Morning. It's a great pleasure to welcome you to the IDEXX presentation. I'm going to provide a brief update on our business and business strategy. I'm Jay Mazelsky, President and CEO of IDEXX. Just by way of context, I'm going to focus on our companion animal, diagnostics and software business, which comprises greater than 90% of the business as a whole. Just a reminder of the Safe Harbor disclaimer, a copy of which you can also find on our investor website. A little bit about diagnostics and IDEXX, we're the global leader in companion animal diagnostics and software. Diagnostics plays this foundational role in veterinary medicine. It drives approximately 80% of the activity within the practice, either directly or indirectly, not just diagnostics revenue, but also therapeutic options, specialty diets, and most importantly, the overall medical services activity. We deliver diagnostic testing solutions through two different modalities.
There's a point-of-care solution modality, which is the patient comes into the practice, and within 10 to 15 minutes, you get a test result and can follow up when that patient is still in the practice, and also through reference laboratory services, where the veterinarian may send out a sample and typically gets a result back within the next day. We think about our testing solutions both as point-of-care solutions, but as part of disease franchises, whether they're vector-borne disease, parasitology, renal health. I'll talk a bit about cancer, and increasingly, customer-facing software is an integral part of our strategy. It enables connectivity and seamlessness, but also supports the workflow within the practice and optimizing the workflow, the productivity of the staff, and the ability of the veterinarian to digitally connect with their clients. We take these innovations and through a high-touch frequency model, a commercial model of subject matter experts work with veterinarians and practices to help them achieve their objectives and really provide insightful advice.
The result of having a consistent approach to strategy and investment has resulted in a durable, high-growth diagnostics recurring revenue stream of 10+% growth potential with a very high ROIC. Let me provide a quick overview of how we think about our portfolio. So you'll notice from this slide that at the center of everything we do is the veterinarian and the patient. We have best-in-breed modalities, be they reference labs or point-of-care, as you see, and invest heavily to be able to provide differentiated testing solutions and seamless service. It's connected through our customer-facing software suite, the principal among these as the practice management system. Think about this as the patient electronic record, the ability to, as a cash register, the ability to invoice customers, but also a set of applications that seamlessly plug into our practice management system and really provide that workflow optimization that I spoke of earlier. The company financial profile. Last year we finished approximately $3.9 billion.
You'll see that we're a very high proportion of that is recurring revenue, of which CAG Diagnostics recurring revenue, I'll show you the split in a minute, represents greater than 80% of the whole. You also see that from this chart that the CAG Diagnostics recurring revenue is growing faster than the company revenue as a whole. Key drivers of our business and business success is innovation. That takes the form of instrumentation and assays and customer-facing software, a commercial model of subject matter experts that position these innovative solutions with our customers and help provide important practice and business insights that help our customers achieve their practice goals, the ability to really develop the opportunity, not just in the U.S., which is our largest geography in the world, but internationally, which is earlier in its development. And I'll share some data with you. And then the sizable software business, really targeted and focused and customized for the vertical animal health industry that's increasingly cloud-based and provides a 15+% top-line growth opportunity.
This is a spotlight, the CAG Diagnostics recurring revenue. You see that it's been a relatively fast growth business over reasonable periods of time, with international in the green there comprising a greater percentage of the whole. And so the opportunity in our international geographies are substantial. They're earlier in the opportunity for diagnostics, principally being more focused on sick patient testing. And then over time, and we've seen similar behaviors in the U.S. through a belief journey change, they more broadly adopt diagnostics. A little bit about the role of diagnostics in the practice and some of the characteristics. You see over this 2019-2024 timeframe, the practice revenue, so this is revenue as a whole, including product revenue in addition to medical services for the U.S. has grown about 6.7%. The clinical revenue, the piece that involves the veterinarian, so excluding things like boarding and grooming and product sales, that's grown at 7.6%. So less than a point higher, but certainly a point higher. And so not surprisingly, the core mission of practices is to deliver medical care.
That's where the focus has been as some of the product sales have migrated outside the practice. The diagnostics, and that's for the sector as a whole in the U.S., has grown even faster, about 170 basis points faster. It's at 9.3%. Not surprisingly, diagnostics plays this unique role. It uncovers disease. It's part of assessing the health status of a patient. It really drives follow-up testing and is a key profit center within the practice. Now, IDEXX has grown even faster than that, greater than 200 basis points faster. Very often I am asked the question, why are we growing faster than the opportunity or the sector as a whole for diagnostics testing? The answer is multifaceted. First among them is our diagnostics are differentiated. They uncover more. They see more. They help the veterinarian practice better medicine. The second thing is our whole solutions work better together. They're integrated. The customer could choose, do I want to do in-clinic testing, reference lab testing. The charges are captured during when they do the test, the patient and pet owner are invoiced as part of the work that they do.
