Good afternoon. This is the Chorus Call conference operator. Welcome, and thank you for joining the DiaSorin Third Quarter 2022 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.
Yes, thank you, operator. Ladies and gentlemen, good afternoon, and welcome to the quarter three conference call result. As usual, I was gonna shed some colors on the quarter results in terms of the top line and the main fundamentals of the business. And then our Chief Financial Officer is gonna take you through the numbers. Let's start from the top line. I remind everybody I'm gonna comment on at constant exchange rate. As you know, otherwise, you know, all the numbers are heavily affected by the revaluation of the dollar. At constant exchange rate, the business in the quarter performed at -14% versus last year. That is according to expectations.
The reason for the decline is attributable to the COVID, as you have seen from the numbers. Compared to last year's in the quarter, we are EUR 50 million down, and we are roughly EUR 90 million year to date. If we look at the business ex-COVID, the business grew 2% in quarter three. As a combination of several events. Although there are a couple of things that I would like to highlight. We had two clear headwinds when it comes to the quarter results. The first one has to do with the fact that in two geographies, and mainly China and the Middle East, we had a performance which was heavily affected by the current situation. So China continues to be a drag.
Ans as far as we are concerned, the main effect today with lockdowns, so we see that in the provinces where we sell, we continue to see a strong effect on volumes. And then in the Middle East, because of the current situation in Iran, we had to postpone some of the shipments. By the same token, we continue to see the effect on Russia, where we were exporting until last year, and the export has been reduced to some very small amount. If we take away these effects, immunodiagnostics in the quarter would grow 6%, year to date, 7%, so this would be in line with the company's expectations.
Now, if we look at the business in immunodiagnostic, and then we look at North America. North America, that, you know, today, does represent the majority of our business. Immunodiagnostic is growing very strong, at 10% in quarter three, 12% year to date. If for one second, we take away the vitamin D franchise that, as you know, has been declining historically for DiaSorin, the rest of the CLIA ex-D business in the U.S. grew 18% in quarter three and 25% year to date. What's the reason behind that success of immunodiagnostic in North America, as we discussed many times, is the hospital strategy where the segment where DiaSorin was traditionally underpenetrated.
And because of the effort that we put in at the beginning of the pandemic in putting together a distribution footprint in terms of more reps and more territories, and this clearly continues to pay out. Today, notwithstanding the effort, if we look at the available market in terms of number of hospitals that we serve compared to the total market, we are below 20%. So we still have a very long runway in front of us in terms of opportunity to grow in North America. When it comes to Europe grew immunodiagnostics at 4% in quarter three and 5% year to date.
As you know, notwithstanding the current situation, economic situation in Europe, the business is a stable business. We continue to grow. If you look at just the growth of the market in Europe, we estimate today the market grows at 1.5%, so we continue to outgrow the market. The strategy is always the same. It's specialties, and the margin contribution certainly is extremely positive. Now, if we look at the rest of the world, in quarter three it is 7% below last year. And this is exactly where we have the two headwinds that we were talking before. Export Middle East and China.
With the exception of these two geographies, if I take everything else, including countries where the company made an investment in infrastructure, and I'm referring to India, for example, or Mexico or Brazil, where we have our local team. Just as a reference, India in the quarter grew roughly 20%, and in the other geographies we are growing high single-digit or low double-digits. I think specifically the problem we have seen in this quarter has to do with the two geographies and the events we've been talking about. Now let's go to molecular diagnostics, 7% growth in quarter three. That is a good performance for the diagnostic molecular assays. Again, we are talking about growth ex-COVID.
And growth has been driven by COVID flu, plus it has been driven by the fact that when it comes to the VERIGENE and the multiplexing business, we have that business, notwithstanding its base on technologies which have been launched over 10 years ago is holding up. Waiting again for the launch of the LIAISON PLEX, which is gonna be the new driver for growth in that segment. When it comes to what we call Licensed Technologies. Here is where in the quarter for the first time the business actually declined 4% in the quarter, but there is a reason about it. Which is the reason there's a reason for this decline, which has to do with the supply chain on the instruments that we manufacture.
