Good morning, everybody. Day three. Who's excited? Come on. Day three. Let's go. Yeah. Let's do this. My name is Brian Weinstein. I'm a Group Head of Life Sciences here at William Blair, and I'm responsible for coverage of QuidelOrtho. It's the first time I've actually said that, QuidelOrtho.
Sounds good.
There you go. It sounds good. I am required to tell you that, for a list of disclosures, please go to williamblair.com. Logistically, the format here, management will be giving a presentation that should last, pretty much the entire 30 minutes. I know they have a lot to go through. Following this, we will host a 30-minute breakout session located in the Richardson room. There's new rooms every day. I've not heard of that one before. The Richardson room. The breakout will be a fireside chat. We have questions prepared, of course. However, we encourage you guys to come and engage with management directly and ask questions of your own. With that, we can jump in.
We are fortunate to have the company's Chairman and CEO, Doug Bryant, with us today, as well as the company's Chief Financial Officer, Joe Busky. I'll turn it over to Doug, and then, we'll adjourn to the breakout session.
Thanks, Brian. Good morning, everybody. Doug Bryant. With me, as Brian said, Joe Busky, our Chief Financial Officer. Also, Brian Blaser, our VP of Investor Relations, and Ruben Argueta, who's now my Chief of Staff and a recent Vice President in our company. We will be making forward-looking statements. I'm gonna commend my general counsel, though, by reducing the number of words on this page. Two companies in the diagnostic space that have been around quite some time, and in fact, the management team, all of us have been around quite some time as well. If you look back, Ortho is actually one of the older companies in the diagnostic space.
They pioneered typing and testing and transfusion medicine way back in 1939 and to the present. They acquired the Eastman Kodak diagnostic platform, which is now called VITROS. It's a clinical chemistry analyzer. I used to, when I was a young guy, compete with them a long time ago. Frankly, they. How do I say this politely? They did very well. They were a tough competitor in those days. Of course, they're now also one of the three major players in donor screening. That's a big part of the business too, very stable, ongoing business.
I used to compete with them when I was a young guy at Abbott, as well, and they were a pain. Our company started in 1979. The company lore, I don't know if this is factual or not, but I presume it to be. Our first diagnostic product was actually a pregnancy test developed for the San Diego Zoo so they could test panda bears. That was our actual first product, believe it or not. Huge seller because, you know, all the pandas that run rampant in San Diego, right? We've been around for quite some time.
I would say that we became known initially, I think, for strep testing at the point of care, and then later through a partnership that we had with Glaxo, we developed a flu test. For whatever set of reasons, Glaxo didn't think that they needed it, which was great for our little company at the time, and then it took off ever since. We essentially had a transformational acquisition that closed October 2017, when we acquired a number of the assets from Alere when they were sold to Abbott. Essentially, our cardiometabolic business is that Triage business. At the time, we also had all the BNP business that was run on Beckman's analyzers.
Recently we settled that case with them, so it's mainly for us just now the point-of-care cardiometabolic business. 2020, March of 2020 was a very interesting year. Actually, that was probably for a while the last investor conference that at least we were at. We were at Raymond James, right? In Orlando. Just a quick story. I know we only have a few minutes, but a quick story. I was at the conference, got a call from the White House, and asked to participate on a conference call, which I actually declined. I think it was mainly around some coordination and plus we were doing one-on-ones, and it just didn't happen.
We went to the airport in Orlando, and we're three of us sitting there, Ruben included, and having, as you do, a glass of wine. I think we might have been on our second glass of wine or so when I got a call. We were delayed. United Airlines, excellent airlines. They were delayed by a couple hours. We weren't really sure we were gonna get out of town or not, but I got a call. Got a call from a lady in the White House. She said the vice president would like to see you. We see that you're on the East Coast. I'm like, okay. How do you know that? I guess they. People know things.
They said, "The vice president would like you to come up, and could you be in his office at 10:00 A.M. tomorrow morning?" I said, "Vice president of what?" Seriously. Second glass of wine, I thought I was funny, right? We went up there. There were really only two diagnostic players in the room. There was Robert B. Ford from Abbott, and myself, and then the rest of the guys were all the reference lab people. We had a little chat. Basically they pleaded with us to go fast and to make a point-of-care antigen test to make a PCR test. Deborah Birx was asking us all to take a look at antibody screening as well. Within...
