Prévisions du marché des organismes de recherche sous contrat pour le diagnostic in vitro jusqu'en 2029 - Impact de la COVID-19, taille, tendances, parts et analyse mondiale de l'industrie par services, type et géographie
Les organismes de recherche sous contrat (CRO) dans le domaine du diagnostic in vitro (IVD) fournissent des services de soutien aux entreprises de biotechnologie tout au long du processus de développement de produits et de commercialisation. Les entreprises de diagnostic et d'équipement nécessitent des services réglementaires et de test différents pour mener à bien le cycle de vie des produits. Les CRO sont spécifiquement conçus pour fournir ces services, afin de réduire les coûts et le temps liés aux activités internes. La demande croissante de diagnostics in vitro et d'essais cliniques, ainsi que les lancements de nouveaux produits par les acteurs du marché, stimulent la croissance du marché des instituts de recherche sous contrat dans le domaine de l'IVD. Cependant, des politiques gouvernementales strictes et un manque de main-d'œuvre qualifiée ont limité la croissance de ce marché.
Selon Pheonix Research, le marché des institutions de recherche sous contrat en diagnostic in vitro devrait atteindre 8 019,53 millions de dollars en 2028, contre 4 738,79 millions de dollars en 2021 ; il est estimé à une croissance de 8,1 % en TCAC de 2022 à 2029. L'importance croissante des services des organismes de recherche sous contrat (CRO) contribuera à l'expansion du marché. Ces dernières années, les services des organismes de recherche sous contrat (CRO) sont devenus plus populaires dans le secteur de la santé. Des avancées significatives ont été réalisées dans le domaine de la santé, notamment en matière de recherche et de développement de médicaments. Les organismes de recherche sous contrat (CRO) gagnent en popularité.
En raison de l'incidence croissante du cancer, du diabète et d'autres maladies infectieuses, le marché des services d'organisations de recherche sous contrat (CRO) est en expansion ; à mesure que le nombre de patients augmente, la demande de services de tests en laboratoire augmente également. Ces services sont également rentables et offrent la technique la moins invasive pour prendre des décisions thérapeutiques. Ces technologies de santé permettent une plus grande flexibilité dans la gestion des soins de santé en permettant une détection et un traitement plus précoces des maladies.
Impact de la Covid-19 La pandémie de COVID-19 a eu un impact significatif sur les organisations de recherche sous contrat (ORC) en diagnostic in vitro (DIV) à l'échelle mondiale et a affecté les essais cliniques de divers produits. La mutation continue du nouveau coronavirus existant et sa gravité ont causé de lourdes pertes humaines et ont eu un impact sur l'économie mondiale. La pandémie de COVID-19 met les établissements de santé face à des défis opérationnels et cliniques sans précédent. La pandémie a eu un impact sévère sur le monde, mais elle a également créé une opportunité pour le marché des organisations de recherche sous contrat en diagnostic in vitro. Les organisations de recherche sous contrat donnent la priorité au développement de kits de test COVID-19, de traitements et de vaccins, ce qui a interrompu les essais cliniques et d'autres activités de recherche et développement.
En outre, les initiatives de soutien gouvernemental et les investissements des principaux acteurs du marché dans le développement de kits de test COVID-19 basés sur le diagnostic in vitro (DIV) ont accéléré les essais cliniques liés aux kits de test DIV. Une fois la pandémie maîtrisée, les essais cliniques pour d'autres diagnostics, ainsi que les kits de test COVID-19 et leur production, devraient stimuler la croissance du marché des organismes de recherche sous contrat (CRO) spécialisés en DIV. Cependant, la pandémie de COVID-19 a entraîné la mise en œuvre de nouvelles pratiques et approches, accompagnées de politiques réglementaires révisées pour les essais cliniques, ce qui devrait avoir un impact positif modéré sur le marché des organismes de recherche sous contrat en DIV dans les années à venir.
Les principaux acteurs du marché des organismes de recherche sous contrat (CRO) en diagnostic in vitro (IVD) sont : Innovations, Clinexa, NAMSA, ICON PLC, Proxima Clinical Research, AKRN Scientific Consulting S.L., DCN Dx, CMIC HOLDINGS Co., une société de Q?? Solutions, LTD, ResearchDx, Nexelis, ResearchDx, Toolbox Medical et autres.
Dernier rapport sur??Marché des organismes de recherche sous contrat en diagnostic in vitro (2022-2029) Segmenté par service, type et géographie. Par géographie, le marché est largement fragmenté en Europe, Amérique du Nord et Amérique du Sud. Les rapports de marché pour l'Europe, l'APAC, le Moyen-Orient et Afrique, et l'Amérique du Sud offrent des informations et analyses approfondies du marché, en mettant l'accent sur des paramètres tels que les tendances du marché, les avancées technologiques, la dynamique du marché et l'analyse concurrentielle des principaux acteurs mondiaux du marché.
