Is Establishment Labs Holdings, Inc. overvalued or undervalued?

As of 20 March 2019, Establishment Labs Holdings, Inc. moved from a grade of does not qualify to risky, indicating a deterioration in its valuation outlook. The company appears to be overvalued, particularly given its negative P/E ratio and poor return metrics. Key ratios include a Price to Book Value of 28.91, an EV to EBIT of -21.81, and an EV to EBITDA of -25.67, all of which suggest significant challenges in generating profits relative to its valuation.
In comparison to its peers, Establishment Labs has a P/E ratio of -12.69, while TransMedics Group, Inc. is fairly valued with a P/E of 50.23, and Veracyte, Inc. is considered expensive with a P/E of 50.97. The company's recent stock performance reflects its struggles, with a year-to-date return of -11.98% compared to the S&P 500's 12.22%, highlighting the underperformance relative to the broader market.