That was March 4th. March 17th we had our first assay, which was a PCR assay. Then on May 8th, we launched Sofia. It was the first rapid antigen product in the market. We were way ahead of Robert Ford and his team at that time, so we took off. The most important thing I can say is that that was a big change for our company. The most important thing is the manufacturing footprint and the scale, the supply chain redundancy that we now have built across all of our platforms, all that occurred during this period of time.
I think we wisely used our cash on both R&D and manufacturing operations. That's the biggest thing that's happened in the last couple years for us, until very recently. At the end of last year, we announced the merger between ourselves and Ortho, and then we just closed that very recently on May 27. Joe will give us an update on how we're doing with integration here in a few minutes. The combination of these two companies creates a leader in the industry, bringing together innovative products. What I could say there is what's really interesting is there's very little overlap in terms of products in any of the markets in which we both participate.
The integration right now of these two organizations is our top priority. It's my personal top priority. I'm more focused on the culture and ensuring we have the right executives and managers in the right jobs and making it easy for them to get those jobs done. I say that because a lot of people are asking me about what am I gonna do with all the cash. We're going to make investments in R&D. If we're presented with an opportunistic interesting thing that fits quite nicely, we might look at it, but we're not actively expecting that at the moment. We're super, I would say hyper-focused on making sure that this transaction, the merger, goes well.
The most important thing for us right now moving forward, in addition to the cost synergies, is making sure that we fully utilize the strength of the combined commercial organizations globally. We're focused on base business execution. As I said, we definitely wanna make sure that we at least achieve what we have in the model. I would say the combination of Joe and my former CFO, Randy. I don't know that there are two people more conservative on the planet. I guess that's a good thing. Here's our recent mugshots, the four executives that are named in the business combination. I've been around quite some time now. I started at Quidel in February of 2009. It says 30+ years. That's being super kind.
I'm actually next year I'll be 40 years in this industry. I have a recent photo taken that just basically shows the stress that I've been living under for the last couple years. Now it's current. The other one, I look at the photo and I think, "Who is that young guy?" To the right there, really good executive personal friend of mine, Rob Bujarski. He's been with us. Actually, he was on board when I started with the company. He's done all sorts of things. When I first came on board, he was actually our general counsel. You know, well, I put him in charge of business development for a while. He did great. Then moved him into commercial.
Now we're swapping roles a little bit. I'm gonna handle most of the commercial side of things, the customer-facing side of things, and Rob's gonna turn his focus internal into operations, R&D, et cetera. I think it's a good move. One of the things that makes that possible is Mike Iskra, on the very right-hand side, is super at commercial. It made sense for us to make sure that we take full advantage of Mike's talents. Of course, you'll hear from Joe in just a second. Joe's been around for quite some time as well. Has a lot of experience in our space. A lot of numbers here. We are as global as any other diagnostic player now, in over 130 countries.
That actually mirrors my experience in my former large diagnostic company. We have 330 products. That's a lot of SKUs. In 2021, we had $3.7 billion in revenue. The first quarter of this year, you know, a bit of an anomaly because of our COVID sales, but the total combined company did about $1.5 billion in revenue in the first quarter of this year. We'll get into the EBITDA. We, for the size of our company, we're one of the few pure play diagnostic companies that routinely operated quite profitably at greater than 30% EBITDA as a percentage of revenue, and we expect to do that moving forward.
We now have over 6,000 employees, and about 2,600 of those are actually customer-facing, which is one of the premises and one of the most important aspects of this combination is our ability to take our Sofia and our Savanna platforms and fully utilize that very large commercial organization. In the U.S., believe it or not, the two companies, the commercial organizations are very similar in size in terms of the number of salespeople. It's not dramatically different, but ex-U.S., it's quite different for us. Over 100,000 installed instruments. 79,000 of those are Sofia, and of those 79,000, 72% are running multiple products and have within the last year recorded revenues.
The average customer or the average box, I'll say, does about $9,000 per year. We've got pretty good cash flow. Originally, I don't know how we pulled up to six already. We were saying we were the seventh largest now. You see a couple ahead of us that I think we can sneak past, at least, in the next few years as we launch Savanna. I'll share with you the market sizes and the opportunity, for that we have in front of us. If we just do a reasonable job in the molecular space, I think that we will become one of the top players.
If I could get to number four or number three, you know, in the not-so-distant future, I would feel very comfortable with that. You know, when you look to the very right-hand side, you see some interesting data. We're still gonna be one of the faster-growing players. You know, we were, as a smaller company, Quidel growing quite rapidly. You may have seen our Analyst Day where we projected to do about 17%-18% compounded over the next five years. Yes, we're acquiring a little bit bigger business that doesn't have that same growth rate, but still, after we combine, we still expect to be growing quite nicely. You know, yeah, we were north of 40% in terms of EBITDA, but now we're still gonna be above 30% as a combined business.
