[Foreign Language]
Now I will switch to English. Welcome to everybody who is connected in streaming. I will give a presentation today where I'm gonna be discussing the strategic setup of the company, market conditions. Then, our Chief Financial Officer, Mr. Pedron, is going to join me on the podium and is going to take you through the numbers. I would like to start talking about who we are. If you remember, the last meeting we had was in 2019, and in 2019 we confirmed the fact that this company to survive, thrive, and be successful has to be a specialty company. We need to be a specialty company because competition is very tough, because the environment is very complicated, and because with this space is actually consolidated by companies which are 10 times the size of DiaSorin.
The only way for a company like ours to thrive and continue to be successful is to stay focused in areas that are complicated, that do require innovation and innovative technologies. This has been for the last 20 years. What we are saying here when we say specialist times three, it means that the Luminex acquisition did not dilute at all the spirit, but actually DiaSorin with Luminex has technologies that will allow us to be specialist again for the future. What's the new DiaSorin after the acquisition? Well, it's a company that fundamentally has 50% of its business in the U.S. market, which does represent 40% of the worldwide market for diagnostics. We are very well balanced today.
50% of our business is immunodiagnostics, which is a traditional business that we have developed over the last 20 years. Thanks to the Luminex acquisition, now we have 36% of the business in molecular diagnostics. We have a third leg, which is life science, which does represent 14% of the business, very profitable. We're going to be discussing next what does life science carry for DiaSorin. Overall, over 3,000 people employed worldwide, of which half of them are today located in the U.S. If we go back to 2019 pre-pandemic, we were in Milan presenting our 2019-2022 plan. Now, understandably, we had no idea what was coming our way. It was June 2019, so 6 months before the world really changed.
When we met with investors, we said that we had certain deliverables. Let's understand how we are scoring against those deliverables. If you remember, we talk about value-based care. Value-based care initiative means that the healthcare system is actually moving toward products that are not only clinically relevant, but they also provide benefits in terms of cost cuttings and less expenses to the healthcare system. In fact, in the last three years, we launched four initiatives, three of which were actually in the funnel, the QuantiFERON with QIAGEN, the LymeDetect for borreliosis, and the Calprotectin. One that was an opportunity that we encounter along the way is the alliance with MeMed.
During this presentation, I'm gonna leave the podium to the CEO of MeMed, who joined us here today and is gonna explain to you what the technology is and what the alliance is about. The second thing we were talking about is the fact that we had to continue to develop products. In fact, as Mr. De Negri said, we have developed 30 products in the last 3 years, 20 in immunodiagnostic and 9 products in molecular diagnostics. This continuous path of innovation and development has been proven again to be very, very valid for DiaSorin as a company, is the one that really allows the company to continue to grow in a market that pre-COVID was just really growing no more than 2-3% per year. We were also talking about decentralization.
You will see today that decentralization actually is really speeding up and continues. We said back then that it was important to develop technologies and system for decentralization. Today you have seen, to the left of the room, you've seen that now we have the LIAISON NES for molecular diagnostic. We have the LIAISON IQ for lateral flow second generation and the LIAISON XS for small hospitals access and improved diagnostics. We also delivered on the platforms. We talk about China. China back then we already said in order to be really present in China, what we have to do is to be perceived as a Chinese company. We were talking about opening up a manufacturing site. What you see over here is a picture of the manufacturing site.
We are on track to start validations next year and start introducing products Chinese made in China starting from 2023. Last but not least, we were talking about M&A and partnership. Well, easy to say we deliver on M&A after the Luminex acquisition, certainly. Also we continue with our M&A policy of finding partners with content and providing to these partners our installed base and access to instruments worldwide. Again, MeMed is a very good example. We're gonna be discussing later about the way we partner with other companies to bring innovation to the market. Overall, I would say if I go back to 2019 and notwithstanding pandemic, I think this company has delivered what we promised to shareholders. We would have been delivered in the plan. Now, let's talk about the market and let's talk about trends.
This is a slide that we presented back then, and we said when it comes to the diagnostic market, there are two opposite forces that are shaping the market. One is consolidation and one is decentralization. The point is always the same. The point is that the healthcare system that today is extremely onerous for our society is finding ways to be more efficient. Consolidation means bigger hospitals, bigger labs, and looking for efficiency through critical mass. Decentralization means getting closer to the patient and then getting rid of all this cost associated with dealing with patients in the hospital, and this certainly requires technology. What's happening today after the pandemic about these trends? Well, certainly the decentralization has accelerated. An amusing example, two months ago I was in New York.
You go to Columbus Circle on the corner of Central Park, and you find the iconic falafel stand that is always there selling hot dogs. Next to it, you find a minivan providing antigen tests for COVID. Well, that to me is the example of how the pandemic really changed the way we perceive diagnostic. It would have been unthinkable two years ago.
Probably is a model that is not gonna be repeated after the pandemic is over, but certainly has demonstrated that, well, first, what's a diagnostic is and what is the value of decentralizing diagnostic when you really need a quick answer to address a concern, a clinical concern. Not only decentralization has accelerated because of the pandemic, it has accelerated also because the governments now are deciding to put real money in through the infrastructure that is actually fueling decentralization.
If you think about it, even Italy, that, over the last twenty years have clearly not spent enough on the, in the healthcare system or well enough in the healthcare system. Today in the PNRR, there are EUR 18.5 billion that are gonna be spent between 2021 and 2026 funding proximity healthcare services, which fundamentally means smaller clinics that are gonna be serving neighborhood of around 50,000 individuals. That's a plan that the government is funding to decentralize the healthcare services. When it comes to the U.S., another vivid example, in 2021, just in one year, the U.S. government has dedicated $8.5 billion to rural hospitals. Again, U.S. was the same story. Consolidation. They forgot about the decentralized care.
Now they are rushing to really fortify decentralized care because it's the only way to serve those rural areas where people simply have no access to any sort of healthcare. What did the pandemic mean for IVD company? In my opinion, three things. The first thing is that today, as said, you can take a cab and even the cab driver everywhere in the world understand what diagnostic is. This is very relevant because prior to that, nobody understood diagnostic. It did represent 10% of the healthcare spending. It was very easy to cut diagnostic because the governments were cutting reimbursement, and our association was not strong enough to represent our interests. Today the perception of stakeholders, individuals and governments is completely different.
The second element, which is really very important for DiaSorin, is that throughout the last two years, a lot of money was dedicated by emergency funding to provide even small hospitals with equipment, the kind that you see over here. This means that when now the pandemic goes away, you're gonna have all this capital equipment which is placed in these hospitals. What we're already seeing is that hospitals are insourcing diagnostic testing. It used to be that they were outsourcing. Now that they have the system, they are insourcing. They're also sourcing specialties, which is what again DiaSorin is a leader about. The opportunity today for us is to really reach also the mid-size and small-size hospitals with our specialties because hospitals now again are insourcing this testing. The third element, it's it...
That we need to consider about the industry is that today everybody understands what molecular means. Until yesterday, nobody had a clue unless it was an expert. Today, the use of PCR is very well known by everybody, including physicians, including small hospitals. There is more utilization of PCR in all kinds of settings, and this is why you're gonna find there the LIAISON NES, which is our next generation small system for molecular diagnostics. By the same token, everybody goes to a pharmacy and can have a swab and antigen test. The technology for the antigen test was developed in 1980 for pregnancy testing. Today we are living with technology developed 40 years ago.
It is very clear that it can work, but it's also very clear that you need to move to a next generation of this technology, which is what we have with the LIAISON IQ, where fundamentally is lateral flow, adding the traceability and the ability really to get the result and send it to the patient or the physician, wherever the physician can be for a clinical decision.
What has been the impact of pandemic also from a geographical point of view? I believe that if we divide the world, at least our market, in the three main economies, so the U.S., Europe and China, after two-year-on pandemic, the conclusion is very different. If you look at the business opportunity for a diagnostic company in the U.S., I think going forward, we see a very positive cycle. Where do we see a positive cycle?
