The Weekly Checkup: Week of April 27-May 1, 2026

Issue #4 | Week of April 27-May 1, 2026

Welcome back.

50 announced transactions this week, the highest count of any of the first four issues. Services 27, Technology 23. 7 platform deals, 43 add-ons, which is a 14% platform rate and the healthiest cadence we've seen since Issue #1. The combination of higher platform creation and elevated add-on volume is the most constructive backdrop we've tracked since launch, and it's worth noting because most of the deal count narrative through 2025 was about volume slowing. Whichever way you read the macro, the actual data this week looked pretty good.

A few things caught my attention: Eli Lilly bought Ajax Therapeutics, the fourth consecutive week Lilly has announced a biotech acquisition. Playground Pediatrics announced four pediatric practice acquisitions in a single same-day press release, an even more aggressive version of the multi-deal patterns we've tracked from Bridge Dental, Southern Orthodontic Partners, and CPIhealth. And Teleflex's announced take-private by CVC and GTCR finally has a clean multiple to work with: $5.5 billion EV at 13.3x EBITDA on a 20.7% margin device business, which extends the 12-15x EBITDA range we've been tracking in mid-cap medical devices through 2026.

The centerpiece of this issue is a deep dive on dental, prompted by ION Analytics’ "Pulling Teeth" piece last week. The qualitative findings are largely correct. The dental deal volume data isn't.

Deal value: $5.5 billion | EV / Revenue: 2.76x | EV / EBITDA: 13.31x

CVC Capital Partners and GTCR agreed to take Teleflex private at an implied enterprise value of approximately $5.5 billion. Using FY2025 revenue of $1.99 billion and EBITDA of $413 million from Teleflex's earnings release, the transaction implies 2.76x revenue and 13.3x EBITDA on a 20.7% margin business.

My take: The headline multiple looks like the 12x to 15x band we've been tracking on mid-cap medical device take-privates this year, but the trajectory that got Teleflex to this exit is the part that deserves attention. TFX peaked above $400 per share in late 2021 and entered 2026 trading in the $115 to $120 range, a roughly 70% decline over five years driven by two specific exposures. UroLift, the Interventional Urology platform Teleflex acquired through its $1.1 billion purchase of NeoTract in 2017, has been in sustained decline since 2023 (Q1 2025 down 10.7%, Q2 2025 down 8.3%) under reimbursement pressure and competitive entry. The Titan SGS bariatric stapler, separately, has been pressured by GLP-1 driven declines in bariatric surgery volume that management acknowledged directly on the Q2 2025 call. A $240 million goodwill impairment on the Interventional Urology North America business in Q4 2024 was the public market's invoice for those issues. Teleflex's response was the December 2025 announcement of a planned separation into RemainCo (Vascular Access, Interventional, Surgical) and NewCo (the troubled Urology, Acute Care, and OEM segments), targeted for mid-2026, alongside a $1 billion share buyback. The CVC and GTCR transaction effectively replaces that separation with a single sponsor-led restructuring. Two implications worth flagging. First, 13.3x EBITDA on a public-to-private take-out for a beaten-down asset is not the same comp as 13.3x on a clean strategic sale; sponsors are paying for what they think they can fix, and the underwriting case here is built around carving out or selling NewCo at a discount and operating RemainCo as a focused vascular access and surgical platform. Second, GLP-1 disclosure as a discrete revenue headwind is now showing up across multiple device categories (bariatric surgery, certain orthopedic indications, sleep apnea hardware), and that disclosure pattern is becoming an underwriting variable rather than a footnote. For anyone valuing a device company with bariatric, sleep, or chronic-disease procedure exposure, the GLP-1 impact needs to be modeled as a structural revenue adjustment, not a near-term volatility item.

Deal value: $1.075 billion | EV / Revenue: 1.67x

Astorg agreed to acquire Thermo Fisher's Specialty Diagnostics microbiology business for $1.075 billion in cash plus a $50 million seller note. The carve-out generated $645 million in 2025 revenue.

My take: A 1.67x revenue multiple on a diagnostics tools carve-out is meaningfully below the 3.5x revenue multiple CareDx received on the EuroBio carve-out two weeks ago, and the delta is informative. CareDx's lab products division was growing 20% annually with a clean clinical specialty focus. Thermo Fisher's microbiology business is a mature, slow-growth product line within a larger Specialty Diagnostics segment. The multiple gap reflects growth profile, not category fundamentals. For anyone valuing a tools or diagnostics carve-out, the takeaway is that the segment-level revenue multiple range is now meaningfully bimodal: 3x to 5x for high-growth, clinical-focus assets, and 1.5x to 2.5x for mature, broad-line product portfolios. The midpoint comp doesn't really exist anymore.

