Good morning, everyone. Thank you for joining us virtually today, and welcome to Quidel's Investor Day 2020. I'm Ruben Argueta, Quidel's Director of Investor Relations. We have a great series of presentations planned for you. Each presentation topic will run about 20 minutes apiece, with the entire presentation coming in at about 90 minutes. We will reserve approximately 60 minutes for moderated Q&A. Please note that we will be making forward-looking statements within the meaning of federal securities laws, including our anticipated revenues for Q4 2020 and other projections. Forward-looking statements, by their nature, involve material risks, assumptions, and uncertainties. In particular, our expectations and assumptions around the impact of the COVID-19 pandemic on our business, results of operations and financial condition, and that of our suppliers, customers, and other business partners are uncertain and subject to change.
This and many other events or factors could affect our future financial results and performance, such that our actual results and performance may differ materially from those in the forward-looking statements. For a discussion of such factors, please review Quidel's most recent annual report on Form 10-K, including the section titled Risk Factors, registration statements and subsequent quarterly reports on Form 10-Q as filed with the SEC, and the forward-looking information notice in the presentation. This presentation contains time-sensitive information that is accurate only of the date of the live broadcast, November 12th, 2020. Quidel undertakes no obligation to revise or update any statements to reflect events or circumstances after the date of this presentation, except as required by law.
With that, let's get started. I'd like to introduce to you Doug Bryant, our President and CEO. Doug?
Good morning, everybody, and welcome to our virtual Investor Day, a day we've set aside to bring you up to speed on the longer-term outlook for the company. Before getting started, I would like to say to the 1,300 members of the Quidel family that I am proud, as always, of all your accomplishments over the years. In particular, I am proud of you for having risen to the challenge that this country, and the globe for that matter, is facing with the SARS pandemic.
Not only did you leap into action once the sequence of the virus had been described by Chinese scientists, by developing and manufacturing one of the first PCR assays, but you were first to bring a high-performing rapid antigen assay, Sofia SARS Antigen, to market, and were first to bring a combination assay on that same Sofia platform that enables healthcare providers to test for influenza and SARS simultaneously from the same single swab sample. More recently, in the last quarter, you more than doubled our manufacturing capacity from 1 million SARS antigen tests per week to over 2 million tests per week.
You kitted and shipped tens of millions of tests to thousands of communities throughout the country. I have no doubt that you will reach our objective of manufacturing and distributing as many as 6 million Sofia SARS Antigen tests per week by the middle of next year. Our goal all along has been to do the right thing, to democratize testing so that healthcare providers and first responders could do their job safely, so that grandmas and grandpas could safely reunite with their loved ones, so that students could get back to class, so that our economy could be restored as more and more people would safely return to work. While the journey is long and there is much to do ahead of us, we are well on our way. We are playing our part. You have accomplished a great deal. Your efforts thus far are truly appreciated. Thank you.
To our investors and our analysts, I would like to start by stating the obvious. We had a great Q3 on many fronts and are positioned very well for an incredible year, due largely to revenue and margin from our COVID products. If you don't mind me saying, without even the slightest hint of arrogance, because that's not who we are, of course we're doing well. For a company our size, we have extraordinary strategic, technical, and commercial competencies. Our executive team is bright, focused, reads everything, and makes decisions quickly. We pick the things we choose to do very well in terms of what is needed to develop lateral flow immunoassays like Sofia and QuickVue SARS Antigen. Our R&D team is as good as any on the planet, and potentially nimbler and more motivated.
The R&D team's processes for developing, cloning, characterizing, and manufacturing antibodies are state-of-the-art, and our chemists are just as good. Our manufacturing processes are highly automated, with direct labor at 4% of our cost. They are just as scalable as any larger company while maintaining the high quality that our brands are known for. Our relationships with our distribution partners are arguably the best in the diagnostics industry. Our direct sales and marketing teams are known for their frequency of contact and impeccable follow-up, which are both critically important to our laboratory customers during these extraordinarily difficult times. Originally a small but relatively successful and happy infectious disease-focused company, we already had all the elements needed to play a significant role in SARS testing. Happy people are more productive, and we are simply executing at speed.
For today's discussion, a few members of our executive team and I will cover three topics. First, we will take you through what our long-range plan looked like before COVID. I will provide a quick comment or two, then we'll jump into the details. Dr. Tammi Ranalli and Dr. Johannes Kehle will bring you up to speed on the SAVANNA program. As you will see, SAVANNA is destined to become the next flagship product for Quidel and is expected to be a key growth driver for the company. Bill Ferenczy will provide an update on TriageTrue, our high-sensitivity troponin, and Rhys de Callier will conclude the base case LRP discussion by talking about the non-COVID Sofia product introductions assumed over the next few years.
Second, I will provide an update on our entire COVID pipeline and will describe our expectations for those products over the next couple of years. Karen Gibson will then give you an update on the Sniffles program, and we'll talk about use cases for the product and the market segments that seem to be the best fit. Third and finally, we will talk about bigger and more aspirational ideas. Dr. Werner Kroll will discuss Project Leapfrog and how this advanced technology could address many diagnostic needs at the point of care or even at home. Randy Steward will talk about our financials over the LRP and our thinking around capital deployment, and then we will take your questions. Let's get started. I will begin by saying that before COVID, that our long-range plan suggested a compounded growth rate for revenue at 12% over the next six years.
In other words, we had expected to double our revenue during that period and to grow to over $1 billion in revenue without COVID. The team will walk you through what that looked like, but I wanted to point out that the projections that you will see could not have considered the collateral and lingering benefit of what has transpired for our company in 2020 as a result of our significant response to COVID. These collateral benefits include, but are not limited to, the following. First, we will have greatly expanded our footprint and capacity for manufacturing and distributing millions more Sofia test cartridges and QuickVue lateral flow strips. Importantly, we will have paid for all that without incurring debt.
The capacity for serving developed world markets like allergy and toxicology and super high volume developing world markets like chikungunya and dengue will be in place within 12 to 18 months. Second, the asset base of Sofia and Sniffles instruments needed to address the democratization of testing that will surely occur as the culture of healthcare evolves will be there, ready to run all the future assays that we develop over time. It's entirely possible that in countries in which a point-of-care market segment didn't exist until SARS testing moved into the clinics, like the U.K. and Germany, other tests will follow, and we will already be there. It's entirely possible that in our own country, where at-home infectious disease testing didn't exist until SARS testing moved into the home, other tests like influenza and Strep will follow.
Third, throughout the course of this year, we have been serving the high-complexity hospital and reference labs with our high-performing, easy-to-use Lyra SARS and influenza products. In doing so with integrity and forthrightness, we have now established hundreds of enduring relationships and lasting brand recognition and strength. As we launch Solana SARS into a receptive audience of moderate-complexity labs and clinics in 2021, we will solidify an existing base of 1,000 Solana customers and expect to double that footprint throughout the year. In 2021, we will be introducing SAVANNA to a set of customers that knows our company and our commercial and customer service teams very well, which will dramatically compress the market development time that we had incorporated into our original SAVANNA revenue forecast.
Moving forward, a prospective customer that is slow to take a phone call from a representative of Quidel will be rare, thanks to everything that we have done and are continuing to do for our customers.
Having said all that, let's talk about SAVANNA . Johannes?
Thank you very much, Doug. I'm Johannes Kehle, Vice President of Research and Development, SAVANNA. We will first discuss some key development or key technical factors of the platform and how these differentiate our system from the competition. In other words, let's review the technical details that will make SAVANNA a very successful diagnostic platform. The basis of the system is built on proven, robust technologies. These are molecular techniques, in particular, the so-called magnetic bead-based nucleic acid isolation and the real-time polymerase chain reaction, or in short, real-time PCR, which enable us to analyze up to 12 pathogens or 12 targets plus controls in a single assay run. Due to a clever combination of many unique factors, we managed to achieve superior and differentiating performance for the turnaround time, the simplicity, ease of use, modularity, and versatility of the platform. Here are some examples.
A very fast turnaround time is achieved by the instrument's unique light fiber optics, which allows us to have excellent test sensitivity in real-time PCR reactions that are as short as 12 minutes, and this for 45 cycles of the reaction, for less than 20 minutes of total turnaround time. Another example, the disposable cartridge is designed in a way that both direct patient swabs and also liquid patient samples can be inserted. Further, the assay chemistry enables room temperature storage for the disposable cartridge, adding simplicity and ease of use to the system. Another interesting feature is the instrument modularity. One main bay or a master instrument can drive up to three auxiliary bays or pupil units in order to expand capacity and simultaneously keep the required lab space and CapEx cost as minimal as possible. Important to mention is also the assay versatility.
In SAVANNA , we can test for analytes qualitatively, meaning screen for a positive versus negative result, but also quantitatively. For example, test for a certain viral load, or in other words, for the number of viral particles in a patient sample. We can also test for a particular pathogen, for example, certain bacteria, and simultaneously, in the same run, determine their antibiotic resistance statuses. This gives us absolute flexibility for the assays that we can develop for SAVANNA . Of course, we want to make full use of this feature and launch the platform with a critical mass of relevant assays. Again, the technology allows us to scale up manufacturing to very high volumes in a very short period of time. That much about the theory.
Let us now examine some key technical factors directly from the components of the platform. We will start with the SAVANNA disposable cartridge, which you can see on this image. On the right side here are the sample ports for the patient swab and the patient liquid sample insertion. These sample ports have this particular cartridge. On the left side of the cartridge, you can discern the real-time PCR chambers. As previously stated, we can analyze up to 12 analytes plus controls in one assay run in these reaction chambers in as short as 20 minutes. As also explained before, the reagents of the cartridge enable room temperature storage of the disposable, and there is an excellent assay integration capability and assay versatility of the platform due to these reagents. In order to run the disposable cartridge, the SAVANNA instrument, which you can see here, is required. The key human-machine interface part is the intuitive touch screen on the upper part of the instrument.
Very important features of the instrument are its small footprint, the integrated barcode reader, and the built-in connectivity. The instrument has both a Wi-Fi and a cellular modem. An illuminated LED ring intuitively informs the user about the test progress and other relevant information during the test run. The image on the right side presents the instrument modularity. The main bay with a touch screen drives up to three auxiliary bays, which can be added vertically and/or horizontally in order to expand test capacity. The SAVANNA test procedure is as simple as can be, a true sample in to result out operation. Either a swab patient sample or a liquid patient sample is added into the respective cartridge sample port. In a second step, the cartridge is inserted into the instrument after scanning the patient sample and cartridge barcodes.
The cartridge barcode automatically tells the instrument which test protocol to open and also run. After 20 minutes, as in the shown example of the respiratory virus panel assay, this test is finished, the cartridge is ejected, and the instrument automatically provides the test results. In the shown example, you can see that the patient sample was positive for at least one analyte. The big plus on the screen shows the test result, of course. Further information can be retrieved by simply pushing the View Results button. After all the details on our SAVANNA platform, there is one final information to review, hopefully, what you have seen about the platform raised the same question in your mind, namely, how far we are with the development of the platform and when to expect the commercial launch. The high-level timeline shown here aims to answer exactly these questions.
The next important milestone is to have clinical trial instruments available by the end of this year. We have very high confidence that this will be the case in order to then start with the clinical trial of the first assay for FDA approval at the end of January 2021. The clinical trials for more assays will be commenced shortly thereafter. The final instrument prototype version is expected by the end of March, beginning of April, prior to availability of production instrument units. We prepare for a commercial product launch early in the second half of 2021. Subsequently, the next panel assays will be FDA approved, and their commercial launch will follow immediately upon approval. After reviewing the technical and development specific details of our SAVANNA platform, let's have now look at some relevant marketing and commercial specific information.
Tammi, I give the presentation over to you.
