Great. Good morning. It's a great pleasure to have a chance to update you on IDEXX's strategy, a couple of what we think are significant opportunities. I'm Jay Mazelsky. I'm President and CEO of IDEXX. Just a quick reminder, this morning is covered by safe harbor disclaimer, a copy of which is also on our website. With that, let's dive into it. We're blessed to really be able to support a veterinary profession and industry that we think represents an exceptional long-term opportunity. We peg this at about $45 billion+ TAM. Of course, we have to develop that over time and I'll talk this morning about our strategies and pillars we use to really drive diagnostics testing. The thing to keep in mind about diagnostic testing is it's foundational to practice and practice health.
You can't prescribe therapeutics or pharma or specialty diets unless you know what potentially ails the patient. It's also a foundational part of just assessing basic health status. Diagnostics plays a unique role, and our strategy is very straightforward in terms of really developing the opportunity, and it starts with innovation. It's an innovation-driven strategy centered around developing platforms, not just platforms for point of care, but also platforms in software and our reference labs that provide really, I think, compelling extensibility. We're able to also innovate, to take advantage and bring innovations for our customers to our large installed base. We have approximately 78,000 Catalyst, which is our chemistry analyzer. In this past 12+ months, we introduced a number of important innovations, just as a, I think, a great example of being able to bring cortisol and pancreatic lipase and new calibration technology.
Of course, our customers are businesses. They're in the business of providing exceptional medical care, whether they're independent practices or corporate groups. They are looked to software to help them really, deliver excellent medical care, optimize the workflow within the practices, engage their clients, support their teams, and there's nothing better than software and data which provides clinical insights to be able to do that and increasingly enabled through AI. Of course, you can come up with exceptional innovation and innovations as we do, but you need a commercial ecosystem to support your customers. We have a very large, sophisticated commercial group that are subject matter experts that partner with our customers, that help them achieve their objectives, and that grow over time through awareness and education-relevant testing.
The net result of innovation and partnering with our customers as trusted advisors is we believe that there's an opportunity to grow our top line at 10%+ over time with really attractive high ROI, you know, type characteristics to the business. Let me just set up my discussion this morning and share with you how we think about our portfolio. You may have noticed that the patient or the customer, the veterinarian and pet owner, are at the center of everything we do. Our customers typically use both point of care and reference labs. It may be situational, depending upon the patient condition and circumstances. It may just be preference. Our strategy around innovation is developing best-in-breed innovations, whether it's point of care or reference labs, tying it together through software and creating a seamless experience.
I'll cover each of these modalities in the next 15 or 20 minutes and give you a sense of how we think about them, how they come together in a very integrated way. Let me now talk about the opportunity, this is at on one level, it's a financial slide, at another level, it's an output from a successful articulation and execution of our strategy. You've seen that we have been able to grow through different time periods, double digits, the U.S. at 10%, international at 200 basis points faster. The just to call out the different characteristics of these time periods from 2015 to 2020, you see it was 13%. What drove that is we introduced a new chemistry analyzer called Catalyst One in 2014, and at least in North America, we went direct.
We began to directly represent our products and solutions and directly with our customers. Internationally, you see that we've been able to grow faster. Part of that is investments we've made, not just in our commercial organization, but building out the enabling infrastructure, reference labs, logistics. VetConnect PLUS, which is our diagnostics portal. Commercial expansions even more recently, and I'll share with you what those look like. Even in the U.S., where we've seen some headwinds with capacity and background factors, we've continued to grow that at a fairly rapid pace. We think that testing and diagnostics testing is relatively underutilized, that there continues to be really nice runway over time to develop these markets. To double-click on the international piece, you see the 12% CAGR is pretty linear over time.
As I mentioned, a couple things have really driven that. Commercial expansions, we see, in our country markets, Germany and the U.K. and Australia and Japan, they love their pets and consider pets to be members of their household just like we do in the U.S. It's just a little bit earlier in terms of overall development and our strategy as a company is to help drive that sector development. And we do that, as I mentioned, through enabling infrastructure, new reference labs, commercial expansions, building out capability across the full value chain. We also do that through product development. If you take a look at the growth in the installed base, it's been very significant from a through a premium instrument lens. Hematology, as you can see from the color code there, has grown very substantially.
That was a result of ProCyte Dx, which is a hematology analyzer we introduced quite some years ago that from a physical characteristic, economics, easy use, fits what our hematology first markets in many of these countries, and more recently, India. We see a very significant opportunity over time as you build that install base, you benefit from the flywheel as you inspire increase in testing. A little bit about the U.S. geography. As I had mentioned, it's a little bit further along and mature than some of our international regions. I think what this highlights is this foundational, very important role that diagnostics plays in practice health. Over a five-year period, which is a, you know, fairly significant time period, clinical visits have been very modest at 30 basis points.
