With that, let me turn to our earnings. Syneos Health had a strong finish to 2018, as we delivered accelerated revenue growth and improved profitability in our fourth quarter and full-year results. We believe customers continue to recognize the value of our biopharmaceutical acceleration model, as evidenced by healthy net awards across both our Clinical and Commercial segments for 2018. Our integration efforts also continued to progress ahead of schedule as we achieved our updated synergy targets for the full year.

Let me begin by reviewing some key performance highlights. First, we had a strong overall sales performance, resulting in total net awards of $3.9 billion under ASC 605 and a book-to-bill ratio of 1.22 times for the full year 2018. This was comprised of a Clinical book-to-bill of 1.25 times and Commercial book-to-bill of 1.16 times, which exceeded our target in 2018. This performance was balanced across customer types and services, providing a solid foundation for growth in 2019 across both Clinical and Commercial. I'd also like to note that beginning with this quarter, we plan to provide net awards and book-to-bill on a trailing 12-month basis only, as we believe this better represents the overall trends in our business.

Second, revenue growth in our Commercial solutions segment continued to accelerate with revenue of 17.5% compared to the fourth quarter of 2017 and up sequentially for the third consecutive quarter.

Third, we saw accelerating growth in our Clinical solutions segment and near record gross awards for the fourth quarter. This was fueled by maintaining our leadership position in the small- to mid-size market, while continuing to ramp up new large pharma relationships.

Lastly, today we announced our intention to refinance our credit agreement, which aligns with our focus on disciplined management of our leverage and interest costs.

Turning to our results by business. We are excited about the sustained momentum in our Commercial solutions segment as our integrated capabilities continue to resonate with customers. The team closed 2018 strongly with total net awards of $1.14 billion for the full year. This overall strength in awards as well as selling solutions backlog growth positions us for continued strong growth in 2019. Importantly, our backlog continues to diversify as we are seeing compelling opportunities in expansion of our European business, with momentum not only in selling solutions but also in consulting and medical communications.

Our pipeline in RFP flow remains healthy, driven by our strategic investments in Commercial business development along with strong customer interest in Syneos One and our other comprehensive outsourcing solutions. We are also seeing the value of our model across the product development spectrum with increased utilization of Commercial services among our Clinical customers. This is evidenced by recent successes where we have demonstrated greater value for our customers by combining Clinical services with our growing Commercial presence.

We were recently awarded a REMS program by one of our largest Clinical customers, a top 20 pharma company for a compound that we supported through the Clinical development process. We secured this win based on our Clinical experience with this compound and our ability to bring the customer an integrated solution, which included our consulting and Commercial capability. This type of award is just one example of the power of our uniquely integrated approach, which provides enhanced value for our customers and positions Syneos Health well for continued growth.

Our Clinical solutions segment also delivered a solid finish to 2018, bringing total net awards for the year to $2.75 billion. This performance yielded year-over-year backlog growth of 14%, establishing a solid foundation as we enter 2019. These awards were broad-based across customer segments with notable strength in the Top 20, driven by our developing preferred provider relationships as well as strong performance among our core small to midsized customers. While fourth quarter gross awards were near a record level, we did experienced elevated cancellations during the quarter, driven primarily by drug efficacy, safety and regulatory issues. We do not believe this represents a trend and this fourth quarter increase has been contemplated in our 2019 outlook.

Importantly, under ASC 605, Clinical solutions adjusted net service revenue growth accelerated to 4.3% for the fourth quarter and 3.6% for the full year 2018 compared to 2.6% for both the fourth quarter and full year 2017. On a constant currency basis, our Clinical growth rate was 5.1% for the fourth quarter 2018 and 3.3% for the full year.

As an update to an innovative customer relationship we highlighted in the second quarter that expands our therapeutic footprint, we are pleased to have finalized the transition of a therapeutic development operation from one of our large pharma customers. This type of strategic relationship allows us to quickly expand our portfolio of services in a capital-efficient manner, benefiting both parties in the process. Through this relationship, we've added experienced staff for the therapeutic dept in dermatology, prosthetics and immunology as well as translational science capabilities and the underlying lab facilities to our European operations. This arrangement also includes a minimum revenue commitment to Syneos Health over the first five years.

Next, I'd like to provide updates on some of our ongoing strategic investments and other activities. We continue to invest in our unique Syneos One offering, which we previously called Integrated Solutions. We believe this updated branding better reflects the unique nature of our end-to-end product development offering. Syneos One collaborates across the business to create custom solutions encompassing our full suite of capabilities. This team provides customers, particularly in the small- to mid-size market with an economic alternative to out-licensing their assets along with insights that are critical to optimizing the development and commercialization plans. We believe this approach can expand our addressable market beyond traditional commercialization services.

In addition to recent wins by Syneos One, this team's deep experience, expertise and integrated approach have already proven critical in winning several other key awards for our Clinical and Commercial businesses.

Our Integrated work is further fueled by our dynamic assembly data digital strategy. This open and highly flexible architecture allows us to partner with the best of the line data and technology providers rather than create and rely solely on in-house technologies solutions.

I'm also pleased to report that we have made significant strides during the fourth quarter and early 2019 in rounding out our talented executive management team. We promoted Christian Tucat to President, Syneos One, Real World & Late Phase. Joining the Executive team, Christian now represents these critical market opportunities across the organization, building on existing results and driving further expansion of this unique combination of offerings. We also added Jon Olefson to our executive team as General Counsel. Jon brings extensive experience in data analytics, intellectual property and global markets with high-growth companies. He most recently served as General Counsel with Cotiviti, a healthcare analytics firm.

Finally, Paul Colvin recently joined our team as President of Clinical Solutions. Paul is an industry veteran having joined us from PPD with a history of operational leadership and large pharma experience, including more than 15 years at Eli Lilly. He brings a customer focus perspective that we believe will help drive our enhanced key account management structure to better serve large customers and further accelerate our growth.

We also continue to make great progress on our integration activities. We realized approximately $22 million of savings during the fourth quarter, bringing our year-to-date total to $76 million prior to our strategic reinvestments. This result is consistent with our increased target for 2018 and we remain confident in achieving $125 million in synergies annually by 2020.