Thank you, Johannes. As someone who has been with the SAVANNA program since the inception of the project, I am absolutely thrilled that we are launching this instrument in the first half of 2021. Part of what is allowing us to accelerate our timeline is the undeniable impact that COVID has had and will continue to have on diagnostic testing. One of the changes that we've seen in the market has been the tremendous growth in respiratory testing. This was an impact that was initially felt in the molecular arena, now has been extended into immunoassay as more tests have been launched into the marketplace. This is projected to result in a compound annual growth rate in testing that is in the double digits over the next five years. This impact is not limited to just the United States, it's felt throughout the entire world.
The changes in behavior that COVID has generated are believed to be long-lasting. Simple symptoms in previous times that would likely be brushed off as mere cold or even allergies are now a significant impetus to go and get tested. As testing is driven closer to the patient, this behavior will be reinforced by the ability to get both accurate and timely results. As we introduce SAVANNA into the marketplace, one of the key questions we needed to answer is: Was there a need for additional molecular platforms in this marketplace? As I look around at the competitive landscape, we find that the current platforms out there all have limitations and trade-offs with their features or functionality. I've got a few of them that I'm going to discuss here today.
We have platforms that are moderate in cost with excellent performance, however, don't have the ability to multiplex with broader panels. Then we have those that have the fastest turnaround times, which obviously make them more desirable for point-of-care testing. Those are generally the most limited in terms of panel size. On the other hand, you've got options where there's platforms that have very large panels, but are far more costly with much slower turnaround times, and also don't allow for any flexibility in analyte choice. We've chosen to focus on the features and attributes of SAVANNA that take into account all of the true needs that a point-of-care system requires in order to be competitive.
Turnaround times of 20 minutes with high performing and flexible panels that an end user can customize as they see fit for their own testing needs, as well as a broad menu of options to choose from. The plan has always been with SAVANNA to develop a critical mass of targets and include between four to 12 analytes per cartridge. The rationale behind this is that we've focused on therapeutically actionable clinical results. Cases wherein getting that test result allows a physician to alter treatment for that patient while the patient is still available. This solution really needs to be CLIA waived with the simplicity of a true sample in, result out, and turnaround times that's relevant for a point-of-care setting.
This is incredibly important as we shift the paradigm from a fee-for-service medicine to more of a value-based diagnostics, and also take into account allowing for pathways around challenging reimbursement issues, which provides the end user with flexibility in selecting which analytes they would like to run for each and every patient. Our current launch strategy for SAVANNA in 2021 is going to be very focused. We're going to be spending the time, while we are developing and enhancing our manufacturing capabilities, to pursue an emergency use authorization on a very targeted respiratory panel in early 2021. This will allow us to get into the market more quickly than planned, then we're going to expand the panel to be inclusive of the full respiratory offering, and that is our RVP10.
We will partner with leading institutions initially to quickly demonstrate utility of the platform and assay, as well as provide a much-needed solution for faster molecular respiratory testing during this pandemic. This will give us the time to generate publications that will be needed during the expansion of our launch over the course of the year. We are in a fantastic position to capitalize on the very large number of relationships that we at Quidel have created over the last nine months with the launch of both our molecular and immunoassay COVID products. As we add in additional menu and scale up our production, we will be able to both solidify and greatly expand our customer base.
In looking beyond 2021 and beyond the impact of COVID-19, we've dedicated our initial development efforts towards the following infectious disease offerings with very focused panels that are going to include STD testing, which is herpes, vaginitis, as well as an STI panel that includes drug resistance. This STI panel I love because it will be the first offering that allows for both the diagnosis of the STI as well as susceptibility to a variety of different therapies, and this can all be done while the patient is in the office. In addition, we'll have several GI panels in development, including a combo bacterial viral offering, as well as a targeted parasite panel.
In addition to RVP10, we will also have a very comprehensive pharyngitis panel. We are also looking into an MRSA and hospital-acquired infection panel as an additional offering because of the continued overuse of antibiotics is increasing resistance problems in hospital settings as well. To conclude, I'd really like to thank you today for the opportunity and very much look forward to the next Investor Day, where we'll be describing our success in the marketplace with the SAVANNA platform.
All right, thanks, Tammi, and thanks to everyone listening in today. As Doug mentioned, I'll be providing an update on the TriageTrue high-sensitivity troponin assay and the opportunity it represents for Quidel. First, a quick overview of the cardiac marker business. Overall, the business is solid, and we are competitive in our target markets. The Triage meter-based natriuretic peptide and D-dimer assays remain the best fit for low-volume hospital laboratories as well as true POC settings. Our BNP test is CLIA waived, which expands testing for heart failure to a wide range of outpatient clinics. Our BNP assay for Beckman analyzers lets us address higher volume, automated testing in larger facilities. Finally, although COVID had a negative effect on cardiovascular testing, we are seeing an increased demand for our D-dimer test related to the concerns that COVID can drive clotting-related disorders.
Outside of the U.S., we also have several unique multiplex panels that give us a strong competitive edge in China and key European countries. The biggest challenge we face is the ongoing adoption of high-sensitivity troponin around the world. Troponin tests on big iron instruments have evolved continuously over the last 20 years, point-of-care assays have not kept pace. Outside of the U.S., instrument-based high-sens assays have been available for 10 years, this has greatly reduced the use of point-of-care assays in hospitals in many countries. The ongoing adoption of high-sens troponin in the U.S. will inevitably impact the Triage cardiac panel business here as well. At the same time, TriageTrue represents the biggest single opportunity for the cardiovascular business. I will explain this by walking through how high-sensitivity troponin improves diagnosis, why point-of-care adds more value, and how this will help grow the Triage business.
First, some background on troponin. Troponin is a protein found in myocytes that is released when heart muscle is injured. Levels range from very low in healthy young people to very high in myocardial infarction patients. In chronic disease, levels are elevated but stable. In acute events such as MI, levels rise quickly and then fall off. Early troponin assays, first introduced about 20 years ago, were very specific but not sensitive. When detected, interpretation was easy. The patient was having an MI. When not detected, interpretation was challenging. Acute coronary syndrome, which includes MI, could not be safely ruled out. Patients were often held for 12 hours and longer to allow time for the troponin to rise to a detectable level, and many patients were unnecessarily admitted to the hospital rather than risk sending them home.
High-sensitivity troponin assays are very sensitive and accurate. By definition, they have to detect troponin in 50% of normal, healthy people, and they are very precise, even at low concentrations. Interpretation is easy if troponin is not detected or stays below the 99th percentile. The patient's not having an MI. Ruling is more difficult since troponin is detected in many non-myocardial infarction patients. Patients are sorted out via algorithms that combine the troponin level and the change in that level over time. Here is a simplified version of such a diagnostic algorithm showing how troponin fits in. When patients with suspected MI present to the emergency room, an electrocardiogram is run within a few minutes. About 5% of these patients will have an ECG feature known as an ST-segment elevation, which is highly diagnostic of a serious MI. These STEMI patients are rushed to the cath lab for angiography and, as needed, a stent.
The goal is to initiate angiography within 60 minutes of presentation to the ER. Although troponin tests are run on these patients, they are not utilized for the initial diagnosis, which is based on the ECG. The remaining 95% of patients will have a non-diagnostic ECG. Approximately 15% have what is known as a non-ST-segment elevation MI, while the remaining 80% are not having an MI. Troponin testing plays a critical role in sorting out these patients. Over the course of a few hours, several troponins will be run with diagnosis based on both the troponin concentration and the change in concentration over time. Based on this algorithm, patients are either ruled in, ruled out, or held for observation and additional testing. Patients ruled in are sent to the cath lab.
With high-sens troponin, high-sensitivity assays can detect troponin elevation early after symptom onset and can accurately track small changes in concentration. This enables accelerated approaches with compressed blood draw times at three, two, or just one hour apart. The majority of patients can be rapidly ruled in or out in just three or four hours, with only 25%-40% of the patients held longer for observation, and they are very safe. Patients ruled out have very low risk of MI. Why a point-of-care test? If we zoom in on an accelerated algorithm, in this case, a zero-one hour version, we can see how point-of-care testing makes a difference. When the testing is performed in the central lab, it takes time for the sample to be transported to the lab, received, centrifuged, and then run on an analyzer.
This can add an hour or more to the time that it takes to get a result back to the doctor, and the results for the initial tests may not even be back before the draw time for the second test. With point of care, the test is run on whole blood at the patient bedside, with results back to the doctor in 20 minutes or less. This can reduce the time to disposition by 45-90 minutes, depending on the facility, and cut the time to patient disposition up to 50%. As just shown, point of care can further reduce the total time to patient disposition. This can have a significant impact on busy ERs because it allows clinicians to focus on the right patients and provide better care, and it increases ED throughput and efficiency, and it enhances patient satisfaction.
A true point-of-care high-sensitivity troponin test platform can also have value in other settings besides the ER. It can be a simpler and more cost-effective approach for low-volume testing in the laboratories of small hospitals with fewer chest pain patients. In concept, this is similar to use of pod-based coffee machines rather than a classic drip system for people who have one to two cups of coffee a day. Point of care can also enable democratization of high-sensitivity troponin testing to urgent care centers and other non-hospital sites by enabling safe, rapid disposition of low-risk chest pain patients and avoiding the need to divert them to a hospital. Can this be done? Can a point-of-care assay meet the challenging analytical and clinical requirements established by central lab analyzers? The simple answer is yes. TriageTrue development was initiated by Alere more than five years ago.
A challenging requirement was a need to utilize the same Triage MeterPro in order to leverage the placement base and ensure synergy with the other assays on the platform. The key to success was the complete redesign of the Triage cartridge. Several innovative features were developed that greatly improve assay sensitivity and precision while maintaining the use of whole blood samples, ease of use, and short time to results. Shortly after the acquisition of the Triage business, Quidel committed to complete the development and launch of TriageTrue. Given the challenging regulatory and market requirements, we felt it was important to establish a strong KOL advisory board to help guide the process. We have met periodically with this well-known group of cardiologists, ER physicians, and clinical chemists since early 2018. They recommended a control market launch with key milestones as follows.
First, obtain CE mark and launch in Europe as the fastest path to market into gaining real-world experience. Second, conduct a major scientific study to validate assay clinical performance prior to initiating an expensive and complex FDA trial. Third, leverage this study to drive market adoption outside the U.S. while completing the FDA trial and clearance. Here is an overview of that launch timeline and where we stand today. We obtained a CE mark in late 2018 and launched in early 2019 into countries where we sell directly or closely support a strong distributor. More importantly, we were able to work with Dr. Christian Müller and his team in Basel, Switzerland, to quickly conduct a major prospective multi-center trial, which was published in the Journal of the American College of Cardiology in March of 2019. Here are the highlights of that study.
The researchers used samples from the well-known APACE study to evaluate clinical performance on 1,261 suspected myocardial infarction patients. The TriageTrue performance was evaluated against a gold standard diagnosis as determined independently by two cardiologists using all available patient data, including angiography and imaging. The investigators also compared TriageTrue to the Roche and Abbott high-sensitivity troponin assays. The results were outstanding and included a validation of a safe and effective zero one-hour algorithm using the TriageTrue test with very high sensitivity, no adverse events at 30 days in rule-out patients, high rule-in accuracy, and high efficacy. 74% of patients ruled in or out at one hour, and only 26% were held for observation. The conclusion was very strong, including the comment that the clinical performance is at least comparable to that provided by the best-validated central laboratory-based assays, meaning Roche and Abbott.
This figure from the publication captures perfectly the safety and efficacy of a TriageTrue used in a highly accelerated 0/1-hour algorithm. TriageTrue proved to be highly effective with rule-in or rule-out of 56% of patients after the initial zero-hour draw and a total of 74% using the 0/1-hour algorithm. It also proved to be very safe, with no missed MIs on the day of presentation and zero adverse events over the following 30 days for those patients ruled out. Based on the APACE study results, the European Society of Cardiology in August updated their clinical guidelines to include the validated TriageTrue 0/1 and 0/2-hour algorithms. Between this and the APACE study itself, we now have strong third-party proof of performance to support our commercial efforts in Europe and the confidence to proceed with the FDA trial. That is reflected with where things stand right now.