The veterinarian can focus on practicing medicine, standardizing protocols, optimizing patient throughput through the practice as opposed to administrative tasks, as opposed to having to rerun tests, maybe challenge the things like sample preparation and management. So this has been a great success. I think it's a key value proposition of the company. Let me talk a little bit about the market as a whole before going into a little bit about our strategy as a company. There's a lot of focus on clinical visits and some of the moderation in clinical visits. That's an important part, of course, of the growth equation. But I do want to highlight some very positive tailwinds. This is updated data for 2024. The way I think about this period from 2010 to 2024, it really represents a generation. If you think about how long dogs and cats live, within a period of a generation, the lifespan of cats has increased 18%. The lifespan of dogs over this period has increased 16%. That is unbelievable when you stop and pause and just reflect on that. Now, there are some important reasons for it.
In the case of cats, certainly being kept indoors, it's safer for them. They live longer. For dogs, there's been a shift into smaller breeds. And we know that smaller breeds of dogs also have a longer lifespan. But I would argue, and we see evidence that the role of innovation, better medical care, not just diagnostics, but our brothers and sisters in the therapeutic and specialty diet industries within animal health has resulted in this. As pet owners, I'd love to see this. This is good. We love members of our family. We want to see them live happier, healthier lives. It's good for veterinary practices. As these pets age, they use more medical services, and it's good for IDEXX as a whole. Now, let me take one level deeper and take an additional cut at this. This is a slide we've shown in various permutations in the past. But what this shows is as these pets age, they use more diagnostics, both from a dollar standpoint, and I can share with you as a percentage of the whole healthcare spend envelope. So diagnostics becomes a more prominent feature of the whole healthcare spend.
Now, what we've done on this slide is depicted the average against the very top practices. Top practices defined as the inclusion of blood work, which is chemistry and hematology as part of a clinical visit. And what you see is they use diagnostics two times, more than two times more than just the average practice. And it's not surprising. These practices have standardized. They're bought into the important role that diagnostics plays. In the case of wellness visits, they realize, these doctors realize that well patients or well visits, that these dogs and cats are not always well. In between 25% and 35% of the cases, depending upon their life stage and age, they uncover things. They uncover things that are significant, emerging, chronic or acute conditions that they wouldn't otherwise have known. So clearly, these pets are living longer. We know from the pandemic, there's been a big bolus of adoptions in 2021. As these pets age, you can clearly see that they use more healthcare. They use more diagnostics. And we're in a very good position as a company to capitalize on that.
So let me now go a level even deeper and talk about our strategy, which is to encourage and inspire the use of relevant diagnostics testing. And the way we think about diagnostics testing is blood work as a surrogate because it's the most comprehensive view of the use of diagnostics. And for the U.S., we have very good data in the U.S. as a result of our PIM systems. We break down visits, clinical visits when a pet actually sees the veterinarian by wellness and non-wellness. The strategy obviously is to be able to grow appropriate and relevant utilization over time. You see from the chart that we've done that very successfully and have grown. In 2024, about 12% of clinical visits, the pets seeing the veterinarian using blood work, chemistry, hematology. In the case of non-wellness visits, it's clearly much higher, as you would expect, because non-wellness visits are primarily sick patient. There's some surgery in there and chronic disease management. Not surprisingly, it's higher. However, these are averages. When you break this down by deciles, you get a very different picture or profile of what's happening in the overall sector.
We divide again by wellness and non-wellness visits. What may strike you as, I think about it as stunning in a way, the variability. Look at wellness. The top 2%, 49%, the top deciles, 35%+ . And then you have on the bottom part of the wellness, the left-hand side, very infrequent use of blood work as part of a wellness visit. Non-wellness, you have less variability, as you might guess, but a far more, far greater number of practitioners around that mean. And there's obviously veterinarians feel like there's more at stake, and they want to make sure that they get it right instead of using blood work. So our strategy is over time, help our customers through this belief journey change through medical and scientific evidence to highlight the importance of diagnostics to the practice of medicine to improved outcomes and happier pet owners at the end of the day. And clearly, that's not just going to happen. It involves awareness and education and innovation. So let me talk about innovation. I've been doing product development in various forms, human health and animal health for over three decades.
And IDEXX is a very rare company that has deep competencies, not just in instrumentation development, but biomarker and assay and menu development, and also software. And typically what you find is companies are good at they have competencies in one or the other, sometimes two, but very seldom three. And the pace of innovation, and you can see from the left-hand side, has, if anything, accelerated. We've spent over $2.4 billion if you go back to 1998. The last seven years, we've spent as much or more from an R&D standpoint as we have in the previous 20 years. That's a result of, I think, our commitment to innovation, the identification of an embarrassment of opportunities with very high returns, and our confidence that by developing these integrated solutions, we really can make an impact. So let me share with you over the last 18 months, just to support this point, the innovation portfolio of the company.
