is open.
Sandy Draper — Guggenheim Securities, LLC — Analyst
Thanks very much. A question for you, Ari, to maybe gaze in your crystal ball a little bit longer term, because I know you’re talking certainly to lot more of the biopharma CEOs than I am. When I look back at what I heard out of JPMorgan, Davos, just other things around how pharma is looking at the next three to five, even 10 years, especially with the Inflation Reduction Act, I hear conflicting messages from about are people going to invest more, hey, we want to get away from, or be more diversified and not so concentrated in one or two blockbuster drugs, and so we want to get more drugs out there. And so there’s more trials or we’re going to pull back? I’d just love to hear what you’re hearing or what you’re thinking about what your customers are looking at, not really from an economic perspective about the current macroenvironment but with how their portfolios are, how concentrated they are in a few really big drugs, and what the Inflation Reduction Act means. Would love to hear your thoughts on that. Thanks.
Ari Bousbib — Chairman and Chief Executive Officer
Yeah. Thank you. Yeah. Look, the Inflation Reduction Act, just similar to what they decided to name it, is very — is in flux right now. There’s a lot of work to be done in finalizing the details of the legislation. We actually spent a lot of time with our clients trying to explain to them what’s in it. Not that we understand it entirely because many of the provisions, first of all, haven’t been detailed enough or specific enough. And we don’t know how it’s going to work. And a lot of it is still subject to negotiations.
Many of the provisions anyway won’t kick in until later in the decade. And again, some parts of legislations are undefined. Many of the rules and regulations are still under discussion. So generally, the statements from pharma CEOs when I speak to them about this is that it’s harmful to innovation and to patients because anytime you start curbing the economics or you try to start curbing the economics for drug development, even if it’s long term and even if the effect, if any, before the other administration changes these things, it will be seen 15 years from now. It could, at least conceptually, lead pharma companies to decide, well, it’s not as attractive, so I’m going to drop this program or that program when I factor in different types of pricing and so on and so forth or reimbursements.
But again, this is not how pharma works. Despite the bad press, pharma is motivated by healing people. And the R&D — all of the R&D heads at pharma companies that I know and that my colleagues speak to day-in and day-out, their motivation, what makes them come to work every day is they are going to come up with a drug to cure pancreatic cancer and to cure breast cancer and to cure diabetes, etc., etc. So this is the underlying motivation, and the model is predicated on pharmaceuticals doing good for society. So the notion that people are going to cancel a program because the economies won’t [Phonetic] get attractive, yes, at the margins. That’s a general observation.
Second observation, in my conversations with clients, is that a lot of — and that’s a trend that’s independent of the Inflation Reduction Act — a lot of the focus is on trying to address more specific diseases, rare diseases, subcategories within subcategories in oncology. I mentioned before, oncology is probably — it continues to be the largest and strongest grower in our business in terms of the demand for clinical trial and drug development work. So that’s just not going away. Until the diseases go away, which we all hope for, drug development is here to stay, and pretty much in the same model. Again, the focus on addressing previously untouched, obviously, much smaller markets that continues. And that, as you know, plays to our strength and capabilities. So that’s a little bit of color on my conversation.
So yes it’s a general cloud [Phonetic] and at a conference like Davos, you could expect to hear such things. But in practice, it is not changing very much day-to-day how our clients operate and make decisions with respect to their investment programs. Thank you.
Sandy Draper — Guggenheim Securities, LLC — Analyst
Got it. Thanks, Ari.
Operator
Your next question is from the line of Elizabeth Anderson with Evercore ISI. Your line is open.
Elizabeth Anderson — Evercore ISI International Ltd — Analyst
Hi, guys. Thanks so much for the question. I was wondering if you could comment on the degree of pricing that you’re getting on new contracts that are going into bookings and also the degree of wage inflation you’re currently experiencing at your labor force. Thank you.
Ari Bousbib — Chairman and Chief Executive Officer
Okay. I’ll take the second part of your question first. Yeah, we are experiencing significant wage inflation. The skillsets that we are looking for are scarce and in high demand. We’re looking for people who have health care expertise, who have data science expertise, who have software development expertise or a combination of all three. And these skills are in very high demand.