As you know, the business that we call Licensed Technologies is a combination of consumable revenues, royalties that we get from partner distribution and instrument sales. As far as this business, traditionally the growth is high single digit low double digits. If I look at the royalty component, which is an indicator of what the partners are doing with our consumable, and the consumable growth, the growth is very strong. Unfortunately, when it comes to the instrument component of this business, because of the current supply chain issues and unavailability of certain parts, in quarter three, we built less instruments than we have orders for. We are estimating that the gap today is between EUR 5 million and EUR 8 million in terms of systems that we should be delivering.
But they are held in the quarter waiting for some of the parts to be completed. This explains why for the first time, Licensed Technologies is not a growth component for the business. But again, it's nothing to do with the fundamentals of the business. It's to do with the supply chain issue. This also explains why margins are very strong in this quarter, notwithstanding the fact that we are missing some of the revenues. This has to do with the margin differential between consumables and royalties and instruments. As you can imagine on instruments, the gross margin is relatively modest, whereas on consumables and certainly royalties, the margin contribution is very high.
The fact that component of the business goes well explains why the overall margins of the company are, I would say, very nice in the quarter. Now let's talk about COVID. COVID continues to decline, is roughly EUR 90 million below last year. Of the EUR 90 million, above 50 million, around exactly EUR 53 million, is in quarter three. The decline versus last year, it is expected, as you can imagine, because we don't sell the antigen test, the rapid tests, which is a market that today is declining, but not as much as molecular or certainly the serology. Although the decline we see is better than what we expected.
The business is still holding in certain key strategic geographies, and this is why we are actually performing better than our expectations. We still don't see in these numbers any effect on differential diagnosis, where we expect to see pickup in volume in Q4 and quarter one, but the jury's out, as we have discussed many times. We're gonna be able to comment on that at, I would say, when we are in the midst of the influenza season, which is around the December timeframe. Couple of things that I would like to discuss that have to do with margins.
As you've seen, margins in the quarter are strong and actually better than what we expected. And this is what is very important to note, that this in spite of the headwinds due to the inflationary effects that everybody, I believe, is facing these days. I think in the last quarter, we quantified the effect of inflation around EUR 15 million annualized. We revised this effect slightly to EUR 17 million, and mainly due to the effect of the cost of electricity in the European plants. Still marginal vis-a-vis what you see in other industries, and certainly manageable from a DiaSorin perspective.
By the same token, what's working good for us has to do is the synergies that we are extracting from the consolidation of Luminex within DiaSorin. As we have discussed already previously, the program is in line with the expectation, and I would say slightly better than we scheduled. The other element, which is very important these days for us, is that all the time and money and education spent in the last few years in terms of improving the manufacturing cycles in our manufacturing sites, especially when it comes to the immunoassay now clearly coming to fruition.
So notwithstanding a situation where there is price pressure, we continue to be able to hold our margins because of the efficiencies that we've been driving through manufacturing. So that makes me quite comfortable even in these difficult times with the combination of increasing cost and decreasing prices. Couple of notes when it comes to two key programs. The first one, MeMed, as you have seen, there has been a recommendation published vis-a-vis the U.S. CMS reimbursement. The proposed reimbursement is around $250, which is extremely high for an immunoassay.
And i believe that what is extraordinary about the proposed reimbursement is that this has nothing to do with the technology per se, but it has to do with the benefit of the algorithm vis-a-vis the way patients are actually accepted and treated when it comes to their emergency room. That's very positive, and I believe MeMed as a company did a fantastic job in educating the regulators on the value of the assay. That certainly will support and facilitate the marketing of the product in the U.S. The second element which makes me very proud in a sense is the fact that BARDA just announced that they have decided to fund substantially the development of the LIAISON NES.
And the contribution of BARDA is $31 million, which, what is very interesting is that these funds are not coming from the COVID fund. As you know, the emergency COVID funds pretty much are over. This is coming from the strategic funding, which means that this reflects the recognition of BARDA that the LIAISON NES platform has with its characteristics of being easy to use, fast PCR response, and can be disseminated in the territories. In capillary system is a key and strategic technology for the U.S. government. That, as you well know, is not simple for a non-U.S. company. That I think is a very interesting and encouraging sign vis-à-vis the acceptance of this technology. So now I'm gonna leave the podium to the CFO, Piergiorgio, who is gonna take you through the numbers. Thank you.