During the emergency, during the pandemic, what the government has done, they've been providing lots of funding with fundamentally 2 objectives. The first objective was to increase testing capacity because there has been a high demand for testing capacity. The second one is to develop new technologies. With the RADx program, the government put $1.5 billion in 9 months to fund new generation point-of-care technologies. That certainly has developed a positive spread, a positive feeling about diagnostic technologies and infrastructure in the U.S.
The second thing which is very relevant, and I believe has a lot to do with the way the Trump administration has looked at this, is the fact that the FDA all of a sudden transformed themselves into an agency that is working with companies to approve products, and not just with a bureaucratic approach, but the approach today is, "Let me work with you, because if the product makes sense, then it is good that the public will have access to that product." I think MeMed is a very good example of a company that has been working with the agency. They got approval with an incredible claim for their product.
I never seen in my life the FDA, after giving the approval, going public and saying, "We are so fond of having worked with a company that brought innovation and is addressing a medical issue in the U.S." This is very different from what the FDA used to be just 24 months ago. Now let's talk about Europe. Europe, we all know that when it comes to vaccination, at least we were able to have central purchasing and negotiating vaccine for all Europeans, but this is it. When it comes to diagnostic, there was no effort whatsoever, or there was not a unified strategy. Each country pretty much went where they really wanted. Certainly in Europe, there is more awareness of PCR testing, as we have discussed before.
Certainly, Europeans that were resistant to the concept of investing into expensive technologies like multiplexing, now they understood what multiplexing is. Overall, Europe post-pandemic, as far as we are concerned, is pretty much equal to the Europe pre-pandemic. Nothing really changed in that market. Finally, China. China is a problem because of the way they decided to respond to the pandemic. First, it's the only country in the world that decide not to approve a single test coming from an American or European company for COVID. So over the last 24 months, they've been dealing with local suppliers. Second, there has been an acceleration of a trend which was there even before, which tends to favor Chinese companies versus foreign companies as suppliers of hospital.
I remind you that there was a plan called 2030, where the objective was by 2030 they really wanted to buy 50% of medical devices, Chinese-made. The feeling and what you see today in China is that there is an aspiration to accelerate that. What does it mean? It means fundamentally that China is becoming a very difficult market. Certainly the only way to survive in China is to become more Chinese. This is why we believe that the fact that we have a manufacturing site, we will have a research and development in China, is the only way to survive in a market that honestly is becoming very complicated. Today, after the Luminex acquisition, China does represent less than 5% of DiaSorin revenue.
We have been de-risking China as a market with the Luminex acquisition. Now, let's reflect on something else. The diagnostic market all in, with all the different tests that you can find in a lab, before the pandemic was around $65 billion, a relatively small market. That market was growing 1%-2% per year, a little bit more volume, pressure on price, a market. The market was developing, but nothing exciting. Then the pandemic hits. Then in 18 months, a $65 billion market became a $100 billion market. It hardly happened that a market which is mature, all of a sudden is increasing by 30%. Now, what does this mean if you look at cost?
Now, if you do the math, usually, a hospital that pays $1 for a product, then the cost to deliver the test result is pretty much 3-4 times that. That means that if today we as an industry see $35 billion of revenues coming from COVID testing between molecular and antigen testing, the system, the healthcare system today is paying annually $150 billion to deliver the testing. Keep this in mind because we are talking again on cost and cost and cost piling up on the healthcare system. Now, if you look at treatment, what is the effect of the pandemic on the cost of delivering healthcare, treatment plus testing.
Now, what this shows is that in 2020, the weight of healthcare costs versus GDP worldwide on average increased by 1%. Okay. If you look at the U.S., it's even more dramatic because when it comes to the U.S., as a net net result of the fact that in the U.S., hospitals are private, they were actually living off elective surgeries that didn't happen during the pandemic, and actually they were loaded with patients that are COVID patients that are very expensive, and they're not really remunerated well by the insurance companies. All the hospitals were going belly up, and what the government had to do is to pour $100 billion in funding coronavirus aid to make that industry survive.
It said as part of the $100 billion, $8 billion just to keep the rural hospitals open. If you think about this and you think about the environment post-pandemic, what is the environment? The environment is cost effectiveness. Whoever is gonna be operating in diagnostic has to consider that element. The system is broke, and the system will only pay for innovation if that innovation will carry two things. One, certainly clinical value, but the other one, which is very relevant, cost effectiveness. More and more companies that are bringing new products and new systems to the market not only have to demonstrate that it's good for the patient, but they also need to demonstrate with the real data that it's very good for the healthcare system. Where are we? In 2019, we said value-based care is coming.
We believe that value-based care is accelerating. How is DiaSorin now responding to this environment? Now let's look at the strategies in the three legs of business. We have the immunodiagnostics, the molecular diagnostics, and the life science business. I would start from the immunodiagnostics. In immunodiagnostics, what we did for 20 years, we continue to do. Which means that, we do have platforms. You see it over there. We have content, and content means, assays that we continue to develop and provide to the hospitals, to run more content on these platforms. We did very well during pandemic. We developed 9 more assays in the specialty area, so fairly unique product for DiaSorin. The plan for the next 3 years is to develop 13 more products.
We're gonna be launching 100 specialty tests, which is gonna make DiaSorin as a supplier to hospital even more unique than what it is today. This is what we've been doing for 20 years, and this is certainly part of the plan for the next 3 years. Now let's talk about a different content. The content we're talking about here is getting together with specialized companies, very innovative companies, and then bringing the two companies together, the content together to allow to have that very smart content delivered on our platform. I'm gonna call to the podium, Doctor. Please join me. Dr. Eran is the CEO of MeMed. He's from Israel. He's gonna tell you what's MeMed and why MeMed is, I think, one of the greatest asset in our industry. Please go ahead.
Thank you very much. Good morning, good afternoon, depending where you are. Let's see if this works. Great. Hi, I'm Eran, again, Co-Founder, CEO of MeMed. I'd like to thank Carlo for the kind hospitality and for what's becoming a growing partnership. Today, I'll tell you a little bit about our story. First of all, MeMed in a nutshell. We're based in Israel and growing our base also in Boston, Massachusetts. We've raised over $200 million in equity and also quite a lot of support from the U.S. Department of Defense and the European Commission. We have a landmark FDA clearance a few weeks ago, and we're a leader in this really exciting new field called advanced host-response technologies that I'll tell you a little bit about today.
It all starts with a simple premise, which is the immune system. Our immune system is built to tell us what's going on in our bodies. What we do, we listen. We listen with this engine that combines machine learning, molecular and biochemical immunology, and IVD in order to generate insights that can potentially transform the way that we manage patients, particularly in the realm of infectious diseases and inflammatory disorders.
The first thing we start with is the most prevalent clinical indication on the planet. A child with sniffles or an elderly patient with coughs, fever, broadly. If you think about this encounter, and we've all encountered this multiple times actually a year, we and our families, several questions come to mind. The first one, is this child in front of me, does he have a bacterial or a viral infection? If it's a bacterial infection, antibiotics.
If it's viral infection, chicken soup. I say seemingly simple problem because bacterial and viral infections are often clinically indistinguishable, which causes two problems. The first one is antibiotics overuse. Roughly 1 in every 2 antibiotics is overprescribed. Less known is antibiotics underuse. 1 in 5 patients that have a bacterial infection are not receiving antibiotics on time. Both parts of the equation have both grave healthcare and health economic consequences that are plaguing the system. Now, sure, we have many technologies, and Carlo talked about this, you know. Right, rapid antigen tests, culture, and multiplex PCRs, and they're good, and they're pushing the boundaries, but there's several limitations. The first is time to results. We often want to have the solution here and now, within minutes, not hours and definitely not days. Number 2, inaccessible infection sites.