In closing, let me officially welcome our new executive team members and express my sincere gratitude to my 24,000 Syneos Health colleagues for their engagement, dedication and focus on world-class delivery. In 2018, we built a strong foundation for the future by making tremendous progress on integration, building our brand, deploying our innovative product development model and strengthening our management team. I am proud of the progress we've made and where we're headed. Our global team is well positioned for the next chapter of our growth.

Now, let me turn it over to Jason for more comments on our financial performance. Jason?

Jason Meggs -- Chief Financial Officer

Thank you, Alistair; and good afternoon, everyone. Before I get into our financial performance, I want to briefly touch on the material weakness disclosure in our 2018 Form 10-K. As part of our annual review of the effectiveness of our internal controls over financial reporting, we determined that material weaknesses existed in the internal controls related to Clinical ASC 606 revenue recognition. This determination was the result of immaterial accounting errors identified during the year-end financial statement audit, which identified design and operating deficiencies related to internal controls developed for ASC 606.

Importantly, we concluded that no restatement of prior periods was necessary and no adjustments to our financial results have been made. Work to remediate these internal controls is under way and we expect to be fully remediated during 2019.

Now turning to our results. Let me remind you that all results are on an adjusted or non-GAAP basis as if the merger closed at the beginning of the earliest period presented as defined on Slide 2. Consistent with prior periods, we will be discussing the current period adjusted results under the previous revenue standard to facilitate the period-to-period comparisons. For these comparisons under ASC 605, we will be discussing adjusted service revenue, excluding reimbursable expenses. Regarding our results, I would like to start with a few key operational highlights.

Fourth quarter adjusted service revenue increased 8.3% year-over-year, led by strong awards and accelerating growth of 17.5% in the Commercial solutions segment. We achieved strong total adjusted EBITDA performance with 15.9% sequential growth during the quarter. This performance along with a lower tax rate and lower interest expense drove a 38.8% increase in adjusted EPS compared to 2017. Our accelerated realization of synergies in 2018 led to $76 million in savings, which further improved our profitability and allowed us to reinvest in future growth. And, today, we announced that we are working with our lenders to refinance our 2017 credit agreement.

In addition, during the fourth quarter, we continued to make progress on our balanced capital deployment strategy with $36.3 million of additional debt reduction.

Now, I will review our financial results in more detail. Slide 3, for your reference, includes our GAAP results under ASC 606 along with the same results presented as if ASC 605 had remain in effect for comparative purposes. On Slide 4, we show our adjusted results under both ASC 605 and 606, but I'll begin by discussing results under ASC 605.

Our total adjusted service revenue for the fourth quarter of 2018 was $834.3 million, up 8.3% compared to $770.5 million for the fourth quarter of 2017. This included a foreign exchange headwind of $5.4 million. The increase was primarily driven by our Commercial segment, which posted another quarter of strong sequential and year-over-year growth with fourth quarter revenue up 17.5% to $271.9 million compared to $231.4 million in 2017. We primarily attribute this Commercial growth to strong net awards during 2018 fueled by our strategic investments in business development and Syneos One along with the strengthening macro environment and the acquisition of Kinapse.

In addition, our Clinical segment grew 4.3% to $562.3 million in the quarter compared to $539.1 million in the fourth quarter of 2017. This Clinical growth was driven by strong net awards in the last 12 months, partially offset by delays in the start-up of new awards, which we highlighted last quarter.

For the full year, total adjusted service revenue was $3.18 billion, up 2.5% from $3.1 billion in 2017. This included a foreign exchange benefit of $8.5 million.

Adjusted EBITDA for the fourth quarter was $186.1 million, a 19.1% increase compared to $156.2 million in 2017, leading to an adjusted EBITDA margin of 22.3%, which is an increase of 200 basis points. This includes a foreign exchange benefit of $5.3 million.

The benefit of Clinical and Commercial revenue growth along with other cost savings and realized synergies were partially offset by increased costs related to our strategic investments.

Adjusted EBITDA for the fourth quarter included approximately $60 million of seasonal benefits related to vacation accrual adjustments and R&D tax credits, similar to the fourth quarter of 2017. For the full year, adjusted EBITDA was $636.3 million, up 9.6% compared to $580.7 million for 2017, including a negligible foreign exchange headwind. Adjusted EBITDA margin for the full year strengthened by 130 basis points to 20% compared to 18.7% for 2017. Adjusted EBITDA also includes the realization of $22 million and $76 million of synergies for the fourth quarter and full year, respectively, before the impact of our strategic reinvestments to drive growth.

Adjusted diluted EPS grew by 50% from $0.70 in the fourth quarter of 2017 to $1.05 in the fourth quarter of 2018. For the full year, adjusted diluted EPS improved 38.8% from $2.27 in 2017 to $3.15 in 2018. These increases were primarily driven by our growth in adjusted EBITDA, the reduction of our non-GAAP tax rate to 24.5% and lower interest expense. Specifically, the lower tax rate contributed $0.18 and $0.35 to our growth and adjusted diluted EPS for the fourth quarter and full year, respectively.

Now I want to summarize our results under the new ASC 606 standard. Adjusted total revenue, which includes reimbursable expenses was $1.15 billion for the quarter, which represents 2.7% sequential growth and $4.4 billion for the full year. This is comprised of adjusted total revenue of $824.2 million and $3.22 billion for Clinical and $324.2 million and $1.18 billion for Commercial, respectively.

Total adjusted EBITDA on the fourth quarter was $173 million, representing 9.2% sequential growth and a 15.1% adjusted EBITDA margin. Total adjusted EBITDA was $597.2 million for the full year, representing margin of 13.6%. Importantly, this includes segment adjusted EBITDA margins that are more closely aligned than those under ASC 605 with Clinical at 14.9% and Commercial at 13.3% for the full year.

Adjusted diluted EPS was $0.95 for the fourth quarter and $2.87 for the full year. These adjusted earnings per share amounts include the impact of our lower non-GAAP tax rate of 24.5%, which contributed $0.11 for both the fourth quarter and full year when compared to our previously estimated tax rate of 27.5%.

Now moving to cash flow and the balance sheet. Cash flow from operations was $112.4 million for the fourth quarter and $303.4 million for the full year 2018 on an as-reported basis. Our combined net DSO for the quarter was 49 days under ASC 605 and 39 days under ASC 606. We ended the quarter with $153.9 million of unrestricted cash and total debt outstanding of $2.81 billion. Note that we have updated our leverage ratio calculation as of the end of 2018 to reflect the full year of ASC 606 reporting, which yields a net leverage ratio of 4.4 times compared to 4.2 times using ASC 605 adjusted EBITDA. We remain committed to the continued reduction of our net leverage with a revised target under ASC 606 of 3.5 to 3.9 times by the end of 2019.