These are products that we've launched or announced or in the process of being launched just over the last 18 months in instrumentation for our point-of-care solutions, for menu expansion in both reference labs, as well as our chemistry analyzer, for example, new cancer screening tests that I'll spend some time and talk about, software, whether it's a VetLab Station or Vello . So these aren't necessarily just revisions like to our practice management systems. These are whole cloth new solutions. So something we're very proud of. I would say that they represent a collection of both point solutions as well as integrated portfolio solutions focused on disease states. So very, very exciting. Let me talk about the point-of-care portfolio. It's a very important part of our solution set. You see that we have on the market chemistry, hematology, urine sediment, and now cellular. We've also telegraphed that we're working on a new platform as we get closer to launch. We'll talk more about that. But we have a first set of principles, as I like to call them, in terms of our point-of-care solutions.
They should, from a performance standpoint, work as well or better than what you find in the reference labs. They should be easy to use, load and go, some sample preparation and management. Keep in mind, veterinary technicians, they're very skilled, but they're not laboratory technicians. The ability to be able to provide a sample prep approach, whether you put a centrifuge on these instruments or you have a quick just load and reagent mix and then go, very, very important. The footprint has to be right, physical footprint. The economics have to be right. It has to fit within the software ecosystem of the practice. As a result of that, customers really have a high degree of enthusiasm for our solutions. What I would also point out is almost all veterinarians use both point-of-care solutions and reference lab solutions. It's just a question of preference. It's also a question situationally based on what the patient needs. If a patient comes in and there's time sensitivity because of the illness connected with that, veterinarians, all things considered, would rather use a point-of-care solution.
They can follow up with the patient right there in the practice. They don't have to play telephone tag for the next 24, 48 hours. This is our newest point-of-care solution addition. It's inVue. It's been, as you can see from the numbers, greeted with a lot of enthusiasm from our customer base. It provides, I think, a lot of the attributes, a lot of the very positive attributes that I described earlier. It's slide-free, so the technician doesn't have to spend 15, 20 minutes preparing a slide. It has the ability to provide turnaround time within that patient window. It's a cellular analyzer. So from a Technology through life design standpoint, any cells that can potentially be analyzed can be done on this. So our initial menu is ear cytology and blood morphology.
We also plan on introducing FNA for lumps and bumps later on in the year. So greeted with a lot of enthusiasm among our customer base. They see this as really addressing and automating very common, well-understood use cases, clinical use cases in the practice, and being able to provide performance, accuracy, and consistency for what otherwise has been a bit technique-sensitive and variable. So the opportunity within our point-of-care business is very substantial. This is 320,000 in front of us. You can see over a period on the left-hand side of 10 years from 2014 to 2024, we've grown our installed base very dramatically. So a little bit south of 150,000 units. The opportunity in front of us is still more substantial. You can see it's more heavily weighted, not surprisingly, towards our international geographies.
The inVue represents about the same size opportunity as hematology going forward, about 90,000 units. A lot of runway. I think a lot of opportunity to continue to build out the full diagnostic laboratories within the practice. Let me move and talk a little bit about our reference lab business and the disease state focus on oncology that we announced at last investment day. We've been in the oncology cancer testing business for about 30 years. The principal part of the business is done through pathology. Submissions is a bit through radiology when customers send in images. We do about 1.5 million test submissions per year to our reference labs. About a 1/3+ end up being positive as the patient having cancer.
Veterinarians will tell you a point of great frustration and sadness is that by the time a patient is clinically symptomatic with cancer and they get tested, it's stage three or stage four very typically, and the ability to drive an efficacious outcome and extend the life of the patient is just more limited. It's no different than on the human health side when you detect cancer later. It's just that much harder to be able to treat, so when we ask customers, and we've done a fair amount of research over time, and these numbers have been really held up, veterinarians first about cancer, about the attractiveness of a cancer screening test. These are unbelievably high numbers. 89% that not just interested in cancer screening, but likely to add a cancer screening to wellness protocols. 86% indicate that it would have a positive impact on your practices.
For those of you who have done market research before, you never see numbers like this. In terms of pet parents, it's also very high. So most pet parents, especially those who maybe have had cancer in their extended families or have had dogs or cats before who have died of cancer, recognize that this is a scary disease and that they would love to be able to screen early for it. So this is a major unmet need. Cancer, for example, in dogs is a leading cause of mortality. It's 3× the number, the cause of mortality vis-à-vis the next greatest cause or vector. So we announced that at VMX that we're launching canine lymphoma in late March. This is the first of what will be a panel of six cancer tests that detect the majority of cancer cases. We're starting on lymphoma for a couple of reasons.