You can only apply many of those technologies if you can reach the infection site, but many times it's not accessible. Ear infections in children, sinusitis, bronchitis, pneumonia. That's one in four patients and the most prevalent indication on the planet. Third, even if you use a multiplex PCR, very expensive, in more than 50%-60% of the cases, you're not going to detect a microorganism or the pathogen, but you still need to treat the patient. Fourth, even if you're lucky and you identify a virus, it doesn't mean that there's not a bacterial co-infection that's lurking behind, and you still need to treat with antibiotics. The question is not only about fancy technologies, it's about how do I manage this patient? Clinical value, cost effectiveness.
When we set out this journey, we imagined a platform, a small volume of blood, a few minutes, that would somehow decode fever, starting with bacterial versus viral infection to treat or not treat the antibiotics. The paradigm, decoding the body's immune response. We're measuring a set of soluble proteins of the immune system together with a layer of computational algorithms, and we create a barcode whether the body is waging a war on the bacteria or the virus to treat or not to treat. Here you see this complex graph here just shows some of the proteins that we're measuring, some which include the world's first virally induced protein. It's a protein called TRAIL that your body is secreting to fight against viruses. It's the first virally induced protein that's been cleared by FDA in twenty-first century medicine.
There's the machine learning component and again, the measurement components. First study, 2009, 2013, published the results over 93% performance ROC curves. A series of studies, prospective, double blind, external, covering over 20,000 patients with real-world evidence published in The Lancet ID, BMJ, PIDJ, Pediatrics, UpToDate, far exceeding industry standard. Why? Because it's not enough that you say that it works. You have to prove it. After five years of working hand in hand with FDA that has been extremely supportive, we recently received a landmark FDA clearance. It's the first technology to aid in distinguishing between bacterial and viral infections based on the body's immune response. This is the claim that we've got. We get the same thing in the U.S. and in Europe.
First of all, it's for both adults but also children, which is not easy, but it is critical. Second, very broad indication for use. Lower respiratory tract infections, but also upper respiratory tract infections, systemic infections, urinary tract infections, and a child with sniffles. Third, EDs, urgent cares, but also upon hospital admission.
Lastly, we've been able to show to FDA that we're able to complement these multiplex PCRs or other type of pathogen detection tests by identifying bacterial co-infections even if you detect the virus. Again, that was one of the challenges we talked about in the beginning. Okay, now we have a platform to measure it. You put the sample 100 microliters within this cartridge. You plug it inside, press the button, wait 15 minutes. Oops. That's basically it. You get the results. It's a score between a 0 and a 100.
The higher the score, the higher the likelihood of a bacterial infection. If you have a mixed infection, you get a high score 'cause you wanna treat. This is where we met with Chen Even and Carlo Rosa and the team, and we said, "Well, how can we combine forces? How can we leverage the complementary capabilities of the two companies?" MeMed brings this knowledge center, world's knowledge center in advanced host-response technologies and clinical adoption, clinical utility, medical sales. DiaSorin, the diagnostic specialist to the power of three, with a track record of introducing these new technologies. We thought this is a really good partner, solid installed base, reputation of quality. If you look at these two platforms, they look very different.
One is maybe 100 times larger than the other one, but they're actually based on the same technology, chemiluminescence magnetic beads, which means you can transform technologies from one to the other, and you have consistency, which is critical. You have a hub and spoke model, which is what's required to take market. Recently, DiaSorin received a clearance in Europe for the MeMed BV on the LIAISON with what we think is not a bad turnaround, roughly a year to develop something like this. And the reason that this happened so fast, first of all, big kudos to the development team and the regulatory team, but also the fact that these two technologies are so compatible. The market is a blue ocean. In the US alone, meeting our FDA indication for use about 200 million cases.
Here you see them segmented according from centralized to decentralized setting. If you only look at the centralized setting in urgent cares, it's a multibillion-dollar opportunity, potentially. To start to summarize, at the end of the day, it's not about the fancy technology. Sure, it's cool technology, but it's most importantly, it's about clinical value and cost effectiveness. On the clinical value, improved accuracy. You reduce the false negatives and the false positives. You have shorter time to diagnosis, and you get better patient management, which we tend to forget. I just flew from Tel Aviv over here, leaving my wife with three kids, one of which has a fever. Nine-year-old girl. We took her to MeMed, ran the test. It's a viral infection and no antibiotics. Today, she's back to school. The anxiety of the parents goes down.
I get a lot of brownie points from my wife and mother-in-law. That's a different story and very strategic. Second part, the peer, the provider. Reducing clinical uncertainty, changing patient management, hospitalization, and of course, saving hospital costs. There's gonna be a publication coming in a few weeks in the Journal of Medical Economics proving a lot of these things, again, based on data. To close things up, the immune system has evolved to tell us what's going on in our bodies. What we did is develop an engine using machine learning, molecular, biochemical immunology, and IVD that we used to develop this first technology, B versus V, together here, moving this forward with DiaSorin. If you had this technology, what else would you do?
There's endless amount of additional diseases and opportunities, and hopefully in the not very distant future, we're gonna be able to share some of the additional products that we're working on. Again, I'd like to really thank Carlo here for the opportunity and for a successful continued partnership.
Thank you. Okay, let's talk about another kind of partnership, the partnership with QIAGEN. This has been now established for 4 years. Let me remind you that with QIAGEN, we had two projects ongoing. One is latent tuberculosis, which was actually launched in the U.S. as well, 2 years ago. We have the Lyme disease for borreliosis. Again, the product has been launched. Then we have another one that is in the works, and we are working on a new assay for cytomegalovirus infection and reactivation in transplantation. Overall, the two companies are working very well together on building this T-cell franchise. As far as the different projects relating tuberculosis is going very well. Today we have over 480 customers, hospitals in Europe that are using this product.
We just launched it in the U.S. 1 year ago. We have today 150 hospitals in the U.S. that are using our technology, growing 25% per year. So far, this project has been greatly successful as a combination of the two companies. As far as LymeDetect is concerned, again, very briefly, it is an algorithm that allows to detect borreliosis, which is a tick-borne disease. It is very common in Central Europe. It is very common in the U.S. as well. In Italy, a little bit in the Trieste area. One of the problems is that if this disease is not properly diagnosed, then it can really give consequences later on in life. At that point, it is very complicated to treat the infection. Where are we with the program?
We have now the product approved and launched in Europe. We are working in Germany in the reimbursement. We believe we're gonna get the German reimbursement by 2023. After that, it's part of the plan, full commercial launch as far as Europe is concerned. When it comes to the U.S., we are doing a clinical study. We did clinical study last year, complicated by the fact that with COVID, it was difficult to recruit patients. We're gonna continue the clinical study in 2022 with the intent of getting the product approved and launched in the market, U.S. market by 2023. This is gonna be another strategic asset in the QIAGEN DiaSorin partnership. Now let's move to the other platform, the LIAISON IQ.
The LIAISON IQ is the cutie one, the one that actually you can find there to the left. It is an antigen for whoever has been using antigen test for COVID. In fact, with the difference is that rather than visual reading, you can really have a machine read it, and then once the result is read, it can be sent to your cell phone or to your doctor so that the interpretation and traceability of this result is guaranteed. Now, what did we do? I mean, that system clearly has been devised for pharmacy use. We look at two main markets. One is the U.S. market, and one is the Italian market for pharmacies, completely different.
In the U.S., there are 60,000 pharmacies, and a third of those pharmacies are actually operated by two main providers that have been consolidating services over the years. Pharmacies are allowed to do testing. Pharmacists are allowed, after a result has been obtained in the pharmacy, to take certain action about medications using that result. Certainly, it is a market regulated by the FDA, so any product that goes into that environment has to go through the FDA. Italy is completely different. 19,000 pharmacies growing, which is an outlier within the European community. As you know, there is a pharmacy with every church, pretty much they say in Italy. In rural areas, pharmacies do represent a way of point of entry to the healthcare system.
The regulatory framework pre-COVID was terrible, meaning that there was not a possibility in a pharmacy to take a test and take action. It was considered auto diagnosis, so doctors could not make a decision based on that result. COVID changed a lot. You can have COVID testing, clearly, in pharmacies today, and you can take action with it. Very recently, as a consequence of COVID, they changed the law and now you can go to a pharmacy and on blood testing, you can have results that the doctor can then use to make a medical decision. In that sense, what we were saying before, the COVID really changed the regulatory environment under which diagnostic is performed. What's the plan for us? The plan for us is to continue investing in this technology.
