Good afternoon, this is the DiaSorin's Call Conference operator. Welcome, and thank you for joining the DiaSorin First Quarter 2024 Results Conference Call. As a reminder, all participants are in listen-only mode. After the presentation, there will be an opportunity to ask questions. Should anyone need assistance during the conference call, they may signal an operator by pressing star and zero on their telephone. At this time, I would like to turn the conference over to Mr. Carlo Rosa, CEO of DiaSorin. Please go ahead, sir.
Thank you, operator. Good afternoon and welcome to the Q1 results. As usual, I'm gonna make a few comments, qualitative comments on the business, and then Mr. Pedron, our CFO, is gonna take you through the numbers. As usual, I'm gonna be making my comments at the constant exchange rate. So let's start saying that I believe we are leaving COVID behind. I feel that this has been the first quarter when we are from a business perspective. So not only from a revenue perspective, we really enter into the post-COVID world, and the good, bad, and ugly about it, but COVID is not a factor any longer. As far as DiaSorin is concerned, Quarter One was a great quarter if I exclude the COVID revenues and same scope of consolidation, meaning that if you remember last year, we sold Amnis after Q1, our CF business.
The business grew 7%, so it's in line with the higher range of the 2024 guidance. So what happened? Why is the business so good? I think what is very reassuring is that the business is good in all the three legs that, as you know, we cover. Our immuno franchise continues to grow very strong, 9%, quarter to quarter. We're gonna go. I'm gonna make some qualitative-quantitative comments by geography. But fundamentally, as you well know, the reason why immuno is so strong is because we do have a menu that is a specialty menu that works very well in all the geographies and is keeping us away from the path of the very large competitors.
And by the same token, we do in a specific geography like the US, we do have, I believe, a very solid winning strategy, when it comes to developing our business, in the hospital segment that continues to be the driver of the growth in the US, together with some success in the large commercial labs. But, primarily, our growth in the US is coming from the strategy, and I'm gonna add more color later. Molecular is back to growth, is +2%. This is due to the fact that, certainly, there was a good flu season in Q1. But by the same token, when it comes to the different quadrants we use to depict the business, we are doing fine in all the technologies that we offer.
And certainly, we are ready for the launch of the LIAISON Plex that, as everybody knows, will happen by June 1st. Finally, LTG, which is 4% up, which is almost incredible when it comes to if you listen to comments coming from our customers that do play in life science that are still experiencing soft quarters. As we, I think, discussed a few times, our LTG business is a combination of diagnostic and life science. So yes, we do experience some softness in life science, but certainly more than compensated by the growth in the partner's business in the diagnostics. So all in all, LTG back to growth. And then COVID, as said, you know, we have expectations of hitting EUR 30 million by year-end.
We are at EUR 9 million in Q1, so we believe that we should get to the EUR 30 million by end of the year. But again, from business perspective, COVID is becoming irrelevant these days. Now, let's go back, by technology first and I would say, or better, let's discuss about geographies, I think is more telling. Now, let's talk about North America and, again, ex-COVID. We had an excellent performance of our immunodiagnostic business. There has been growth of 15%, and this is, again, driven by the success of the hospital strategy. When it comes to molecular, +4%. And, again, this is, notwithstanding the fact that we are still in Q1 affected by the loss of the Cystic Fibrosis business. This is, by the way, the last quarter where we had business last year. So starting from Q2 is gonna be a clean comparison.
Without the CF business, growth is high single digit when it comes to molecular, so it's good growth. Primarily, this growth is coming from what we call the targeted segment, which means less than so monoplex or less than triplex. And this is a traditional molecular business that came from DiaSorin, based on traditional products in certain niches of the molecular testing, even like HSV, for example, for transplantation or some other application. And a chunk of it is ASR-related. And again, ASR, notwithstanding, you know, the recent discussion about regulations, our business of ASR, which is serving the LDT customers in the U.S., we believe it is gonna be shielded, whatever the decision is gonna be, because of two effects.
First one is that the new regulation under discussion is grandfathering in every application that is on the market today. And by the same token, what the FDA is trying to impose to the industry is the fact that if there is validation by some of these technologies and this validation is submitted to some agencies that do actually regulate LDT testing, that's okay. And the vast majority of the DiaSorin U.S. customers are large commercial labs or very large hospitals. They do actually follow this regulation. So just to preempt a question that I know has been coming our way, we don't expect that whatever happens to the LDT, we don't expect that to affect necessarily our business. So when it comes to the U.S., as said, immuno very strong and molecular strong and ready for the launch of the Plex.
When it comes to Europe, again, our European business is primarily an immunoassay business. As you know, traditionally, we have not developed our molecular business significantly, and we don't intend to launch the Plex in Europe. It's a U.S. play for phase one for DiaSorin. So if we look at the European business, the growth of 6% is actually primarily driven by our immunodiagnostic franchise, which is growing 8% overall, driven by continuous volume improvement and add-on strategy to a very vast install base of XL that we do have in the European market. Now, if you look at ex-Europe, ex-North America, that together do represent 85% of our business, and we look at the rest of the world, the business is slightly declining 3%. But it's actually a combination of two things: very good performance in China.
The very good performance in China means that in Q1, China did +13%. Although I wanna caution everybody, that doesn't mean that all of a sudden, China is back in business. It means that there is an effect of favorable comparison to last year where still Q1 was relatively soft due to COVID. And also, there is another effect on pricing. And this is because notwithstanding the fact that we have been awarded listing in the VBP, so we now have access to thousands of hospitals that did follow the VBP tender. That tender, that is, which we anticipated to start in Q1, really has been postponed to end of Q2. And so there is an effect of price cutting or price decrease that we were expecting, that is delayed.