Slide 8 provides an update on our debt management and capital deployment activities. We remain focused on a balanced approach to capital deployment to drive shareholder value. This includes debt repayment, tuck-in acquisitions and share repurchases as determined by available cash flow as well as market opportunities and conditions.

I would like to highlight a couple of key milestones related to the balance sheet that we have achieved. First, we are working with our lenders to refinance our 2017 credit agreement, which we expect to close by March 31st. This transaction is expected to expand our term loan A facility by $587.5 million to $1.55 billion. Of this incremental capacity, we intend to draw a $187.5 million upon closing in order to refinance a portion of our term loan B facility at a lower cost. We plan to utilize the remaining $400 million of our new term loan A facility to redeem our senior notes during the fourth quarter at the first call date. These transactions are expected to reduce our interest expense for 2019 by $4.2 million and by $15 million annually thereafter. This refinancing also includes the expansion of our existing revolving credit facility to $600 million to provide additional liquidity.

Second, during the fourth quarter, we've repaid an additional $36.3 million of our term loans, bringing our total debt reduction, since the closing of our merger, to $222.4 million.

Turning to the tax line. Our final GAAP effective tax rate for the full year 2018 is 24.5%, approximately 300 basis points below our previous expectations, which we expect to continue into 2019. This lower tax rate stems primarily from our reassessment of the application of certain provisions of the Tax Cuts and Jobs Act based on, among other things, due guidance which was released in late 2018. Importantly, given the benefit of our NOL deductions, we only expect our actual net cash outlay for taxes to be approximately $10 million for the year.

Turning now to our guidance as outlined on Slide 9, we've taken into account a number of factors including our existing backlog, current sales pipeline, trends in cancellations and delays and our estimated merger synergies, net of reinvestments. Further, our guidance is based on current foreign currency exchange rates, expected interest rates and our expected tax rate. Our guidance is also based upon our estimated diluted share count, excluding any share repurchases subsequent to the fourth quarter. We expect full year total adjusted service revenue for 2019 in the range of $4.62 billion to $4.73 billion, representing growth of 4.9% to 7.4%. This is comprised of adjusted Clinical revenue of $3.35 billion to $3.41 billion, or growth of 3.8% to 5.8%, and Commercial revenue of $1.28 billion to $1.32 billion, representing growth of 8.1% to 11.9%. We expect total adjusted EBITDA to range from $625 million to $660 million, growing between 4.7% and 10.5%.

Lastly, we expect adjusted diluted EPS in the range of $3.03 to $3.23, representing growth of 5.6% to 12.5%.

We based our guidance for the full year on, among other things, expectations of interest expense of $125 million to $130 million, which includes the expected impact of the refinancing transaction we announced today, realized merger synergies of $100 million $110 million before the impact of our related strategic investments and a fully diluted weighted average share count for 2019 of approximately 106 million shares, which will vary by quarter.

I also want to provide you with some commentary for the first quarter, given our typical seasonality and expected 2019 growth profile. We expect total revenue of $1.11 billion to $1.3 billion, representing year-over-year growth of 4.1% to 6.5%. This is comprised of Clinical adjusted revenue growth of 1.9% to 3.1% and Commercial revenue growth of 10.8% to 16.3%. We expect total adjusted EBITDA of $130 million to $140 million, representing year-over-year growth of 1% to 8.8%, which reflects relatively flat adjusted EBITDA margin at the midpoint.

This completes our prepared remarks, and we would be happy to answer any questions. Operator?

Questions and Answers:

Operator

Thank you, sir. (Operator Instructions) Our first question comes from the line of Eric Coldwell of Baird. Your line is open.

Eric Coldwell -- Robert W. Baird -- Analyst

Hey, thanks very much, and congrats on getting through this so quickly with the solid quarter and outlook. Given all that you had on your plate, I don't think that the material weakness disclosures in your 10-K or the ASC 606 challenges are really that surprising, but it would be interesting if you could give us some anecdotes on the immaterial accounting issues that you cited just so we have something to hang our hat on here, and then I might have a follow-up or two.

Alistair Macdonald -- Chief Executive Officer

Okay. Thanks, Eric. I'll give you some kind of environment and then hand you over to Jason for a bit more color. We, I think, through 2017 and then through '18, obviously with the scale of the merger, we consolidated onto one ERP platform across Clinical, took inVentiv obviously from private to public, implemented a new revenue standard, CFO transition. We moved a lot of things and we changed a lot of things and getting the new controls in place to get that testing done with something that we were focused on and conscious about all year.

I just say on record ready for the team, very proud of where we got to, substantially complete on our audit same with Deloitte and then we get the letter from the SEC before we file. So we have to pump the brakes really and look at, make sure with the audit committee that we had everything correct, that we haven't really missed anything from 606 that we've been looking at. So it's been not a process that I would look to repeat, but obviously we've got through it quite quickly and got through earnings today without any changes. So I'll pass you onto Jason for a bit more color.

Jason Meggs -- Chief Financial Officer

Yeah. Thanks, Alistair. I appreciate the question, Eric. Yeah, if you look at the Item 9A in the 10-K, you'll see some colors in there around because of framework and where things -- where the immaterial accounting areas that we saw were mapped to the framework and it will give you some sense of, sort of, what we saw about -- we are not going to talk about much more than that publicly. But as part of that -- as part of just our normal annual review of the effectiveness of our internal controls, we did recognize that we had these material weaknesses in the Clinical ASC 606 revenue. So this was part of our normal management assessment, process or controls and certifications part of what we do with our external auditors as well as then the audit committee independent review that Alistair mentioned.

So we went through all of that and, importantly, I think what I'd reiterate again is that we didn't have any restatements from what we saw and we didn't have any changes to the numbers that we were looking at as we started that independent review. So we're getting after the remediation work as quickly as we can and expect to be fully remediated here in 2019.

Alistair Macdonald -- Chief Executive Officer

Yeah. And just to add, sorry I just add on the end of that, I think it's important to note that just to be clear, we picked out this material weakness before we received anything from the SEC. So this is not linked to receiving that letter. We have come to this conclusion prior to that with external -- with our auditors and, as Jason said, start remediation work straightaway. So...