We're gonna be using it in the next three years. Italy is the primary market. We are extending menu on the LIAISON IQ, and we're gonna be touching areas like vitamin D. We are touching area like celiac disease. We're gonna be touching area like ferritin measurement. Everything that will allow the pharmacist at that point to take action, which is not necessarily medication, but is more supplementation. We believe that with that technology, we can really break through in this space.
Now, the question is why Italy? Because we are learning. It is a very complicated segment. We are not in that segment, and we wanna continue to experiment until we really understand what it takes to be a player in the pharmacy market with lateral flow. Different story, clearly, is gonna be with molecular diagnostics. I'll talk about it later.
Now we have the LIAISON XS is there. Very excited about this platform for a very simple reason. This platform has been designed to go to midsize hospitals, especially in the U.S. We got approval of tuberculosis testing very recently, a month ago in the U.S., so we are ready to unleash this system in 1,200 hospitals in the U.S. The very important factor here is that of these 1,200 hospitals that today are a potential target for the system, 700 are already served with Luminex products. The very interesting opportunity here, the cross-selling about the DiaSorin technology and the Luminex customer base with this product.
Last but not least is the future, what we're gonna be investing in this cycle, and we expect this system to be available to the market after 2025. This system is the LIAISON XL, the strategy, the reason why we're doing this is very simple. The LIAISON XL, which is today the king master of DiaSorin, that system has been launched in 2011. We now have 5,500 systems deployed worldwide. We are placing over 600 every year, but that system needs a replacement. By the same token, if you look at the installed base of our systems in the hospitals, 70% are standalone, so one hospital does well with one system, but 30% of hospitals have multiple units.
Today we are under pressure because those multiple units don't have the capacity that consolidation is really bringing to these hospitals. We designed the LIAISON XXL in a modular system. One module is actually substituting one LIAISON XL, actually with increased throughput, and two, three modules are actually substituting two, three LIAISON XLs, bringing it together and making it much more convenient for hospital to run high throughput. At that point, at the end of this project that will consume EUR 20 million of investment with our partners that we're gonna be selecting to develop this, plus probably EUR 30-40 million of direct cost in DiaSorin R&D department.
EUR 50 million-EUR 60 million later, we're gonna have the substitution of the XL and we're gonna have a high-throughput system to again face consolidation on the market. How do we stand in immunodiagnostics? We have it all. We go from point-of-care to the high-throughput. We have over 100 specialty products that I mentioned at the beginning. I feel very comfortable with the fact that this engine that does represent today 60% of our business is really well taken care of. Now, let's move to molecular diagnostics. Molecular diagnostics is why we decided to buy Luminex, as you remember. Now, there is a concept that people that are not expert in this field have to understand. There are two different clinical needs for molecular diagnostics. One is identify pathogen confirming existing clinical suspicion.
Let me give you a very simple example. These days you sneeze, you get fever, you have flu-like symptoms, you wanna be damn sure that is not COVID. So what do you do? A very simple test. It's a molecular test that is gonna discriminate between flu A, flu B, and COVID. This is called singleplex technology. Is a technology we have. Is a technology many companies carry today.
Few years ago, availability of multiplexing technology, so the ability to detect from one clinical sample, imagine just one swab of your nose, up to 40 different targets. These technologies really taking place into hospitals and is very important because it is identifying a pathogen in absence of clear clinical suspicion. Is very expensive. Is a very complicated technology. But today, to be a player in the market, you must have both.
Now, if you look from a technology point of view and market maturity point of view, certainly you are facing two different situations. Singleplex has been there for over 20 years, so is a mature market.
You have multiple suppliers. You do have established testing. Certainly, pandemic in this segment has now pushed the utilization of these technologies down into a decentralized setting. Okay, that's the novelty. Until yesterday, singleplex done in a hospital lab. Starting from today, there is a need of doing singleplex in a decentralized setting. Now, price pressure in a mature segment, for sure. The other thing which is very relevant about this segment is that you need to be a specialist because it's a mature segment, and this is how DiaSorin has been positioning itself with its menu. Specialty menu in a mature segment with new platforms.
When it comes to multiplexing, it is a completely different story. Multiplexing is the future. Multiplexing is a market that has been booming over the last five years with double-digit growth. Certainly, it is a market. Since it is an expensive technology, it is a technology that is driven by reimbursement. Guess what? In the U.S., it is very well reimbursed, and so the market today is primarily U.S. market. In Europe, there has been resistance to multiplexing because governments are payers, and you know, when payer, when government is a payer, then the overall discussion is much more complicated about savings, at least until yesterday, pre-pandemic. There is a limited number of panels available, five panels, fundamentally.
A couple for blood infection, one for gastroenteric infection, one for respiratory infection, and one for CNS infection. It is a limited number of products that you can develop. It is not infinite, right?
The other thing that we need to take into consideration is that through the pandemic, when there was an issue at the beginning really to quickly differentiate from symptoms if it was COVID or not, more multiplexing with funding availability also happened in Europe. If you play in these two segments, you really must have a different strategy. What's the DiaSorin strategy? Let's talk about the singleplex first. Today, we are an established player in this segment. We have 2,700 customers, platforms worldwide. I would say 70% of it is in the U.S., 30% is spread around Europe. We have over EUR 400 million revenues. Certainly a good chunk of this is COVID and respiratory-related, associated with this product.
We do have a very good menu of specialty products, and we serve medium hospitals, small community hospital, and some of the smaller commercial labs. What is the future? The future is a system that you see there. It's called the LIAISON MDX Plus. What's the LIAISON MDX Plus? The LIAISON MDX Plus is a system that is allowing to do singleplex in a much quicker way than what, the platform that we carry today are able to perform. If a COVID testing today on a DiaSorin platform takes one and a half hour, with the LIAISON MDX, the time is gonna go below one hour. There is certainly an improvement. All the major that today goes on our platforms is gonna be transferred on this one.
It's gonna be launched in Europe in 2022, and then clearly you're gonna have a full effect starting from the 2023. It is, for us, the strategic platform that will allow us to combine what we have today into a future platform, so as said, overall to defend and continue to grow our business of EUR 400 million, which is what we have today in our singleplex molecular diagnostics. I think that there is a video.
Introducing the new LIAISON MDX Plus, the next-generation molecular diagnostics solution from DiaSorin. The LIAISON MDX Plus is a highly efficient and fully integrated real-time PCR system. It offers flexibility in patient testing to meet the needs of any laboratory. With LIAISON MDX Plus, labs can perform testing in a sample-to-answer workflow with prompt reporting of actionable results within maximum 60 minutes. For medium throughput testing, the system enables real-time PCR testing starting from minimal sample input. Enhanced features such as simplified usability, touchscreen simplicity, and hardware improvements enable faster turnaround time in both IVD assays and user-defined tests. The LIAISON MDX Plus system is a compact solution with ultimate flexibility and a powerful menu of tests.
Okay, now let's move to the second platform. Again, always in the singleplex, and is this one. I'm particularly fond of this platform because it has been the result of a strategic consideration that we made a few years ago, and the consideration was. Actually it came through with the pandemic. What we thought about is today, all the molecular platform that you have out there are unfit for true decentralization. In fact, look at how COVID is happening. You go to a pharmacy, you don't get molecular testing, you get, at best, an antigen test. Just for reference, an antigen test for COVID is able to detect, at best, 300,000-700,000 copies per mL of the virus. A molecular test today is able to detect 300 copies.
You understand that from a technology point of view, if you were able to take the molecular technology and bring it to the pharmacy, you would have an incredible benefit in terms of sensitivity. This is what this NES system actually is all about. It's a small system, has been designed in working together with a British company that from where we acquired all the rights for this technology two years ago. It's been designed for physicians, for pharmacists, for very small hospitals, so decentralization of molecular testing. I keep saying, think about it. Think how the pandemic would have been different if two years ago, rather than having nothing, we would have had a system like this available in an ambulance to do a COVID testing in 15 minutes. Unfortunately, nobody had it.