Moving forward, we will ramp up the commercial efforts in Europe, an effort we had hoped to initiate back in March before COVID closed things down. To that end, the Quidel European team has developed and has begun the execution of a comprehensive plan to drive awareness and adoption there. We are also expanding commercialization to target countries and other regions. We also plan to initiate our FDA trial in December. Based on the rigor of high-sensitivity troponin trials and the scrutiny given them by the FDA, this translates into an estimated U.S. launch of the product in the fourth quarter of 2022. Finally, to maximize product adoption outside the U.S. and to prepare for a successful U.S. launch, we will be conducting studies that demonstrate the impact and value of the TriageTrue test.
What kind of opportunity does TriageTrue represent? Based on a number of factors, the focus will be on Europe and the U.S., we have sized the potential accordingly. Across these two markets, there are an estimated 15 million-20 million chest pain presentations. Based on APACE and other non-Triage studies, we have calculated that the average patient will get tested for troponin twice during the initial presentation, and we are looking at a price range of $12-$15, varying by region. With all that considered, we estimate a market potential somewhere between $360 million-$600 million. How much of that can we get? To figure that out, we started by identifying the target market segments that are a good fit for point of care, as outlined earlier. ER point of care, low volume hospitals, and decentralized urgent care centers. These are shown in green.
We then determined the positioning, opportunity, and model assumptions for each, a level of detail shown here, but that I will not be addressing fully today, other than one important exception. This is U.S. hospital-centric, but it is a good example since it's the biggest opportunity, and the underlying logic applies to other segments and regions. The model is built on positioning and penetration of TriageTrue based on number of beds per hospital. We expect good penetration in small hospitals. The sales process is simpler since testing is done in the lab, and the value proposition is cost effectiveness at low testing volumes. Uptake should occur relatively quickly due to the simpler sales process. While the volume per site is low, there are many sites. On the other hand, we are modeling limited penetration in large hospitals.
The sales cycle is longer and more complex since testing is done in the emergency department, and we need to demonstrate the value of faster patient disposition. While only some hospitals will adopt point of care testing, the volume per site is very high, and we will conduct the needed outcome studies to support this sales effort. We've applied this approach to the market segments in both Europe and the U.S. and developed the revenue projection shown here. Note that we based it primarily on the U.S. and Europe for a variety of reasons. They have well-developed, high-sensitivity troponin markets. TriageTrue fits well into multiple market segments, and there is adequate reimbursement. Although hospital is the biggest contributor, we included other segments that will grow over time, and we did include some pull-through of other Triage tests that we gain with new placements driven by TriageTrue .
It starts slowly, after U.S. clearance in the fourth quarter of 2022, the revenue begins to ramp in 2023, reaching $125 million in 2025, and then $175 million two years later. At this point, the China opportunity is still to be determined, given that the high-sensitivity troponin market there is still in the early stages. It's a hospital-centric market with fewer decentralized testing settings. There are registration challenges and timing that are still uncertain, and the current Triage business there is already at the point of care and in higher volume settings. At the outside, TriageTrue would likely cannibalize existing business.
Finally, we have included very limited revenue for the rest of the world at this point. I'll end by saying that we are excited about the opportunity to revitalize and grow the Triage cardiac business and look forward to making it happen.
This brings me to the end of my session, and I will now hand things off to Rhys de Callier .
Good morning, everyone. I'd like to spend the next few minutes describing some of our near-term growth drivers of our Sofia franchise. As a reminder, Sofia is Quidel's market-leading point-of-care platform that provides results in minutes and is heavily utilized in CLIA-waived doctor's offices and hospitals. As you all are aware, Sofia has been making a positive impact in our society's fight against COVID-19. We expect new products to experience a collateral benefit due to these new COVID-related placements. Now I'd like to proceed by providing you all with some visibility into our Sofia pipeline. First, we will be leveraging our rapidly growing Sofia placements through the development of a highly competitive GI portfolio of six assays. We believe this market is both large and includes unmet needs that can be met by Sofia. For example, in the U.S. alone, the market in end-user dollars is approximately $400 million.
A large percentage of this market comes from C. diff and H. pylori testing. The cornerstone of this portfolio will be our C. difficile assay, which provides differentiation between toxin A/B and GDH. Over the past decade, we saw a shift to molecular methods for the detection of C. difficile infection. Many health systems are now looking to reincorporate antigen testing back into their algorithms, as PCR had been found to detect non-toxigenic patients. At the moment, there is one visually read antigen-based assay that represents the bulk of antigen testing. Our intent is to launch an IDSA guideline-compliant antigen test to be used within the multiple testing algorithms. As we near submission for this assay, we are confident it will perform very favorably against the leading visually read assay.
Next, the stool antigen H. pylori market is another one where it is dominated by one player and ripe for entry. Our goal here is to provide a cost-effective assay with a test of cure claim. This test will detect active infections, as well as confirm the absence of infection following treatment. The other GI products in this portfolio will also benefit from Sofia's platform features, including objectivity, connectivity, and performance over culture and visually read assays. Now, I'd like to turn to another exciting project, Strep98 . Today, the Strep A market is somewhat of a commodity. Much of the 40 million tests performed in the United States are generic products made overseas and sold for a few dollars per test. Most of these tests are run in pediatric offices on children and young adults aged 5- 18. Current guidelines suggest any negative test must be reflexed to culture for confirmation.
This is a key disadvantage of these tests, as culture confirmation is a process that can take as long as two to three days. There is shared frustration in this process among kids, parents, and physicians. We believe patients, providers, and payers will benefit from a rapid, low-cost, no culture backup assay that can be run in CLIA waived settings. In addition to cost, we've learned through many conversations with physicians that Strep A infections are a key driver of antibiotic misuse. As we near submission for this assay, we are confident in our ability to address this problem. As we think about our go-to-market approach, there are still some unknowns, particularly around reimbursement and pricing for this assay. As such, we're modeling a few scenarios covering a wide range of potential revenue.
We are confident in our ability to convert about a third of the competitive antigen market to Sofia. Now I'd like to give you all a brief update on our Sofia Lyme test. As you may be aware, Lyme disease can be a very challenging disease to diagnose, leading to pain and frustration for patients. The CDC, Quest Diagnostics, and the nonprofit FAIR Health all released reports in recent years demonstrating the growth and spread of Lyme disease. While physicians can treat based on the bull's eye rash, the CDC estimates 20%-30% of those infected with the bacteria that cause Lyme disease may not develop this rash, while some studies have estimated the number may be closer to 50%. Our Sofia Lyme assay provides Tier 1 detection of both IgM and IgG antibodies to the infection.
It is CLIA-waived and uses a finger stick whole blood sample and provides results in minutes as compared to days for the typical lab send out process. The pandemic has dramatically reduced the number of patients visiting their primary care provider in person. Despite this drop in visits, we've continued investing in broad awareness campaigns and marketing programs internally. To date, we have more than 600 contracted customers. As patients begin returning to in-person visits to the primary care doctor, we expect to grow this number.
In closing, we plan to further leverage this platform as we ramp to 75,000 Sofia placements. As I mentioned previously, in the short term, we'll be launching Strep98 and a portfolio of six new assays targeting gastrointestinal diseases. Longer term, there are several areas of interest in which our R&D teams are investigating. Thanks for your attention today, and I hope you all stay well.
Next, let's talk about our COVID product pipeline. I will keep this succinct and tight. We'll plan on answering your questions during our Q&A. What you already know is that we developed and are currently shipping four COVID products. Lyra Extracted SARS PCR, which was EUA cleared in March, Sofia SARS Antigen, which was EUA cleared in May, Lyra Direct SARS PCR, which was EUA cleared later in May, and Sofia 2 Flu and SARS, which was EUA cleared in October. Moving forward, we have eight assays in development. Here are the anticipated EUA submission dates. One, QuickVue SARS Antigen for the point of care, already submitted and under active FDA review. Two, Solana SARS, our 25-minute isothermal assay, submission any day. Three, Lyra PCR Flu and Extracted SARS, submission this month. Four, QuickVue SARS At-Home, submission in December.
Five, Sofia 2 SARS IgG Antibodies to nucleocapsid and two spike protein epitopes, submission in December. Six, Lyra Direct PCR flu and SARS submission in January. Seven, SAVANNA Respiratory Viral Panel-4, which includes flu A, flu B, RSV, and SARS submission in the first quarter. Finally, eight, Sofia 2 RVP4, which uses our new strip and spotting technology submission in March. Clearly, there's still more to do in playing a significant role in addressing the country's need for tests with various use cases.
Now for something really exciting, Karen Gibson will kick us off on our big idea segment with an update on Sniffles. Karen?
Hello, I'm Karen Gibson. I'm the Senior Vice President for Digital Health here at Quidel. The Digital Health business unit was formed to use innovative digital technology to enhance our products and expand diagnostic testing into new areas. Today, I want to share some information about a very exciting product currently in development, one we affectionately call Project Sniffles internally. The current COVID pandemic has changed the world of diagnostic testing forever in an extremely short period of time. We have all seen or experienced personally the need for affordable and scalable testing for SARS. The pandemic has brought testing to the forefront of the healthcare system. Diagnostic testing is now woven throughout the fabric of everyday conversations. You can now schedule a test online. You even have the ability to choose what type of test you want from an e-commerce shopping cart.
Would you like a PCR test, a rapid antigen test, or an antibody test? Another outcome of the pandemic is the rapid adoption of new patient care models. A recent McKinsey survey shows that in 2019, less than 11% of consumers were using telehealth services, where now, over 76% would have no issue using a telehealth system. Physicians have adapted their practices, and we are seeing the regulatory agencies adapt as well. In the last year, over 80 new telehealth services have been introduced. While this trend may go downward as more physicians return to their office practices, most industry analysts are convinced that the adoption of telehealth is here to stay and will continue to grow as more services can be offered as part of the virtual visit. One of those key services lacking is the ability to do diagnostic testing with telehealth.
Diagnostic testing is a huge value-added service for the provider, and it also improves the patient experience as well. The timing of the pandemic intersects with another key trend, which is the application of advanced technology within the healthcare industry. It is more common today to see the usage of AI, machine learning, biometrics, IoT, or informatics used within healthcare, which is very exciting to me personally. At Quidel, we envision a future of diagnostic testing that uses innovative technology to not only improve patient care but to open up new business models. Diagnostics is clearly being digitized. Project Sniffles is the embodiment of all three of these key trends. It's an affordable and scalable testing platform using advanced technology, and due to its mobile IT infrastructure, it can be used to expand testing into new and novel patient care settings.
I'd like to introduce you to Project Sniffles, currently under development, we will be announcing it for release in the near future. Sniffles is the combination of a small diagnostic reader about the size of a grande coffee cup, as you can see here, that's able to read a standard Sofia fluorescent immunoassay cassette. After the sample is taken and prepared, you simply insert the cartridge into the reader. Images of the cassette are captured on the reader and transmitted via Bluetooth technology to a mobile device. The result is interpreted using our proprietary AI software model on an app, which has been downloaded to the mobile device. As I said earlier, there are many benefits of the Sniffles platform. First, affordability. To manufacture this device is less than 20% of a Sofia instrument to manufacture. Due to the simplicity of the design, it's highly scalable.