About a quarter, 24% of canine cancers are lymphoma cancers. There's pretty good therapeutic options when you detect it earlier in terms of cocktail mixes, chemo cocktail mixes. We've had a number of technical breakthroughs on the biomarker discovery, reagent development standpoint, as well as testing platforms, which allow us to deliver a very high performance, 99% specificity, which means there are very few false positives, 74% sensitivity, much higher than what you see for most cancer tests, screening tests on the human health side. Typical turnaround time is a couple of days, two to three days. We're able to phenotype the lymphoma by B-cell versus T-cell. The significance of that is B is more prevalent, but less toxic. T is less prevalent, more toxic, and you use different chemo cocktail mixes depending upon the phenotype of the cancer. So very excited by this.
We think that I'll share with you what our overall sector development strategy is, but we think that this is a game changer. The other thing that I would point out is, as it turns out, there are breeds that have high incidences of cancer. So cancer is obviously correlated with age. Age is an important factor, but in certain breeds like Labradoodles and Labradors, and French Bulldogs, German Shepherds, there's a high incidence of cancer. So being able to identify them earlier is important. And so our belief is, based on our market research, based on talking to customers, based on really understanding the pet owner, is that there's a major opportunity to inspire the use of cancer and cancer diagnostics as part of a comprehensive wellness screening strategy.
So the way this market, if you will, or wellness market has typically developed and evolved is it started with basic screening as part of a wellness visit, vector-borne disease or parasitology. And 47% of these wellness visits, when the dog or cat sees the veterinarian, involves that. It extends to include comprehensive blood work, testing, chemistry, and hematology, but that's only 12%. And so from a pricing standpoint, and this gets back to the previous slide where we're pricing it at as low as $15 as part of wellness and an in-clinic diagnosis for select sickness screens, pet owner doesn't have to make a choice.
The veterinarian doesn't have to make a choice between, I want to screen for or test for cancer, or, I want to do something that a lot of pet owners think about more ambiguously, which is blood work, that we want to be able to do both. It's an essential part of the wellness screening profile. And so I think over time, we can inspire that usage. We can inspire the inclusion of cancer diagnostics as part of a blood workup. Software, as I mentioned, is a great opportunity for us. It's important. If you think about practices as businesses, whether they're independent or corporate groups, workflow helps really support the productivity of the practice. It supports staff productivity, workflow optimization, increasingly through Vello, the ability to engage the client digitally. We have focused on really driving a vertical SaaS strategy with our PIM systems and plug-in applications.
We think that there's an opportunity to grow top line at 15%+ with attractive margins. And obviously, it represents an attractive opportunity to deploy capital as part of our plug-ins. Now, always the pet owner engagement application that I spoke earlier about. Increasingly, pet owners who are of the younger generation are digitally native. They don't want to have to play phone tag with the receptionist. The ability to engage them digitally so that they can book appointments, prepare, be pre-socialized, prepare for a visit.
Maybe their dog needs to fast for four hours before coming in to provide a fecal sample to create some awareness around the importance of diagnostics as part of the screen, as part of the visit. And then post-visit, the test results, populating the medical record with the results of education in terms of follow-up and when they need to come in next, is an important tool in the hands of veterinarians to engage their clients. And also, as I had mentioned, as part of cancer, being able to identify and target younger dogs in this case who may benefit from screening is an important toolset, marketing toolset in the hands of the veterinarian. So an important part of our strategy is not just to invent great stuff. It's to bring great stuff to our customers, to position it correctly. The international opportunity is very substantial.
We've invested in expanding our commercial footprint in seven international countries. We continue to build out in the U.S. more recently in our diagnostic imaging and telemedicine opportunity. In 2024, you see South Korea. We've now gone through two expansions. Very attractive opportunity. We know we have to call on customers. We have to form relationships. We have to create awareness and education. And ultimately, consideration our high-touch frequency subject matter commercial organization enables us to do that. As a result of great innovation, great customer experience, part of our growth algorithm is making sure our customers are satisfied. We track that in a couple of different ways. Our customer retention is in the high 90s across all of our modalities. I think this is very rare among any company in any industry. It's something we attach a great deal of importance to.
We also continue to be able to build our installed base. Our premium instruments on the right-hand side as a result of a technology for life orientation. We invest in the menu, in the products, in the customers to see no reason to really search or chase other solutions. The net result, and this is for a period of 2019 to 2024, is really nice solid financial performance where we've been able to grow revenue at 11%+ . Operating margin expansion on an annual basis has averaged 150 basis points. Earnings per share growth as a result of that and disciplined capital allocation of 20%+ and an ROIC in 2024 of 45.8%. We think that as a result of our strategy, consistent investment in the strategy, and durable growth outlook, that there's an opportunity going forward to continue to grow top line at 10%+ , operating margin gains of 50-100 basis points, and earnings per share bottom line of 15%-20%. Thank you very much.