Eric Coldwell -- Robert W. Baird -- Analyst

No, that's great. If I could just quickly shift gears. One other item and overall I think it's impressive where you are with guidance given everything that you did highlight, it's a lot of work for the last year and a half or so. But first quarter EBITDA just a tad below the Street, not that surprising you've been there before and things have worked out fine, but you gave some color on 4Q seasonal drivers to the upside. I expect a reversal of that is really the biggest gating factor in Q1, but are there other factors in play that would -- have that sequential decline from 4Q to 1Q, perhaps be a tad bigger at least nominally than what we've seen in the past? I'll just leave it with that and cede the mic here.

Alistair Macdonald -- Chief Executive Officer

Yeah. So, Eric, the -- what you said is correct. That's a driver, those seasonal things do reset. We also have all of your other tax resets and things of that nature that flow through in the first quarter that also have that sort of pacing throughout the year, it creates that pacing throughout the year. So we also have that we've talked about previously, new large relationships that we are standing up in both businesses that we will see some drag from that early in the year and then start to see that come out. And if you look at the pacing overall throughout the year, which you alluded to, it's pretty similar to what we've seen in the past.

Eric Coldwell -- Robert W. Baird -- Analyst

That's great. Thanks, again, guys. I'll let others jump in.

Jason Meggs -- Chief Financial Officer

Cheers, Eric. Thank you.

Alistair Macdonald -- Chief Executive Officer

Thank, Eric.

Operator

Thank you. Our next question comes from the line of John Kreger of William Blair. Your line is open.

John Kreger -- William Blair -- Analyst

Hi. Thanks very much. Alistair, just given what you said a minute ago, can you just maybe fill us in on what your findings were from the internal review that you did over the last few weeks?

Alistair Macdonald -- Chief Executive Officer

So that internal review from the Audit Committee, as Jason said, we haven't changed any numbers, we didn't find anything in the review that we weren't kind of seen before in the audit, there's nothing really to add. There is no extra color around that. We are moving through processes as usual now. So we completed that, loaded that, review some of the friends at work to look through that and we're happy with where we've got through with it, Audit Committee is happy and we call it OK.

John Kreger -- William Blair -- Analyst

Great, thanks. And another similar one, are you able to expand it all on your commentary with the SEC either in terms of substance or maybe timing in terms of how their process will proceed?

Alistair Macdonald -- Chief Executive Officer

No, no, really. I mean we've told you pretty much all that we had. We got the letter from Division of Enforcement in 21st of Feb and we've had some (technical difficulty) dialog with them and we've -- we used kind of some of the areas they wanted to look at, which we put out in the press release around book-to-bill, revenue controls, and forecast to guide that internal review. So you can get a sense from that of where we've been laser-focused as we've gone back over kind of the 606 implementation et cetera. So -- and, as you know, back to what Jason said, we didn't change any numbers, we are pretty happy to have got through that process and be back where we are today following that and doing the earnings.

John Kreger -- William Blair -- Analyst

Excellent. Thanks. And then maybe one last quick one, you mentioned the strategic investments a few times on the call. Can you just remind us what sort of magnitude you're thinking in '19? And what you are putting that money on?

Alistair Macdonald -- Chief Executive Officer

Yeah. So we've increased the amount of investment over '18 in the prior years, this year. We're continuing to invest in Syneos One, we're continuing to invest in building our business development both across Clinical and Commercial. And I think we're seeing good benefits from that through the year. You saw the book-to-bill on the Commercial side creeping up over the target that we set for ourselves. So we're pretty pleased with that and then we get the return on that investment. This year we're looking at what we invest in and around our data and digital approach. We've launched, kind of -- well, we've launched the strategy that we've always had, using the best of what's on the market in our dynamic assembly model. We've done that before with tech, as you guys know, and we're doing it now with data.

So we will have to invest in that now, because obviously we got to integrate those -- the data together and drive the analytics and the insights and that kind of thing. So that's where we'll be spending our money. I think we've identified that those areas have helped us drive growth in 2018 and have helped us really integrate across the model and drive some of Syneos One success. Jason, you want to?

Jason Meggs -- Chief Financial Officer

Yeah. John, it's Jason here. Just to add to what Alistair said, so we had talked about $15 million to $20 million in 2018 in the areas that Alistair outline, which as he alluded to as well, we did see good progress and awards and things of that nature coming off that. So as we looked at our strategic plan and looked at what we wanted to do in '19, we did take that up to the $25 million to $30 million range is what we're looking at for '19.

John Kreger -- William Blair -- Analyst

Great. Thank you.

Alistair Macdonald -- Chief Executive Officer

Cheers, John.

Operator

Thank you. Your next question comes from Robert Jones with Goldman Sachs. Please go ahead.

Robert Jones -- Goldman Sachs -- Analyst

Great. Thanks for the questions. I guess just to go back, Alistair, not to beat this to death, but it's not something we come across all the time. It sounds like you're clearly very comfortable that you identified and rectified the material weakness and that didn't result in any restatements or changes to filings, but is there any sense you have from the SEC on, I guess, A, whether or not this addresses what their concerns or/and probably, more importantly, when they would proceed or wrap up their side of this investigation?

Alistair Macdonald -- Chief Executive Officer

Hey, Bob. No, I mean, what we said in the press release that we pushed out in the 12b-25, I think it's the number of the form and what we said today that's all we have. We are cooperating with the SEC in anything that they want, probably anything that we're concerned about in that regard. We don't know how long it will take or what it will constitute, but we are ready to continue that collaboration with them and that cooperation with them and get through it however long it takes.

Jason Meggs -- Chief Financial Officer

Yeah. And, Bob, obviously, Jason here, we will -- as appropriate, we will update the disclosures as we move through the periods, through the quarters, as necessary.

Robert Jones -- Goldman Sachs -- Analyst

Got it. And then I guess just on the synergies and the investments, strategic investments, you guys hit the number that you had put out there or raised for the full year of synergies, but not a ton of sequential synergies if I just look at what you guys have done cumulatively through 3Q versus what you did for the whole year, any sense you can give us on kind of what's left the pace at which we should think about that in '19? And then are the investments, Alistair, that you just touched on, are they bigger than what is kind of left out there to realize from an identified synergy standpoint?