We're currently under contract to manufacture over 100,000 of these devices by early 2021, and we have the capability to expand our manufacturing into the millions if desired. Imagine a world of diagnostic testing without instrument constraints. The real value of Sniffles is in its software technology. With the artificial intelligence capability, we can train our models interpreting the assays to be smarter and more accurate over time. With the inherent cellular connectivity, we can use that mobility for our customers who are going beyond the lab and physician office, and we are seeing that currently today. Cellular connectivity also allows us to integrate with other software platforms easily, giving us the ability to address the entire testing experience. The biggest advantage is that we can target software features quickly to adapt to market opportunities.
I'd next like to share some of the current thinking around where Sniffles can be applied. As you can see here on the slide, we have our professional point-of-care market, the telemedicine market, which will allow a healthcare professional to oversee the sampling process and guide the patient through the interpretation of the result, and potentially, even a home market, where the patient can test themselves for a result. When we think of the professional point of care market, we see it in much broader context than the traditional physician office or hospital. We have customers today picking up and transporting our analyzers to parking lots, sports stadiums, concert locations, and we've even seen a storage closet set up to accommodate testing, which by the way, we don't recommend. Sniffles can handle those environments, but it also addresses more permanent mobile medicine needs of concierge medicine and home healthcare services.
Introducing the Sniffles platform will allow our customers to choose the analyzer platform that meets their needs the best, be it a Sofia, Sofia 2, or a Sniffles. Telemedicine is a very enticing market for Sniffles as it completes the virtual visit, giving the physician more insight, even though they're not physically in the same room as the patient. Think of the benefits of having a virtual visit combined with a SARS test. The patient is not sitting in the waiting room or ER, potentially infecting others prior to a consultation, and the physician can give immediate guidance. The convenience of this care model may also incentivize patients to reach out more quickly for help before their condition worsens. Naturally, the next step from telemedicine is having the diagnostic in a form where the patient can test themselves without oversight.
While we are not recommending foregoing healthcare professionals, the improved technology of Sniffles allows an affordable and accurate test, just like the ones performed in the physician office with immediate convenience. This empowers a patient to take charge of their own health and seek out professional assistance faster. Home testing under instruction from a physician can also allow for better monitoring of chronic conditions, enabling a very strong patient care plan. There are many opportunities to apply Sniffles technology. Let's take a look at our current thoughts around a launch roadmap. Sniffles is simple by design. Our focus has been on building a platform that can be adapted to new markets quickly by adding new software features. We have an ever-evolving roadmap that will allow the platform to expand. At launch, we plan to leverage the benefits of Sniffles being developed on a native mobile technology platform.
As I stated earlier, the diagnostic testing is moving outside of the boundaries of traditional point of care environments. This little 1.5 lb device can be easily transported where it's needed the most. One of the key areas Sniffles can quickly integrate is into the telehealth marketplace. Combining physician oversight with an accurate diagnostic test directly enhances the provider's capability to service the patient, and again, improves the patient experience. It is truly a game changer for telehealth and diagnostics. Next, we plan to focus heavily on the professional segment as we will develop software features more suitable for the diversity and the rigor of the traditional settings. In this setting, an analyzer as affordable as Sniffles allows testing to scale dramatically. We can also develop new and more complex AI assay interpretation models for new disease conditions.
Finally, we do see the capability to take Sniffles directly to the home at some point. Imagine a time when you can test yourself in the convenience of your own home with the confidence of a result that physicians have depended upon for years. In conclusion, this little analyzer is actually a pretty big deal. It can shape a whole new future for diagnostic testing. Thank you for your time today.
Now I'd like to introduce Dr. Werner Kroll, who will give you even more big ideas coming from Quidel.
Good afternoon, everyone. As Doug and Karen already mentioned, I'd like to update you on our advanced technology platform project, the next generation immunoassay platform for point of care applications, which is run under the code name Leapfrog. The driver for this project is the need for improved immunodiagnostic assays to successfully support the healthcare trend of switching from contemporary medicine to predictive health, to detect and treat diseases in earlier stages than it is currently done. With this project at Quidel, we want to expand our current strong position in point of care infectious disease diagnostics and identify infections at an earlier stage when they are still effectively treatable without long-term implications to the patient. Examples where improved analytical sensitivity can be an enabler for earlier detection are Lyme disease or TB diagnostics, measuring microbial parameters instead of indirect serological responses, what is currently state-of-the-art.
As importantly, however, we also want to expand our current focus beyond acute disease diagnostics of infections and cardiac conditions and enable better and earlier diagnosis in the field of chronic diseases. In the U.S., around half of all adults have at least one chronic health condition, and treatment cost of these patients account for about 86% of the national healthcare spending. Most chronic diseases are not curable but can be managed. On a physiological level, the changes on health or disease status are most directly seen on the protein level. Immunoassays are needed to diagnose and monitor those changes in protein levels along with disease status. Since biochemical changes are small at early disease stages, these applications require more sensitive detection methods as well. Besides the impact on a medical level, this paradigm shift will also have significant implications on healthcare cost.
The shift to comprehensive and stratified patient management has the potential to reduce healthcare costs and improve medical outcomes by enabling earlier individualized interventions that can diminish subsequent health problems, avert adverse events, reduce or prevent hospitalizations, and avoid the cost of late-stage or unnecessary treatment. This trend is further amplified if testing is possible in decentralized settings, supporting the new trend of telemedicine and expanded personal responsibility for own health. The Leapfrog platform is a logical next step in the development of our successful immunoassay point-of-care product line that started with QuickVue, fast lateral flow-based assays with visual readout. This was followed by the Sofia platform, providing improved analytical sensitivity through instrument readout of fluorescent signals. With Sofia 2, multiplexing capabilities for lateral flow assays, as well as improved connectivity, were added. Sniffles is the latest instrument of this line.
It utilizes the same assay cartridges as Sofia and provides improved affordability, connectivity, and scalability. Karen already presented the key features of that platform and its impact on democratizing immunochemical testing. So far, all these immunoassays are based on lateral flow technology and were incrementally improved over time. Leapfrog, however, represents a disruptive technology jump in that sequence. The improvement Leapfrog provides over the lateral flow technology can be compared to the improvement digital PCR provides over PCR. While digital PCR, however, cannot be applied in point-of-care settings, Leapfrog is designed to work in decentralized, CLIA waived locations. The Leapfrog platform enables robust, ultra-high sensitivity down to femtogram per mL level in comparison to triple-digit picogram per mL levels achieved by the Sofia platform. Other key features are integrated sample handling, which is supportive of CLIA waived applications, and self-learning data analysis algorithms to improve signal readout.
Full connectivity will enable data handling and communication in the 2020 decade. This platform is developed with an experienced technology partner, complementing Quidel's point-of-care diagnostics expertise. The technology is based on localized plasmon resonance as a basis for digital signal readout. Digital signal readout provides an improved signal-to-noise ratio that enables a limit of detection in the femtogram per mL range. The basis of the assay principle is a sandwich immunoassay with a capture antibody on a chip surface, capturing analyte molecules at one epitope, and a second antibody coupled to a gold bead, which reacts with a second epitope of the analyte and thereby fixes the bead to the chip surface. Instead of measuring the entire integrated plasmon resonance on the chip, the signals of individual beads are collected, and the number counted on the chip surface.
As long as the protein concentration is low enough and the percentage of beads labeled immune complex obeys Poisson distribution, each bead will either capture one single immune complex or none. For this condition, the analyte concentration is proportional to the number of marked beads. When the concentration is higher, the instrument switches to analog signal measurement. Thus, the dynamic range is expanded to six logs. As mentioned earlier, conceptually, this technology improvement can be compared for the switch from PCR to digital PCR. Currently, the platform development is in the feasibility phase. The model assay we have chosen is based on the high-sensitivity troponin assay of our Triage platform. The assay principle is the same for both assays, utilizing the same antibody Fab fragments, respectively, the complete antibodies in a sandwich assay. This allows direct comparison of experimental results and quantitation of development progress.
When using complete antibodies, the limit of detection for troponin in human plasma is about 47 femtogram per mL, and the limit of quantitation, one picogram per mL. When using Fabs instead of complete antibodies, the limit of detection is improved to 22 femtogram per mL and the limit of quantification to 247 femtogram per mL with a CV of around 10%. The precision in the digital range is between 3% and 7%, depending on the design of the assay. Overall, the assay spans a range of approximately six logs. We can measure troponin between around 25 femtogram per mL and 10 nanogram per mL. This allows the coverage of rule-in and rule-out applications without dilution using samples at finger prick volumes. The ability to use low sample volumes is also driven by the technology's low detection limit.
The detection of an analyte is driven by the total number of analyte molecules in the measuring device. Besides the concentration of the analyte in the primary sample, it is also proportional to the sample volume. The better the analytical sensitivity, the lower the required sample volume. This allows the use of finger prick samples instead of venous draws for blood-based analytics, a key feature enabling sampling in point-of-care testing sites. As Bill explained earlier, for our Triage high-sensitivity troponin assay, this assay will allow rule-out of MI in the ER, and allow for faster discharge of about 45%-55% of suspected MIs. At the same time, the assay provides results for rule-in at concentrations in the double- to triple-digit picogram per mL concentrations without sample dilution.
A key advantage of this technology is the improved assay robustness, reflected by the underlying digital counting technology and the improved analytical sensitivity, providing better position around the medical decision points in the three picogram per mL or so concentration range. Other applications we are evaluating are in the field of cytokine quantitation or direct TB diagnostics. As we have seen during the COVID pandemic, cytokines are important parameters in the evaluation of disease severity, and the Leapfrog technology provides a sensitivity level at which the relevant concentrations in early disease stages can be quantified for prognostic disease evaluations. The target applications for this platform are CLIA waived point-of-care assays. In order to achieve the respective requirements, we must provide a solution that covers each step along the process flow, from sampling to sample preparation, to sample analysis, to data analysis, and result communication.
The assay itself will be performed in a cartridge and does not require any manual manipulation. All reagents are on board. Sample addition and metering are also integrated in the cartridge and do not require any external manipulation. Assay signals will be converted on board the instrument and are supported by self-learning, artificial intelligence-based algorithms. This should improve assay precision and accuracy, as well as eliminating sampling or handling errors. Broad communication features, as already shown by Karen, will complete the system.
With that said, I'd like to hand over to our next speaker, Randy Steward, who is Quidel's CFO.
Greetings from San Diego. Thank you for joining us today. It's been quite the business transformation for Quidel over the last several years. In 2016, we recorded revenues of $192 million, with EBITDA of approximately $27 million. In October 2017, we purchased the cardiometabolic asset from Abbott. In total, we paid $680 million for the business that generated approximately $250 million in annual revenue. Over the next two years, we spent significant time integrating the business, creating a global enterprise with commercial sales in more than 100 countries today. We built a strong global commercial team while creating an infrastructure to support that global footprint. During the early days of the integration, we operated under a transition service agreement with Abbott. The integration and elimination of the transition service agreement was completed successfully within the first two years.
In March of this year, we launched the first of several SARS-CoV-2 assays, our molecular Lyra SARS-CoV-2 assay. We continue to demonstrate our R&D expertise by launching the first antigen test into the market in May, and the first combination flu A and flu B, plus COVID antigen test, which received EUA approval the first week of October. With all the activities in the last three years, we have maintained our financial discipline. We significantly reduced our debt profile from 2017 and improved our cash flow generation. We have much more to go. We also appreciate the success we have realized and the positive impact we are making on testing in the world. For full year 2020, we are estimating revenue in the $1.6 billion-$1.7 billion range, dependent on supply chain constraints, with a very significant EBITDA contribution in excess of 65% of revenues.
Since March, we have continued to challenge ourselves to significantly increase production while having a supply chain that can support and exceed our production expectations. For our Sofia assays, going into this year, we had weekly capacity of approximately 1.6 million tests, or 84 million tests annually. By adding additional shifts, plus converting one of our manual lines to Sofia, today we have weekly capacity of 2.1 million tests. Very early in the pandemic, we put together a plan that would allow us to greatly increase our capacity by adding four additional automated lines to our already existing two automated lines we installed in 2016 and 2019.