Thank you, Carlo. Good morning and good afternoon, everybody. In the next few minutes, I'm going to walk you through, as usual, the financial performance of DiaSorin during the first nine months of 2022. I will make some remarks on the contribution of the third quarter. Let me please remind you that consistently with what we did over the last calls, in order to better understand the performance of the business. I will refer to adjusted P&L items, therefore sterilizing the impact of the Luminex deal related elements. In the press release available on our website, we are providing a line-by-line bridge between adjusted and IFRS items. Please also remind that we completed Luminex acquisition in July 2021, so starting from this quarter, we have the same perimeter of consolidation.
For that, as usual, I'd like to start with what I believe are the main highlights of the period. 2022 year-to-date total revenues at constant exchange rate grew by 10% or EUR 82 million vis-à-vis 2021. As we saw, it's a combination of a decrease in COVID sales by 32%, more than offset by an increase in the ex-COVID business by EUR 171 million. The new diagnostic franchise ex-COVID had comparable effects, grew by 4%, driven by an increase in the CLIA ex-D business just short of 10%, in spite of the weak result in the Chinese market that Carlo just discussed about and the headwind we faced in the export business. Partially offset by the negative performance of vitamin D, I mean, the increase in the four percent of the Immuno business and the ELISA franchises.
The molecular business ex-COVID growth is mainly driven by the different perimeter of consolidation and by a very good performance of DiaSorin molecular reagents. The Licensed Technologies franchise variance year-over-year is mainly due to a different perimeter of consolidation in the first half of the year, partially offset by the slowdown in the third quarter that Carlo just commented. Q3 total revenues at constant exchange rate decreased by 14% to EUR 47 million as a result of the anticipated decrease in COVID sales, partially offset by an increase of the ex-COVID business by 2% to EUR 5 million. We should be able to recover most of the gap in the Licensed Technologies business that Carlo has discussed and the immunoexport business by the end of the year.
These elements, the one that we just saw, explain the soft increase in the Immuno business and the decrease of the licensed technology franchise. Whereas, we saw the molecular franchise increase by 7%. Year-to-date adjusted EBITDA at EUR 391 million records an increase of EUR 8 million or 2% compared to 2021, with a margin of 39% on revenues compared to 45% of 2021. The expected decrease in marginality is a result of the combination of a diluted gross profit, mainly driven by different product mix and the lower operating leverage, driven by the inclusion of Luminex in the perimeter of consolidation and the very high COVID sales of 2021.
Both these elements are in line with the assumptions we made at the time of the Luminex acquisition and are embedded in the outlook shared during the Capital Market Day and the updated guidance we've just released today. Q3 2022 adjusted EBITDA margin at 37% or EUR 122 million records a decrease towards Q3 2021 of EUR 17 million or 12%. The variance is mainly driven by lower COVID sales, EUR 47 million in the quarter, to be precise, and as a consequence, a lower operating margin. We keep confirming our ability to generate a very healthy free cash flow. EUR 150 million year to date, with an increase compared to last year of 2018 million euro or 13%.
As you might remember, when we released Q1 2022 results back in May, we announced that DiaSorin board of directors resolved to launch a share buyback program for a total maximum of 1.5 million treasury shares to support the potential settlement of the outstanding convertible bond and the management equity plan. As of the end of September, within that program, DiaSorin bought back about 1.3 million shares for an equivalent amount of about EUR 160 million. On a different note, and before moving to the main items of the P&L, I'd like to provide an update on the impact on the inflationary pressure on DiaSorin total cost base.
We saw that number was EUR 15 million back when we closed the half year, and in the light of the recent increases in energy cost, that number has been increased to EUR 17 million. Now, moving to the P&L items. September year-to-date total revenues of EUR 1,012 million grew by 18% or EUR 153 million compared to last year. Luminex products revenues in the period amount to EUR 277 million vis-a-vis EUR 91 million in 2021. COVID revenues amount to EUR 201 million vis-a-vis EUR 276 million, therefore recording a decrease of EUR 74 million. The first nine months of the year have seen some EUR 71 million FX tailwind, mainly driven by the USD appreciation.
Considering Q4 2021 USD euro exchange rate and the current FX trend. I think it is fair to expect that a similar positive tailwind will continue for the remainder of the year, and we will end up with a positive FX effect full 2022 over 2021, just short of EUR 100 million on the top line. September year-to-date adjusted gross profit at 672 million euro, grew by 16% compared to last year, closing the first nine months with a ratio over revenues of 66% compared to 68% of the same period of 2021. The full year contribution of Luminex and the different product mix are the main drivers of this variance.