Alistair Macdonald -- Chief Executive Officer

So -- as you have already identified there, Bob, we've accelerated a lot of our synergies through 2018 through integration and reduction of spend on licensing and consolidation of offices, et cetera. So that pace will naturally slowdown now between now and the $125 million by the end of 2020. So -- and -- the pace of reinvestment won't outstrip them. So there will be -- we will carefully be making sure that we reinvest appropriately in the business from the overall synergies gained.

Jason Meggs -- Chief Financial Officer

Yeah. I mean, Bob, in the prepared remarks I identified the $100 million to $110 million of realized merger synergies during 2019, which will be on the $76 million that we did. You can do that math there and then if we do have the strategic investments around that $25 million to $30 million, that sort of how we are thinking about that in '19. Do have more things that we are proactively doing in early '19 as we move through, whether it's -- it continues to be headcount related or procurement related or whatever it might be, lower cost opportunities that we might have in the operation. So those are the things that we're looking at in 2019.

Robert Jones -- Goldman Sachs -- Analyst

Great. That's helpful. Thanks so much.

Jason Meggs -- Chief Financial Officer

One thing, Bob, we still are on track, we're still targeting the $125 million by 2020. So...

Robert Jones -- Goldman Sachs -- Analyst

Okay. Got it, right. Thank you.

Alistair Macdonald -- Chief Executive Officer

Cheers, Bob.

Operator

Thank you. Our next question comes from David Windley of Jefferies. Your line is open.

David Windley -- Jefferies -- Analyst

Hi. Good evening. Thanks for taking my questions. I wanted to circle back to the, I think, kind of strategic partnership that you talked about, and I think Alistair you described it as a therapeutic area, therapeutic operational development transfer, something to that effect.

Alistair Macdonald -- Chief Executive Officer

Yup.

David Windley -- Jefferies -- Analyst

And I wanted to understand kind of the magnitude of that? What the clients' expectations are around that? And I think you mentioned that there is a minimum revenue amount that goes along with that, if you could give us any color on that, that would be great.

Alistair Macdonald -- Chief Executive Officer

Yeah. So this is something we've talked about with the customer. I think Q2 last year, in 2018, and put that in place in that period, and it constitutes the Syneos Health taking on employees from that organization, so rebadging them. And then as part of that rebadging, we've ops skilled ourselves in the areas that we talked about immunology, prosthetics, dermatology, translational sciences and that translational science piece enables us to -- on a stretch out Syneos One model one step further forward. So we can literally take people off the bench and into formulations et cetera. There is a minimum revenue commit around that from our organization for that period of time.

We will not disclose the value of that, because of thing -- that's some competitive information, but we're pleased -- I think we've created a relationship there or the expansion of an existing relationship that was a real kind of win-win for both of us. It enabled us to secure new talent in the therapeutic areas that we are seeing some good growth in, expand that Syneos One footprint into the translational sciences arena and also get that revenue commit for taking on some very talented people as well. So -- and it helps our customers achieve some of their corporate goals. So, we are pretty pleased to have got that done. So Jason, any...

Jason Meggs -- Chief Financial Officer

Yeah. Dave, I'll just add to that. There is that commit there. However, there's also -- we also received a large Phase III study that as well as other work that right now, we are seeing that ramp up. So the commit, while there we are relying less on that and just trying to get the teams up and working and running their study well.

David Windley -- Jefferies -- Analyst

And the revenue commit, it sounds like a basic structure and this will kind of fall into the FSP style bucket, are you -- the broader question is, how are you dealing with the backlog recognition related to this? Is it kind of the rolling 12-month FSP style or, I guess, a project that you just mentioned probably goes into more of a full service bucket?

Alistair Macdonald -- Chief Executive Officer

Yeah.

Jason Meggs -- Chief Financial Officer

That's right. That's exactly right.

Alistair Macdonald -- Chief Executive Officer

They are actually more full service orientation, Dave. So basically we just pull the revenue through as we execute that Phase III program. So it -- yeah, I mean, I can see why you think they would be more of an FSP style, it's actually more of a full service, because a lot of the people that we took in are actual therapeutic, they are therapeutically focused, not functionally focused and, therefore, we can expand that full service on the therapy side rather than kind of on the functional horizon -- horizontal kind of layer.

Jason Meggs -- Chief Financial Officer

I mean there is a smaller option of, Dave, that's -- just a real quickly, Dave, sorry to interrupt there, but there is a small portion that -- that's function on folks, but it's animal and the only thing that we put into our awards is that Phase III study that has been booked full service wise that we are running actively.

Alistair Macdonald -- Chief Executive Officer

Yeah.

David Windley -- Jefferies -- Analyst

Okay. All right. Good clarification. One last quick clarification. So you said guidance is based on current FX rates, it seems like CFOs in the space have had some different opinion -- different kind of views on what current means. Could you tell us is that March 15th, is that the end of February, is that January 1, what is current?

Jason Meggs -- Chief Financial Officer

That's last week.

David Windley -- Jefferies -- Analyst

Great. Thank you.

Jason Meggs -- Chief Financial Officer

You are welcome.

Alistair Macdonald -- Chief Executive Officer

Thanks, Dave.

Operator

Thank you. Our next question comes from the line of Tycho Peterson of JPMorgan. Question please.

Tycho Peterson -- JPMorgan -- Analyst

Hey, guys. Thanks for taking the questions here. So, Alistair, I just wanted to pick your brains a little bit on the overall, sort of, environment here. One of your peers pointed to a bit of a slowdown in RFP flow and elevated cancellations, possibly over-indexed to the small players within mid-cap biotech, was that what you were alluding to in terms of some of the similar dynamics that you saw? And what gives you confidence that this won't be a drag on the remainder of the year? Is it just, sort of, healthy pick up in 1Q year-to-date?

Alistair Macdonald -- Chief Executive Officer

Yeah. I'm not sure we've seen that slowdown really in those in that small- to mid-sector. I mean, we're coming (technical difficultly) in a couple of ways, does that say just, by the way, on the phone.

Tycho Peterson -- JPMorgan -- Analyst

Yes, it is.