We are currently executing on that plan. This January, we will increase our capacity to approximately 2.8 million tests a week by adding line 7. In Q3, when we have added our fourth line, line 10, we will have estimated weekly capacity of 4.8 million tests to service our Sofia customers. If history is any indication, we are confident that we will be able to exceed these weekly capacity numbers. During this time period, we have also added a second supplier to manufacture our Sofia instruments, completely sourced and manufactured in the United States. That second supplier is currently online. By the end of this month, plus the contribution from our original supplier, we will be in a run rate in excess of 10,000 instruments per month. Remember, until this year, we were placing between 6,000 and 8,000 instruments per year.
We currently have a back order of instruments, by the first quarter next year, we are estimating we will have inventory that allows us to expand our customer base and sell into Tier 2 and Tier 3 customers. QuickVue production capacity today is 50 million tests per year. With the addition of equipment in Q2 of 2021, that capacity will double to 100 million tests per year. In order to get to our ambitious goal of 50 million tests per month, we have several different options. Each or in combination gives us confidence we will be able to achieve this goal in 2021. Certainly, facility expansion is critical to this production ramp. We were able to add the additional production equipment for Sofia into our existing footprint at our McKellar Court facility.
All non-manufacturing personnel have now relocated to our Summers Ridge facility, which is acquired as part of the asset purchase from Abbott. We were also able to solidify a long-term lease on 106,000 sq ft distribution facility located between our McKellar Court and Summers Ridge facility. A very efficient location. Here are a couple slides showing the addition of line 7 in our warehouse facility prior to adding the racking system. In total, the investment for this expansion is currently estimated at approximately $70 million, of which NIH will reimburse us up to $65 million upon the completion of specific milestones. Here's our McKellar expansion. Here's actually line 7, of which we actually have our first pouch product that came out today. Here's the new distribution center that we will basically have up and running by April of 2021.
We launched our first COVID molecular assay in March this year under the Lyra brand. If you remember, our Lyra molecular business in 2019 sold approximately $3 million in product revenue. By May of this year, we ramped up production and increased our production capacity to approximately 480,000 tests per week. Through further process improvements and resource allocation, today our capacity stands at slightly less than 600,000 tests per week. At the current time, we are selling approximately 40% of our capacity. We believe we will realize increased demand as we gain more customers and add a COVID test to our Solana platform anticipated this quarter. We will be increasing our lyophilization capacity by the end of this year. This will increase our weekly output to slightly less than 1 million tests per week, providing ample capacity as we head into 2021.
Our strong revenue growth expectations for Quidel's core business, non-COVID related, has not changed. We are expanding our installed base franchise for both Sofia and Solana during this time period. We anticipate exiting 2020 with a Sofia installed base of approximately 75,000 instruments. In 2021, we anticipate continued strong demand for the instrument and could see a doubling of the installed base over the next couple years as we launch into non-traditional markets. For the Solana instrument, we currently have approximately 1,200 instruments installed. We anticipate this number growing appreciatively in 2021 as we add COVID customers and expand existing customer test requirements. As Rhys mentioned, with the addition of gastrointestinal assays, Strep98, and others, plus strong continued investment in our R&D projects, we anticipate continued expansion of non-COVID assays on our large Sofia installed base.
We are estimating an overall growth rate of 13% in our rapid immunoassay business over this five-year time period, driven by the new products as well as the growth in our respiratory products from the incremental instrument placements. In 2021, we will finally realize the fruits of our labor and our patience with the launch of our SAVANNA platform. This is very exciting news for us and our customers, as Tammi stated, a very important market for us to nurture. In year three of launch, we have estimated revenues in excess of $300 million, very significant to our total product portfolio. The other important product launch during the next two years is our high-sense troponin assay. As Bill stated, the first high-sense point-of-care product could have a major impact on the market once launched.
We have estimated the clinical trial could take up to one year and approximately the same amount of time to get approval through the FDA. With a U.S. product launch estimated in the back half of 2022, we have estimated a revenue contribution of approximately $80 million in 2024, the second full year of launch. In summary, we continue good execution from our R&D and commercial teams. We are estimating an 18% cumulative average growth rate for our total Quidel core business. This slide illustrates our financial discipline and ability to pay down debt quickly utilizing Quidel's excellent cash flow from operations. In 2024, when it was difficult for us to use the traditional debt markets, we used the convertible debt market to raise $172 million in cash proceeds. This cash was targeted for a potential M&A opportunity and ultimately was used to help fund the cardiometabolic acquisition.
The term debt, revolver, and deferred and contingent consideration were all sources of cash used to fund this acquisition. As of the end of this year, the only remaining debt is the deferred and contingent consideration, which has three more annual payments remaining. We are estimating that we will have in excess of $500 million of cash on the balance sheet at year-end. Over the last several years, we have gone into the market several times to repurchase the convertible bonds, and that certainly proved to be the right decision based on a repurchase weighted average price of $61.43. Now that we have delevered the business and are generating great cash flow, we are poised to take advantage of the next great opportunity. It is our intent to utilize our strong balance sheet and access to the credit markets to further advance our strategic objectives through M&A.
We are not looking for quantity, instead focused on the quality of a target and is it the right strategic fit. How does a potential target complement our existing product portfolio? Does it help us expand into adjacent markets, such as telehealth and telemedicine? Does it expand our geographic reach or solidify our global supply chain and allow us to control more of those products? From a financial perspective, we believe it should fit into our long-range objectives of revenue growth, strong margins, and cash flow, and when utilizing the debt markets, create the ability to delever at least a half turn per year. The ability to integrate a business timely with synergies is also a key component in our evaluation of potential acquisition targets. We have a current pipeline that we are actively reviewing.
In summary, we remain very focused on our priorities and excited about the future of our company. We have come a long way over the last several years, have learned a lot, and continue to learn and listen as we pursue continued growth and expansion. For 2021, we have identified the following as critical goals. Number one, continue to expand our production capacity, whether for QuickVue, Sofia, or our molecular products, including SAVANNA, and exceed our capacity targets as outlined. Number two, successfully launch incremental COVID-19 assays, serology assay for Sofia, home-use testing, and additional molecular assays. Number three, continue investing in R&D to support our long-term objectives and meeting and enhancing the needs of our customers. Number four, commercialize SAVANNA. There's a great future for this product, Our perseverance in commercializing this product will pay significant dividends, as you heard from both Tammi and Johannes.
Number five, complete TriageTrue clinical trials. This product enhances our Triage position in the global marketplace and creates a benefit to patients and has the potential to save dollars for our healthcare system. Last, pursue an M&A transaction. We need to take advantage of our strong balance sheet, access to the credit markets, and new stature in the marketplace. Thank you for your words of encouragement and appreciation. As we fight this virus together, we remain focused on the task at hand and will continue to execute on our plan.
Welcome to the live Q&A. I'm here with Doug Bryant and Randy Steward, who will answer your questions today. To ask a question, type your question into the Q&A section on the right-hand side of the webcast screen. Our first question today is, how does the recent vaccine news affect your COVID-19 test manufacturing plans for 2021 and 2022? Doug?
Hello, everybody. Much for a softball from the start. That's a good place to start, I suppose. Let me begin by saying I'm not, obviously, an immunologist, nor am I a vaccinologist. I would just encourage anybody looking into this to make sure that the folks that they're talking to actually do have a qualification to comment on the subject. I just read so much out there, some of which seems right, some of which doesn't seem right. What I do have, based on our position in the marketplace and access to people who do know about what's going on, is I do have a good feeling for what the experts are actually saying in that regard. I would just start by saying that, of course, we want to have a vaccine that is effective.
Of course, we want to, along with appropriate masking and social distancing, sterilization of surfaces, et cetera, plus vaccination, of course, we want to do whatever is necessary to get those people who may be immune-compromised to the point where they can reenact, re-engage with their loved ones, whether it's grandmas or grandpas, folks who may be undergoing treatments and haven't seen people for a long time. Of course, we want that for everybody. What I'm told rather recently is that we should be looking at this with an extraordinary amount of caution. We've never made a vaccine in such a short time.
I think if you were to ask people who are in the know, they would say that they're concerned that the plasma B cells that are producing the antibodies, those plasma B cells may likely be short-lived, we can't actually be sure how long these B cells are going to crank out the antibodies. There is some concern being expressed that I'm hearing out there that in 6- 12 months, there may be no protection. The other interesting point is that each of these vaccines so far is targeting the same spike protein antigen. If they are safe, and they are used, and I hope that that's the case, then they will all put essentially the same pressure on the virus to mutate, and essentially invite the arrival of a surviving new strain.
I'm told by experts that should this occur, that we're looking at a different pandemic, but it is nevertheless another pandemic. I think there is optimism with the vaccine, but there's also appropriate caution, and we should keep that into account. When you look at from our perspective, of course, we make PCR tests, but we also make an antibody-based test looking for the nucleocapsid protein. I think something that I do know pretty well from listening to our folks internally is that the genome coding for the virus, this protein, the nucleocapsid protein, when it mutates, the virus often dies, and it cannot replicate. It's just a point worth making that these rapid antigen tests will be appropriate even after the virus mutates.
Just to summarize, not to put too fine a point on it, but the coronavirus is constantly mutating. Werner's here with us as well. He can talk about a couple of the new mutations that are out there, but there's really been little or no selective pressure for a mutated version to pop up and become prominent. When the arrival of these new vaccines over the next few months, when they come out, there will be selective pressure for the arrival of a newly mutated coronavirus. Continued R&D monitoring, assay development, and testing will be essential to detect, to track, and differentiate new viral strains that might appear. Everything that we've learned from influenza and RSV and other respiratory virus informs and demands our commitment to continued innovation against COVID-19 and the SARS-CoV-2 virus. Our work's not done.
In a second, I'll ask Werner to step in real quick and talk about, as a result of what we see happening with a vaccination, what we think we might be doing from an R&D perspective. Clearly, our work's not done. We think that, therefore, testing is likely to continue, and so do the experts, for some period of time. Our plans to ramp up production are unchanged. We are happy to have further questions on what we think about volumes and all that and moving into 2021, 2022. Our plans at this stage, based on the suggestion that a vaccine is forthcoming, as we always suspected it would be, our plans at this stage are unchanged.
Werner, could you step in for just a second.
Sure.
Talk a little bit about what we've previously thought in terms of serology, what we're thinking about differently now as a result of vaccines, et cetera, what we think we might be doing moving forward.
Hello, everybody. Yeah, I think we are still learning a lot about the virus. Over the last, let's say nine months or so, we made pretty good progress. We are monitoring the behavior of the virus and learning out of that, I think we are anticipating that there will be changes as soon as the vaccine is coming. The virus is going to behave differently. We see first changes already, not necessarily connected to the vaccine, but mutations are happening at low frequency. As Doug mentioned, we have this on the N protein as well as on the S protein. The S1 is the one the vaccines are going to target. What we have seen recently are the latest ones, and companies like Lilly, like Vir, like Regeneron, are also looking very carefully into these mutations, monitor them so their treatments are being effective.
Where we come into play is also see what mutations we have on these spike proteins, if these antibodies are effectively interacting with it or can interact with them. Then monitor also, once you have received the antibodies, that they are still in high enough concentrations. That's the same for vaccines. When you get a vaccine, are you still having enough antibodies for protection? Are you losing this? We know this from cases like HBV in the past, where we are also checking titers on a regular basis. We expect that also to happen for the SARS vaccine. That's where we are working right now on an assay, looking for the function of activity against neutralization. We will have an assay over the next few months that we are getting ready with to measure these neutralization activities, as well as a serology assay.
Did you generate antibodies at all with the vaccine? We have to see. The vaccine not necessarily will be active in anyone, not due to the vaccine itself, but due to the logistics around it. The RNA vaccines will have to be stored at - 80 degrees. We will definitely see problems with that, which will relate to no response in patients, most likely. We will be able to monitor that as well. I think lots of changes coming. We are preparing for that.