I think we learn from the pandemic, and the next wave that will come, if it will come, companies will have technologies that will really allow the decentralization of molecular testing. What's the benefit of decentralization? We really spoke at length about it, but the most relevant thing to me of the decentralization is the fact that you can take action where the patient and if the patient needs action right there. Decentralization should not be a mantra for everything. Many, many clinical conditions can actually be taken care and are taken care much better in a hospital.
There are certain things that you don't want to take care in a hospital. There are infectious diseases where you don't want infectious patients to walk in a ward, and this is what it's all about. There is a video on this one as well.
LIAISON NES, a novel point-of-care molecular CLIA-waived solution from DiaSorin. Patient samples can be directly loaded into innovative, ready-to-use cartridges, which simplify the laboratory workflow, enabling actionable results in approximately 15 minutes. The smart user interface makes near-patient testing possible with best-in-class accuracy and quality. A fully integrated system with enhanced connectivity allows a streamlined and error-proof experience. LIAISON NES is a compact and portable solution for healthcare providers or pharmacists, bringing sustainable and accessible solutions closer to the patient.
Okay. Now let's move to the third element, which is multiplexing, which again is the reason why we bought Luminex. Now, Luminex is a multiplexing company, and today they already have over 1,000 systems installed in hospitals, mainly in the U.S., which are using these technologies. From a revenue perspective, it does represent for DiaSorin a little bit over EUR 100 million per year. It's an established brand. We do have today all the five panels that I was mentioning before. What is the problem? We have it in a form and a format that belongs to previous generation. It requires hands-on time. What did Luminex develop, and what did we really buy with Luminex? This technology, the LIAISON PLEX. LIAISON PLEX is actually displayed over there. This is not intended for decentralization. This is intended for laboratory use.
It goes inside a hospital. What does it do? As said, there is a very small cartridge, you're gonna see it. You put the sample of the patient inside, you load it, you wait 2 hours, and in 2 hours you're gonna know whether it's one of the 20 bacteria that the assay can detect or the 20 viruses the assay can detect. So very specific, precise diagnosis. Think about it, an algorithm whereby we can use the MeMed technology just for the first screening, and then if it is bacteria, let's understand what kind of bacteria this is using actually this technology. There is a video for this one as well.
Introducing the LIAISON PLEX system, a molecular sample-to-answer solution designed with Flex testing capabilities. With the ability to scale up to six modules, the LIAISON PLEX can fit the lab's budget and throughput needs. The system is fully integrated and performs extraction, amplification, hybridization, and detection all in one cartridge. The proprietary Flex software enables users to test and pay only for selected targets with the option to unmask results as needed. This provides laboratories and clinicians with a cost-effective diagnostic tool designed to improve clinical outcomes.
Let me just explain to you what is the difference. Today, there are already systems out there they can do multiplexing, but what is that we offer is called Flex the Plex. What is the problem today? If you're a hospital, you wanna run one of these multiplexing, you're gonna pay for 40 different results because companies are gonna sell you a cartridge. Within that cartridge, you have 40 different between viruses and bacteria. You're gonna pay for all. What is the problem with this system? It's very expensive. 60% of the times it's negative, but you're paying for 40 different results. The way that Luminex is positioned in this is extremely interesting. The cartridge does contain the possibility to get 40 different results, but the customer is gonna pay only for 20. A basic panel.
They run the basic panel, and if within the basic panel of 20 they get what they want, they don't need to go behind that. If they want to open up results, they buy credits from us, and spending the credits, they can get, on the same sample, additional results. It's really providing customers with the needed flexibility to adopt this technology in a cost-convenient manner. This is very, very important for two things. In the U.S., because today, notwithstanding the fact that the reimbursement is generous, there is a pushback on cost. The second thing, in Europe. In Europe, the problem there has always been pushback on cost because one of these tests is costing EUR 150 at least for each patient. Now, hospitals can design their own panels.
They can pay for a minimum panel, and they can decide which one they wanna open up, which results they wanna have, and what they wanna pay for, depending on their budget. This is very innovative and goes behind the issue we were discussing before, the costing element of providing innovative technologies to the market. What do we have at the end of the story? We do have a slew of new technologies. When it comes to molecular diagnostics, which today does represent 35% of our business, in the next three years, we're gonna be launching three different platforms. Very innovative, as we described. This is why I'm saying, starting from a business that today overall is $500-$600 million. Based on that platform, on that customer base, we're gonna hit the market with this new platform.
Very exciting as far as the opportunities that DiaSorin does have in this growing business. Last but not least, then we're gonna leave it to the call numbers, licensed technologies. What are the licensed technologies? Licensed technologies are fundamentally a technology that Luminex has been developing to supply to the research community to do their own research. We're talking about two different platform.
One is called xMAP. I'm gonna make it very simple for you. If you are a researcher today, and you're looking at a protein expression, and you wanna look at hundreds of targets because you want to understand in a patient, as actually Eran had to do when he put together his own algorithm, what are the proteins that light up during an infection? With this technology, you can multiplex up to 500 results. Certainly this is not for clinical use.
It's for research use, but the system is unique. It's the only one on the market able to do so, and it has been launched two months ago. Second thing is flow cytometry. Flow cytometry is a technology that are used in hospital research, and the company does have a business of roughly $50 million today that is growing nicely, 10% per year, with a very sophisticated technology that allows to identify better and visualize all the different cell parameters within a cell. So this business has been doing fantastic for us, for Luminex first, and now for DiaSorin. Number of installation over the last five years have been growing 9% per year.
If you go and look at all the main hospitals worldwide, you name a hospital, and you're gonna be finding one of these systems. Over 20,000 publications have been actually done by scientists using these technologies. What's the opportunity here? Certainly, when it comes to the multiplexing, we are not working by ourselves, we are working with companies like Thermo Fisher, like Bio-Rad, like Bio-Techne. The bigger diagnostic companies in the world working life science are actually buying this system from us and displaying and placing these systems in all the research and academia facilities. Certainly, the opportunity of working with these big companies is providing the DiaSorin with new ideas about technology and the use of this unique technology.
It's very important for us to seek next to these leaders in life science and continue to fuel the R&D and ideas about this technology and the use of this technology. That said, the IntelliFlex, which is the name of this platform, was launched a couple of months ago. Already we have a backlog in terms of supply, and actually the plan for the next three years calls for hundreds of this system placed in academia and basic research. The last video.
xMAP IntelliFlex is the only compact flow-based multiplexing platform that combines the proven performance of xMAP technology with modern features to enhance performance, empower innovation, and simplify the user experience. xMAP IntelliFlex offers multiplexing of up to 500 analytes per well, a broad dynamic range, and a new dual reporter capability that enables users to acquire two parameters per analyte. Its intuitive software is designed for speed, flexibility, and simplicity, empowering users to master the platform with ease. With more than 54,000 publications, 1,000 assays, and a new dual reporter capability, xMAP IntelliFlex is a proven and flexible platform for today's life science researcher.
Before we move to the numbers, let me just make a final comment. I hope that I convinced you that the future is certainly bright. I am convinced the future is bright. Why is it bright? It is because we do have technologies and we do have the products that actually fit in the request of a very dramatically changing market for the post-pandemic. Certainly, we gave our view about COVID. Nobody knows what is gonna happen with COVID. We gave an estimation for 2022, which is based on the fact that we know certainly what is gonna happen in the Q1 . We have no idea what is gonna happen next year because a lot of it has to do with effectiveness of vaccination, new variants, and so forth.
Every operator in this market that looks at 2022 and after really doesn't know what COVID is gonna represent. We gave our own view that, Mr. Pedron is gonna give you in his presentation. Thank you for staying with us. PG, please come over here and talk about the numbers.