Alistair Macdonald -- Chief Executive Officer

Yeah, it states. We are coming out of it with a couple of assets right now. So we've got the normal approach that we would take with full service Clinical, fit to those multi -- the SMID players, but also with the Syneos One model. And I think the Syneos One model resonates quite well in this. So maybe with the two models now looking at that, we're seeing -- we're maintaining a position and not seeing that dip. I got Paul Colvin here with us as well. Paul, any -- have you seen anything on that smaller to midsize on the Clinical side?

Paul Colvin -- President, Clinical Solutions

No, I see you hit the nail on the head there. We have not seen a decline in that sector. I think, again, as we ramp up some of our large partnerships, we're likely to see that helped from the pipeline growth as well in the future.

Alistair Macdonald -- Chief Executive Officer

Yup.

Tycho Peterson -- JPMorgan -- Analyst

Got it. And then just switching gears to Commercial here for a second, what -- any color that you can share on recent pricing trends? And is there anything that we should be thinking about in terms of lumpiness in the selling dilutions part of the business over the course of the year?

Alistair Macdonald -- Chief Executive Officer

Okay. When you talk about prices -- pricing trends, Tycho, you're talking about drug pricing or our actual pricing to our customers?

Tycho Peterson -- JPMorgan -- Analyst

Your actual pricing to your customers within Commercial? Yup.

Alistair Macdonald -- Chief Executive Officer

I think the environments. Tycho, Michelle's here. So Michelle, do you want (multiple speakers) on that?

Michelle Keefe -- President, Commercial Solutions

Sure. So first question on the pipeline. Our pipeline continues to be strong. As we've said, we're very confident about going into 2019 with (technical difficulty) we've said before that our selling solutions backlog has grown significantly from '18 over 2017. So we're going in with a much stronger backlog than we had previously. As you saw, our 12 months book-to-bill is at where we wanted, at 1.1. We ended up at around 1.16 for the full year. So the pipeline looks strong and the conversion more importantly looks strong of book-to-bill. And we are seeing more and more of integrated offerings and working closely with Syneos One to bring integrated offerings into the Commercial business line. So all those things combined give us confidence that we're in good shape for 2019 to achieve what we shared in guidance.

Your specific questions about lumpiness, I think a couple of things, when we look at the 59 products that were approved by the FDA in 2018, a lot of them are orphan and specialty products. And so you're seeing a much more diverse -- a larger diversification of the backlog of the kinds of services that we're delivering even in selling solutions. So there are smaller teams, there are integrated teams, they are not just sales reps, they have reimbursement specialists, they are multichannel, call centers, et cetera. So all those things are the reasons why we're confident in the guidance we just shared on Commercial.

Alistair Macdonald -- Chief Executive Officer

Yeah. I think one interesting stat that, Tycho, I think is, over the last 18 months or so on the Michelle's guidance and the build out that we've done on Commercial, we've seen a big transition from selling point solutions where we would -- I think we only have 5% of our sales. It's straight out of the merger that incorporated multiple service lines across the Commercial engagement. Now, we're looking at 55% to 60% of our sales have a field team, some support from digital comms, some support from the call center, reimbursement specialist, et cetera, et cetera. So we're building a lot -- we're building a very Integrated Solutions within Commercial as well as the Syneos One, so it stretches right across from Commercial into -- sorry from Clinical into Commercial as well, so they are help driving -- helping us drive that diversification of the backlog across the business not just in the selling solutions.

Tycho Peterson -- JPMorgan -- Analyst

Got it. Thanks so much for the color, guys.

Alistair Macdonald -- Chief Executive Officer

No worries. Thanks, Tycho.

Michelle Keefe -- President, Commercial Solutions

You're welcome.

Operator

Thank you. Our next question comes from the line of Erin Wright of Credit Suisse. Your question, please.

Erin Wilson Wright -- Credit Suisse -- Analyst

Great. Thanks. Can you elaborate a little bit on the cancellations. You mentioned the nature of the cancellations, was this across Commercial and Clinical or just Clinical and can you quantify how that business will roll off in 2019?

Alistair Macdonald -- Chief Executive Officer

Yup, sure. Thanks, Erin. So you occasionally get these spikes in cancellations, I guess that's the nature of the beast, right, in Clinical, majority of cancellations are in Clinical. I think, I mean, Jason, will give you a better call on that. But really through efficacy, regulatory changes, not really Syneos performance related, so it's just one of those timing things and I think we see -- well, we don't see as a trend as you look at -- when we -- obviously we see more detail, but you look at why they cancel it makes a lot of sense from an efficacy perspective and obviously there is the ethical obligations of stopping the trial that's we're already doing and I think so. But, yeah, you just got these peaks now and again I think we had one in 2017 and sometimes you just got a miracle, but we don't see as a trend, it's just slow peak. Jason, any more color on it for Erin.

Jason Meggs -- Chief Financial Officer

No. I mean the only thing I would add is that it was -- when we mentioned it, it was Clinical, we were referring to not Commercial Erin. And, as Alistair said, we don't have such a trend at this point and it's all factored into how we're looking at our guidance in 2019.

Erin Wilson Wright -- Credit Suisse -- Analyst

Okay, great. And you alluded, I guess, in the incremental expenses, I think, in the 10-K associated with the SEC investigation, is that something that's embedded in your 2019 guidance, or should we anticipate that that's excluded from an adjusted metric, or how should we be thinking about that?

Alistair Macdonald -- Chief Executive Officer

Yeah. Good question. It is not in the current guidance, it's too early for us to have a really good sense of what that will be. But as we've talked about it, the thought is that we would talk about that separately and show that separately from an ongoing operating standpoint.

Erin Wilson Wright -- Credit Suisse -- Analyst

Okay. Thank you.

Operator

Thank you. Our next question comes from Ross Muken of Evercore. Your line is open.

Luke Sergott -- Evercore ISI -- Analyst

Hey, guys. It's Luke on for Ross. Just kind of wanted to talk -- you seem to be gaining a lot of traction in those Syneos One, can you talk about -- just give us anecdotally what you guys are seeing win rates there versus peers with maybe just a data asset or just a full versus what your total offerings is?

Alistair Macdonald -- Chief Executive Officer

Yeah. Sure. Hi, Luke. So, we are basically the only people who have the offering. So, when we get in front of the customer, it's more of a moving outsourcing style than an RFP-driven thing. It's we're working with customers who want to be virtual, they're small to mid, maybe they are US based, some are into Europe or vice versa. We've got Asian customers who are connecting into as well, which is why I massively encouraging obviously.

