For the treatment of patients with mild-cognitive impairment and very mild Alzheimer’s disease, releasing positive final results. Regarding Biotest, Trimodulin and Fibrinogen trials are advancing as expected, and we are fully focused on capturing its strong growth opportunity. To this end, we have completed the enrollment in the Fibrinogen ADFIRST trial and are on track to publish top line results early Q1 ’24. For the Trimodulin ESsCAPE trial, first patients have already been enrolled. These positive developments are testament to our commitment to maintain an increased effort in developing new products and indications, which we plan to continue to accelerate for the remainder of the year onwards. We expect the appointment of Jorg, our Chief Scientific Innovation Officer to enable us to execute on our objectives and further accelerate our pipeline.
Now in Slide #10. Diagnostic revenues declined 3.1% at constant currency in the quarter, but 0.9% on a year-to-date basis. As mentioned in previous quarters, our NAT technology was negatively impacted due to the pricing concessions given in exchange for extending a large contract with a key customer of us. However, strong instrument sales in Japan and Indonesia are helping to offset part of this decline. In blood typing solutions, we are seeing a strong growth across the U.S., Argentina and the Middle East, partially offsetting the lower sales of GelCards experienced in China lately. In recombinant proteins, contract manufacturing from our Emeryville plant, we have signed a renewed 10-year supply agreement with an important partner in the diagnostic field.
And now moving to Slide 11. In Bio Supplies, revenues declined 14.1% in the quarter due to lower cell culture sales driven by subdued demand. We look forward to leveraging the acquisition of Access Biologicals and capturing the full potential of this business unit. And I will now hand it over to Alfredo, who will go through the group’s financial performance.
Alfredo Arroyo : Thank you, Victor. Good day to everyone. Slide 13. Overall, we have delivered strong performance across the board, improving revenues, profitability and strengthening our balance sheet. Our revenues continue to grow sustainably at 9% at constant currency in Q3, bringing the year-to-year growth to 11.7%. Our EBITDA margin continued to show sequential expansion, further improvement to 25.1% from the 23.4% in Q2. On the back of our enhanced profitability, which will continue to improve in the coming quarters, our leverage ratio has declined to 6.7x from 9x peak of last year. Organic efforts have been a key piece so far on our deleveraging path. Slide 14. Revenue has shown a very positive sequential trend throughout this year.
On a last 12 months basis, total revenue has reached more than €6 billion with 11% growth. Biopharma continues to be the key growth driver with a solid underlying demand, particularly in IG and more notably, our subQ product, which continued to gain further traction as well as our albumin franchise in China. Our ex U.S. strategy has been also an important growth lever, together with mid-single-digit price increases. Slide 15. Our gross margin has significantly improved over the last quarters, reaching 41% in Q3. This quarter show the steepest gross margin expansion in recent quarters, improving by 400 basis points compared to the same period of last year. This is due to Biopharma remarkable performance and a 22% decline in cost per liter, which is now clearly reflected in our P&L after a 9-month accounting lag.
On the right-hand side of this slide, you can see a significant decrease in our SG&A cost as a percentage of revenue. This reduction, which amounts to nearly 120 basis points compared to Q3 last year is primarily attributed to operational leverage and efficiencies resulting from our €450 million operational improvement plan. Slide 16. All of this has culminated into higher EBITDA margin for the group, reaching the 25.1% in the third quarter and more than €1.3 billion on the last 12 months basis. Year-to-date, it has reached more than €1 billion and 23.2% margin, reflecting sequential improvement of 480 basis points compared to end of ’22. Most of the improvement has come from Biopharma, driven by both volume and cost per liter improvement.
Our operational improvement plan has made also significant contribution to EBITDA. On a last 12 months basis, EBITDA has increased by 28% with a significant margin expansion. Slide 17. Considering this significant margin improvement, we are now very confident in our ability to achieve the high end of our previous EBITDA guidance. We expect full year ’23 total revenue growth of 10% to 12% at constant currency, which is supported by Biopharma revenue growth of 12% to 14% at constant currency. Regarding EBITDA margin, now we expect for the second half of this year to be at 25% from the 24%, 25% period range and 24% margin plus for the full year ’23. All of this confirms our adjusted EBITDA guidance of €1,450 million by the end of the year. And if we consider the annualized cash savings, the pro forma 23% EBITDA margin would be in the 28%, 29% margin range, bringing us back to the pre-COVID margin levels.
Slide 18. Building on all efforts made through previous quarters, we continue to make solid progress on our deleveraging path down to 6.7x at the end of September of this year. This has been driven by EBITDA improvement backed by business performance, cost savings and operating cash flow improvement. We remain confident to achieve a leverage target of 4x by the end of ’24. Our current liquidity is more than €1 billion, including €454 million in cash. Now I hand over to Thomas for the final remarks.
Thomas Glanzmann : Thank you, Alfredo. Maybe to put all of what you have heard in the perspective. Last year, we embarked on a journey to turn around Grifols financial performance as well as to build an increasingly performance-oriented, efficient and accountable organization. The third quarter has been testament to that we are well underway to meet our objectives. Our fundamentals have never been as solid, and we have delivered a strong performance across the board, executed on our key priorities and very importantly, delivered on our commitments. One, we have grown our revenue sustainably. Two, we have enhanced profitability and have sequentially updated our EBITDA guidance for the full year ’23 accordingly, and remain on track to reach 2019 EBITDA margin levels next year.
And three, driven by all of these improvements and a commitment to delivery deleveraging transaction of at least €1.5 billion still in ’23, we will strengthen our balance sheet and are on track to reach our guidance of 4x by 2024. At the same time, we are not losing sight of what’s ahead of us beyond ’23. We are now very focused on realizing Grifols full potential, and in doing so, maximizing value for all stakeholders. Our efforts will concentrate on a number of strategic levers. One, we will build on where we see our core strength and the best competitive advantage. Two, we will continue operating as a global market maker and shape in our markets, seizing those commercial opportunities that are most promising and hold great potential. Three, we will continue to accelerate and bolster innovation, focusing on a select number of therapeutic areas and prioritizing those projects in our pipeline that will boost our profitability and differentiate us with our customers.