Q3 2022 adjusted gross margin at 68% is better than last year by 2 percentage points. The overage, in spite of lower quarterly revenues, is driven by a different product and geographic mix, and some one-off positive elements that we had in the quarter. I believe, though, it is important to underline that in spite of the inflationary pressure we discussed about, we have been able to put in place cost containment measures and initiatives that have allowed us to preserve our margins. September year-to-date adjusted operating expenses of EUR 345 million grew by 42% compared to the same period of 2021, with a ratio of our revenues of 34%, vis-a-vis 28% of last year.
This increase, once again, in line with our expectation, is mainly driven by the different perimeter of consolidation and much higher COVID sales in 2021 that generated back then a very material operating leverage. The negative FX effect and higher travel costs mainly drive Q3 2022 adjusted operating expenses increase towards last year of EUR 13 million or 12%. I believe it is important to underline that net of the FX effect and these additional travel expenses, we would have actually had a decrease in OpEx in spite of the inflationary pressure we just discussed about. Year-to-date other operating expenses are substantially in line with last year. As a result of what I just described, September year-to-date adjusted EBIT of EUR 319 million has decreased compared to 2021 by 3% or EUR 11 million.
September adjusted interest expenses at EUR 4 million are lower than last year by 30% or EUR 2 million, mainly because of better yield on our cash investment, whereas the adjusted tax rate at 23% is in line with 2021. The adjusted net result at EUR 244 million or 24% of revenues is lower than the previous year by EUR 4 million. Lastly, year-to-date adjusted EBITDA at EUR 391 million or 39% of revenues is higher than last year by 2% or EUR 8 million. The variance at constant exchange rate is negative by 5% with a ratio of our revenues of 39%. Let me now move to the free cash flow and the net debt position.
In the first nine months of 2022, as just said, DiaSorin generated EUR 252 million free cash flow, so EUR 28 million better than last year. At the end of September 2022, the net debt of DiaSorin was negative for EUR 1,012 million, vis-a-vis negative EUR 986 million at the end of 2021. The difference is a result of very strong cash generation, which has been more than offset by the following items, the share buyback program for EUR 160 million, EUR 90 million of negative translation FX effect, and EUR 56 million dividends to shareholders. Lastly, let's now move to the updated 2022 full year guidance as usual at previous year constant exchange rate.
The guidance has been increased as follows: total revenue to grow between 2% and 3%, with the ex-COVID business growth at about 22% and COVID sales at around EUR 225 million, and the adjusted EBITDA margin between 38% and 39%. The increase in the guidance for the top line is mainly driven through better COVID sales, whereas the weak performance of the Chinese market is the core driver of the revision of the ex-COVID sales. Now let me please turn the line to the operator to open the Q&A session. 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 touchtone telephone. To remove yourself from the question queue, please press star and two. Please pick up the receiver when asking questions. Anyone who has a question may press star and one at this time. The first question is from Aisyah Noor of Morgan Stanley. Please go ahead.
Oh, great. Thank you for taking my question. I have two, please. The first one is on the shipment delays that you highlighted in the Licensed Technologies business. Could I confirm that your revenues would have been EUR 5 million -EUR 7 million higher, if not for the delays that you observed? Related to that, how much visibility do you have in resolving this issue by Q4, and that that situation is not going to impact your existing orders to be delivered in Q4 itself? On a second is on multiplex on Luminex. Are you able to provide an installed base for the Luminex multiplex platform as of today? Could you provide, you know, some color as to whether you were able to expand the installed base this quarter? Thank you.
Aisyah, thanks for your questions. Question number one, yes, I confirm that, as said, had we been able to fulfill all the orders, revenues would be higher by EUR 5 million-EUR 7 million. In terms of visibility in Q4, I don't think we have visibility these days because the supply chain is very weak, and we have deliveries of parts which are scheduled in the next few weeks. The real problem today is that they can call you two days before and simply delay the shipment.
This is the current situation, I think, generally speaking, in the medical sector. If I may give a little bit of color to it, because this is counterintuitive compared to what we see in the consumer goods. I have a feeling that the supply chain made a strenuous effort to work with consumer goods. Although the designated victim has been our sector, because our sector is typically low volume, high value. Although what some of our suppliers that we enlisted are telling us is that in order to fulfill consumer goods, we had to cut somewhere else. I think this is the price we as an industry are paying.