I mean it's really think about it is as we actually push the asset all the way through the organization rather than taking point awards of all the different things that we could deliver. So once we get -- Christian Tucat, who we have promoted to the executive team has done a really, really nice job of getting this model launch with support from Michelle and Paul and all the SG&A team, because obviously we have to look at it right across the business of its impact.

Once we get that team -- of custom made just -- I think it makes the customers like so much easier, because they've got the compound, they've got the money, we've got all the operational capabilities, the advisory capabilities, the insights to be able to take them all the rest of the way. So they're dealing with one group who is going to take the asset all the way across the -- effectively a CRO and the CCO, that might be. If you did it yourself, it might be, what you reckon, 50 contracts, 50 or 60 outsourcing decisions, you made one decision at the beginning and Syneos Health -- the Syneos One team drives it all the way through the model with Syneos Health.

So I think it's a matter of -- it makes us really quite easy to work with to -- easy to do business with from that small company perspective and it's a significant spend for them. So it's on our radar. These relationships are $80 million to $120 million normally, something in that range, right? I mean they varies (multiple speakers) some of the bigger ones are. And that gets our attention even as a large organization, that's an attention grabber. So it's a good model, it's a unique model and once we get it in front of the right kind of customer, it becomes very compelling, I think.

Luke Sergott -- Evercore ISI -- Analyst

Okay. That's helpful. And then, I guess, just a little bit more on the margin cadence of -- through '19, you guys have the investment, probably in the first half and then also the synergies, kind of how does this offset themselves on top of -- you have the mix dynamic going on as well?

Jason Meggs -- Chief Financial Officer

Yeah. I mean, I think you hit a good bit of it there, also when you look at the first half, as I mentioned earlier, in addition to those items, you come out with the seasonal benefits again in the second half that we typically have, but also if you parse out the growth in between the two segments in the first quarter, early half of the year, as we're standing up some of these new Clinical relationships that we've mentioned, just a headwind early on in the year, so as we come out of that, it also starts to increase the margin percentage in the second half. So those are the things that we're looking at the synergies, the investments, the seasonal items and then standing up these larger relationships.

Luke Sergott -- Evercore ISI -- Analyst

Okay. That's helpful. Thanks.

Alistair Macdonald -- Chief Executive Officer

Thanks, Luke.

Operator

Thank you. Our next question comes from Sandy Draper of SunTrust. Your line is open.

Sandy Draper -- SunTrust Robinson Humphrey -- Analyst

Thanks very much. Most of my questions have been asked and answered, but maybe just a couple of quick ones. Just following up on the cancellation topic. Alistair, was there any pattern around any therapeutic areas that tended to get a little bit more, or was it really just spread out and just seemed somewhat random?

Alistair Macdonald -- Chief Executive Officer

Hey, Sandy, I'm just looking at my paper on that. I don't think there's any real patent to them in terms of therapeutic area, it's more random. (multiple speakers)

Sandy Draper -- SunTrust Robinson Humphrey -- Analyst

Okay. That's helpful. And then maybe not sure if this is for Jason or Michelle, in terms of the margin impact of some of the mix, revenue mix, putting more pressure on Commercial, when you think about that, is that something -- I know we're just starting '19, but when you think longer term, is this something that can bounce back year-to-year and just depending on the selling it, it snaps back and you could have a notably positive margin mix or do you think this is sort of a longer-term trend that the mix of business you're sort of going to be seeing for a few years is likely that, obviously, hopefully, you scale the margins up as you get synergies and you get it, but you're not going to have a big step-up because of mix or do you think year-to-year, we could see this type of movement? Thanks.

Jason Meggs -- Chief Financial Officer

So, Sandy, I'll start and I think if I'm not answering the question just come back please. But the Commercial business will see margin improvement in 2019. When you look at the different -- all the businesses are growing in the main and selling solutions, which is the largest business that has historically carried the lowest margin. Actually, as Michelle mentioned earlier, the growth areas underneath that and the type of field teams, the smaller field teams, the nurse educators, the reimbursement specialist, the MSLs, they carry a higher margin than your traditional sales rep, so we see a lot of things that are actually very helpful for the margin in that business after having a tough, sort of, first half of '18 from a margin perspective. Does that answer your question?

Sandy Draper -- SunTrust Robinson Humphrey -- Analyst

Yeah. I guess, that was really (technical difficulty) actually I was thinking, when I was flipping through the slides, I was looking at '18 comment about unfavorable revenue mix and you're stepping up, so I guess that goes back to the question of year-to-year, there can be -- it's about anything to general trend as more toward the better margin. I guess, I'll maybe rephrase the question.

Jason Meggs -- Chief Financial Officer

Yes. And then there is some things in 2017, Sandy, that were sort of one-time-ish, where a lot of larger field teams were coming down and you get sort of positive cancel fees or risk pair fees and things of that nature from that, that sort of one-time-ish. So that's some of that mix as well.

Sandy Draper -- SunTrust Robinson Humphrey -- Analyst

Okay. That's helpful. Thanks.

Alistair Macdonald -- Chief Executive Officer

Thanks, Sandy.

Operator

Thank you. Our next question comes from the line of Jack Meehan of Barclays. Your line is open.

Jack Meehan -- Barclays -- Analyst

Thanks. Good afternoon. I wanted to follow up on some of the commentary around the seasonality, appreciate some of the comments on the revenue line. I was curious what you're seeing on the bookings line to start the year. I know last year on the Clinical side, you got off a little slower, do you think that's kind of normal cadence you would expect this year as well?

Alistair Macdonald -- Chief Executive Officer

So we've been looking at -- well, I think, we're just a different organizations to what we were in the past. So we are seeing good RFP flow, seeing what we would expect to normally see quarter-on-quarter. I think we've got a better business development engine, I think we have got more engaged in a broader operational footprint that's driving great RFP flow. So I'm not going to give you any intra-quarter information on that, but other than to say I think the environment we're in, likely other have said is, it remains really strong.

Jack Meehan -- Barclays -- Analyst

Helpful. And then one follow-up on the guidance for 2019. Just looking at some of the adjustments I think share-based comp, $56.5 million, or quite a little bit of a step up from 2018, was there any change in the compensation policies or anything just worth noting on that line?