Notwithstanding all of this, you know, China over the last year or during COVID times has always been a detractor to growth for DiaSorin. And when I made my comment at the beginning of this call and I said, "COVID is back, is finished," I think that also in China now we're back to regular business. That doesn't mean that again it's not gonna be challenging, but at least the market in terms of volume growth will provide a positive trend to our immunoassay business. Then before we get to the numbers, oh, sorry. Let me just finish up. When it comes to the rest of the world, the negative, or actually a constant perimeter, it will be actually flat. Then we are not growing because we do experience delaying revenues in the Middle East because of the current situation.
And I think it came up already a couple of years ago. We do have significant business, relatively significant business, in countries that today they're not formally under embargo, but clearly shipping products is becoming more complicated. And therefore this is the effect that you see there. All the other geographies where we are direct, Australia, Mexico, and Brazil, are actually growing high, say high single digit or low double digit, okay? So not a real worry as far as we are concerned. Last comment. As said, gearing up for the launch of the LIAISON Plex, all the manufacturing activities have been completed. Inventory now we have an inventory of all the products that we need to launch. All the training activities have been completed.
Our US sales force is now eagerly out, working with a very interesting customer base that is waiting for a reasonable solution for multiplexing, you know, that the strategy of DiaSorin, I remind everybody, is relatively simple. Plex does allow customers to achieve cost savings, significant cost savings vis-à-vis the use of other technologies, point number one. And point number two, which is also relevant, it does allow customers to being able to counter some of the issues that they are experiencing more and more with reimbursement because of the fact that more and more insurance companies are denying use of full panels and actually asking customers to adhere more to the guidelines which restrict the use of the target that are actually reimbursed, depending on a certain patient population. So, we are positive about the technology, positive about the launch.
I think we're gonna be then talking about it in Q3 and Q4. Now, P.G., please go ahead and take them to the numbers.
Thanks. Thank you, Carlo. Good morning. Good afternoon, everybody. Thank you all for joining DiaSorin Q1 2024 earnings call. In the next few minutes, I will make some remarks on the financial performance of DiaSorin in the first quarter. Then I will turn the line to the operator for the usual Q&A session. Q1 2024 total revenues at EUR 289 million are substantially in line with last year despite the expected decrease in COVID sales and the different perimeter of consolidation coming, as you might remember, as Carlo just reminded us, from the carve-out of the flow cytometry business in Q1 2023.
The business ex-COVID is growing in the quarter at constant exchange rate by 5%, which becomes 7% excluding the flow business, therefore in line with the higher range of the full-year guidance. COVID sales in the quarter accounted for EUR 9 million vis-à-vis EUR 21 million in 2023, down to a run rate of EUR 13 million, confirming our 2024 outlook, which is calling for nearly nearly EUR 30 million. The FX impact in the quarter is not material. First quarter adjusted gross profit at EUR 191 million or 66% of revenues is substantially the same as last year.
The carve-out of the Flow Cytometry business and all the initiatives aimed at improving operational processes and containing costs alongside a more structured approach to pricing allowed us to preserve margins despite the inflationary pressure experienced in the last 18 months, now muted, and the manufacturing costs we are incurring into to set up our new plant in Shanghai, which has not started the production yet according to our plan. I believe this to be a remarkable indicator of the success of our efforts to safeguard profitability. Q1 2024 adjusted operating expenses at EUR 114 million decreased by 1% compared to 2023 with a ratio of revenues of 40% in line with last year.
The fact that operating expenses have not increased despite the investment we have already discussed about a few times to support the MeMed acceleration program in the U.S. and the physiological yearly labor cost increase is a clear demonstration of our discipline in managing the cost base and the result of the synergies delivered after Luminex acquisition. Adjusted operating expenses negative for EUR 3 million are substantially equal to 2023. As a result of what we just described, adjusted EBIT at EUR 74 million or 26% of revenues is largely in line with last year. Adjusted interest income at EUR 2 million is slightly better than last year, mainly because of improved yield on our cash investment, whereas the adjusted tax rate at 23% is the same as 2023. Net result at EUR 59 million or 20% of revenues is once again very similar to last year.
Lastly, Adjusted EBITDA at EUR 97 million or 34% of revenues is in line with 2023 and represents a very strong start of the year considering that 2024 guidance is calling for a profitability between 32%-33%. Let me now move to the net financial position. We closed March 2024 with a net debt of EUR 749 million vis-à-vis EUR 776 million at the end of 2023. This improvement has been mostly driven by the free cash flow generated in the fourth quarter, EUR 42 million vis-à-vis 28 in 2023, therefore recording an increase of 50% or 14 million. The variance with last year is mostly due to the fact that in 2023, we had some negative phasing issues that have not repeated in 2024.
Lastly, we confirm 2024 guidance, which is calling at previous year exchange rate for an increase in revenues ex-COVID of 5%-7% with COVID sales at about EUR 30 million and an Adjusted EBITDA margin of 32%-33%. Please remember that, as discussed during 2023 year-end call, the guidance does not include any possible negative impact from the payback in Italy consistently with the position we took last year in the light of the latest legal developments. Regarding this matter, let me please remind you that DiaSorin, as many other, I would say almost all the other diagnostic companies in Italy, decided to continue its legal dispute, which might take three years before reaching its conclusion. We will keep on monitoring the evolution of this complex and changing situation and update investors as soon as something happens.