That's terrific. We described eight programs that you've got under development now in the COVID space. One of which is the serology assay that detects antibodies to the nucleocapsid protein, but also to S1 and S2. That's a little bit different, but what I think I'm hearing you say is you've got a ninth that you just informed me of this morning, which is great. You've got a ninth program where you're looking at, do these targets that we're going to look at, are they indicative of neutralizing antibodies?
Yeah.
In other words, are you, as a person, you've become vaccinated, are you going to actually clear the virus?
Clear the virus or does the virus still have a chance to interact with your own body cells?
Yes.
Just having an antibody against the virus doesn't necessarily mean the antibody can still interact with your system.
Right. This is why you're telling me that despite the fact that we're going to try to get everybody vaccinated in our company, I don't know if we'll be successful. Well, let's just say we're successful because we're in an industry where, frankly, we need our people healthy and at work, right? I could make an argument that we, maybe not ahead of grandma and grandpa, but ahead of just the standard person, companies like ours should be vaccinated first because we're manufacturing product, right? Let's say that we're successful. All of us get vaccinated, excuse me, but you're still telling me I got to test everybody weekly for antigen, aren't you?
First of all, I think the first test will be, does everyone respond?
Yes.
Therefore, that's very important.
You're not going to let me get rid of my weekly COVID testing, are you?
No.
No.
Definitely.
Okay, I think that's the answer, folks. I think that's the answer in a nutshell.
Absolutely not.
All right. Thank you very much.
Thanks, Doug. Jack Meehan had a related question for Doug. How does the timeline for a vaccine impact your thinking around the durability of the testing demand in context of all the supply that we're building? More related to the demand.
The demand still, at this point, is endless. We're going to ramp on the QuickVue SARS, we're going to try to ramp to 50 million a month. That more than likely will not happen earlier in the year, obviously. We're going to have to move quickly to get that done. That'll be a run rate of about 600 million tests per year. We think we can get to somewhere north of 240 million tests on the Sofia SARS antigen product. From our perspective, I don't think the vaccine reduces the demand at all at this stage for the reasons that I stated. I don't know that vaccinating my people will actually confer protection. I don't know that they can come to work and not worry about it.
I think as more and more is known and is not politicized, that people are going to recognize that these experts that are saying the testing's not going away, the masks aren't going away, the social distancing's not going away. I would kind of like to go to a restaurant on occasion. A lot of this is not going away, including testing, for some time.
Awesome. Another question from Brian Weinstein. He says: what does the OUS opportunity look like now post-COVID-19? You spoke a little bit about increased utilization where testing did not take place today, how is that factored into your revenue assumption?
We have very little forecasted for ex-U.S. We do have some opportunities that are selective, where it would make sense, but we feel like we have an obligation to do whatever's necessary here in the U.S. first. For the foreseeable future, I don't know that I can get to what's being asked of us to deliver what's necessary in the U.S. We haven't forecasted a lot ex-U.S.
Okay, great. Let's move on here, to Joy Mitchell asks: can you discuss the distribution of your current Sofia installed base customers or your expected installed base at the end of the year? What percentage are urgent care hospitals, nursing homes, et cetera? Looking for a breakdown there.
I don't have a breakdown off the top of my head. We will exit the year, as I said before, at about 75,000 analyzers. We haven't addressed what I'll call new markets in any significant way. We haven't done, other than the Pac-12 and the Big Ten announcements that are tied to studies, and we obviously will try to help the NCAA out with the basketball program. Those are small numbers relative to our total. The bulk of what we're shipping right now is into hospital labs, into the urgent care centers. I think we had a review on urgent care centers, that particular area is expanding. That and freestanding EDs is expanding greatly. We really haven't done anything outside of what I would call our traditional space at this stage, with some limited exceptions, as I pointed out.
My short answer is most of the business is right where all the flu testing was in the first place. That has not changed dramatically. Frankly, we haven't been able to address even the smaller accounts that were flu and strep customers. We haven't had the ability to ship them SARS products. That's the status so far. I can't really give you a breakout on percentages. I would just say the percentages are not different than they had been before. They haven't been yet, despite the fact that a number of folks are asking us to start shipping product in the employee space and the entertainment space. We're getting a lot of calls right now.
Okay, great.
Yeah, we have said that Tier 2, Tier 3 are more Q1 initiatives.
Yep.
Okay. Larry Feinberg asks: when is QuickVue approval expected, and what additional requirements are needed to file EUA for home use, specifically the SARS test?
We're under active review, Larry, at the FDA with QuickVue SARS. As soon as we get finished with that, we'll do the initial or the additional, excuse me, studies necessary to complete the template for at-home use. We'll do so initially with the product without the requirement other than visually reading it. Then we will also submit with an app that can be used, an app that's on an iPhone, for example, that can be used to do either transmission of the data to state and county public health departments who want the data, or assist the individual with reading the results. Again, we'll finish the professional segment EUA shortly. It's under active review. Immediately after that, we will compile and submit the data necessary for the at-home template. Visually read only to be immediately followed by an amendment that would include the app.
Okay. A follow-up on that. How can we expect QuickVue to be priced relative to Sofia for both the professional and for the at-home markets?
Haven't priced the at-home at this point. I would say that we are concerned with having a price that's too different from the Sofia price. I do think that without some of the costs associated with Sofia, that we should be able to come in somewhere, something lower than $20 at an end user level for the QuickVue SARS in the professional segment. We have done preliminary pricing studies on at home, but they were more related to flu and strep. I would just say that we're not going to have to give up a lot on price necessarily. Either way, it's going to be profitable.
Great. Alex Nowak asks Quidel has never been a consumer-facing company. How do you plan to modify the company for at-home tests, either from internal changes or M&A? How would at-home tests be sold?
We have two paths right now with consumer-facing companies that are widely known. Two very large consumer-facing companies that we are in discussions with right now. Your point, Alex, is a good one. We don't know the consumer space well at all. This is why we're going to partner with somebody who does. We are looking at M&A from the perspective of things that could take that product and make it more friendly at home. As Randy would point out, we have cash and access to capital, and we have a number of things that we're looking at at the moment that are under active discussion. I think that's the answer to the question. Let me know, Alex, if you need more.
Great, here we have-- in through. Alex also asks, why would someone buy a Sniffles versus a Sofia? Can you please explain the centers that would adopt Sniffles? What is needed for FDA approval? How and when would this product move into the at-home space?
The advantage of Sofia 2 is in sites that can batch, and sites that don't necessarily need that so much. I think that the Sniffles, our internal product name for the smaller device, could be more beneficial in lower cost or more democratized settings like retail clinics, for example, and potentially for at-home use. You can see how testing for not only SARS, but other things over time could be useful at home, and having that device could be particularly useful. Effectively, the difference between Sofia 2 and Sniffles is that we've taken the optics of Sofia and made them smaller, and all of the intelligence of the analyzer we've moved off of the analyzer onto an app on a cell phone.
Effectively, the Sniffles product takes images of a Sofia cartridge and then transmits those images by Bluetooth to the app, and the app, through a trained algorithm, is interpreting that image and determining positive or negative. The main difference is size, cost, and scalability. We think that we can be early in the first quarter at about 100,000 Sniffles units. We think that we can build reasonably quickly to something more than 1 million a year, I think that's extremely advantageous. Other than that, there's not a whole lot of distinction between the two products. Cost and scalability are the two factors.
Okay, Andrew Cooper has a follow-up to the at-home question. When you say at home, could you talk about the difference between needing an RX versus a direct OTC purchase by the consumer? How do you envision that, and how do you prioritize where the capacity will go?
Well, we want to be there regardless of which way regulatory agencies decide this is going to be affected. There's a world in which I buy over-the-counter, a QuickVue SARS tests. I take it home, I run it myself, and I have no responsibility to report it. I just have an answer. That's one world. I don't know if it will go that way or not. The other extreme is, of course, I don't get to have a test unless somebody authorizes me to have one, then it has to be done under some level of supervision, or certainly some conversation with a healthcare professional. In the event that that is where the market goes, we want to be there as well.
I do think there's an advantage of engagement with physicians in order to get all this done, but I'm also hearing from experts in epidemiology, and that's not what they're thinking. They're thinking, make it available so that people can just go without any repercussion. They can go get tested, and then if they're positive, do the right thing. We're going to be ready whichever way it goes.
Great. Can we talk a little bit about SAVANNA now? I think folks are asking a lot about SAVANNA now.
Okay.
Mark Massaro asks, is SAVANNA, do you expect it will sit on a floor or a lab bench? Can you give the approximate dimensions?
The dimensions are the same as you may have seen at the AACC a while back. They're somewhere around seven by 8x8 inches each module, so it's actually quite small. I wouldn't put it on the floor. You might step on it.
A follow-up to that, how does it compare to the GeneXpert system and the BioFire FilmArray?
Well, it doesn't really compare very well with the Sofia. First of all, we're doing four PCRs instead of one. The cycle times are dramatically shorter. Our menu, because of the four PCRs, will be dramatically different than the Cepheid analyzer. For example, Cepheid's going to do CT and NG, but they do that today successfully. They've done a nice job. The market really isn't just CT NG, it's CT NG, Mycoplasma genitalium, and Trichomonas vaginalis. Those four are what is required for an STI panel, and so they're missing two. On the other hand, if you try to compare with BioFire, again, it's not very comparable either, because cost, speed, smaller footprint, time to result, all those things, and the ability for integrated delivery networks to pick and choose what they do and to push certain tests out into clinics, I think will be significantly advantageous with the BioFire.
The BioFire is a great product as well. If you're looking to run a lot of analytes all at once and you're scientifically curious, I think it's a very good product. It is slower, it is more expensive, and instead of lowering the cost, they just keep adding analytes, and I think that's an interesting strategy, but it has a bit of a limit there. In a nutshell, I would say that SAVANNA doesn't really compare very well with either one. It's sort of in the middle of the two.
Great. Steven Mah with Piper is asking, "On SAVANNA, you mentioned that you are developing both an identification test and also an antibiotic resistance test simultaneously. Could you give us a little more detail on what you are looking for in terms of antibiotic resistance versus the functional assays that require culturing with antibiotics?
Yeah, I could, but rather than make a mess of it, since I got Werner standing right next to me, I'll just have him step over and answer the question for us.
I think we're going to do two things, genotypic resistance testing as well as functional resistance testing. We were just talking about SAVANNA , and there we have also the space to do certain mutations for NG in the instrument. There, we will always have the situation that we have to run after the mutations. Only if we know the mutations and the impact, we will be able to see if there is resistance. The functional test has a big advantage that you actually do a test with the antibiotic, and see the direct impact of the bacterium onto the antibiotic. You don't need to know up front if a specific mutation will cause resistance or not, and that's a big difference. The differentiating factors here is that we intend to do this in a very short time, and sample in, result out activities.
We're going to employ a new way to identify bacteria, using bacteriophages, and then also have a differentiating readout after exposure to the antibiotic. I think it comes nicely together.
In effect, what you're saying, and to be clear, is you actually have two different programs. You're doing resistance markers on SAVANNA , which makes a lot of sense, but you're also, through a phage technology that you've been looking at for a few years now. You're looking at susceptibility testing as well. It's an important category, whether we're looking at phenotypic, as in your phage technology, or genotypic, which obviously there's need to do that as well on these PCR products.
Yeah. I think this is very practical for the major mutations. For new mutations, definitely the phenotypic assay is going to be more differentiated.
In terms of SAVANNA, because you've got four PCRs, I guess that allows you some space to add on things like resistance markers.
Correct.
Whereas other people couldn't do that.
Yeah.
Okay, good. Thank you.