Thank you, Carlo, and thank you, everybody. It's the time for the core numbers now. I will try not to be too boring. Again, good afternoon, good morning, and welcome to the DiaSorin Investor Day. It's very good to see so many of you here in person today. It has been a while since we were last able to meet, and I'm glad for the opportunity to discuss DiaSorin guidance with you this afternoon. Over the next few minutes, I will try to translate from a financial viewpoint, so to say, all the initiatives that we have seen in the past few minutes. Before we start, let me please qualify a couple of technical points in order to better understand the evolution of DiaSorin performance after the acquisition of Luminex.
As you will see, we have broken down our financial results into two steps, highlighting the impact of the change of scope from 2021 to 2022, and then presenting the expected evolution at constant perimeter of consolidation from 2022 to 2025. This will allow us to normalize the effect of the change in perimeter and would facilitate a better understanding of both the progression and the performance of our business. Moreover, as usual, all the numbers will be presented at constant exchange rate. With that, I'd like to start with the top line.
To start, I would like to highlight the performance of our business excluding COVID. As you can see, we expect 2022 sales to grow 42% vis-à-vis 2021. As a combination of the change in scope of consolidation and the growth fueled by all the initiatives we just saw.
Beyond next year, we anticipate a compounded average growth rate of approximately 10% from 2022 to 2025. This means, and I believe this to be one of the main take-home messages of this slide, that we project to reach revenue of around EUR 1.5 billion by 2025. Therefore, more than doubling in absolute terms 2019 results. In a pre-COVID and pre-Luminex world, which were roughly EUR 0.7 billion. I believe it's also worth noting that 2022 total sales, this time including COVID, will be largely in line with 2021. Which means that thanks to the Luminex acquisition, we will avoid the cliff of the top line caused by the expected decline in COVID testing volumes.
Also, please note from the slide that 2025 projection includes the contribution of nearly EUR 150 million, driven by the programs we discussed a few minutes ago. I'd like now to spend a few minutes discussing about COVID revenues. In line with many of our industry peers, we share the opinion that there is very limited visibility regarding testing volumes and the related revenues, both in 2025 and beyond. As we all know, the COVID pandemic evolves daily. We all wake up to news regarding changes in variants, the availability and effectiveness of medical treatments, vaccination programs, and so on and so forth. Given that, we share the view of most IVD players and analysts that cover testing volumes, and we believe that sales will decline from the peak of 2021.
What is almost impossible to predict is the extent and the speed of this reduction. Our assumption today, based on what we know today, is that we will see a slowdown from nearly EUR 370 million achieved in 2021 to about EUR 150 million in 2022. Beyond that, we foresee approximately EUR 50 million by 2025, when COVID will potentially become an endemic disease. Consistent with this approach, the following slide discussing the evolution of sales by technology and by geography will normalize the impact of COVID in order to focus our attention on what we believe matter most, which is all the activities and initiatives that we have just covered. In this slide, you will see a breakdown of revenue projection by technology.
Before we dive into the numbers, please allow me to clarify what the content of each technology in light of the Luminex acquisition. The licensed technology bracket represents the sum of the legacy business, flow cytometry, and licensed technology of Luminex. Regarding moleculars, the graph represents the complete offering from the LIAISON MDX to the VERIGENE, ARIES, the LIAISON PLEX, the LIAISON NES. Immunodiagnostics represents DiaSorin legacy offering, mainly CLIA and ELISA products. That said, in 2022, growth rates for molecular and licensed technology is affected by the change in scope of consolidation, while the immunodiagnostics growth is like for like, and not impacted in the same manner. 2022 immunodiagnostics growth is driven by CLIA ex-Vitamin D, for which we expect an increase between 10% and 15%, which more than offset the slight declines in our vitamin D and ELISA revenues.
2022-2025 immunodiagnostics growth is expected to continue at a 7% compounded rate, and is likewise driven by CLIA ex-Vitamin D products and all the initiatives that we've just seen. Looking at the midterm projection for our molecular business, we anticipate a compounded growth rate of 23%, which is mainly driven by the launch of the LIAISON PLEX and the LIAISON NES on top of the additional sales deriving from the conversion of the single/low plex platforms to the LIAISON MDX Plus, and from an acceleration of the business in Europe, where we will leverage the COVID-driven install base. To conclude with this slide, I believe the main take-home message is that our growth is very well distributed across all three of our different technologies, with molecular being the top performer, thanks to the new programs we just saw.
Moving on to the next slide, here we can see how we anticipate the revenue trends across the different geographies in which we do business. As mentioned, 2022 growth is affected by the consolidation of Luminex, which is clearly affecting the increase in North America. I think though that the main take home message of this chart is indeed that if we consider 2022, 2025 expected progression, North America, and to be more precise, the U.S., will be the geographical engine of our growth with molecular and immuno businesses and the key projects therein fueling our performance. As you can see in Europe, where DiaSorin market penetration has been historically higher, we anticipate a compounded growth rate of 7%.
We will achieve this by leveraging the new immunodiagnostics programs by selling Luminex products via our broad direct commercial presence in this geography, and lastly, by building on the COVID-driven molecular install base. Now, since North America and Europe will represent approximately 80% of our total sales, we have decided to cluster all the remaining geographies on one single bucket, represented here as the rest of the world. This area includes Asia Pacific direct, LATAM direct, and our distribution business. I would highlight that APAC is the main contributor of growth in this geography, with midterm compounded growth rate of almost 9%, mainly driven by China.
Overall, our rest of the world business is showing a compounded growth rate of 6%, which lags the other geographies as a result of a lower impact of our multiplex offering in these geographies, and the lower growth rate in those countries where we do not have a direct presence, meaning the export business. I believe also this slide is very interesting, and with this one, I will close my slides on sales. Because what I would like to do here with you is to share three snapshots of the change in our revenue profile from 2019 to 2025, so considering a pre-COVID and pre-Luminex acquisition starting point.
Beginning with the first snapshot, I believe it is important to highlight how DiaSorin sales in North America will increase from just shy of 30% of total revenues in 2019 to almost 50% in 2025, with a 2022 ex-COVID already at about 45%. Let me please remind you that this is in line with, what we defined back then aspirational target, and I believe this was happening two years ago when we last had our investor day. The second snapshot shows the breakdown of sales by technology. Here, I would like to highlight how in 2019, almost 90% of DiaSorin sales relied on a single technology, immunodiagnostics. Looking forward to 2025, we will have a more balanced and diversified portfolio of product offerings, with immunodiagnostics representing around 55% of our business, molecular about 25%, and licensed technology 20%.
Please note that 2022 breakdown does not really look much different from 2025, with strong growth across all the technologies not changing the mix significantly. The third snapshot I'd like to share with you all is intended to present recurring revenues, meaning reagents, consumables, and royalties vis-à-vis non-recurring revenues. Here, I would like to emphasize that in spite of the change in the composition of sales by geography and technology that we just discussed, the share of recurring revenues is substantially stable at 90%, therefore confirming the predictability and the resiliency of DiaSorin business. Let me now move to this slide. Before going ahead with the EBITDA guidance, I'd like to spend a couple of minutes on how we see the progression of synergies related to the Luminex acquisition over the next few years.
Back in July, when we announced the Luminex deal, we anticipated achieving approximately $55 million in cost synergies within the third year after closing. Since July, we have had the opportunity to work with the Luminex leadership. To review our assumption and thanks to a deeper understanding of the combined business, we are revising our cost synergies estimate upward to $60 million by 2025, confirming the target of $55 million within the third year after closing. In addition to cost synergies, we also believe the integration of the two businesses will provide a further $30 million in revenue synergies. This will be driven mainly by sales in the U.S. to hospitals served by Luminex, which do not overlap with those served by DiaSorin today. By the opportunity to leverage DiaSorin direct commercial presence outside the U.S. to promote Luminex product.
