BSX Posts Q4 Earnings: Should You Buy, Sell or Hold the Stock?

Boston Scientific BSX reported its fourth-quarter 2025 results on Feb. 4. Both top and bottom lines exceeded the company’s guidance ranges and topped the respective Zacks Consensus Estimate. Closed acquisitions contributed 160 basis points to sales, resulting in 12.7% organic revenue growth. Boston Scientific generated more than $20 billion in sales in 2025, with mid-teens growth for the second consecutive year, which management attributed to innovation and execution across its business units and the strength of its global team.

However, supply-chain issues weighed on Urology’s performance. The Axonics integration caused greater commercial disruption than initially anticipated. In the quarter, Boston Scientific lost share in Electrophysiology (“EP”), one of its key growth drivers, amid competitive product launches. Management also indicated that tough comps and product discontinuation will impact the near-term financial outlook. Shares of BSX tumbled 17.6% following the earnings announcement.  

BSX Stock Price Performance

In the past six months, Boston Scientific stock has dipped 28.7%, significantly underperforming its industry’s 11.9% decline. Shares have also lagged competitors Edwards Lifesciences EW and Stryker SYK, which have fallen 2.3% and 3.4%, respectively. The broader Medical sector has gained 11.7% in the same time frame.

3 Positives From BSX’s Q4 Performance

WATCHMAN Momentum Continues: The business delivered 29% year-over-year growth in the fourth quarter, driven by the strong adoption of U.S. concomitant procedures. For the full year, WATCHMAN posted strong double-digit growth across all major global markets. Boston Scientific also announced a strategic partnership with Siemens Healthineers to develop and commercialize its next-generation 4D ICE catheter called AcuNav, aimed at enhancing imaging for stand-alone WATCHMAN or FARAWATCH procedures.

Strength in Neuromodulation: Neuromodulation sales grew 10% in the fourth quarter and 8% organic growth for the full year. Growth in the brain franchise was led by the Cartesia X and Illumina 3D offerings. The pain franchise continued to benefit from Boston Scientific’s strategy to expand the portfolio and bring options to the physicians, patients and hospitals it serves. The Nalu acquisition strengthened the Neuromodulation lineup by adding the peripheral nerve stimulation (PNS) therapy. The company also received expanded reimbursement coverage for the Intracept procedure and initiated a full market launch of the Intracept EDGE Stylet to improve the treatment experience.

Solid APAC Performance: Sales in this region jumped 15% operationally in the fourth quarter and 14% for the year, driven by strength in Japan and China. Japan’s growth was boosted by WATCHMAN and EP, backed by OPAL Mapping System placements and increased FARAPULSE catheter utilization, alongside continued share gains. China had another quarter of double-digit growth, driven by EP, WATCHMAN and Interventional Cardiology Therapies.

Boston Scientific’s 2026 Outlook and Challenges

The company expects organic growth between 10% and 11% in 2026, excluding foreign currency fluctuations, and certain acquisitions and divestitures. Neuromodulation is projected to be a top performer, while Urology is anticipated to return to market growth with supply-chain issues resolved and upcoming product launches.

Boston Scientific exited 2025 with roughly 65% share in the PFA market. Despite potential share losses from competition, management anticipates gaining above the expected 15% market growth rate, supported by the ongoing expansion and utilization of mapping systems and global PFA adoption. Regionally, the EP momentum is also likely to continue in China in 2026, supported by the NMPA approval of the FARAWAVE NAV device and expanded persistent atrial fibrillation (AFib) indications.

In January, Boston Scientific announced agreements to acquire Valencia Technologies and Penumbra, which will enable entry into strategic urology and cardiovascular adjacencies, respectively. The CHAMPION trial comparing WATCHMAN FLX to novel oral anticoagulation will be presented as a late breaker at ACC in March. Positive data could support WATCHMAN as a first-line stroke prevention therapy and expand the indicated population from roughly 5 million to 20 million worldwide.

From a profitability standpoint, the company anticipates full-year adjusted gross margin to remain roughly in line with 2025, as a favorable product mix will be largely offset by global supply-chain investments and the annualization of tariffs. The adjusted operating margin is projected to expand 50-75 basis points (bps), with adjusted EPS in the band of $3.43-$3.49, implying 12%-14% growth.

First-quarter 2026 operational and organic revenue growth is guided at 8.5% to 10%, including an approximate 150 bps impact from the discontinuation of the ACURATE valve and a transient impact tied to the product removal of certain sizes of AXIOS devices. The quarter also faces the toughest year-over-year comparison in 2026. 

Here’s how the consensus estimate for Boston Scientific’s earnings and revenues currently stands.

Image Source: Zacks Investment Research

BSX’s Valuation

BSX currently trades at a forward, 12-month Price/Sales (P/S) of 4.87X, below its median but above the industry average of 2.67X. In comparison, Edwards and Stryker trade at a one-year P/S of 6.89X and 5.06X, respectively.

Conclusion

Boston Scientific delivered a strong finish to 2025, supported by strength across its major units and robust performance in its largest APAC markets. The company’s 2026 outlook acknowledges near-term challenges while expressing optimism in sustained financial performance. Despite the lackluster performance in recent months, the stock holds solid potential to rebound with progress across growth drivers, upcoming launches and clinical momentum. BSX’s valuation also remains attractive relative to major rivals. Considering all, it seems prudent to retain this Zacks Rank #3 (Hold) stock currently in the portfolio. Prospective investors should wait for a better entry point. You can see the complete list of today’s Zacks #1 Rank (Strong Buy) stocks here.

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This article originally published on Zacks Investment Research (zacks.com).

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