With that said, let me please turn the line to the operator to open the Q&A session. Thanks.
Thank you. This is the Chorus Call conference operator. We will now begin the question and answer session. Anyone who wishes to ask a question may press star and one on their touch-tone telephone. To remove yourself from the question queue, please press star and two. We kindly ask to use the handset when asking questions. Anyone who has a question may press star and one at this time. The first question is from Marianne Bulot with Bank of America. Please go ahead.
Thank you very much. Thank you for taking my question. Maybe the first one, could you please provide some color on what drove the 34% EBITDA margin in this specific quarter? And obviously, if you compare it to the guidance range, 32%-33%, that's a bit above.
So maybe could you comment on the phasing you're expecting for the rest of the year? Thank you.
Hey, Marianne. This is P.G. speaking. Yes. So we were expecting in our budget to have, let me say, a little bit better Q1 if I think about the phasing of our budget. So Q1 was slightly better than the following quarters, but actuals are a little bit better than our expectations. You know, there are many moving parts. It's not that easy to forecast variances of less than 1 percentage point. But nevertheless, I think Q1 came stronger than our expectations considering a budget in which Q1 is anyway a little bit higher than the remainder, the other quarters of the year. And this is mainly because of the phasing of our operating expenses.
If you go back and look at the phasing of our OpEx by quarter in the previous years, you would see that usually there is an increase towards Q3 and Q4, which is in our projection. That's how we built our projection. Nevertheless, once again, Q1 came in a little bit stronger than what we originally projected.
Okay. Thank you. And maybe if I can squeeze a second question, maybe more for Carlo, could you provide a little bit of an update on the LIAISON Plex and kind of what you're expecting into this year?
As you know, I can't. Again, the only comment I can make is that I think we did our homework. I believe that we have a strong positioning, which is, I think, should be understood very well, especially for people that have been following DiaSorin for many years.
You know, we have always positioned the company as a specialty company and pointing on the technical performance of our product. That was the immunoassay in, in a way, also, we continue we followed that positioning with our MDX products, right, where we, we go specialty. And this is where they're growing very in that franchise, by the way, including ASR is growing very nicely. In this case of Plex, it's way simpler because it's a financial consideration by the customer that can verify very simply, simply looking at the prevalence of the disease in their population of patients. And again, second element is usability. It's a way modern system than some of the platforms that are out there simply for aging reason. You know, some of those were launched 10 years ago. This is simply 10 years later.
I think it's a no-brainer, if I may define it, it's a no-brainer positioning. Okay. So I think we'll talk about it in Q3 and Q4 after launch. And, I'll give more color about what's happening in the US. And again, please, let's make clear everybody understand, is a U.S. launch because we do not intend to dilute our effort outside the U.S. And, we believe that, Europe, is, gonna be our second priority. But it's, it's a 2025 story. The whole company is focused on a successful US launch that, as everybody knows, does represent 70% of the syndromic market.
The next question is from Andrea Balloni with Mediobanca. Please go ahead. Yes. Good afternoon.
Thanks for taking my question. My first one, is a follow-up on Plex.
If you can give us an update in terms of the feedback you are receiving from your clients. And my second question is another follow-up again on margin. I understood your point, that Q1 was expected to be anyway stronger compared to the rest of the year. But I also understood that it was even stronger compared to your expectations. So I was wondering if we can assume for the full year profitability closer to the top range of your guidance, which is in the region of 33%. And my very last question is on the immuno division that has reported a quite impressive trend in Q1. If you could elaborate a little bit on this growth and of a main driver in terms of test in case you have experienced any rather strong performance for some specific product. Thank you.
Andrea, I will take the last question, right, on immuno and the Plex. And then, I think, P.G. is gonna elaborate on the rest. Look, immuno. I define immuno here as a carrier in the fleet because it's big, it's solid, it's based on a complete menu. It's working off an install base of thousands of systems, very much appreciated by our customers. And it continues to be the result of a strategy that was devised 15 years ago and has always been very successful, as I think we discussed many times, for a very simple reason. We have been extremely careful to stay away from the path of the gorilla and very focused into specialty areas, which do provide interesting opportunities if, again, you are global, you have an install base, and you have a credibility with your customers.
More specifically, I believe that, if I may name some, QuantiFERON has been a very successful partnership with our friends at Qiagen. They've done a phenomenal job in building a franchise on QuantiFERON. And the fact that they transition to a recognized QuantiFERON platform clearly is providing to customer easy access to products, a product that is still growing in terms of demand worldwide. So it's making a very good test very much simpler. Second is a stool franchise that is growing even more than our QuantiFERON. They go quite often together because it's part of this set of specialties that customer want to see perform together in a platform. And that's great.
And so also there, you know, the competition that we have is pretty much our ability to continue to supply good quality and work with customers to provide clinical data to support the adoption of this assay. Lastly, that I want to comment, you know, we never discuss about it. But at the end of the story, a similar size of business is our infectious disease franchise and the hepatitis. And, you know, if you look at our hepatitis menu together with our HCV menu because of the fact that, you know, for example, hepatitis C, today, because of the availability of treatment, the use of it is increasing dramatically around the world. And the testing clearly is important for the diagnosis. We do enjoy a very nice growth as well in this what you would call me-too product line.
