Investing in BillionToOne – Amplifying the power of molecular diagnostics

At Premji Invest, we are excited to partner with companies that we believe have uncommon potential. Our evergreen and long duration capital base allows us to make long-term investment decisions, supporting companies which can create enduring value by tackling hard to solve problems.

Today, we are delighted to announce our partnership with BillionToOne, an emerging leader in the molecular diagnostics space. In a short period of time, BillionToOne’s incredible team, led by founders Oguzhan Atay and David Tsao, have established the company as one of the most innovative platforms in a highly competitive segment. The company’s proprietary Quantitative Counting Templates (QCTs) enable cell-free DNA testing at a higher precision than otherwise possible, creating tests that can detect abnormalities earlier and more accurately.

With the use of QCTs, supported by BillionToOne’s in-house machine learning algorithms, the tests can detect conditions caused by tiny DNA variations that are sparsely represented in the bloodstream. The potential applications in disease detection are numerous, following a successful foray in the prenatal space the company is now expanding into oncology with its liquid biopsy products. One of the advantages of the platform was visible in the response to the recent RhoGAM(R) shortage¹, where BillionToOne was able to test over 80,000 patients² for Rh incompatibility providing physicians with a screening tool to manage the shortage and alleviating concerns among expectant parents due to the drug shortage while helping them avoid unnecessary treatments.

Innovation backed by immaculate execution

When we first met BillionToOne, almost two years ago, we were impressed by the company’s technical prowess but maintained a healthy skepticism with regards to their ambition in what we perceived to be a highly competitive market, with even established players focusing on new therapeutic segments. The space already had multiple well-funded companies which contributed to the pricing pressure and growth struggles for new entrants. Over further interactions, the team’s consistent execution and responsiveness has turned us from sceptics to believers. Since early days, BillionToOne has constantly managed to surpass the ambitious goals set internally, while remaining true to the company’s mission of delivering superior diagnostic tests. Billion To One’s outstanding execution makes us confident in our investment.

‍

Through the two years we have known the company, the team led by Oguzhan has been exemplary in navigating the short-term pressures of a volume driven business while staying focused on the longer-term vision of creating products that improve patient experience and provides physicians with data to make more informed decisions.  As we spent more time with the company, we found an innovative platform with potential for varied applications across disease segments. The company’s technology is a key differentiator, addressing inherent problems in existing solutions. However, it is the team’s focus on designing tests which solve for key bottlenecks in clinical workflows and a calibrated approach to managing costs of testing against new features that has been critical to the rapid adoption of the tests in the prenatal space. Despite being a late entrant into the segment and operating at a smaller scale, BillionToOne has managed to achieve operating metrics which are comparable with established peers. The operational rigor and the focus on customer experience should hold the company in good stead as they expand into newer segments. The initial response to BillionToOne’s oncology liquid biopsy products has been positive as the tests have a lower limit of detection and higher precision compared to other assays on the market. BillionToOne's therapy selection tests detect 50%+ more actionable mutations in head-to-head clinical studies³, enabling oncologists to have more effective therapies available to more of their patients in late-stage cancer patients. This is accompanied by an innovative tumor-naive monitoring assay that can then precisely track the response of the patients over time.

On the path to being the definitive molecular diagnostics company

Our investment in BillionToOne reflects our belief that the company has the potential to transform the diagnostics landscape and emerge as a category defining company. BillionToOne’s technology and the incredible team are well poised to deliver products which are impactful to millions of patients. We are thankful to Oguzhan Atay, David Tsao and the rest of the BillionToOne team for this opportunity and are extremely excited for the future of this amazing company!

‍

1) https://www.aabb.org/news-resources/news/article/2024/02/14/regulatory-update--fda-announces-shortages-of-rho(d)-immune-globulin

2) https://billiontoone.com/billiontoone-mitigating-rhogamr-shortage-with-unity-fetal-rhd-non-invasive-prenatal-test/

3) https://ascopubs.org/doi/10.1200/JCO.2024.42.16_suppl.3072