When you look at it, and compare us with those ahead of us, we're doing fine, and we expect to do very, very well, moving forward. I like this chart. It points to what we're chasing after. You know, size the prize, as they say. Point of care is where we have done super well, since I've been with the company, at Quidel. It's still a really nice addressable market for us. It still has reasonably good growth, and driven by a number of factors, including expanded access. There is this democratization of testing, I've been calling it for a few years, that's been ongoing. Recently, because of COVID, people know a lot about testing and tests. Public awareness has increased dramatically.
People who have a runny nose and a fever or whatever are now going to an urgent care more frequently to get tested than they would have in years past. We would expect in 2023, these numbers at the bottom with a mix of our businesses. We did it that way. Brian put it together this way because he wanted to show that this year's gonna be, you know, pretty dominated by point of care just because of, you know, COVID sales. As we move forward into next year, I'm making an assumption that this flattens out a bit. You know, I'm a little concerned with these new variants, BA.4 and BA.5. They're already up to 5%-8% of the positives now.
Each variant, it seems, appears to be more contagious than the previous. At the same time, people are recovering more quickly, and hospitalizations are going back up right now, but fewer people are dying. They're getting treated, and they're going home. I think there's less of a concern from a mortality perspective, but it is a little bit of a pain these days. In my own company, we're now wearing masks. If you enter our building, you have to wear a mask. If you don't wear a mask, as you know, maybe you wanna go to the men's room or whatever, you don't put your mask on, somebody will turn you in. That's I live in a state where that would be common behavior.
Clinical chemistry, a lot of people talk about the fact that it's not a high-growth market, but it is the most important platform in a laboratory, particularly in the central labs, where, you know, our own customers now are doing 3-4 million clinical chemistry tests per year. That decision that the laboratory director makes is super critical, and it drives a lot of other things. When we talk about bundling together in those accounts that Ortho traditionally has owned and where they have 93% recurring revenue from those accounts, are super important. ClinChem, not a fast grower, but in the segment where we're competing now, we're doing extremely well in this medium to higher bed size hospital setting. Immunoassay has always been an extraordinary market.
My former company has done super well, and the other big competitor at the top of the chart, also super well in this category. It's the most profitable for most companies, and we expect to do quite well moving forward. Not only are we continuing with the launch of Sofia, but we've now manufactured 100,000 Sofia Qs, so when we go out further penetrating and decentralizing. We're already ready to go, and that runs the same cartridge that we manufacture for Sofia today. We also have a platform we're calling Leapfrog, which is the next generation immunoassay analyzer that dramatically improves both sensitivity and precision at the low end, which is particularly important with quantitative assays.
At Ortho, an immunoassay program that they all call Bam Bam underway now. A big review middle of July, where we're gonna go through the details there and see where we're at, make sure that we can hit the timeline that we think. Molecular. We've been in molecular as a small player, but more recently, we just launched Savanna in Europe, in a couple different countries. Have done super well. We took pretty significant share from Cepheid recently, in Italy. I think right now the demand creation is not the issue. Our ability to scale up both instruments and cartridges is critical. Then transfusion, I would say the exciting part there for us is plasma donor screening is on the rise and expected to continue.
That's the growth driver, there, and that's all for pharmaceutical use. Okay. I'm watching the clock, Joe. We are positioned to take advantage of market trends. You know, public awareness is one thing, but you know, chronic diseases, inflammation markers, people with immune disorders, rising diabetes and cardiovascular disease, these all point to increasing diagnostic testing over time. Just the space itself, diagnostics, in vitro diagnostics is I think becoming increasingly interesting. I've been using this chart for a while, but it basically shows that you know, from where I started in 1983 as a young guy, we were just focused on that left-hand side, the reference in the hospital market. There wasn't all this stuff to the right, and it's been moving that way.
This democratization of testing has been moving that way for several years now. You're seeing all sorts of ambulatory clinics and specialty settings. They're by far more decentralized, but at the same time, they're also smaller. The cost to serve can be higher, but that's also why we leverage distribution the way we do. It's the most economical way for us to go to market. At the end, we saw retail and home testing recently with COVID. We expect that to be a potential for us moving forward. We're not relying on it exclusively, of course, but we are definitely planning for it. That's why we developed Sofia Q.