And of course, actually, if you notice made some of the comments, I wanna pick up on the comment that Stratec made specifically because they're the DiaSorin supplier. The only thing I wanna make sure everybody understand is that when it comes to Stratec is that fortunately the quarter is not really on the DiaSorin systems. The LIAISON XL, the LIAISON XS, and the MDX, no problem of supply, although they cited supply chain issues with other systems. Second question about multiplex.
No, we don't provide installed base because we believe it's proprietary information. Although my comment is that especially with the LIAISON MDX system, yes, we expanded the installed base. Clearly, there the problem is that the revenue per box are strongly declining compared to last year because of COVID volume. We have a revenue per system declining, although the install base continues to increase.
Great. Thank you very much.
The next question is from Peter Welford of Jefferies. Please go ahead.
Hi. Thanks for taking my question. I've just got a few. Just first of all, just going back to the underlying growth of i think largely immuno. I wonder if it's possible for you to sort of quantify that, the gap you mentioned between sort of 2%-3% versus 6%, I think you said in the quarter, excluding the headwinds. Can you possibly try and give us an order of magnitude of the effects of China lockdowns versus the Middle East Iran delays and versus Russia, just to try and give us some color as to the relative magnitude, I guess, of those three to account for that sort of 400 basis point delta in the third quarter growth.
Secondly, just on the COVID trend, the outlook seems to imply, you know, less than EUR 25 million or roughly 25 in the fourth quarter of COVID sales. I guess, given your comment that you've yet to see differential diagnosis pick up for the flu season in Q4, Q1, I guess, why do you assume that COVID declines another 50% quarter on quarter in the fourth quarter, apart from. I mean. I appreciate none of us know at this point. But I wonder if you can at least talk us through the mechanics of your thinking around that, and why we shouldn't be assuming COVID at the very least is potentially flat on the third quarter, given the season is just picking up.
Just finally, just with regards to the MeMed recommendation from CMS. At this point now, what's the sort of, I guess, strategy and procedure forward now? Is this now a case that you can begin rolling out and educating and marketing to the U.S. or how should we think about the strategy and the limiting gating factors from now for this to be rolled out in the U.S. market? Thank you.
I'll take the last two questions, and I think PG will take the first question. As far as COVID, sorry, but I don't understand the math. I think that if you take year to date versus expected, we are talking about around EUR 35 million delta, and that is EUR 13 million per month, which is today what we see without the effect of the differential diagnosis. We always stated that it's really complicated to predict the increase in what may the effect of differential diagnosis, because it's gonna happen at the end and in the season, and we don't know what the medical guidance is gonna be. So the COVID number and the logic of the COVID number is what we see today, what we experience today as our monthly current trends.
I believe, Carlo, if I may add a comment on COVID. The misunderstanding can come from the FX effect, which is pretty material in the quarter, right? The guidance we gave for COVID is EUR 225 million at constant exchange rate, right? So you cannot compare the 225 to the 201 that you have at current exchange rate. I believe that is where your. You should get EUR 25 million is coming from. What Carlo said is what we see is the EUR 13 million or so at constant exchange rate per month, which moving you from the 190 or so, 189 at constant that we have year to date to the full year, if that makes sense, Peter.
We come to your question on MeMed and the strategy. As you well know, to sell in the U.S., there are two elements which are needed. One is the approval, and the second one is the reimbursement. The approval we got months ago, and now we are very close to getting also the second element, we meaning us and MeMed, because MeMed has a responsibility for that, to now get the second strategic element for the effective launch of the system. So what we are doing today, we are targeting a set of roughly 100 hospitals where the DiaSorin system is already installed. And we are going through an education program whereby we clearly explain the value of this product within the diagnostic algorithm that these hospitals use.
I think as we discussed last time, the strategy calls for an initial export directed toward the education of in the children's hospital. Because today, talking to the physicians in the emergency room, what they see as a primary objective or application for this product is actually an immediate diagnosis for kids showing up with unknown fever. Just, I think we discussed it last time, in terms of numbers in the U.S. there are 4.5 million admissions, hospital admissions of children with unknown fever. What is very interesting is that the European number is pretty much the same, is around 4 million.