Deal value: $160 million (plus up to $100M contingent) | EV / Revenue: 4.71x

CareDx agreed to acquire Naveris for $160 million upfront and up to $100 million in contingent consideration. Naveris generated $34 million in 2025 revenue and is expected to grow 30% to 40% annually for the next three years.

My take: Same MRD diagnostics category, second deal in two weeks. Roche paid 4.0x forward 2028 revenue for SAGA Diagnostics in Issue #3. CareDx is paying 4.7x trailing 2025 revenue for Naveris with potential earnouts that bring total consideration up to 7.6x trailing revenue if the asset performs. The valuations look very different on the surface but converge when you adjust for the time period (CareDx's 4.7x trailing is roughly equivalent to Roche's 4.0x forward when you compound through expected growth). MRD diagnostics is now firmly established as a 4x to 5x forward revenue category for strategic acquisitions, and the comp set continues to fill in. The contingent payment structure is also worth flagging for sellers: when a buyer is willing to pay only 60% of total consideration upfront, they're either pricing in execution risk on the growth assumption or hedging against the reimbursement environment. Either way, sellers should expect this deal structure to become more common in molecular diagnostics M&A.

Fourth consecutive week Lilly has announced a biotech acquisition (Centessa, CrossBridge Bio, Kelonia Therapeutics, and now Ajax).

My take: The pattern is no longer subtle. Four biotech acquisitions in four weeks across cardiometabolic, ADC oncology, in vivo CAR-T, and now JAK/STAT pathway oncology means Lilly has moved from "actively interested" to "systematically deploying." If you advise a biotech seller in any of Lilly's focus areas and you have not had a strategic conversation with their BD team in the last 60 days, you are missing the window. Strategic buyers don't run programs this visibly without internal conviction that the current valuation environment is transient.

Playground Pediatrics announced the acquisition of Purcell Pediatrics, Cobb Pediatrics, Kids Kare Pediatrics, and Smyrna Pediatrics in a single press release.

My take: This is now the third consecutive issue where we've flagged a multi-deal same-day announcement pattern (Bridge Dental's GP+specialty pair in Issue #1, Southern Orthodontic Partners' two-state pair in Issue #2, CPIhealth's same-day MD+ASC pair in Issue #2). Playground Pediatrics doing four practices in a single press release is the most aggressive version of this structure we've tracked. The reasons platforms structure same-day announcements like this are now well-established (regulatory close coordination, press release efficiency, market signaling), and the pattern is clearly becoming the standard playbook for active roll-up sponsors. For sellers, the practical implication remains the same: if you're talking to a roll-up platform and they go quiet for two or three weeks, the most likely explanation is that they're working to close adjacent deals first.

42 additional transactions this week including notable activity in pharma carve-outs (CareMetx / Cencora's Lash Group + TheraCom, Sun Pharma / Organon, Siegfried / Noramco), digital health, pharma services (Esperion / ARCHIMED, LEO Pharma / Replay, Teva / Emalex Biosciences), and dental (Heartland / Soto Dental Partners, Pearl Street / Best Dental, True North / TechTown Dentistry).

Ion Analytics's Dealspeak North America published "Pulling teeth: Why dental deals are getting harder to close" on April 21. The qualitative findings are mostly right: Sellers are anchored to peak 2021 pricing, buyers are recalibrating risk., and deal structures are shifting toward less upfront cash and more contingent consideration. Several high-profile processes (Paradigm Oral Health, Southern Orthodontic Partners, Sage Dental's continuation vehicle) confirm that platform-scale dental exits are harder to clear than they were three years ago.

However, the volume data cited does not match what we track. The article reports North American DSO deal activity falling from 126 deals in 2023 to 67 in 2025, with sponsor-backed buyouts and add-ons dropping from 83 to 46, while Scope's database tracks materially more dental transactions than that, and the trend line is different.

What our database shows. We tracked 469 dental transactions in 2023, 520 in 2024, and 400 in 2025. The 2024 to 2025 decline is there (a roughly 23% drop in count), but was not a 50% collapse. Q1 2026 results so far show 82 deals, slightly below Q1 2025 totals of 94, and we expect announcements for a few more Q1 deals to continue to trickle in.