Me too, meaning that the gorilla all the gorillas are gorillas, have it. But as we have indicated several times, we are not only a specialty company. We drive placements through the specialty. And then we get customers also to use some of our high-quality infectious disease products. So long story short, I believe that, together with the hospital strategy in the U.S., we've been talking about it. We've been executing on it. We have been investing on it now for many years. And the fact that we now bring to the market innovation like MeMed, for example, which I keep saying has a very tangible and very much intangible value for DiaSorin because it's a door opener for the assay and others to come on the same box.
And to come, we have the LymeDetect, which is very exciting for me because of the fact that it does solve a clinical problem for customers. And more than that, I believe that we were able in the U.S. to find special relationship with some of the major operators that are gonna help us actually to diffuse and educate the customers. So all in all, I'm very, very comfortable with the position of our franchise. When it comes to Plex, Andrea, I believe I said enough, right? Now, jury's out. It's a simple message. I'm you know sometimes I'm saying, as it happens, in many cases with technologies, you get to a point where you need to democratize technology, meaning that that typically happens through either an effect of price.
We've been there with vitamin D, by the way, many years ago. But it happens all the time. The second way to do it, if it's not price, is just make it for the customer reduce the cost in use, which is what we are trying to do. So, I believe that the business, which have been developed in an incredible way by BioMérieux, they did a phenomenal work educating people and explaining syndromic, getting reimbursement. Now it's big enough that it requires a sort of innovation, both, I would say, from smaller panel, yes, although we all know that the vast majority of the business is respiratory, or by innovation in the way that the test is performing. And I think we're bringing to the table a new concept in terms of the way to use it, okay, flexibility to customers. That's it.
Hey, Andrea, this is P.G. Ciao, Andrea. This is P.G. speaking. Going back to the margin question, you know, you really need to allow us some flexibility here. It's just the first quarter. What I can say, I guess, is that I feel very comfortable with our guidance, which, let me remind you, is calling for 32%-33%. I think it's early days to say if it will be more close to 33%. But certainly, it has been a good start of the year, and a little bit better than what we expected, which is encouraging. And then we see we have three more quarters in front of us. But once again, I'm happy with how we started 2024.
And thank you, P.G. And just to follow up on the margin, clearly understand your point.
Just wondering if you see anything that could go wrong in the next three quarters that could affect your profitability.
No, the big question mark, I again, you know, I already discussed about the payback thing, right? But there, you know, it's gonna be long. It's gonna take three years. So I don't think it's gonna be an issue over the next three quarters. And then, you know, it's very difficult to say. I mean, I from the visibility I have now, I would say, difficult to imagine some material headwind. But again, you know, more than that, I don't have a crystal ball, right? So I cannot tell you if everything that we think might happen has been incorporated in our guidance. Let me put it differently.
Okay. Very clear. Thanks a lot.
The next question is from Giorgio Tavolini with Intermonte. Please go ahead.
Hi. Good afternoon. Thanks for taking my questions. The first one is on the ARIES conversion. I was wondering how it's progressing, if you have already withdrawn most of the platform. So basically, you migrated most of the 70% of the client that you were targeting on the to the LIAISON MDX. The second one is on the QuantiFERON. I saw we saw some headlines very recently regarding a launch of a new automated fully automated product for the diagnosis of tuberculosis testing by a U.S. player. So I was wondering if you had any comment on this competition, if you saw any competition from this product, and if you are still targeting the registration in China for the QuantiFERON in 2024, so when we should expect some update on that. Thank you.
Giorgio, I will take the QuantiFERON one. I think what you are referring to when it comes to the new launch, a new automated assay, is the Oxford, which is, it's an attempt to, let me say, automate an assay that fundamentally is a very, very nice research tool, but it's very difficult for it to become a real product to the market. In fact, if you look at where the assay is used today, to my knowledge, the only significant volume done with that assay is at Quest. And Quest is actually using for half of their business, I believe, the QuantiFERON, traditional QuantiFERON assay. And half of the business is with this technology. But they are offering it, they offer it in terms as an, as using an LDT that they develop.
So using a product that fundamentally they bought is a facility, a lab, where they perform this assay because it's extremely complicated. So it is very difficult to be decentralized. So not a worry, to be honest, with you. When it comes to QuantiFERON in China, yes, we are doing clinical studies. You know, these days, the registration in China takes forever. But yes, we are doing clinicals with Qiagen to get the registration of the LIAISON product in the Chinese market. The Chinese market is vast in terms of clinical issues, meaning that TB is an issue in China. It's a relatively small market when it comes to testing because still they do either they don't test or they do a lot of skin tests and/or they do X-rays. Okay? So it's an opportunity, certainly.
It's a market to be developed, but nothing comparable to what we see as an opportunity clearly in the U.S. and in more established markets. And the ARIES conversion, yeah. The ARIES conversion is ongoing. We made the last manufacturing lot in April, distributed to customers, and proceeding to the conversion. I think that we're gonna achieve easily the target that we indicated. But it's, from a revenue perspective, a relatively small business. I think that it is needed for us. The real added value is that we reduce complexity in manufacturing, in service, and so forth, because we expect that the uptake of the Plex will clearly need those resources. And this way, we actually did it, okay? And it is our intention to kill it as fast as possible exactly for this reason.
Thank you, Carlo.
The next question is from Kavya Deshpande with UBS. Please go ahead.