Total practice revenue and clinical revenue has grown approximately 6.3%-6.9% respectively. Diagnostics revenue, 90 basis points faster than that. That gets back to you can't treat, you can't assess basic health status unless you first diagnose. In the case of IDEXX, we've grown 180 basis points faster than that average. I'm often asked, why do we do that? What explains that? It comes down to a variety of factors. Our diagnostics are differentiated. We uncover more, and when you uncover more, you find more things and you treat them. It's also integrated as part of a workflow, so you can integrate and harmonize care protocols. You can make it very easy for customers to test. I'll talk about our point of care platforms in a minute, they're load and go.
You don't have to have, get into very complicated sample preparation and management activities, and that drives diagnostics usage, you know, over time. A couple of market or macro, I think, tailwinds that I like to describe, and this is a very important one and one that we're very proud of as a company. Pets are living longer. In fact, dogs and cats approximately two years longer, just over a single generational lifespan for these pets. Now, a lot of things explain that. There's been a mix shift into smaller breeds of dogs. The smaller dogs live longer than larger dogs. In the case of cats, they're being kept indoors, which is more often, which is safer for them. Also the role of innovation should be understated or underappreciated.
Innovation that we have made in diagnostics in terms of uncovering more and really assessing the basic health status of a patient, innovation that our colleagues in the pharma space and specialty diet or nutrition space have also contributed. This is good for pet owners. Those of us who have pets, we love the dogs and cats that are members of our family. It's good for veterinarians because they're dedicated and very purpose-driven to provide longer lifespans and healthier pets. It's good for business because as these pets age, and I'll share with you in just a minute, they consume more healthcare. This is a slide that we have. It's a sub point of this notion of as pets age, they consume more healthcare. This is broken out or spotlighting specifically diagnostics.
A way to think about this is just like it very analogous to what we as humans experience, that as we get older, we have more disease typically, and that you need more healthcare. In the case of pets, it follows that exact same relationship. You can see as they progress from young to adult to senior and geriatric, significantly more diagnostics is used. In fact, diagnostics both in an absolute value sense and as a percentage of total healthcare spend increases disproportionately. We think that this, as pets live longer, as they age as a result of what we saw step up in pandemic, that there's a tailwind connected with medical services, consumption, and the use of diagnostics, which drives that. A little bit more about the pet population piece 'cause that's the other very significant tailwind in front of us.
During the pandemic, 2020 to 2022, so that three-year period, there was a four times increase relative to the pre-pandemic baseline of 2019 of the number of pets that were adopted. In the U.S. alone, it's over $20 billion, you know, pets. These pets, as they age, getting back to the point that I made earlier, they're gonna use more healthcare, consume more healthcare, and veterinarians are going to use more diagnostics as part of assessing and treating patients.
We, in fact, as we've indicated in our last two earnings call, have begun to see the front end of that, what we think may be the front end of that green shoots, if you will, within that age five through seven cohort, where on a non-visit or non-wellness clinical visit standpoint, we're starting to see slightly modestly positive growth in that respect. Typically, if you look at dogs, just to maybe highlight that, at age seven, historically at age seven or so, they need more medical care, and that line begins to pivot and goes up. We think that this is another long-term tailwind to the business. Let me talk about now going from tailwinds to testing and how we drive testing utilization. It starts with innovation.
Innovation is an important part of our value proposition to our customers, solving their most challenging, not just medical problems, but business problems. If you think about practices as in the business of providing medicine, they can be independent practices, they could be corporately owned practices, but they need solutions and technology is really helps provide that solution. We have accelerated the investment that we've put into innovation. If you think about this in chunks of $1.2 billion, snap the tape beginning at 2025, we'll invest approximately at that level in a period of 4+ years. If you compare that amount and how long it took previously, it was seven years, and before that, 20+ years. We're investing more. We're very focused.
I'll share with you in a minute and across this broad solutions portfolio, premium instruments, biomarkers or menu, software data and AI enablement. Having now almost four decades in human health and animal health, I can tell you very few companies have this type of broad capability and competency across all these areas and how we bring these areas together for pit fit, for purpose, fit to task for what our customers want. You know, I'd say that even though we're spending and accelerating in innovation, solving our customers' most challenging problems, we're very focused. We're disciplined capital allocators. We're disciplined and prioritize where that investment goes. We think about this in terms of disease states or disease conditions that offer multiple billion-dollar TAM over time. Now, in the case of vector-borne disease, that's a great example.