Platform deals tell a more interesting story. ION's narrative implies platform creation has slowed recently. Our data seems to show the opposite at the platform level. After dropping to 12 platform announcements in 2024 (the lowest annual count we've recorded since 2021), platform deals rebounded to 17 in 2025 (although 2026 has, admittedly, been weak so far). Platform creation in dental doesn’t really look like a collapse; it had a soft 2024 and is now back around 2023 levels.

Where the multiples have actually moved. Platform-scale dental deals (transactions with disclosed enterprise values of $100 million or more) traded at a median EBITDA multiple of approximately 14.3x during the 2018-2021 peak window and 15.4x in 2022. The 2023-2024 platform median fell to 11.8x. The 2025-2026 platform median sits at 11.1x, with a tight range of 11.0x to 12.5x across the four 2025-2026 transactions in our database. That's roughly 3 turns of EBITDA contraction from the 2021-2022 peak, which matches the characterization of valuation gap dynamics but quantifies it more precisely.

Add-on multiples have been stable. Tuck-in dental practice acquisitions (transactions with enterprise values below $50 million) have traded at a median 6x to 7.5x EBITDA in every year from 2018 through 2025. Whatever has happened at the platform level, the math on individual practice acquisitions has not meaningfully shifted in eight years. This is a critical point for individual practice sellers thinking about exit timing: the comp set you should be looking at is the add-on universe, not the platform universe, and the add-on universe has been roughly flat through every cycle of the last decade.

What this means for sellers and platforms. First, individual practice sellers anchored to 2021 platform-scale pricing are using the wrong comp set; the right comp set is add-on multiples, and those have not changed. Second, platform sponsors evaluating their portfolio companies right now should expect a 2 to 3 turn EBITDA multiple haircut from peak 2021-2022 marks, not a complete reset. The 11x to 12x range is now the realistic platform exit benchmark. Third, the qualitative observations reported about deal structure (less upfront cash, longer commitments, EBITDA maintenance requirements, super-GP scrutiny) are the mechanisms by which buyers are getting comfortable paying 11x to 12x for assets sold for 14x to 15x a few years ago.

The sector is recalibrating, not collapsing. Anyone advising a dental seller right now needs the actual transaction comp set, the right adjustment for the seller's scale, and a realistic view of structure. That last piece is now where most of the negotiating leverage lives.

Scope Research's valuation database has approximately 2,900+ healthcare M&A transactions with disclosed or derived revenue and EBITDA multiples going back to 2010, including approximately 60 dental transactions with financial detail. The underlying source documents, including SEC filings, fairness opinions, audited financials, and press releases, are what make those figures reliable.

In keeping with this issue's dental focus, all five listings this week are dental practices.

Location: Midwest (state undisclosed) | Asking Price: $24.0M | 2024 EBITDA: $4.0M | EV / EBITDA: 6.0x

Seller is pursuing a majority recapitalization at approximately 6x EBITDA with a stated goal of doubling unit count over 2-3 years by acquiring nearby practices. No revenue figure disclosed in the listing.

My take: Worth revisiting in light of the dental deep dive above. A 6x EBITDA ask on a $4 million dental platform sits below the 6.75x to 7.5x median range for dental add-on transactions and well below the 11x to 12x current platform median. That gap is the entire story on this listing. Either this is genuinely a tuck-in opportunity priced as one (in which case 6x is fair to attractive depending on platform fit), or the seller is being advised to a price that sophisticated dental buyers will use as a starting point rather than an ending point. The "EBITDA" figure disclosed in a teaser is rarely the figure a buyer uses in their model. After normalization, a buyer's underwriting EBITDA is typically lower than the disclosed figure, and the effective multiple they're paying is correspondingly higher. A buyer doing the right normalization work will probably find themselves paying close to 7x on properly prepared earnings, which puts them squarely in line with the high-end of dental add-on comps, but still well below true platforms.

Location: South Florida | Asking Price: $2.45M | Revenue: $1.34M | Cash Flow: $258K | CF Margin: 19% | Price / Revenue: 1.83x | Price / Cash Flow: 9.5x

Multi-provider implant-focused practice with modern digital workflow, fee-for-service positioning, and a loyal patient base. Implant, restorative, cosmetic, and general dentistry services. Modern facility with expansion capacity.