One more on SAVANNA from Jack Meehan. Could you clarify the readout for SAVANNA? Does it tell the physician if a patient is positive for the panel broadly, or does it get more granular to the analyte for which they test positive for? I wasn't sure from the example.
If I understand the question correctly, maybe you'll help me, Ruben. Are we asking, do I get an individual answer for each of the things on the panel in a SAVANNA cartridge?
Yeah, that's the question. Do you get a specific answer?
That's a simple answer. It's yes. You get an answer for each.
Great. Jack also asks, on SAVANNA , "You're targeting $300 million worth of sales for SAVANNA . What is your thought around the potential for cannibalization of Sofia sales? How's it?
It's a different market altogether. We've said this many times before when people said, "Oh my gosh, molecular products are coming out. You're going to lose market share." I said early on, and I say it again over and over again, this is not a zero-sum game. What you're going to see over time, and I think Tammi's data actually illustrated this through a third party, was it's anticipated that, at least for respiratory markers and others, having multiple technologies doesn't actually take away from any one of the technologies. They're just different use cases. I don't see SAVANNA at home. I don't see SAVANNA necessarily in a doctor's office unless it's a certain type of practice and they're doing a lot of, I don't know, STI panels, let's say.
For the most part, we've developed SAVANNA to be an integrated delivery network product that can be distributed throughout all of the locations broadly, and to be all tied into the same data management system. Sofia is a completely different product, where you're looking at a lot of outpatients in really widespread locations. I don't necessarily see, for example, SAVANNA in Rite Aid. Maybe, but it's not really the right product.
Okay. Moving back to Sofia. We have a lot of questions on Sofia now. Brian Weinstein asks, "What is the current utilization per Sofia box today, and where do new assays take it? And what is the difference between expected utilization on recently placed instruments from COVID-19 versus the legacy placements?
I'm going to punt that one to Randy, and do you have any idea on what your average placement is for COVID? We can obviously talk about how we modeled things before COVID and where we're at in that regard.
Yeah, it's a great question. Unfortunately, we're right in the middle of the whole COVID volume and trying to understand that. It'll differentiate once we go to Tier 2 and Tier 3 customers. On average, pre-COVID, we're at approximately $4,000 revenue per box. What we're seeing currently, continued contracting and stuff, we don't see that changing.
Yeah.
It's really difficult to say what the next six to nine months looks like as far as revenue per box, COVID-wise.
The major thing that causes me to pause on the question, Brian, is I have no idea what it looks like if we could ship people what they actually want. For each Sofia, I've got demand that was X, and now it's coming back 4X. I'm not actually able to ship it. Is it really 4X of what we're shipping now? I have no idea. What I can say is, this is a unique situation with Sofia right now and COVID because so many people are batching in a way that they didn't before because they have higher volumes. It's a great question. We probably should spend some time analyzing it just so we understand it, and we can monitor it over time. Right now, I don't know how we would answer the question.
What are the minimum annual purchase requirements for Sofia instruments? Is there a two or three-year term for these purchase commitments?
They're typically on a three-year agreement. For the folks who were already on a three-year agreement, I think we amended agreements for another two to three years in most cases.
By majority of them.
Yeah. We really haven't had an absolute minimum. I think we might have initially when we first launched, but we don't actually have a minimum. It's not really something that we have to worry about. If they're agreeing to purchase our product, so far everybody's been ordering more than they said they were.
Right. We certainly lowered that minimum when we rolled out.
Initially, we did.
Yes.
We did, yeah, because of the lower cost.
Okay, one follow-up here from Steven Mah on Sniffles. "Given the low cost of the instrument, do you think or do you envision more outright purchases, or would you stay on the typical Sofia sales approach with test minimums?
I think it depends on segment. If indeed you're looking at at-home or over-the-counter, or in clinics, whether it's urgent care or retail clinics, I think they all have a different thought. What I would say is Sofia 2 costs us somewhere north of $500 to build. Right now, the first 100,000 Sniffles, we need to disclose what we know the name's going to be, since we have it decided. I'll tease everybody at the moment. We have decided.
Yeah. Based on a pretty nice analysis. That first 100,000, because of the small number, we're looking at somewhere north of $25. Is that right?
Yep, that's right.
At a million, I'm not sure where we're going to get to. I know that on a chart one time somebody told me it was between $7 and $10. I don't know if that's changed at this stage. Either way, it's going to be significantly lower. You can see that on the retail segment, if my cost is $10, depending on that retailer, those two retailers I was talking about, where they want to price it. I think there's just a lot of flexibility for that consumer market based on what you look at if you go down the aisles and look at the other medical device products that are out there in the retail segment at the moment. I think we're going to be fine.
Great. A couple of follow-ups here on the at-home opportunity from Will Tong. "How do you ensure the test result is reported?" Let me read that again. "How do you ensure test result reporting integrity?
Well, first, I don't know that test reporting will be required. If it is, this is why we're doing the work on an app. This is also why we're doing the work with Sniffles to make sure that the test result is reported wherever it's supposed to go. I would imagine as this evolves, we're going to get advice on what has to happen. I know that right now people are saying, "Just get the product out there." Initially, there was guidance that said they wanted a reporting mechanism. Now that's gone away. I don't know where that's coming from or who's responsible for that thinking individually, but we're going to need to be ready to go whichever way it goes. We're preparing as if we have a high level of integrity from that image that we're capturing.
Remember, we're not actually capturing the test result, we're capturing the image. The image is then being interpreted. That interpretation is a data set, and that has a high level of integrity with respect to sending the data forward. Obviously, if somebody's running it at home visually, and they're hopeful that it's not, they don't see the faint line, maybe, I think that's a concern. On the other hand, encouraging people to do it on their own and then maybe that's where people are thinking. Short answer, we're going to be prepared regardless of which way this goes, whether we report the data, obviously, we have experience on how to do that with Sofia and Virena, or not. We'll be ready to go.
Okay, I have a question here on Leapfrog from Steven Mah. Can you give us a sense of the costs versus the existing lateral flow tests? I think Werner mentioned that it would use the same cartridges. If it's a single molecule digital test, I would think you would need a complicated chip to partition the single molecule reagents. Could you expand on this?
You want to answer that?
Yeah, I can.
Sure. Speaking to the cost of.
I think the same chip concept. It is a different chip. It is not a lateral flow chip. We will have another plastic surface-based chip. We do believe that we will get into areas of the same cost though as what we have for our current one. Chips are much smaller, and therefore, you can cut them also in smaller pieces. That means per chip, the costs are going to be really, I think, in this same area.
The scalability of chips.
Yeah, because you can really start or you only need very tiny amounts. That means, as Doug said, scalability is fantastic, and also thereby the cost is going to be reduced significantly.
Right. Yep.
Yep.
Thank you. That's terrific.
Okay, I have another question from Brian Weinstein. How do possible molecular entrants to at-home markets impact your value proposition with immunoassay products?
I don't think the technology matters at home. What I think matters at home is ease of use, speed, and to a certain extent, reliability. The difference between a high-performing immunoassay and some of these molecular products that could have the potential for point of care at home, I think the distinction in terms of performance is quite small. I don't think it's a threat, honestly. If it were a threat, I guess we could put SAVANNAs in homes. No, I'm joking. These molecular products, if they were handheld, didn't require an instrument and were extremely inexpensive, and could be done reasonably quickly, could be competitive. That could be disruptive, I suppose.
Any other technology as well, that we're not even thinking about, could be equally acceptable. At the end of the day, end-user studies and performance is going to matter, and cost.
Great. Alex Nowak. Sorry, Alex. Question here. What needs to happen, or who does Quidel need to partner with to hit 50 million QuickVue tests per month? What needs to happen to hit that number?
We have a game plan already that's going to cost us about $50 million in capital. We will have solved the distribution end of it. Randy showed you a picture of the distribution site, 106,000 sq ft that we're standing up right now to be done by April. That part of it is not so much of an issue. Antibody production, making grams of an antibody that yields, what, a couple hundred thousand tests per gram, something like that, is not going to be the issue. Spotting technology is a matter of us bringing on board more spotters. Those spotters are not that difficult to put in place. Lamination equipment, on the other hand, and cutters and these sorts of things are going to be required. To get to 50 million tests per month, we have a plan. It's about execution.
To speed it up, I will have to engage with more engineering firms to do the fabrication on some of the more difficult pieces of equipment. To go beyond that would require probably partnering with somebody in order to get more floor space. In that environment, we would probably do the stuff that right now we can ramp without constraint. That's making antibodies, the chemistry, the striping, the spotting of the components onto the lateral flow strip. All those things we can do at far greater capacity than we can cut, put in the cartridge, and pouch. To go beyond the 50 million a month, ideally we would partner with somebody who already had some of that, either the space or the wherewithal.
There are some bigger companies that do have the capability of scaling up on that end of the process that how do I put this? Is less of the secret sauce that's on the front end of all this. Good question. I think we're comfortable that we can get to 50 million a month. I hesitate using the word comfortable. I would just say we know how to do it. We have the pieces. We would have to hire more people, too. I think we're in the process, therefore, of hiring another 200 people in terms of both direct and indirect labor related to the increase in capacity. That's going to have to happen over the next few months as well.
Okay, great. Tycho Peterson has a question here. What are the baseline expectations for the number of COVID tests in 2022? Is it 50 million-60 million? Perhaps more. How should we think about the baseline?
For us, 50 million-60 million tests?
Yeah. That would be for us, yeah, in terms of units.
Yeah, that would be hugely low. Right? We're being asked to ramp up to 50 million tests a month by the NIH. Simultaneously, they're asking others to do the same. What's envisioned is, even with vaccination, that there needs to be significantly more testing in order to get kids back to school, to get employees back to work across the country in industries that aren't necessarily deemed to be high priority, but I would say they're pretty high priority because people aren't working. In order to get people back to work, we're going to have to do a lot of testing. Could be a combination, though, of both antigen testing, and I say antigen also for PCR, it's RNA versus protein, but testing for the infection versus testing for having been infected, in other words, serology.
I think the combination of that's going to be with us for quite some time. I'll just state 50 million, I don't know where that number comes from, but I don't think that's damn close. Right? I don't know what we'll do, but right now we're being asked to get to somewhere around 1 billion tests. As Brian Weinstein asked earlier, you haven't addressed the international market yet. No, we haven't.
Another question by Tycho. What are expectations for Sniffles revenues? You will have made 100,000 devices by 1Q 2021. How should we think about Sofia cannibalization? Sniffles revenues and then cannibalization to Sofia.
I don't see cannibalization because we're moving Sniffles into market segments where we're not. Whether that's in a school, whether that's in a retail clinic, with occupational health, the numerous companies that want to do testing out there for all sorts of uses. I don't see cannibalization at the moment, because right now, I think we can address the segment. I think potentially we can address the segment that we call the professional segment with Sofia 2. Ramping to around 10,000 a month, we'll effectively have doubled our number of placements on the ground by the end of next year. I think we'll be in good shape from Sofia 2. Sniffles is intended for this whole concept of democratization of testing, moving into the home. There's still a huge population of people who want to be tested who are not getting tested right now.
Okay, we have a couple of follow-ups on the vaccine. Alex Nowak asks, how does the vaccine news, if it works, change the asymptomatic market potential for testing?
I don't know what that question means, actually, Alex. We're going to vaccinate a lot of people. Some of those people will have stimulated B cells to make antibodies, and we don't know whether those antibodies are going to be long-standing. In my population of people, which must have one of the lower populations of employees in this county. You think about it, we have a moral obligation to stay safe. We mask in the buildings, we clean the surfaces every 90 minutes. We test everybody on Wednesday. We have a program where if somebody in a cohort tests positive, we keep testing the other people. We're extremely diligent about all this. All that testing is on asymptomatics. If you vaccinated my employees, how do I know which employee is actually not infected still? How do I know? I don't.