We've been investing in vector-borne disease for over three decades, starting with heartworm, expanding to include the full vector-borne disease of Lyme, anaplasmosis, ehrlichiosis, then more recently, Leishmania in some of our international country markets. We continued to improve performance. We brought rapid assay and that testing portfolio into the IDEXX diagnostics ecosystem with SNAP Pro. This is great business for us. Parasitology with fecal antigen, another great example, where we introduced fecal antigen at our reference lab, which detects more. We're detecting proteins before the eggs become available, so we can detect more and we can detect earlier. Then we expand the menu more recently over the last couple of years, flea tapeworm and Cystoisospora.
Renal, we reimagined what was possible in renal, starting with SDMA in 2015 to really detect far earlier than creatinine chronic kidney disease or kidney impairment. We expanded to include Cystatin B, which is an acute kidney injury marker. The importance of this and the focus of this is driven by the fact that kidneys really are an indication for overall patient health. More recently with oncology, and I'll share with you, provide an update on our oncology offering. The challenge is we do today over 1,300,000 tests in for detecting or validating cancer. This is on a global basis.
By the time the patient comes into the practice and is clinically symptomatic, the challenge with that is that there's, from a treatment standpoint and an outcomes and efficacy perspective, there's not as much you can do. In fact, it's, you know, in many cases, tragic. Being able to detect cancer earlier, being able to do something when it the disease is in its earlier stage is a very, very important clinical contribution that we made. I'll come back to that, but I wanna just touch on our point of care modality. I'm not gonna go through each of these. I will spend some time and talk about IDEXX inVue Dx, but I do wanna point out that, you know, we've earned our industry-leading franchise in this space through really delivering what the customer wants.
We follow a set of first principles in terms of developing new instruments. First and foremost, from a performance standpoint, it should work as well or better than what you get at the reference labs. It needs to integrate within the workflow, within a practice. We believe that veterinary technicians are not laboratory technicians, so from a sample prep standpoint, having a load and go functionality is extremely important and as important as anything else is what we call technology for life, which is menu extensibility. Making sure that when a customer purchases a Catalyst One 10 years ago, that their investment is protected, meaning that they have the same feature, functionality, and capability as a customer who purchased Catalyst One two weeks ago. A little bit about inVue. This has been a really successful, I think, well-received analyzer.
We've had the fastest ramp in the history of any of our premium analyzers. Last year, approximately 6,400 of these were placed. I think this fits those first principles that I described in terms of easy use. It's slide-free. Customers don't have to spend 15, 20 minutes preparing a slide. It fits within the workflow. It delivers differentiated performance at the hands of the veterinarian. It takes variability out of the interpretation equation. It supports very high volume, well-understood use cases and menu extensibility technology for life. Starting with blood morphology to AI cytology, we expanded it in Q4 of this past year in a controlled launch for FNA for mast cell tumor.
As you can see from the slide, as we count up the total number of manual cytology exams done today on a global basis, it's $150 billion. It's a very significant opportunity still in front of us. This is obviously good medicine. Veterinarians love having their investment protected and having this type of technology for life capability. Let me just give you an important analog. It's also good business for IDEXX, which is when we introduced Catalyst One, which is our chemistry analyzer, it had a comprehensive menu with it back in 2014, late 2014. Through the 10+ years since then, we've introduced SDMA on a slide, Total T4, Fructosamine, cortisol, pancreatic lipase. There's a series of tests that we introduced. The economic value of that platform has grown 2.5x .
I think there's an analogy with IDEXX inVue Dx that we create technical architectures for cell cytology. Anything done manually in cytology has the potential to be adapted and adopted onto this platform. It's something we're very excited by. The point-of-care business, though we've been very successful, and we had a record year of over 22,000 placements in 2025. We have a very large installed base, but you can see from this slide that it's still early in terms of, at least in terms of international adoption and for the new analyzers. We think there's a really nice opportunity still in our largest market, which is the U.S. We think that this is a function of the fact that veterinarians want a laboratory within their clinic.
They want the type of capability that these analyzers generate or create for them. We've seen really nice traction over time, and we think that those international country markets and geographies provide very, very compelling opportunities, ones in which we'll continue to pursue. Let me move into the reference lab business and maybe spotlight or highlight our cancer diagnostics platform. You know, we've now been on the market for about a year or so with canine lymphoma. We started with lymphoma because it's highly prevalent and it's hard to detect early. In fact, one in four dogs through their lifespan will get these type of common cancers. It's been very successful as a test.