There is today a total available market of roughly 8 million -9 million admissions that MeMed and DiaSorin are going after with this new product. Certainly, as we have discussed, it requires so the reward financially, as you can see from the reimbursement, is very high. The effort of education also is very high. Adoption requires education, capillary education, which is what today MeMed and DiaSorin are focused on primarily in the U.S. Question number one?
I don't believe we're going to provide an exact breakdown of where we are short in terms of China and the export business. As a ballpark number, year to date, China is accounting for give or take 50% of it, year to date, and the remainder is the export business.
PG, I think that during one of the initial, I think it was Q1 or Q2 calls, I believe that an analyst was asking how big is your Russia business, and quantify the Russian business around EUR 8 million. Combination between Luminex and the DiaSorin business. The total amount of business at stake is around EUR 8 million. Keep also in mind that part of this business was COVID related. A non-COVID molecular, but COVID serology. And because last year there was a very large adoption in Russia of the serology assays in absence of large availability of molecular. Just to give you an idea of the Russian damage versus last year is around EUR 8 million.
The next question is from Maja Pataki of Kepler. Please go ahead.
Yeah. Hi. I have also several questions. I'll take them one by one. Carlo, starting with MeMed. If you look at the CMS recommendation with regards to reimbursement, does that change, is that significantly different from what you were anticipating? Does that change the targeted price that you will sell at and therefore also, you know, the potential target for 2025?
Maja, do you wanna ask all the questions together or one by one?
No, I think I'll take it one by one then, you know, it's easier, then it won't get forgotten.
Okay. Yeah. We had an expectation, and we had a range, and this is certainly on the high end of the range. It's if you look at the reimbursement. I don't recall, honestly, an immunoassay ever reimbursed at this level. And to me is what MeMed, and nothing to do with DiaSorin, because this effort is clearly attributable to MeMed. I think that what they were able to do was to explain that this should not be reimbursed as a technology. So it's not an immunoassay, but the value is the medical information. Otherwise, you know, typically an immunoassay in the U.S. is reimbursed anything between $16-$25. That's it. So Certainly, as just a short answer, a higher end of what we expected.
Does that change the way you're thinking about your 2025 contribution from MeMed to your sales target?
You know, in Italian we say piano. I think it is.
Okay, fine. Good. Got it.
You got it?
Got it.
Thank you.
Yeah, I got it. Second question. Apologies if I've missed that, but you talk about molecular ex-COVID growth in the quarter of around 7%. It didn't seem like there were any extraordinary impacts affecting molecular as it was in immunoassay. In your 2025 strategy plan, you have the molecular franchise growing very strongly on a CAGR base above 20%, and I know that there are several product launches coming. So my question is, can you help us, how should we think about the growth cadence, like, or growth acceleration cadence over the next three years? Is 2023 going to be, you know, a low teens year and then, you know, going above? Or how should we model that? How should we think about that?
Look, Maja, yes. The growth that as you can imagine, the dynamics here of growth and acceleration has to do with the fact that we're gonna be introducing to the market two systems, right? One which is brand new, where we need to build the business, and that's the LIAISON XS and for decentralization, that's one piece. So there we start from zero with all critical business. The other one is the LIAISON PLEX, which when we discussed, I believe the strategy of that, we have an existing installed base of several hundred customers, especially in the U.S., that today are using the current platform with. And that business was traditionally built by Luminex, primarily on the blood culture assay.
Because the VERIGENE system was the first system introduced to the market with the blood culture panels, and there is where they built. And this, by the way, explains why if you look at our mix of revenues in multiplexing versus the BioFire revenues, BioFire is 70% dependent, I think, on respiratory, whereas for us the respiratory component is relatively small. The plan there is clearly to go to the existing install base, upgrade the install base to the plex, and then build to add to the blood culture, the gastro, and the respiratory, okay? But certainly the competitive part of this, in my opinion, is the gastro, which is the true differentiating. The respiratory panel is certainly very important and very sexy these days, but it's also a very crowded space, as you can imagine.
Long story short, the growth that you see later has to do with the full addition with these two product lines to our arsenal. When it comes to the performance of the businesses we speak, I think, 7% growth. Let's understand the portfolio we're talking about. We're talking about the LIAISON MDX, so singleplex. The ARIES is older technology that today is pretty much COVID business, and as you can imagine, is not a growth element. It's a drag element to the top line. The LIAISON MDX continues to grow, and there is where we are expanding the base.