Coming back to cost synergies, we anticipate the following initiatives to be the key drivers. Platform consolidations, think about the LIAISON MDX+ and the LIAISON PLEX that we just saw a couple of minutes ago. The rationalization of the geographical footprint, the integration and the rightsizing of the two organization, and operations and supply chain optimization. Let's now move on and discuss the adjusted EBITDA margin. I believe this chart helps to put things into perspective and to understand the margin evolution from a pre-pandemic world, which means 2018 and 2019, to the period covered by our plan. Here, I think it is very important to remember the starting point, which is before COVID and Luminex acquisition, DiaSorin was enjoying an EBITDA margin around 38%-39%. 2021 EBITDA margin is a kind of outlier.
As discussed several times during quarter end calls, it has been largely impacted by the very high COVID sales, which generated a very material operating leverage. In addition, 2021 includes only six months of Luminex business, that as we know, enjoy lowest margin compared to DiaSorin. Now, looking forward to 2022, we expect to experience a dilution in our gross margin and higher operating expenses ratio over revenues compared to 2021. Why that? The gross margin dilution will be primarily driven by the fact that we will replace higher margin COVID sales with lower margin Luminex sales, and by the addition of an absorbed cost linked to the investment on our manufacturing site in China that we saw again a few minutes ago. The higher OPEX ratio is attributable to the fact that 2022 will be the first year full inclusive of Luminex expenses, with synergies not yet fully realized.
With total revenues, if you look at the top line, as we saw, which are broadly in line with 2021, and this is simply the reason why we believe the EBITDA margin in 2022 will sit at around 35%. Looking past next year, by 2025, we believe the EBITDA margin will climb back to 38%, which is in line with our pre-COVID and pre-Luminex acquisition performance. With an EBITDA value that will have doubled in absolute terms compared to 2019. We will achieve this through the full realization of the synergies outlined in the previous slide, and the additional operating leverage coming from the growth in the top line.
The gross margin will improve compared to 2022, but I don't believe we go back to the pre-COVID years because of the different product mix, which now will be more skewed towards molecular products that we know enjoy lower margin, and let me call them partnership products, such as latent tuberculosis, MeMed, LymeDetect, which carry higher royalties rate. In summary, we believe that we will be able to return to our historical level of profitability once COVID is behind us, and the Luminex business is fully integrated with an EBITDA value, which in absolute term again, will be slightly more than twice what we had in 2019 and above EUR 550 million.
Now, before moving to the next slide, please allow me to make two technical comments associated with the impact of the Luminex acquisition on our financial reporting, which I deem will be useful for modeling purposes. First, in 2021, we began to highlight an adjusted EBITDA. However, we expect that by 2023, the difference between the EBITDA and adjusted EBITDA will be completely negligible. Second, our estimate of the purchase price allocation amortization impact coming from the Luminex acquisition on the net result will be about EUR 60 million per year. This chart shows the evolution of the net debt ratio adjusted EBITDA. Based on our projection, we believe the ratio will decrease to 0.5 in 2025 from 1.9 at the end of 2021.
Therefore, confirming a quick deleverage of the company as a result of the free cash flow generation across the period. The anticipated small leverage ratio increase in 2022 is simply the result of the reduction in that year of the adjusted EBITDA that we just discussed in the previous slide. With that, I'd like to move to my last slide. In this slide, I will conclude my remarks on the financial translation of the plan described by Carlo and highlights and summarizes what we have seen in the previous slides. More precisely for the period 2022-2025, we project revenue compounded average growth rate of 10% excluding COVID and 7% with COVID. The adjusted EBITDA compounded growth rate will be at 10%.
The cumulative free cash flow generation over 2022-2025 will be above EUR 1.1 billion, and the leverage ratio will decrease to 0.5 by 2025. Let me close my remarks saying that based on the initiatives and strategy presented today, we are very excited with the positioning of DiaSorin as we emerge from the pandemic. As the financial highlighted, we are confident that we will continue to drive sustained growth and value as we have done in the past. With this, let us open the Q&A session, and thank you.
Thank you. Okay. I think that, we have some questions that is coming from the audience that is connected.
Hello, everyone. The first question from the internet is Flex the Plex. Can you please provide more details of how it works and how many targets are included in the basic panel?
We don't know yet what the basic panels will be because it depends from the different disease states. I think the idea is that 50%, give or take, of the targets are gonna be provided with just purchasing the kit. The remaining 50%, either as a single or in groups, are gonna be associated with credits that customers can buy and then open up the result for the patient at it, at their will.
Thank you. The second question is, can you please talk a bit more about the LIAISON NES portfolio, and do you think it will be more of a U.S. market as flu testing is more U.S.-based?
The portfolio is today what's in development is COVID flu. That would be the first assay that is gonna be launched very clearly for differential diagnosis. The market is not only U.S. for that product, it's gonna be also for Europe. The second assay that we have in the funnel is for GAS, group A strep, and that also certainly does complement the differential diagnosis for flu and COVID. We are looking at sexually transmitted diseases as the third panel that is gonna hit the market.
As far as what is the market for us, certainly the U.S. is our primary market for this because of the level of decentralization, the reimbursement, the fact that we believe that there is space in pharmacies with this technology, but we're also investigating the opportunity in the different European countries. The difference is that in Europe, you do have 27 different healthcare systems that you need to investigate, whereas the U.S. is a very large market with fundamentally one legislation.
Thank you. The last question we have from the web is regarding the partnership with MeMed. We saw the opportunity in the MeMed CEO slides. What about the DiaSorin opportunity? Can we have some more color on what you expect and when?
I think that we gave a gross number, and the number is EUR 150 million that in the next four years are gonna be generated by these opportunities. For confidentiality reasons, we are not gonna do the split, also because first we need to really understand with MeMed how we wanna handle this information. To me, what is very intuitive about MeMed is that the product goes right away on all our installed base, because our installed base is primarily into hospital settings. There is where MeMed with the capital that they raised are gonna hire people, especially in the U.S., to do all the promotional activities which are necessary now to generate demand.
That demand will actually go to two platforms, as we have discussed. One is the MeMed platform that is taking care of the emergency calls. When volume piles up, the hospital will have the flexibility to manage the emergency with the MeMed platform and then the volume that piles up with the DiaSorin system. Let me remind you that the LIAISON XL actually generate the results within 20 minutes, so it can also be used for emergency.
Thank you. The last question from the stream is, did I get right that the minimum pathogens on the LIAISON PLEX is 20 in one go?
In general, yes, but does not mean that that's a decision made for all the panels. It depends on the clinical indication.
There's another question. Can you clarify what you mean by saying the difference between adjusted EBITDA and EBITDA would be minimal in 2023, and what is the ex PPA?
Sure. When I say minimum, I mean below EUR 5 million. When we define adjusted EBITDA, we mean EBITDA adjusted by all of those costs that we sustained to integrate the Luminex business. We believe by 2023, basically all of those one-off extra additional costs will be over. When I say the PPA thing, this is a request that has been asked by many analysts, is the impact of the purchase price allocation depreciation coming from the Luminex acquisition on our financials. I understand for many techies that is an important number to model the PNL and the financials, so I wanted to disclose it to the financial community. The PPA exercise has not been completed yet.
We are running it as we speak with the help of a consultant, but our estimate is that more or less it will be EUR 60 million per year.
Thank you. Do you think there is more space for cost and revenue synergies over the next 3-5 years?
No, I don't think that there is more space. I believe that now four months into the acquisition, we had the time to mature a plan that has been actually presented and shared internally to the management. I believe that what is up there, which is by the way an improvement in terms of not only value, but also time-wise, what we've been discussing before, it is what this company is committed to achieve.
Thank you. How does the LIAISON NES compare to Roche cobas liat and Abbott ID NOW, and what are the differentiated features?
Well, interesting. I think a marketing manager here should take the question, but I'll try to address it. If you take the Abbott ID NOW, it's a system that, by the way, has been on the press because it has been one of the system that has been used in the U.S. for decentralization. One of the problem, which by the way is there still today, is an alert that the FDA ask the companies to insert about the sensitivity because again, these technologies are technology that was developed some time ago. It is what we have today available, but still not as sensitive as the more modern systems. The other thing is that it does require offline hands-on time.