My take: The 9.5x cash flow multiple is meaningfully above the dental add-on comp range and requires a story to justify. The story here is implant focus combined with fee-for-service positioning in South Florida, which is a legitimately premium combination because implant procedures carry significantly higher per-case revenue and margin than general dentistry, and the FFS focus sidesteps PPO rate compression. The diligence question is whether the cash flow figure reflects the practice's actual earning power or just owner compensation captured at the SDE level. A 19% CF margin is on the lower end for an implant-focused practice (which typically runs 25%+ at scale), which suggests the practice may be sub-scale. Two paths to value here: a buyer adds implant volume through marketing and capacity expansion, or a buyer uses this as a satellite location for an existing implant-focused platform. The 9.5x ask is full strategic price for a small practice. A first-time buyer will struggle to clear it; a strategic buyer with implant operating experience might be able to make it work, but this is one to negotiate.

Location: North San Diego County, CA | Asking Price: $799K | Revenue: $893K | Cash Flow: $411K | CF Margin: 46% | Price / Revenue: 0.90x | Price / Cash Flow: 1.95x

Modern fee-for-service and PPO general dentistry practice in a suburban North San Diego County market. Established and patient-centered with steady growth.

My take: A 1.95x cash flow multiple on a profitable dental practice with a 46% CF margin may or may not be below market for an individual practice. The cash flow figure definitely includes substantial owner compensation that won't replicate for a buyer paying market wages to a hired dentist, so the EBITDA multiple is way higher. In dental specifically, the difference between SDE (which includes the selling dentist's clinical compensation) and post-transaction EBITDA (which doesn't, because a hired dentist gets paid at market) routinely doubles or triples the multiple. After that adjustment, this is probably a fair-priced solo practice rather than a steal. Further, there could be a structural issue not visible in the teaser (lease problem, key staff dependency, declining patient volume, looming reimbursement change).

Location: Santa Fe, NM | Asking Price: $1.295M | Revenue: $979K | Cash Flow: $332K | CF Margin: 34% | Price / Revenue: 1.32x | Price / Cash Flow: 3.9x

Established 2004. Prevention and wellness-focused general dentistry. 250+ five-star online reviews. Owner retiring. Two unused operatories provide expansion capacity.

My take: 1.3x revenue and 3.9x cash flow is high relative to where solo retirements have been trading. The interesting feature is the two unused operatories, which represents potential growth capacity if a buyer wants to add producer days or hire an associate. The diligence priorities are standard for a solo retirement scenario: patient list age and recall compliance (older established practices often carry significant inactive patients that inflate the active patient count), the seller's role in driving new patient flow versus referral and reputation, and the lease term and renewal terms on the existing space. Santa Fe specifically is a smaller market with limited associate pipeline, which makes the post-transaction staffing question more acute than in a metro market, but it’s also an attractive place to live, so who knows? A buyer who plans to operate this as an owner-operator inheriting the patient base likely struggles to underwrite the ask. A buyer who plans to hire an associate, needs to verify that an associate is locally recruitable before committing, and feel confident in a profitable growth strategy.

Location: Texas | Asking Price: $1.0M | Revenue: $1.05M | Cash Flow: $378K | CF Margin: 36% | Price / Revenue: 0.95x | Price / Cash Flow: 2.6x

Specializes exclusively in root canals. 20+ years of practice. Advanced imaging including microscopes and CBCT. Same-day emergency appointments.

My take: Endodontics is one of the more strategically valuable dental specialties for a few reasons: high per-case revenue (root canals carry significantly higher fees than general dentistry procedures), procedure-driven workflow that supports productivity scaling, and referral economics that are largely independent of the broader dental market. There are several active endodontics-focused platforms that have recently sold at multiples above the broader dentistry market, and a clean specialty practice is a strategic asset for any of them, although this is probably too small for anything more than an owner-operator at this juncture. The diligence priority is referral source concentration. Endodontics practices live or die by their general dentist referral network, and a 20-year practice may have strong relationships that depend on the retiring endodontist personally. Texas Corporate Practice of Medicine rules apply to dentistry as well, which a non-dentist buyer needs to navigate.

That's it for Issue #4.

See you next Tuesday.

Will Hamilton, CVA
Founder, Scope Research and HealthFMV

The Weekly Checkup is published every Tuesday morning. Written for general informational purposes. Engagements through Scope Research or HealthFMV require a separate agreement.