And then we have in the first waiting for approval of the congenital CMV assay for the U.S., so it goes into the children's hospital segment. The Candida auris that has been launched as an ASR, the next plan is gonna be the next assay to come on the MDX. It's an MDX strategy. The rest of the portfolio, which is what we inherited from Luminex on the multiplexing, you have a VERIGENE one that is holding up and grows not necessarily by placement, it grows depending on two elements. One is how the respiratory part goes. Even if it is small, it's still there. The other one is volume growth, because we are not.
I think this, the multiplex business is not at the glory days where the volume was growing 35%, but still you have volume growth, okay? If you hold onto the base, you see volume growth. To the contrary of the [audio distortion]
Of the multiplexing portfolio, which I think you need to keep in consideration. There is a first generation technology which is very manual, which we call non-automated assays. It is actually manufactured in Toronto. It's extremely profitable with anything in this business that you do manually. By the same token is the older piece of the technology, which is certainly declining, okay? If you consider these bags that you have, 7% growth without the new systems is a fairly decent growth. By the way, profitable. You know, these days in molecular, to be profitable without COVID, I think is not simple.
Okay, perfect. My last question. PG, you talk about the business ex-COVID growth at 29% CER for the nine months. Could you give us a number for the third quarter? Because I remember that there seems to be a bit of a difference of the FX impact on the base business and COVID revenues.
Yeah. For the third quarter, you mean, Maja, yes, without COVID, it's 2%.
Yeah. 2%.
2% is a combination of the immuno, you know, all of those elements we discussed about the immuno, molecular, and life science technology.
Okay, great. Thank you very much.
Thank you.
The next question is from Hugo Solvet of Exane BNP Paribas. Please go ahead.
Hi. Thanks for taking the questions. First on COVID, have you seen any positive impacts from stocking on your COVID sales number in Q3? Then on for Carlo, you mentioned on the Q2 call that you were losing some customers on the VERIGENE one, given the strength of your Luminex business in Q3, is that something that you have managed to stabilize in Q3? Lastly, on LIAISON XS, can you give us indications on where you are on the rollout here and the contribution for the growth in the immunodiagnostic segment? Thank you.
Mr. Hugo , it was quite difficult to hear you, but let's understand if I try to answer to what I understood and correct me if I'm wrong. When it comes to stocking, I know that specifically one competitor in their quarterly report, they announced that Q3 was very strong because of stocking, and we didn't see any stocking effect. Because we did not notify or alert customers of any stocking needed. Okay, no stocking effect in Q3. The second question, if I understood correctly, is to do with VERIGENE. I believe that when I explained the business to Maja just a few minutes ago, I think I gave good color on the VERIGENE business that we have.
I said the VERIGENE business, just to summarize, three characteristics, is North America business, so we don't have a noticeable install base outside the U.S. It's primarily gastro and blood, and respiratory is only 30%. It enjoys volume growth that is not double-digit as it used to be, but now multiplexing adoption and usage is still increasing low single digit. Certainly is a profitable business for DiaSorin. The third question, if I understood correctly, is LIAISON XS. Is that the question?
Yes.
Okay. The rollout of the LIAISON XS, if you remember, the LIAISON XS program was primarily directed toward two geographies, and one is China, and that, as you can imagine, is frozen. Second one is the U.S., and actually, the rollout is starting in the U.S. because we got approval of the QuantiFERON on the LIAISON XS. Okay, so now we have the full menu for the LIAISON XS. Today, we were able to serve the hospital segment in the U.S. with the LIAISON XL because of the QuantiFERON and strong volume that was big enough to justify placement of LIAISON XL.
LIAISON XS is clearly part of the next three years plan in the US that I said is focused on continuing the expansion on the hospital segment, which is working very well for us. Now we are moving from the large institution to the midsize institutions, and there is where the LIAISON XS plays a role. Now we have the full menu approved and the program is starting.
Thank you.
The next question is from Odysseas Manesiotis of Berenberg. Please go ahead.
Hi there. Thanks for taking my questions. Firstly, on the immunoassay manufacturing operating efficiencies that you mentioned, are these largely taken through now, or is there more runway for efficiency gains here in 2023? Secondly, on the back of this, could you also update us on any progress in price increases? I know you're still working on this, but what would be a realistic timeline to think that you'll take through these price increases, let's say, next year? Last one, a follow-up on your U.S. hospital strategy. You said you're now at just below 20%, I think around 200 hospitals, and that you have some decent runway to grow further.