In fact, the performance, as you can see from the chart, 99% specificity, so very few test results are false positive. Very high sensitivity. In majority of cases, we can phenotype B versus T, which is important from the type of therapeutic pathway that the veterinarian pursues. At VMX, we were able to come out with some additional data that up to... We're able to detect or have a test consistent with canine lymphoma up to eight months before clinical symptoms appear. On average, it's about three months. Very, very important. Also, when lymphoma is detected, the treatment of choice is CHOP, which is a four-agent chemotherapy regimen. It tends to last five to six months. It's not always efficacious.
Our biomarker for canine lymphoma is able to detect molecular remission, meaning if it's not working, if it's not molecularly going away, then the veterinarian should stop and maybe pursue some other means. We announced at that point that at VMX that we will introduce mast cell tumor as part of a panel expansion sometime in the middle of the year and one other test this year. Our belief is and our commitment is to be able to provide a panel and by the end of 2028 that detects 50% or plus percent the majority of common canine cancer cases. Again, keep in mind that cancer is very prevalent. One in four dogs through their lifespan will develop cancer.
We've priced this for access at $15 when included as part of a blood work panel, two to three day turnaround time. When we include mast cell, we're not changing the price, we're not changing the workflow or the time to results. I think it's a very compelling offer in that customers are not only using it as an aid in diagnosis but as a screening tool. This is a depiction of how diagnostics over time has developed. Typically, what we've seen historically in the business is that pet owners and veterinarians when a pet comes into the practice, they will screen. They may screen at some very basic level for heartworm or vector-borne disease or fecal testing.
Then over time, as they recognize the value in diagnostics and blood work is included, you see a more comprehensive panel or approach given. In the U.S., which is the most advanced market for diagnostics in the world, only about 12% or so of these tests include blood work. We believe that cancer, because of what our customers have told us, can change that paradigm from left to right to right to left. That it's such a, you know, a huge driver of adoption based on what pet owners and veterinarians are telling us. This is a great chart that I think is a global market research survey that asks pet owners and veterinarians their interest in cancer screening and testing. You can see in its high 90s in many countries.
High 90s in many countries from a pet owner standpoint and, you know, and veterinarians equally compelling. Just a great opportunity, and we look forward to continuing to develop this market over time. Software is an important part of our overall solution or portfolio, as I mentioned in the beginning. Veterinary practices are businesses. They want to optimize workflow. They want their teams to be productive. They want to be able to communicate, in many cases digitally with pet owners. Being able to provide a full vertical stack, really focused and fit to task for the animal health market is an important part of our overall solutions portfolio.
You can see it's PIMS, pet owner engagement application, our Vello solution, VetConnect PLUS, which is our diagnostics portal, and the ability to leverage our balance sheet and provide payment and financing in some cases here to support other payment processing solutions. I've talked about innovation and the importance of innovation and our solutions orientation as a company. This market is not gonna just develop by itself. It requires subject matter expertise. It requires a partnership approach with our customers, interfacing with them to understand their most challenging problems and how our solutions can help them. What we have found is key to being able to democratize our solutions and drive our solutions orientation is this partnership with customers, and it requires frequency and reach and access. Over time, we've expanded our commercial footprint.
Just recently in 2025, we announced four commercial expansions of our ecosystem, the U.S. as well as our international country markets, given the backdrop of the opportunity that I described to you. This is an area of continued focus for us. We believe that when the data tells us that when we call on our customers and create awareness and education and consideration for diagnostics, they use more diagnostics. We grow faster, and the pets get better care. This is something that over time we'll continue to invest in. It's an important part of our overall value equation. Let me now bring this together 'cause just down to the last minute or so. We are blessed to participate in this remarkably compelling, robust, long-term opportunity that we've pegged at $45 billion+ tail.
Diagnostics plays a foundational role within the practice. Yet you can't treat, you can't assess basic health status unless they first diagnose. Our innovation strategy is around creating differentiated platforms, whether it's point of care, software or the reference labs, bringing them together in a compelling way. As a result of this innovation strategy, a commercial ecosystem, which is large and sophisticated and trusted by our customers, we're able to generate attractive long-term returns for the business. We believe that over time, we can grow top-line revenue at 10%+, operating margin expansion 50-100 basis points, capital allocation leverage as a result of share buybacks, and long-term EPS growth potential at 15%+. Thank you for attending this conference. I've enjoyed providing a quick update and overview of IDEXX.
For those of you joining us with a Q&A session afterwards, look forward to answering maybe some specific questions you have.