I'm still going to have to test. I think I asked the question of Werner before, Werner's not going to recommend that we stop testing because we all get vaccinated. I don't know if I can get vaccinated, but if we're able to, it's not going to change my testing at this point in time. We're going to need to know a lot more moving forward before I'm going to decide not to test my employees.
[crosstalk] I would guess we're less than 1% prevalence. We've had one positive since we started the testing program. Right? My guys are doing a great job, wearing the masks, staying apart, doing what they're supposed to be doing, not expanding of social infrastructure over the weekend.
Brian Weinstein asks, "What studies are you doing to show performance in asymptomatic populations?
Yeah, you saw the University of Arizona data. Those were done independent, of course. It was encouraging to see the data. It was encouraging to read their conclusion. It was encouraging to see that after all this testing that they had done comparing the PCR that they've now, a while ago now, are reliably using Sofia antigen on the front end, which is great. In addition to that, we are engaged with an NIH study that Ron's managing. That's ongoing right now. In addition, we are participating with a small consortium that's looking at testing at home, and so we've shipped that group of people a number of QuickVue SARS tests. In that study, they're calling it more of a familiarization.
We've sent the tests into a university where they've quarantined some kids, and during that quarantine period of time, they're going to use QuickVue SARS and test themselves daily. I think it's not necessarily a performance-related study. It's a familiarization. Was it easy enough to run? How do they feel about it? That sort of thing. So those are the things that we are doing on asymptomatics that we're driving. We do know that some people out there are also running other studies on their own.
Great. I have another follow-up on vaccination from Tycho Peterson. "After a vaccination, if you're still unsure if it works or not, wouldn't it make more sense to run the most sensitive test you can, a la PCR, to try to catch those cases where the vaccination didn't work, versus instead using a once-a-week antigen test?
Yeah. This is a really good question because I think maybe, I'm not a scientist, but what I just read the other day, I think is sort of what's thought these days. In the first few days before you're actually infectious, you could be positive by PCR. You could have RNA, but may not be infectious yet. Is that test at that point in time important? People are arguing that it's not. Conversely, on the other side, we know that a person is infectious for some period of time, then I'm still going to show, as I'm falling off, potentially RNA, when a person is not infectious. Is the PCR test actually in that situation in the asymptomatic population, is it actually useful?
You could argue, as some are now arguing, that it is useful in certain use cases, but in that particular use case may not be so important. You have a discussion that's going on right now that says, if it's above a certain number of cycle thresholds by PCR, in other words, I have a small amount of RNA, what does that RNA mean? If it's above a certain number, should I even consider that? We are definitely sure that they're positive for RNA, but are we sure that that particular student, as in the Arizona case, is actually infectious? I think the debate now, is it at 30 CTs? Is it at 33 CTs? Well, we happen to know that Sofia in some studies is picking up at 37, 38 CTs.
It's quite interesting that when we do the initial testing, we can learn something, but if you don't repeat the test and see is it reproducible, I pick up something that's 35, 36 CTs by PCR, but then I test it again and it's negative. What does that mean? Right? Long answer to a short question. I don't think that wanting the most sensitive way to detect whether somebody has been exposed or not is actually what is wanted.
Alex Nowak--
Frequency and time to result matters a lot more.
Okay. This is moving toward election-related questions. Alex Nowak asks, "President-elect Biden's testing plan talked about expansion of antigen testing. Are there any specifics from the plan that you've seen or heard that would lead to increases in the COVID business next year?
I haven't heard anything specific. I will say that, initially, because of being the chairman of AdvaMedDx, I was contacted by one of the members of the new task force. This individual called me confidentially and let me know that he had been working on advising Vice President Biden on what a testing plan would be. I spent a couple hours, twice, for a total of four hours on the phone with this individual. It became pretty clear to me that that's what they have in mind, because they had been looking at how do we ramp up and get more PCR testing done? How do we get it done more frequently? How do we get it done quicker? They concluded that the way forward was rapid antigen testing.
All I've seen so far is a comment that said he wanted a sevenfold increase in the amount of antigen testing that's being done right now. I don't know where that comes from either. I would say that a number of us in my industry will be reaching out to that group shortly to see if they have any thoughts that would be instructive. I don't imagine anything I'm going to hear is going to tell me to slow down my ramp-up of production. It's a good question. Short answer, I haven't heard anything specifically from that group at this point.
Sofia Manufacturing, Kevin Guiang asks, "How much visibility do you have on pull-through of your new manufacturing capacity base of 10,000 Sofia tests a month, or Sofia instruments a month, I should say?" How much visibility do you have on the pull-through?
On the pull-through. Again, we're just getting to the 10,000 instruments a month. I can tell you that every customer that we sign up is requiring more and more volume. I don't have a feeling for what the pull-through on each of those instruments is. Right now, it is such a wild dynamic of every instrument we get, we ship. Every cartridge we make, we ship. In advance of all that, I get calls from people saying, "Where's my stuff?" Right? I don't know what the pull-through for instrument is at this stage. If it starts to slow down a little bit, I think we'll get a feeling for it. Right now, I have no way of knowing what every single instrument is doing.
I have a question here from Andrew Cooper, asking about the longer term plan. Can you offer any context for the COVID assumptions in the LRP? What is the longer term winning product, and what level do you think is sustainable?
I really don't have an answer to that. What we've done is some modeling. What I can tell you for sure is that the model is probably not right. It's got too many variables, and so therefore it's probably incorrect, and judging by the way that we normally do our modeling, it's probably on the low side. Every estimate that we've had to this point for ourselves has been we've under-called it.
Yep.
I would see this running out for a few years now. As I wanted to point out, though, in this particular discussion today is that what we believe truly is the benefit for our company is not necessarily all the cash we're generating at this point in time, but the collateral benefit of having more assets on the ground to do things like allergy, do things like toxicology, do on one hand, and then if indeed we're able to create an at-home market, think about what other products that we could put through that same either platform or some process. I do see testing moving, for routine conditions anyway, out of the traditional segment, and I do see the data suggesting the propensity of people to use telehealth now versus going to see their physician. We were going to move that way anyway.
That's what was in our plan. This COVID situation is creating an opportunity for us to think about doing things a little bit more quickly in terms of the democratization of testing. There's no reason to think that that won't happen in the U.S. Ex-U.S., you think about countries where there really isn't a point of care opportunity at all because that's not the way that medicine was administered historically. There is no point-of-care market in the U.K. If I go to a physician, the test gets sent to another larger facility within that same NIH, or excuse me, NHS part of the country. Germany's the same way. Most of the testing is in big central labs, only in places like Switzerland, and I think a lot of that has to do with reimbursement, is it any different?
I think with COVID testing, it's going to expand the number of places that we never thought about shipping Sofias to. My Sofia placements in Germany are, not my guys' fault, but I don't want them to hear this, but it's small. My number of placements in the U.K. is small, but over time, that's going to change. This COVID situation has really created an impetus for more testing closer to where the patient lives.
Great. I have a question here from Brian Weinstein. Will there be demand going forward for a standalone flu test, thinking about one to two to five years from now? What's your thought on that, Doug?
I don't know. I would say for this season and for sure next season, it makes sense. I like the idea of the SAVANNA respiratory panel because you can get the things that are most common that are related to these same symptoms. Will we have demand for it? I don't know. I think it's going to be more, Brian, the situation of, do I have the capacity to make a test that's completely separate? If indeed we have mutation of the virus, the SARS virus, testing continues, the symptoms are the same. For a while, I think we're going to be with the combo assay. Mainly because most of us manufacturers, we're switching to combination assays because we can't make enough of everything at this point.
One more from Brian on M&A. Between products, technology, and infrastructure, which are the most attractive for M&A?
We think that anything up to our size where we could leverage a global footprint that didn't have too much overlap would be a priority. We also think that things in the digital health space, whether it's telehealth or anything related to the moat around an at-home solution would be appropriate. We're looking at several things there. Then in a third category, which may be actually more actionable over the shorter time, is things that actually help us with capacity issues.
Right. Moving on to Triage. Alex Nowak asks, how quickly could TriageTrue ramp as the standard troponin test is well known? Is it a rapid conversion, or is the ramp slower and similar to traditional diagnostics?
The ability to rule in, rule out at the point of care, we are told, will cause this to have a fairly rapid uptake. There isn't, at this moment, a point-of-care high-sensitivity troponin. High-sensitivity troponin is becoming the standard. The question is, how quickly does it move out of the lab and into the ED or into the urgent care setting where formerly liability was more of an issue? I see high-sensitivity troponin, whether it's us or another company, I see that to be a fairly easy layup for any company that can get this through the FDA.
A related question from Jack Meehan. Can you give us an update on the toxicology launch? What has limited the initial adoption of the test? Does that influence your thinking at all around the potential for the high-sensitivity troponin assay?
I don't see the connection between toxicology and high-sensitivity troponin. What I would say is, on the side of high-sensitivity troponin, we haven't completed the clinical trial in the U.S., so it's impossible to understand that situation. On toxicology, we're talking about, we have all the demand that we can supply. Our job right now is to increase manufacturing capacity on the toxicology panel, which truthfully, as we've reported before, has been somewhat of a challenge. The business that we acquired, the Alere business, had a certain format with respect to the cartridge and the manufacturing processes, and we've got some work to do to increase our manufacturing capacity there. Right now, the rate-limiting issue with respect to toxicology is our ability to make the panels more reliably.
If we don't solve some of these things, that would be what would cause us to have issues with respect to the high-sensitivity troponin as well. You can imagine that we would be able to generate unbelievable demand for the product, but then if we fell short, that would not be good. At this point in time, as I look at the LRP, my risk is not demand for almost anything that we've got, but mainly our ability to supply. Stay tuned, we'll update folks as we move along. We've got some pretty smart people working on it. We have to improve our yields and our capacity for manufacturing of the Triage products overall.
Okay, second to last question as we're coming up against it, from Thomas DeBord, moving back to COVID. Did Quidel receive a contract for COVID antigen testing for Canada similar to BD?
I thought we did.
Yeah. If we haven't, it's close to being finalized.
My instant answer was yes, because I saw a press release that was being put together.
Yeah.
Yeah. No, we're in the mix there. Who did the press release from the BD? Did BD do its own press release? That's the thing that's different.
Yeah. No way.
Previously, the Canadian Ministry did their own press release. They did it for Abbott. They were engaged with us on the press release on our product. It looks like maybe Becton, Dickinson decided to do their own. I don't know what drove that press release.
We can follow up pretty quickly on that one, Tom.
Last question here related to COVID and new tests from Len Yaffe. What new tests may be required in the post-vaccine world? How critical will non-instrument testing be in the everyday world, i.e., employers, cruise ships, international travel, and large events?
Well, we like QuickVue SARS for that category after the comma there. All those sites, we think, are particularly useful. At home without an instrument, I can see how that might be valuable. A certain segment of the population may prefer to have a reader like Sniffles, but I see the visually read product as being appropriate, provided the performance can be achieved.
Great. Okay, Doug, that's the last question. Any closing remarks?
I'll just say great quarter, great progress in the fourth quarter. We're in good shape, we believe, to achieve everything that we said that we would do in the quarter. As always, want to say to my team, my guys, really proud of what the R&D organization has done, really proud of what the guys in supply chain and ops have done to ramp up production relative to what our models were initially. They've exceeded expectations. You have to remember, we've got 1,300 people, and we're competing in a world where our competitors are significantly larger. We love the challenge. We like to be David in the David and Goliath story. At the end, my guys really think about the fact that as an industry, we're all competing against the virus, really.
I'm equally pleased for the other companies in our space, what they're doing, but obviously, I'm proud of my guys. Thanks for listening and happy to follow up later with any questions that you might have. Thanks, everybody.
That concludes our Investor Day presentation. Thank you for joining us today, and thank you for your support. Goodbye.