Hi guys. It's Kavya from UBS. Thank you for taking my questions. I've got two, please. The first is on the immunoassay business. So I was wondering if you could provide any color on the number of U.S. hospitals that you've added to the customer base, just how much progress you've made on the target outlined at the investor day of I think it was 600 by 2027. And you were around 300 at the end of last year, so that would be great. And then my second question was around reimbursement pressure and multiplexing. It's been picking up a lot of press as well. And you said that you're also seeing increased cost sensitivity driving more interest in the Plex. Is this budget pressure affecting mainly smaller labs in the U.S., or is it more broad-based?
Thank you. Hi Kavya. No, it's actually the concern is nothing to do with smaller or big because it has to do with the payers. And therefore pressure is on. And it makes sense to rationalize testing because honestly, if you look at clinical data, it doesn't make sense to use a multiplexing with 17, 18, 20 targets as a screening pro screening meaning everybody's showing up with a symptom. You run 20 tests. It doesn't make sense. And you start to see rejections because they're where there was a very specific reimbursement scheme that would allow you to do perform up to the full panel to a certain population. And I think my sense is that hospitals and commercial labs have been actually using it outside these boundaries until recently. There was not nobody was paying too much attention.
But then, starting from the Palmetto moving forward, that there has been increasing attention because it's a lot of money in terms of reimbursement. And so yes, I think this is the right time to bring a product like Plex to the market because you're providing an answer to a concern, okay? On the immunoassay, on the hospital strategy, look, I think we've said it a few times. We have mapped the U.S. opportunity in terms of how many hospitals out there would fit with the DiaSorin product offering, right? And we said, around 2,200 hospitals, give or take, would actually be the market, available market in the U.S. for the kind of system we offer, the kind of menu we have, and so forth. And today, we have roughly 350, right, roughly, that we are offering, that we're serving.
We have, fundamentally, an objective, a target, to add 100 per year, right? And we do have, and this is what we have been experiencing when we started this program. And we continue to see requests. And we have a backlog, actually. We have a backlog of 2 months of installation in the US because, as said, we are, you know, we are, you know, you've been sent to work with DiaSorin recently. But we are known to be cautious when it comes to OpEx. And so, we have what we would believe is the right infrastructure to serve the business at a reasonable cost to the business, right? So long story short, we have a runway. We have, I think, a very positive response from customers now for a few years. We have the menu.
We are adding to the menu. What to me, what is very relevant, Kavya, is that, we're not relying you know, we're not riding the wave. We are getting ready for the next wave with, with assays that do go to the same account. So now, you are gonna feed the base. And, and this is the, LymeDetect. This is what we discuss about the Calprotectin 3.0 plus a series of products that we don't talk about, which is interesting, which, goes back to the DiaSorin 2.0, so the phase two of DiaSorin life, which, every year, we continue to launch, two, three products that we call fillers. And these fillers are actually they go on the installed base. So they don't revolutionize diagnostics.
They go back to the basic principle of making diagnostics simpler for these customers, right, which do contribute, certainly, to the growth and to the appreciation of our product offering. Sure.
Thank you very much. That's very helpful. Thank you.
The next question is from Gaurav Jain with Barclays. Please go ahead.
Hi. Thank you. Gaurav from Barclays. So I have two questions. One is on your organic growth rate. So we have seen from a lot of your competitors that pricing in hyper hyperinflationary countries like Argentina, Egypt, Turkey flattens the organic growth rate. So would you be able to quantify for us, you know, how much would be the benefit to your organic growth rate from, from, from this dynamic? And second, my question is, you know, again, on the margin questions that were asked, so correct me if I'm wrong.
But I think your immunodiagnostic business is lower margin because you have the royalty payment to Qiagen. So despite the fact that your lower margin business is growing at a higher rate, your margins are still expanding, which would mean that your underlying margins are expanding even more than what we see on the first page of your results. So is that the right way to think, that your underlying margin expansion is happening despite an adverse mix shift?
Gaurav, listen. I'm a little bit embarrassed because immunoassay is actually not diluted. It's actually the franchise that traditionally is pushing the highest margin. So the fact that in the mix, immunoassay growth grows, it actually pushed the margins in the right direction.
Then we have discussed about the fact that, within the immunoassay, the fact that, we pay royalties to Qiagen is diluted to what the margin should be. But the growth doesn't come also only from Qiagen, from TB. And therefore, overall, certainly, Qiagen would be diluted if it would represent 100% of the growth. But it does not represent, clearly, 100% of the growth, okay? I'm a little bit lost in the first question because, Argentina—can you just repeat it, just one second, what the question was about?
So, see what has happened with some of your peers. Let's say you have, you know, just for numbers' purposes, let's say you have a business of 100 in Argentina. And the currency is depreciated by, let's say, 50% for everyone.
What a lot of companies have done is that they increase prices by 100%, okay?
So that, that. Gotcha.
50 becomes back 100. But on the organic growth rate, you're essentially showing a 100% revenue growth rate in Argentina but practically, it's zero. So, how can you just remind us, how do you account for these hyperinflationary currencies?
Listen, fortunately, most of the business by choice is 85% of our business is U.S., beautiful U.S., and in Europe. Unfortunately for us, Turkey and Argentina, all these lovely countries are not a market. We are actually working in markets like Mexico and Brazil and India where you don't have this problem.
So long story short, by geography, by the mix we have, we don't experience this effect of having to increase pricing or in opportunity, depending on your seat, increasing pricing in markets where you have a very high inflation, which I thought was your question, right?
Yes. That's exactly what I was trying to address.
Okay. Thank you.
Thank you so much.
The next question is from Shubhangi Gupta with HSBC. Please go ahead.
