Medpace Holdings: 26.5% Revenue Growth Masks A 0.88 Book-To-Bill Warning Signal!

Medpace Holdings, Inc. reported first quarter 2026 revenue of $706.6 million, marking a 26.5% year-over-year increase. This growth was supported by net new business awards entering backlog, which rose 23.7% to $618.4 million, although the net book-to-bill ratio declined to 0.88, reflecting more cancellations than new bookings. The ending backlog as of March 31, 2026, was approximately $2.9 billion, up 2.9% year-over-year, with an expected conversion of about $1.94 billion into revenue over the next 12 months. EBITDA for the quarter increased 25.9% to $149.4 million, maintaining an EBITDA margin of roughly 21.1%, while net income rose 8.1% to $123.9 million, partly weighed down by a higher effective tax rate. Adjusted diluted net income per share grew to $4.28 from $3.67 a year prior. The company generated $151.8 million in operating cash flow and held $652.7 million in cash at quarter-end.