When it comes to the Roche cobas Liat, let me say, probably the closest system that today it is out there to what we are thinking. It's above 20 minutes. What we are talking about, the LIAISON and NES is around 15 minutes. When it comes to the design of the system, the simplicity of the system, and the way it's been thought, certainly belongs to a next generation system in terms of decentralization because it has been solved for pharmacies and is extremely simple. The cobas Liat system has been designed for decentralization, extremely successful for decentralization in the U.S. in specialized setting.
Thank you. The last question from the stream we have is, how should we think about the Luminex gross margin profile, given all reagents for up to 30-40 targets, are included in the cartridge, which will be offered at a lower cost?
This is a very interesting question. The thing is, obviously, the idea behind the LIAISON Flex is that, the cost of the cartridge is not gonna change. What is gonna change is the possibility for the lab, to decide how many results they want to unmask. Our focus now is to really make the whole manufacturing process as streamlined as possible because we want to bring to the market a cartridge which is very cost-effective. Based on our analysis, the margin we will get, even with the minimum level of results that will be unmasked, is broadly in line, with, the margins we're making on, molecular, products. Just a few percentage points below. I don't wanna be too specific there.
As much as you go above the minimum level of results which will be unmasked, obviously, the margins will be increased likewise. In our projection, when we are saying that by 2025, the gross margin of the group will increase, we are already assuming a certain balance among the number of results which will be unmasked. I feel pretty comfortable that what we are embedding now in our numbers is a target that we will achieve.
Thank you. Luminex has already 700 hospitals. How big do you see the opportunity there with the LIAISON XS?
I don't think that we are available to discuss specific targets. I don't think this is the kind of presentation. My point is, we discussed in the previous plan about the LIAISON XL opportunity, and the LIAISON XL opportunity back then was 150 new hospitals that this company would achieve within three years. That has been a target that has been clearly overachieved as an effect of the pandemic on one side, and the fact that more hospitals really wanted to have more systems placed.
I believe that when it comes to the LIAISON XS, certainly the number of systems that we expect to place in the next four years far exceed what we did with the LIAISON XL, and simply because the multitude of hospitals that can take the platform, and also the fact that we do have 700 addresses today we can go that do know DiaSorin and do understand Luminex makes this plan much less complicated than the original plan that we launched in 2019 with LIAISON XL.
Thank you. That will be all from the stream. If anybody else has questions, please do ask them.
You can't touch your mic.
I can't touch it, sorry.
Yeah.
Can I turn around?
Yes.
Hi, it's Peter Welford at Jefferies. Couple of questions. First, can we just ask with regards to the LIAISON PLEX, first of all, what sort of feedback have you had from your customers so far? Given the delay, if you like, in the U.S. launch, can you talk a little bit about what you're doing with your existing VERIGENE and ARIES customers, I guess, to keep them on side so that you can then potentially switch them to the LIAISON PLEX when that becomes available? Can you just talk a little bit about the importance of building a franchise. I think we understand from some of your competitors that they're leveraging existing instruments and places to place their instruments.
Can you talk a little bit about the importance you see of that, and whether you do see price pressure building up in multiplexing, given there's new entrants entering this market almost every year at the moment? Secondly, just on the trajectory of the margin, given you talk about-
Can you hold your thought?
Yeah, yeah.
Otherwise we're gonna forget the-
I'll do one by one. Okay. Sorry. Okay.
Okay, let's first talk about the ARIES, the VERIGENE I, and the LIAISON PLEX, which I think is your question. Well, first, ARIES has nothing to do with the VERIGENE platform. ARIES actually is a growing franchise today. It is growing as a result of increased manufacturing capacity that we now have in Austin compared to what it was there just four months ago. Certainly it's COVID driven. ARIES is not a target for the LIAISON PLEX. It's actually an opportunity long term for the MDX Plus. When it comes to the VERIGENE I, what I said, we have today roughly 1,000 users of the VERIGENE I technology.
The business is flattish, and so it's been fairly resilient over the last few years, notwithstanding the fact that certainly BioFire has been hitting the market hard with their systems. The reason why it is being resilient is because that technology has been one of the first technologies that hospitals have adopted, especially for blood infections. You have a very solid customer base. Last but not least, don't forget that what we understood when it comes to multiplexing is that quite often hospitals are actually using different technologies for multiplexing. The strategy to me for the LIAISON PLEX is very simple. You're gonna go and replace these systems with the VERIGENE II, the LIAISON PLEX system.
The way that you grow a good percentage of the growth that we envision we're gonna take is just adding one more panel to the existing panels that customers are using on the VERIGENE I platform. What was the last question about gross margin?
It's more on pricing pressure in the sense there's new entrants entering this market all the time, including some pretty big companies. Obviously, we hear they're potentially gonna use, I guess, weight basically as they supply tons of products to these labs. Do you see pricing pressure growing significantly in the multiplexing market as some of these bigger players enter the market?
I do see. I certainly do see price pressure. I think we discussed about it. It's part of the new world. Excuse me, ma'am, I think he's not done. I believe that yes, there is a price pressure. I said it is the new rule of the game in diagnostics. I believe that you must have a technology. If you wanna make money in this space, you must have a technology that is manufacturable in quantities, in scale, and with relatively low cost. I'm saying relatively low cost because certainly these are expensive cartridges. I believe that when it comes to multiplexing, you are not gonna enjoy the same margin level that you have with some of the specialty products, and this is embedded certainly in our plan.
By the same token, I also believe that the margin, the price level that today these products do receive and the reimbursement that is there today, the price structure with a good manufacturing practice does allow gross margins which today are in line with the gross margin of the molecular space. Keep in mind that prior to pandemic, prior to COVID, so take COVID out, because COVID completely is an outlier, right? I think a good molecular company was actually making gross margins in the range between 50%-60%, okay? If you are in that space, I think this is what you need to look after.
If you wanna really then have a contribution to the EBITDA, which is in line with the rest of the business, you must really flex on the operating leverage.
I've got two more, but they're fairly short, so I'll throw them together in case I lose the microphone again. Firstly, just the trajectory on the margin. Given China comes online 2023, so obviously costs are there, given the time to do our launch Luminex is really 2023 in the US, should we be thinking not linear, but more of a hockey stick from 35%-38%? Secondly, just on the net debt to EBITDA, 0.5x by 2025 seems very conservative given EUR 1.1 billion of cumulative free cash flow. Is that? You know, are you assuming within that further business development, partnerships, acquisitions other sort of small deals? Or otherwise I would have thought by 2025, you could potentially almost deleverage entirely.
Yeah. Let me start with the margin one. Yes, you're right. If you think about the trajectory of the gross margin, I believe we closed Q3 2021, which you can consider the first full quarter where we consolidate Luminex and the DiaSorin number, the 65%. Then you're gonna see, as I said, the manufacturing impact of the plant in Germany.
China.
China. At the same time, what you see is that you have a replacement of COVID sales, which are margining more than 70%, to Luminex sales, which on average are margining 60%. I see 2022 as the bottom in terms of margins, and then you see a peak up, but with more of a hockey stick effect, as you just said, closer to 2024, 2025. To go back, I believe, to a gross margin at around, let me say 66%. Considering the fact again that the mix will be different, not just immunodiagnostics product, but a big chunk of business with the molecular diagnostics. At the same time, the revenues coming from those initiatives that we discussed about.
You know, in terms of the leverage ratio, we made some assumptions in terms of CapEx. Many of these programs that we discussed about will require some funding. Think about the LIAISON XXL, think about what we still need to do on the LIAISON nes all the other projects. You might say that we've been conservative. What I can tell you is that the 0.5, the number, I feel very comfortable to commit to. Potentially we might be better, we'll see. 0.5 is definitely a number we will, we feel very comfortable with.
Are you done, Peter? You're done, right? Okay, good. Anybody else? Okay, good. Listen, thank you for participating and again thank you for participating.
Thank you.