According to the National Venture Capital Association, funding totaled $35.8 billion through September 2021, already exceeding the full year of 2020.
The pipeline of late-stage molecules continues to expand and is at an all time high with almost 3,000 molecules in active Phase II or Phase III development.
Clinical trial starts are trending well ahead of recent years with year-to-date starts up 23% over 2020 and 13% over 2019.
And finally, new drug approvals by the FDA are keeping pace with the historically high levels of 2020 with 40 new drugs approved year-to-date, which sets the stage for a strong volume of upcoming commercial launches.
Revenue for the third quarter grew 21.7% on a reported basis and 21.1% at constant currency and was $64 million above the midpoint of our guidance range.
Third quarter adjusted EBITDA grew 20.5% reflecting our revenue growth, as well as productivity measures.
The $8 million [Phonetic] beat above the mid-point of our guidance range was entirely due to the stronger operational performance.
Third quarter adjusted diluted earnings per share of $2.17 grew 33.1% that was $0.07 above the midpoint of our guidance with the beat coming from the adjusted EBITDA drop through, as well as favorability in below the line items.
For example, we had a recent major win to deliver an external comparator in a cardiovascular study for top 20 pharma clients.
We had 10 new client wins in the quarter, bringing the total number of OCE wins to-date to 169 customers.
We now have 165 customers that have bought the site portal module, representing 155,000 sites and 1,716 active studies that are using our site portal module.
We have successfully deployed over 150 projects across 35 different therapeutic areas.
To date, we have over 70 customers using this platform, including eight of the top 10 pharma clients.
The platform has processed over 10 million unique patient responses in 65 countries and across 28 languages.
When we step back and look at the growing importance of DCT in our own portfolio, we find that up to 30% of our active full service trials utilize one or more components of our DCT Offering.
We've been awarded 89 trials to-date, totaling over $1 billion.
These awards are with 34 unique sponsors of which 10 have multiple decentralized trials ongoing with us.
These trials spent 12 different therapeutic areas, 32 unique indications and have recruited over 200,000 patients in 40 countries, our ability to combine advanced clinical technology with an extensive network of investigators and care professionals differentiates us in this space and makes us the partner of choice for decentralized trials that utilize the full capabilities.
We had approximately $2.6 billion of net new bookings in the quarter, bringing our LTM net new bookings for the first time to over $10 billion including pass-throughs.
This resulted in a contracted net book-to-bill ratio of 1.39 including pass-throughs and 1.28 excluding pass-throughs.
At September 30, our LTM contracted book-to-bill ratio was 1.38 including pass-throughs and 1.37 excluding pass-throughs.
Our contracted backlog in R&DS including pass-throughs grew 12.7% year-over-year to $24.4 billion at September 30, 2021.
As a result, our next 12 months revenue from backlog increased to $6.9 billion, up $300 million sequentially versus the second quarter.
We recently announced the opening of our new 160,000 square foot Innovation laboratories in North Carolina.
And this expansion of course comes on top of the investment we announced last quarter in our 130,000 square foot facility in Scotland.
Third quarter revenue of $3,391 million grew 21.7% on a reported basis and 21.1% at constant currency.
Year-to-date revenue was $10,238 million, growing at 27% reported and 25% at constant currency.
Technology & Analytics Solutions revenue for the third quarter was $1,337 million, which was up 10.8% reported and 9.9% at constant currency.
Year-to-date, Technology & Analytics Solutions revenue was $4,038 million, which was up 17.6% reported and 14.9% at constant currency.
In the third quarter, R&D Solutions had revenue of $1,853 million, up 32.4% at actual FX rates and 31.9% at constant currency.
Excluding the impact of pass-throughs, third quarter R&DS revenue grew 24.7% year-over-year.
Year-to-date revenue in R&D Solutions was $5,612 million, up 37.7% reported and 36.2% at constant currency.