This shows a bunch of instrument platforms, but at the end of the day, as I said, we already have 100,000, and we expect thousands more moving forward, particularly with the Savanna launch. Very quickly, the expected growth drivers, of course, both the cost and revenue synergies at $90 million and $100 million respectively. We do expect a lot of benefit from cross-selling across the globe. You know, Ortho has a commercial excellence program. In fact, that was in Mike's title, Mike Iskra's title. I think they've done an excellent job of actually targeting and choosing where they wanna go, and it's been super effective for us.
Moving forward, what we'll try to do is we'll try to figure out how to take that same customer and roll in more products. That same Ortho customer taking on board next generation platforms from Quidel. A lot of menu pull through with 79,000 Sofia instruments out there. I've already talked a little bit about Savanna. We do have a strong balance sheet, and we expect to make investments in R&D just as we have before. These are the products. I've talked about these in general already. Here's a shot of a Savanna. We can multiplex up to 12 analytes. We're doing thermo cycling at 45 cycles in under 12 minutes. The thing is fast, right? Fully integrated, scalable.
We've already manufactured a number of products in our R&D site in Boston. We expect to have a pretty compelling and competitive menu. I talked before about the global footprint, now I'll turn it over to Joe. I think I've left you almost enough time to cover integration and a couple financial things.
Thanks, Doug. That was a strong finish to get us back on time there. It's nice to see everyone. So happy to be back in person for these events. First slide I've got, which I probably should advance to, is on the integration. I'm happy to say we've made lots of good progress here. We have announced Doug's direct reports. We've established system integration roadmaps. We've established an operating model. To minimize the customer disruption, we've organized fairly quickly joint commercial efforts. IT system integrations and shared service integrations obviously will take a little longer. We're targeting those integrations to be more in the 18- to 36-month range. Now with the close behind us, which we're all happy to have behind us, we are operating as one integrated leadership team.
We're focusing on optimizing the R&D portfolio and obviously focused on achieving those synergies in the next three years. This slide is a view of our financial profile. In 2021, we did pro forma revenue of $3.7 billion in a $50 billion addressable market. We've got long-term growth profile on the top line in the high single digit to low double digit. 30% EBITDA margins, as Doug showed before, and $700 million of annual cash flow. We do have a strong balance sheet at close, and that balance sheet will get stronger as we generate that significant cash flow and pay down debt. Pay down debt is our near-term capital deployment plan. The bottom line is if you liked Quidel, we now have a global capacity.
If you liked Ortho, we now have higher growth areas, and we span that whole centralized to decentralized market. Next page. This slide looks a bit complicated at first blush, so I apologize for that. But the overall conclusion is that there's very little customer overlap in the U.S. market. Once the deal closed and we had access to all the data that was previously in the clean room, we were able to see this data very clearly. The top 20% of the accounts in the U.S. represent the vast majority of the U.S. revenue. It is very much the 80/20 rule.
You can see on the left side, there's significant cross-selling opportunities given that there's only 51% overlap on the hospital market, 5% overlap in the physician's office, and 26% overlap in the reference labs. We believe this post-close data really de-risks our projected $100 million of revenue synergies that we've teed up over the next three years. This next slide is on some of the pro forma information. We are planning to give some combined company guidance on the Q2 call. This slide does show the pro forma information for 2021 and then Q1 2022. Down at the bottom on the slide, we've got four business units. Molecular is the smallest, but it's the highest growth potential given the Savanna growth. In the middle pie chart, the regional revenue.
We are a bit over-indexed on North America, but given the strong, you know, given that strong point-of-care business that we have, but we again, we do have significant OUS opportunities with about 80% of our synergies identified in OUS. In the far right, you've got a still large percentage of recurring revenue within the business. My final slide before I turn it back to Doug for some closing comments is on the balance sheet perspective. The legacy Ortho business was about 3.7x levered in Q1 2022. Quidel, as you know, had very little debt. On May 27, we did a refinancing. We have $2.75 billion term loan A, $750 million revolver to refinance the Ortho debt and finance part of the acquisition.
This facility is less than 3% interest rate, and the conclusion here going forward is we're gonna save about $45 million annually on the combined company interest. Real nice result here on this refinancing. With that, Doug, I've given you 20 seconds for a closing.
Perfect. Thanks for being here. As I say to the guys all the time, there's a difference between whether you can do something and whether you should do something. When you look at putting these two companies together, it's pretty clear we should be focused on making sure this turns out well. We can do something else with the cash, but we probably will not at this time.