What is, in your view, a realistic target for let's say a steady state market share here over the next three-four years, if you could provide that? Thank you very much.
Okay. On the immuno inefficiencies, I think that what we have today is a European footprint which is in very good shape, where we have consolidated everything where it was needed. I don't expect more efficiencies in Europe. I believe that today the plan is to focus on our US footprint, where next year the Minnesota plant is gonna be the one where we will start to see fruition from all the programs we set in place.
In parallel, today we did not focus necessarily on footprint of Luminex because we just bought the business. Today, when it comes to Luminex, the primary objective was actually to invest in one of the facilities. We are investing $20 million to set it up for the manufacturing of the Plex. All the investments for Plex were already done by DiaSorin before the acquisition in Cypress, so that building is ready to go. There is no more need. Certainly, now we need to bring a little bit more discipline to the molecular team.
And then when I call it discipline, it's that I think I made this comment before. Coming from literally a two-cent business, which is immuno, I said this is a EUR 0.02 Business, meaning that you must make your money with a relatively low price business, right? When you get to the molecular space, what we found amazing is that the molecular companies tend to assemble stuff that they buy rather than making stuff that they buy, which is exactly the contrary of what we have in immuno. We started already at DiaSorin before the Luminex acquisition, an effort to in-source manufacturing raw material, which was very successful. Now that we have a much bigger footprint, that effort has to continue, and we are actually.
We are coming to the end of a period of time where we looked at the benefits of the insourcing and rationalizing some of the stuff. I believe that in the next two to three years, that is going to be the effort, right? I think that's the benefit we have seen when we looked at Luminex from a DiaSorin perspective. You know, more discipline, which we now call synergy, but more discipline in manufacturing equal an opportunity of margin expansion than if you look at what Luminex was. Again, referring to public numbers, in 2019, Luminex was actually the last pre-pandemic year. I think they reported a 7% EBITDA margin. Today, we don't disclose the Luminex EBITDA margin.
But if you look at the overall company DiaSorin margin, which is 38%, you understand that a little bit of discipline really gave us great results. Long story short, I believe that the next two years are gonna be strong effort in the North America manufacturing platform to get the same efficiencies we got in Europe. Second thing, price increase. We have raised prices for our RPG business, right? As a consequence of the fact that contracts allow us to do so. We did raise price and it's coming in effect in January 1st, 2023. By the same token, our partners will increase price through their channel to the customers, okay?
Which are the research and pharmaceutical institutions that you know to the contrary of the IVD business that business the price elasticity is far bigger. Now, we're engaged with a consultant to look at our IVD business and understand how much of that business is subject to contractual terms, and they cannot be touched. I cannot quantify it right now because we're in the middle of the process. It's a very long one because we need to take all contracts. I believe that there will be an effect also on the IVD. I cannot quantify it right now.
When it comes to the hospital strategy, as said, if you look at the, you know, in the U.S., overall, U.S. 5,000 hospitals, if you count all of them, we believe that only a certain number of hospitals is actually a good subset of hospitals where we can sell our platform because of menu and size of the systems and throughput. Today, we serve as a DiaSorin after the last effort, roughly, 250 hospitals. I'm sorry if I still refer to DiaSorin and Luminex, but that's still, unfortunately, the way we look at the business.
DiaSorin through its effort came to serve 250 hospitals out of total available market which we estimated around 1,200. Luminex to the contrary, because of their instrumentation, was actually serving roughly 500 hospitals in the U.S. A good chunk of these are actually smaller institutions that we would not be able actually to approach or leverage on with our own platforms. We estimate that 20% of these hospitals which today we don't serve are actually an opportunity of what we call top-line synergy, right? That would be considered. The ability to cross-sell across the two customer groups.
As you know, starting from right after the acquisition, one of the first effort was to redesign the U.S. commercial footprint, which we did. Now we do have in place all the reps and everything that is needed to go after the business. Just to understand each other, we are saying that today we still have an opportunity of 1,200-1,300 overall institutions in the U.S., of which we serve 250. We have 100 that we are serving with some products and we're not serving with others. This is why I'm saying the runway is still big for us.
Very clear. Thank you.
Mr. Rosa, there are no more questions registered at this time.
Thank you, operator. Bye-bye.
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