Finally Contract Sales & Medical Solutions or CSMS revenue of $201 million was up 12.3% reported and 12.8% at constant currency.
Year-to-date CSMS revenue was $588 million, growing 6.5% reported and 5.1% at constant currency.
And let's move down the P&L to adjusted EBITDA, which was $728 million in the third quarter, up 20.5%, year-to-date adjusted EBITDA was $2,194 million, growing 33.1% year-over-year.
Third quarter GAAP net income was $261 million and GAAP diluted earnings per share with $1.34.
Year-to-date, we had GAAP net income of $648 million or $3.32 of earnings per diluted share.
Adjusted net income was $423 million for the third quarter and adjusted diluted earnings per share grew 33.1% to $2.17.
Year-to-date adjusted net income was $1,264 million or $6.48 per share.
Backlog now stands at $24.4 billion.
In last 12 months, net new bookings including pass-throughs rose to over $10 billion.
At September 30th, cash and cash equivalents totaled $1.5 billion and debt was $12.2 billion.
This resulted in net debt of $10.7 billion.
Our net leverage ratio at September 30th came in at 3.65 times trailing 12 month adjusted EBITDA.
Cash flow from operations was $844 million and with capex of $162 million, this resulted in free cash flow of $682 million.
This third quarter performance brought our free cash flow year-to-date, that is through the first three quarters to almost $128 billion, which continues the strong improvement trend we've had over the past three years.
In the quarter, we repurchased $125 million of our shares, which leaves us with $697 million of share repurchase authorization remaining under our latest program.
As you saw, we're raising our full-year 2021 revenue guidance by $188 million at the midpoint, this reflecting the third quarter strength and the continued operational momentum in our business.
Our new revenue guidance is $13,775 million to $13,850 million, representing year-over-year growth of 21.3% to 21.9%.
Of note that included in this guidance is a $30 million headwind from FX versus our previous guidance.
Now looking at the comparison to the prior year, FX is a tailwind of about 120 basis points to full-year revenue growth.
We've increased our full-year adjusted EBITDA guidance by $20 million at the midpoint.
Our new full-year guidance is $2,980 million to $3,010 million, which represents year-over-year growth of 25% to 26%.
Moving down to EPS, we're increasing our adjusted earnings per share guidance by $0.10 at the midpoint.
The new guidance range is now $8.85 to $8.95, which represents year-over-year growth of 37.9% to 39.4%.
Fourth quarter revenue is expected to be between $3,537 million and $3,612 million, representing growth of 7.2% to 9.5%.
FX in the quarter is a headwind to growth of about 100 basis points.
Adjusted EBITDA in the fourth quarter is expected to be between $786 million and $816 million, up 6.9% to 11% and adjusted diluted earnings per share is expected to be between $2.37 and $247, growing 12.3% to 17.1%.
R&DS backlog improved to $24.4 billion, that's up 12.7% year-over-year, next 12 months revenue from backlog increased to $6.9 billion, up $300 million sequentially versus the second quarter.
We reported another strong quarter of free cash flow, which at $1.8 million through the first three quarters of the year is a market improvement over prior year.

Summary:
Third quarter adjusted diluted earnings per share of $2.17 grew 33.1% that was $0.07 above the midpoint of our guidance with the beat coming from the adjusted EBITDA drop through, as well as favorability in below the line items.
Third quarter revenue of $3,391 million grew 21.7% on a reported basis and 21.1% at constant currency.
Third quarter GAAP net income was $261 million and GAAP diluted earnings per share with $1.34.
Adjusted net income was $423 million for the third quarter and adjusted diluted earnings per share grew 33.1% to $2.17.
Fourth quarter revenue is expected to be between $3,537 million and $3,612 million, representing growth of 7.2% to 9.5%.
Adjusted EBITDA in the fourth quarter is expected to be between $786 million and $816 million, up 6.9% to 11% and adjusted diluted earnings per share is expected to be between $2.37 and $247, growing 12.3% to 17.1%.