Hi. Thanks for taking my question. So my first question is on your guidance of 5%-7% ex-revenue growth. So if especially related to the life sciences business, or the LTG business, so if we think about the larger life science peers, most of them are talking about H2-weighted recovery.
What are your assumptions about life science recovery, and what are the assumptions that's built into the guidance? Second, on the margin phasing, so you mentioned that you haven't seen VBP impact, which was anticipated in Q1. You expected from end of Q2. Should we think about Q3 and Q4 having like a headwind from this VBP impact on margins? Thank you.
Hi Gupta. Listen, let me start from first from VBP. It's very marginal. Let me put it this way. I think we were talking about EUR 3 million. Yeah. Annualized. Yeah. Right? And now, what we are seeing, which was embedded in the number in our forecast, and now we see that you know, the 3 millions are not gonna be there simply because VBP has been pushed right to second half of the year.
We are talking about very small numbers in terms of in terms of effect. By the same token, I believe that the fact that we are in the VBP list so now we have been granted access to thousands of hospitals that are in that list. And now they can buy from us is providing an opportunity. My comment was more related to the fact that +13% in China in Q1, which is a great result, should not be taken by anybody like saying, "Hey, you know, China is back to double-digit growth because we continue to see that China is; we need to watch out. China is an opportunity long term. Short terms, there are a lot of question mark on that business, which again for us overall is less than 3% of our turnover. So again, not marginal.
When it comes to the guidance. LTG. What do you think is gonna happen? Look, we said that it is gonna be, you know, now, fundamentally, the 4% that you saw is a combination of decline in life sciences, everybody is reporting. Because don't forget, we fundamentally, we sell to the companies that then eventually sell to the life science customers. And so what they report is fundamentally reflected on our numbers. And so our life science business is declining. But by the same token, you know, as everybody, not only DiaSorin but several companies are reporting good numbers on the immunoassay side, our diagnostic franchises does benefit from this success. If in the second half we will see a recovery from life science, certainly we could have a positive impact on our LTG business, right?
That's a fair determination. But at this stage, I think we should really be waiting and seeing what happens in the summer.
Thank you. And if I could just squeeze in one quick question. So regarding the immunodiagnostic business, can you give a sense of what part of it is QuantiFERON?
Gupta, I'm afraid I would love to give it to you. But I would give to every competitor that is listening to this call. So I'm not. I cannot disclose that number.
Okay. Fair enough. Thank you.
Thank you. The next question is from Odysseas Manesiotis with Berenberg. Please go ahead.
Hi. Thanks for taking my questions. Firstly, Carlo, I understand most of your licensed tech customers may include larger labs. And they have gotten their LDTs cleared already, hence not quite impacted by the ruling.
But wouldn't the FDA ruling on LDTs affect new business by making it more difficult for customers working with new LDTs using your xMAP platform?
Again, we are not talking about, so our ASR. We're talking about our ASR business, right, ASR? Okay. The ASR business actually goes on the MDX platform, is not an LTG business per se. And as I was saying before, it's a business that DiaSorin had prior to the Luminex acquisition, nothing to do with Luminex. And as said, I don't see this, so honestly, an effect on this one because the customers that we serve do already go for licensing and certification for their LDT applications. You know, the ASR business is being a molecular business.
Initially, 10 years ago, it was fundamentally very much widespread in the US, with mid-large and mid hospitals. What happened because of the fact that there has been an increasing pressure on technicians and experienced technicians and PhDs that are actually needed to develop these assays, fundamentally, today, the business is concentrated with few very large customers. And yeah, talking about Quest, Labcorp, Sonic, Kaiser Permanente, the major teaching institutions in the U.S., which do have resources today to actually do validation and submit for licensing. So this is why I'm saying, if we are gonna have an impact that is gonna have an impact. Their regulation is gonna have an impact specifically on our business.
Understood. So from what are you saying, for your royalty business, on the licensed tech side that's not marketed as an LDT?
No, they're not. Actually, you know, now I understand your concern, your question. The diagnostic side of our business, of the LTG business, okay, is actually made of diagnostic companies, very reputable companies. I cannot name them. But you can maybe if you look at the product category, you know who they are that actually have 510(k) products. So you're talking about a legit diagnostic IVD product that are registered and sold in Europe, the US, and China, all across different geographies, and are registered. So that is not touched at all by any LDT because it's not an LDT business.
Understood. Thank you very much. And one last follow-up, if I may. So on QuantiFERON pricing, given the lower competition here, would it be fair to assume that this is your most profitable immunoassay?
To help with modeling with potential competition, would a 20% price cut here be very material to margins? Is there any metrics you could help us with?
Again, as said before, I can't, but I can make a statement. It's certainly not the most profitable assay that we carry. You know, in this business, the margins come from things that you make that you spend money in R&D. You develop. You register. You manufacture yourself. We have our immunoassay portfolio is, what, EUR 600-700 million, give or take? And the vast majority of it is DiaSorin-made. QuantiFERON is a product that adds value to the platform, certainly, because of the increasing use of it.
It does carry a satisfying gross margin but is not to the level of everything else we make and does not represent, if you compare it to our overall business, such a significant business that price increase would be significant for DiaSorin.
Price decrease, sorry, not increase,
decrease.
All very clear. Thank you for taking my questions.
The next question is from Maja Pataki with Kepler Cheuvreux. Please go ahead.
Hi. Good afternoon. Thanks for taking my questions. I have three, please. Thank you very much for clarifying on China, the EUR 3 million. Could you remind us what kind of pricing impact you were embedding in these EUR 3 million? That would be my first question. My second question, Carlo, could you elaborate a bit on how the sales process is gonna work for the Plex because you have the panel price.