Jason Meggs -- Chief Financial Officer

No, I think Jack, it's Jason, I think we just had some things in '18 that were good guys with some turnover. And then, also, we didn't have a change in compensation, sort of, philosophy or methodology, but we did have expanded grants early in '18 that you're seeing come through for the full year without those good guys coming through in '19.

Alistair Macdonald -- Chief Executive Officer

Yeah.

Jack Meehan -- Barclays -- Analyst

Appreciate it. Thanks, guys.

Alistair Macdonald -- Chief Executive Officer

Thanks, Jack.

Operator

Thank you. Our next question comes from Daniel Brennan of UBS. Your question, please.

Daniel Brennan -- UBS -- Analyst

Great, thanks. Thanks for taking the question. I just wanted to ask a question on the -- back to the investigation, if you don't mind. Can you just comment that this was a formal or informal investigation? And did M&A from the SEC is like normal review like your -- of your financials, which we think is necessary as part of Sarbanes-Oxley or do they come from somewhere else maybe like a whistleblower or third-party?

Alistair Macdonald -- Chief Executive Officer

So, Dan, we have talked about -- that came from Division of Enforcement. So the letter arrived before we filed the K and I don't want to speculate on why we came to their attention. I mean, we'll find out as we get more engagement from the SEC as we go through the investigation. We've told you everything we've got. So we'll continue to be transparent and we've -- we did the extra work on the investigation, independent investigation by the Audit Committee, because we wanted to make sure that we implemented 606. We haven't missed anything fundamental and our (technical difficulty) so and that's what we've got and we are continuing to cooperate and engage with the SEC on their timeframe, but we don't know what that is yet and we don't know what they come and look at.

Daniel Brennan -- UBS -- Analyst

Great. Thanks, Alistair. And then maybe just on the Clinical side, can you just discuss we haven't done all the math yet, but kind of what's the implied burn rate in your Clinical guidance for the year? And how do we think about kind of that -- assuming that the burn rate is coming down, how do we think about it stabilizing? What are the drivers for that?

Jason Meggs -- Chief Financial Officer

Yes. So, hi, Dan, it's Jason. So we are -- we saw that stabilizes as you probably have noted in quarter four relative to quarter three in the first half. We are continuing to see our average project life lengthen. I think we're up to 52 months or something like that now from high-30s, low-40s, just a couple two short years ago as we're winning more oncology, where if, as you know, the large partnership we won in the second quarter is oncology. That's going to extend things out larger partnerships, generally speaking, whether it's oncology or what it is with larger studies tend to have a slower ramp and then we have some of our SMID customers that despite our best efforts, we just don't seem to get those moving as quickly as anticipated, although all within policy, it just doesn't move as quickly. So all of those factors are putting pressure on that burn rate. We are projecting it to tick down throughout 2019, but nothing quarter-to-quarter as significant as what we saw from quarter two to quarter three of '18.

Daniel Brennan -- UBS -- Analyst

Got it. Great. And maybe just one final one just on the Commercial business. Can you just discuss what the environments, like, on the large pharma, I know with Syneos One you discussed throughout the call kind of the trend and the excitement over VirtuOx [ph], I think with large pharma, what's the trend like? Kind of what you're seeing in the US and kind of overseas in terms of your appetite?

Alistair Macdonald -- Chief Executive Officer

Yeah, sure, let me start with that, Dan, and I'll pass over to Michelle. So I think the thing we are excited about is we're seeing engagement across all the sectors in Commercial, small to mid, 21 to 50 kind of group and the large pharmas, where we've traditionally had good connection, where the scale player in the Commercial space and we're using that to our advantage. Michelle?

Michelle Keefe -- President, Commercial Solutions

I think that's something that's evolving with large pharma and outsourcing is the way they look at outsourcing. They traditionally would outsource for capacity with sales representatives, that's the conversations with large pharma are candidly much more strategic than they were maybe three or four years ago, discussing opportunities to think through more holistically and integrated offering, what is the full commercialization strategy and which pieces of that strategy should be outsourced for flexibility and scalability. So we're having a much greater, I think, a different type of conversation with large pharma than we've had in the past and we're seeing some early successes and some of the more diversified offerings. And I think, Alistair referenced one feature around the fact that, we are now -- we just awarded a REMS program from a top 20 pharma company, which is a piece of our business and consulting that REMS around. So we're starting to see much more -- a differentiated way they're looking at it moving forward.

Paul Colvin -- President, Clinical Solutions

And Dan, this is Paul. I think just the continuity of service is, they're starting to think about that a lot more than they have in the past when you move from Phase III into late stage in real world, you can keep the same team and the same knowledge base. There's a lot of synergies to be add on by our clients. I think we're seeing more of those discussions occur on a larger scale.

Daniel Brennan -- UBS -- Analyst

Great. Thank you.

Alistair Macdonald -- Chief Executive Officer

Thanks, Dan.

Operator

Thank you. At this time, I'd like to turn the call back to Alistair Macdonald for any closing remarks. Sir?

Alistair Macdonald -- Chief Executive Officer

Thank you. As we've highlighted, we are well positioned to accelerate growth in 2019. Our pipeline of opportunities and RFP flow remains healthy, driven by our strategic investments and strong customer interest in our integrated outsourcing solutions. So thank you for your attendance today and for your interest and investment in Syneos Health. Have a great evening, and be good. Thank you.

Operator

Ladies and gentlemen, this does conclude your program. Thank you for your participation, and have a wonderful day. You may disconnect your lines at this time.

Duration: 65 minutes

Call participants:

Ronnie Speight -- Senior Vice President, Investor Relations

Alistair Macdonald -- Chief Executive Officer

Jason Meggs -- Chief Financial Officer

Eric Coldwell -- Robert W. Baird -- Analyst

John Kreger -- William Blair -- Analyst

Robert Jones -- Goldman Sachs -- Analyst

David Windley -- Jefferies -- Analyst

Tycho Peterson -- JPMorgan -- Analyst

Paul Colvin -- President, Clinical Solutions

Michelle Keefe -- President, Commercial Solutions

Erin Wilson Wright -- Credit Suisse -- Analyst

Luke Sergott -- Evercore ISI -- Analyst

Sandy Draper -- SunTrust Robinson Humphrey -- Analyst

Jack Meehan -- Barclays -- Analyst

Daniel Brennan -- UBS -- Analyst

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