Secondly, frankly, we are a hunting ground for competitors of all kinds in the healthcare sector, in the tech sector, and in the data science sector. And as a result, we are compelled to raise our compensation programs, and that causes inflation. So you have the general inflation out there, plus reasons that are specific — idiosyncratic to our business and to our company.
Now I mentioned before that despite that, you can see that we are growing our margins. So we are addressing it, and that’s through essentially cost management programs, meaning we do more work in lower-cost areas, etc. Now I lead into the first part of your question, which is pricing. Are we able to offset those cost increases with pricing? Generally, in the commercial sector for shorter-cycle businesses, theoretically, yes, and we are when we can. But it’s always a negotiation with clients. And it’s a competitive market out there. You’ve got a lot of smaller competitors who are fighting for the slice of the pie. And often, we got to defend against that. And so our pricing flexibility is limited. It does exist, in theory, on the commercial side.
In R&DS, for clinical trials, yes, of course, rates have to reflect what the labor cost is. And again, that’s also subject to negotiation. But we do transfer at least a portion of those wage raises to our clients in the form of rates that are applied to determine pricing for a clinical trial. But I remind you that the clinical trial business is a long-term, long-cycle business, meaning that what we book today, which may reflect some level of price increase, won’t be realized into revenues until the next one to five years.
So what we are delivering in revenue today and tomorrow was sold several years ago under different labor cost assumptions. So there is a delay, if you will, in the clinical trial business because of the long-cycle nature of the business. There are contracts where we have escalation clauses for inflation, but they never envision the type of inflation that we are facing in some of the markets. So that’s the picture on pricing. Thank you very much, Elizabeth.
Elizabeth Anderson — Evercore ISI International Ltd — Analyst
That’s very helpful. Thank you.
Ari Bousbib — Chairman and Chief Executive Officer
We’ll take one more question.
Operator
Your final question comes from the line of Charles Rhyee with Cowen. Your line is open.
Charles Rhyee — Cowen and Company, LLC — Analyst
Oh great. Thanks for taking the question. Maybe, Ron, I might have missed it, but when you talk about the impact to EPS from these buckets, can you break down for us the relative contribution between the higher tax rate, interest expense, etc., that makes up that delta on EPS growth? And then if you think about — for this year, yes, for EPS.
Ron Bruehlman — IQVIA Holdings, Inc., Executive Vice President and Chief Financial Officer
Yes. Well, look, the U.K. corporate tax rate increased added about 1 percentage point to our overall effective tax rate. So you start with that. But most of the impact year-over-year is coming from interest expense. So we were, I think, slightly over $400 million in interest expense in 2022. We told you about $615 million in 2023. So you can do the math on that. And at 190 — roughly 190 million shares and figure out what the impact is. It’s principally coming out of that. And that’s why we excluded those 2 items and showed you that absent those, our EPS growth rate underlying operational was still very strong double digit.
Charles Rhyee — Cowen and Company, LLC — Analyst
And that assumes the debt paydown assumptions and going into swap agreements? Or is that if you do those things through the course of the year?
Ron Bruehlman — IQVIA Holdings, Inc., Executive Vice President and Chief Financial Officer
Yes, all that’s baked in.
Charles Rhyee — Cowen and Company, LLC — Analyst
Okay.
Ron Bruehlman — IQVIA Holdings, Inc., Executive Vice President and Chief Financial Officer
Yes. All of that is baked into our assumptions.
Charles Rhyee — Cowen and Company, LLC — Analyst
All right, great. Thanks.
Ari Bousbib — Chairman and Chief Executive Officer
Thank you.
Operator
I will now turn the call back over to Mr. Childs.
Nick Childs — Senior Vice President – Investor Relations and Treasury
Okay. Thank you, everyone, for joining us today. We look forward to speaking to you again on our next earnings call. Myself and the team will be available the rest of the day for any follow-up questions you might have.
Operator
[Operator Closing Remarks]