But then, you also have the credits. So, are you, is it going to be that, basically, all the products will be the basic panel prices, like, whatever it is, whether it's 60% or 70% of the entire panel? And then, there will be just a continuous credit system filled up on at the client side, which they then can use just to understand a bit the billing process, how that works. That would be very helpful. And then, my second question, also to you, Carlo, please. Prior to COVID, the outpatient part of the syndromic market was around 20%. That was hotly debated back then, when the first Palmetto cut came. Where do you think or how big do you think the outpatient part of the syndromic market is today in the U.S.? Thank you very much. Okay.
Let me start from the last, the last for the best. From our current business, it's 50/50, give or take, give or take, right? So we do have a syndromic business, as you know. And today, we see 50 outpatient and 50 inpatient. Second question, which I love, the Plex kit, is a very simple concept. So you buy a basic panel, which is made of 7, 8 results, right, which are the most common, prevalent viruses, bacteria that you experience in your population. And you pay a price. Then, you run your assay. And, if you wanna, on a certain account, on a certain patient, you really want to you know, you run the basic panel. And it's negative, right? It's negative. Now, you suspect that, well, it's not the one of the prevalent ones. It's one of the most, rare ones.
Then, you have a credit that you buy. Just, for reference, okay, and it's not the actual price. It's just a simple number. It's $1. So you buy one credit is $1, okay? You buy the hospital buys 500 credits. And it's a QR code, right? And, now, they wanna, on that specific patient, they want to open up results. So they download from the credit they bought $1. And then, they open a result. And they wanna do another one, another $1, another result, and so forth. It's a very simple one. It's managed through the software, the system. And it's very intuitive and very simple because you buy, fundamentally, two things, right, as a customer. You either buy the kit. And that comes with the basic panel. And then, you buy a credit, right?
It's like your telephone, if you think about it, when you were buying the cards to be used on the phone, it's the same story.
And can I just have a quick follow-up here, Carlo? The credits, I guess, they can be downloaded, they can be purchased immediately online, 24 hours, right? That's so super easy. So in case it's not possible that your customers will run out of credits. And they didn't notice. In such a case, they could just go online and immediately download credits like with a computer game or something.
No, actually, it's different. Since you expect that you may have an emergency. And you don't have credit, we do allow them to have a certain number of not negative credit but minus coins. Minus coins. They can actually overuse, right?
And then, next morning, they can buy and fill it, right? So it's not that you if you are at zero, you're locked out, right?
Okay. Got it. And just two clarification questions, please. You referred to your split outpatient, inpatient 50/50 for the existing Luminex business. Do you think this is representative of the market? Or do you think it is more, you know, it was very Luminex-specific? And the second question, the 7-8 pathogens that you were giving us as a basic I guess that was just a reference. It's not 7-8 patho gens that you will have in the basic package.
Now, don't forget. I'm a CEO of a EUR 1.2 billion company. I don't remember the details about the market. So outpatient, inpatient, I can refer to what it is.
Certainly, I'm gonna get myself educated and come back to you with a better number. But today, keep in mind that our business in the U.S., the Verigene I business, is, fundamentally midsize hospitals, and commercial labs. So I would expect that what we see is, fairly representative of what the market is today. But Maja, please, on this one, don't quote me because
no, no.
I won't. You know,
I you know. It's okay. I was just wondering.
Yep. I think you had a question. VBP. Yeah. On China, it's 50%. This is what you're proposing.
Sorry. 50 or 15?
I didn't. No, I wish. It's 50. I mean, this is true for.
Okay.
It is true for everybody. Fundamentally, this VBP has been issued for this. But you're talking about 8. So the VBP was taking care of 17 products. Yeah.
Around 17 products, right? 23 provinces. Hepatitis and some of the thyroid, some of the, the chemiluminescence products, high volume. It was pretty much everybody, I think, participating and being awarded, had a price c ut in the range between 50%-60%.
Okay. Super. Great. Thanks a lot.
The next question is from Aisyah Noor with Morgan Stanley. Please go ahead.
Hi. Good afternoon, Carlo. And Piergiorgio, thanks for putting me in. Just three quick questions. The first one is, where are adoption levels today for MeMed? And do you think it's growing at a level where it could be a significant contributor to growth in 2024 or 2025? Second one is also on MeMed. There was announcement from MeMed this week that they chose Beckman Coulter to distribute the MeMed BV test on their MeMed Key platform, which is FDA cleared.
Do you think this might compete for your volumes among the hospital customers you currently have? Or will it be complementary to your approach? And then, the third one, just a clarification question on China. Did I hear correctly? It was 13% growth in Q1. And you are expecting positive growth for China in 2024 because this would be somewhat more optimistic than what your peers are expecting from China this year. Thank you.
You know, I'm not an optimistic guy. So difficult for me to be optimistic. China, I'm saying that, 13% was a great result in Q1. But I don't think you know, I said, nobody should get overexcited because I share concern. And, actually, I was one of the first to say, "Hey, watch out on China." I share the concern that the market is a difficult market. So Q1 was a surprise.
It was, though, a favorable comparable because last year, Q1 was still very light in terms of volume because of the tail end of COVID. I'm saying, moving forward, I expect that 13% to be diluted for because now, you are comparing to normalized situation. And also, you are back to where everybody is, you know, price cuts and so forth. So, at the end of the, I believe that we may end up closing the year flat or modest growth. But certainly, there is no reason why we should continue to grow double-digit. So, MeMed. Okay. Let me start with Beckman. I think, listen. First, I always stated that good news, there are more people in this playing in this field because the major hurdle today in developing the business is educating people.
So the more you educate, the more the better it is. The announcement about the strategic relation and MeMed and the Key distribution, we do have the Key distribution ourselves since the beginning, right? And why is it? Because, and this is what Beckman Coulter will not be able to offer. When it comes to this test, you always have a hub-and-spoke strategy because you go to these hospitals you know, these hospital networks in the U.S., quite often, they have a core lab, central core lab. And then you have the actually smaller clinics where they shut down all the labs. And they left emergency, right? So when you go to this hospital network, you need to be able to provide, in the center, a higher throughput machine. And in the periphery, the for emergency, a smaller platform.
We adopted, since the beginning, the Key as, clearly, the element that allow us to provide a full solution for the customer, that Beckman today doesn't even will have when they're gonna be launching on their high throughput platform, the, the product, okay? MeMed. Overall, as said, we will, I think, make a comment on MeMed, I at the end of the year because we are gonna have enough experience with the uptake in terms of transforming the adoption into guideline. You know, I think I made a comment, saying that the problem with MeMed has nothing to do with the clinical validity. Now, it's been validated to the moon. There are publications on New England Journal of Medicine, Lancet. MeMed itself did a great, great, great job with doing that.
The problem, again, is for a busy doctor to go and say and take it and put it in the guidelines so that, when the patient comes in, the patient is actually tested. It's part of the algorithm of the hospital. And what does it mean? And why is it so difficult, everybody's saying? It's very simple because, either you say, you know, everybody walks in with a certain symptom and get tested, which it doesn't happen. Or the doctor should say, "Okay. If you walk in and you are pediatric, you always get tested. Or you are immunosuppressed. And you always get tested." You don't. They do with an assay that has a certain cost; they don't test everybody that walks in the room, okay? And this is what I call education.
So, maybe to better qualify it, the education is not a clinical education. I, I feel these days because, and some of you called hospitals and called doctors and say and said, "Hey, what do you think about MeMed?" And everybody said, yeah. We know it is a great product." So that, that door is open these days, is more put it in practice, make it part of a guidance, and then start testing. And again, as said, we're gonna comment on it, by year-end. But I think I reiterated this concept several times. For the assurance, specifically, that it's not a one-trick pony. But we make our living in immuno with 120 different products we offer. MeMed is a phenomenal door opener because it's an innovative assay. And customers and hospitals really wanna hear, hear us talk about it.
And when you open that door, you open the door with also the traditional products, right, that we can offer. And this is why I'm saying there is an immediate value that is intangible, meaning that open the door and start selling stool while the doctor is working on actually, getting the guideline ready so that on that box that we are placing now, add also MeMed. Hope it's clear.
That's very clear. Thank you.
Thank you, Aisyah.
The next question is from Hugo Solvet with BNP Paribas Exane. Please go ahead.
Hi, guys. Thanks for taking my questions. I'm left with two. First on the U.S. launch for the Plex. Just a clarification. Is it something that could move the dial in 2024 relative to your guidance? And what actually begs into your guidance in terms of install-based or sales? If you can clarify a bit here, thank you.
Second, just a follow-up on MeMed. Are you able at this stage to maybe give us a bit more detail on how you guys will split market access with Beckman Coulter? I'm not sure I quite understood your earlier comment, Carlo. And maybe, if you can, give us a bit of a better understanding on what's the overlap between your installed base and that of the other partner of MeMed. Thank you.
No, Hugo, sorry. I don't understand, actually, the second question on Beckman Coulter, on MeMed. Let me, and then PJ is gonna take the one on Plex. I'm saying today that what was announced yesterday by Beckman Coulter if this is your question what really they announced? They announced that they took distribution of the MeMed Key. MeMed Key, sorry, I gave it for granted. But it's the small very small system.
It's a mono test that MeMed has in the U.S. They don't distribute. They try to distribute it themselves. And then they fail because clearly they didn't have a commercial organization. And it's one test at a time. And it's very good for the emergency department, so very small labs, you know, as soon as because it's one test at a time. As soon as you know the volume goes up, then it is oh, honestly worthless in a hospital system where they have the hospital system is organized with one core lab serving 10 hospitals and then 10 emergency small labs in the periphery. In the periphery of the hospital, in the smaller clinics and so forth.
It is very relevant to provide a combined offer where you offer the MeMed Key for the, you know, small clinic emergency rooms. And in the core lab hospitals, you put your high throughput analyzer. So the LIAISON, since the beginning, had the ability to take the Key and take Key is the name of the MeMed assay and take the, the LIAISON assay and offer to the hospital hub and spoke, right? I place both, core lab, the XL, the Key in the small lab. What Beckman announced yesterday, they gave the Key. So they're gonna go out and, and work with the Key, which is, to me, it's great because they're gonna be working and educating. But, they're missing the hub component.
I don't know when, when it's gonna come because they never, ever, I think they never, gave, any indication of, expectation in terms of approval in the U.S. I hope that this has answered your question.
Yeah. It does. Thank you.
Okay. And then, regarding Plex, PJ?
Yeah. The Plex guidance. Certainly, in our guidance, we made some assumptions in terms of the Plex contribution. So it is baked into our guidance. That's the short answer.
Okay. Thank you.
Thank you.
Mr. Rosa, there are no more questions registered at this time.
Thank you, operator. Bye-bye.
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