Segmentation du marché Par Services Essais cliniques Services réglementaires Expertise thérapeutique Services de développement d’essais Services d’aide au remboursement Services de biostatistiques et de gestion des données Autres
Par type ??? Chimie clinique ??? Diagnostic moléculaire ??? Hématologie ??? Immunochimie ??? Histologie et cytologie ??? Diagnostics compagnons ??? Microbiologie ??? Autres
Par région Amérique du Nord ??? États-Unis ??? Canada ??? Mexique
Europe ??? Allemagne ??? Russie ??? Royaume-Uni ??? France ??? Italie
Moyen-Orient et Afrique Amérique du Sud ??? Argentine ??? Brésil ??? Bolivie ??? Autres
Table des matières
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Paysage concurrentiel
Competitive Landscape
This is the most fragmented market in the diagnostics cluster by a wide margin. In haematology and coagulation two private companies hold 29.7% of the field between them. In infectious disease diagnostics the largest pool is 11.86%. Here, no provider plausibly exceeds 8%, and the twelve largest together are unlikely to account for 40%.
We are not publishing a share table with decimal places, and the reason is not reticence. No provider in this field discloses an IVD services revenue line. The specialist firms are privately held and do not report segment revenue; the generalist CROs report therapeutic-area mixes in which diagnostics is not separated; the laboratory groups report by geography and by test type. Any table assigning a precise share to a named firm in this market is an allocation presented as a disclosure. Bands are the honest unit.
| Capability pool | Representative providers | Share band | Basis of competition |
|---|---|---|---|
| Specialist IVD regulatory and technical documentation consultancies | NAMSA, Medidee Services, Donawa Lifescience, Eclevar Medtech, AKRN Scientific Consulting, L3 Healthcare | Largest single provider 4–8% | Notified-body track record; depth of technical file experience |
| Diagnostics-focused clinical research organisations | Cerba Research, Nexelis, ResearchDx, DCN Dx, Q Solutions, Clinexa, CMIC | Largest single provider 3–6% | Site networks and specimen access; clinical performance study delivery |
| Generalist CROs with a diagnostics practice | IQVIA, ICON, Allucent, Proxima Clinical Research | Each under 5% of this market | Sponsor relationships and global regulatory footprint |
| Laboratory groups selling development and validation services | Eurofins Scientific and reference laboratory networks | Under 5%, rising with sample-heavy work | Owned laboratory capacity; pass-through economics |
| Regional and national providers, largely China and Korea | Domestic registration consultancies | 20–25% collectively | Local regulatory access and price; largely invisible outside the home market |
Why concentration is impossible here
Three reasons, and the third is the one that decides the market’s shape.
There is no capital requirement. A competitor needs an office, a quality system and reviewers. Nothing in the production function benefits from scale in the way a reagent plant or a sequencing instrument does. The fixed cost is a professional indemnity policy and a validated QMS.
The asset is mobile. A reviewer who has taken forty Class D files through two notified bodies is the entire productive capacity of a mid-sized provider, and that person can leave on a month’s notice. Acquisitions in this sector are therefore priced on retention, not on revenue, and the retention terms are usually two to three years.
Demand is not homogeneous. A Class D technical file for a blood-screening assay and a software verification package for a middleware release share a regulator but nothing else. A provider that is excellent at one is not automatically acceptable for the other, which fragments the market along capability lines rather than geography — and is the reason the largest firms are still under 8% after fifteen years of a growing transition market.
The competitive dynamic that actually hurts
It is not a rival winning a tender. It is a client deciding to insource, and the pattern is consistent: a manufacturer that has just cleared a Class D portfolio builds an internal regulatory function with the people it was previously renting, because at that point it has enough devices to keep them busy and it has learned the format from the providers it hired. The providers whose revenue depends on documentation volume are exposed to that reversal in a way that providers selling strategy and notified-body navigation are not. This is the mechanism behind the 5.48% growth in assay development and validation against 7.98% in regulatory strategy, and it is why the two lines should be valued differently even though they are sold to the same buyer in the same meeting.
How consolidation actually happens
By acqui-hire and bolt-on. The pattern of the last five years is a mid-sized provider buying a twenty-to-forty-person specialist to acquire a capability or a notified-body relationship, and a private-equity platform assembling several such firms under one quality system without integrating delivery. There has been no merger of equals of any size in this field, because two fragmented firms with no capital assets and overlapping client lists produce no synergy beyond cost, and the cost is people a competitor will hire anyway.
The strategic consequence for a buyer of these services is counter-intuitive: the largest provider is not automatically the safest, because the failure mode is a file going to a second round, and that failure is a function of familiarity with a specific device class and a specific notified body rather than of firm size. Procurement that selects on scale is selecting on the wrong variable.
Chaîne de valeur
Value Chain and Margin Capture
The chain runs from a device that does not yet have a file to a certificate that expires in five years, and the value does not sit where the science does. It concentrates at the two ends — the strategy that decides what evidence will be needed, and the interaction that decides whether the evidence is accepted — and it is thinnest in the middle, where the studies are actually run.
| Step | Who captures it | Margin character | Structural note |
|---|---|---|---|
| Gap assessment and regulatory strategy | Specialist consultancies | Highest per hour | Decides the scope of everything downstream; sold before the client knows what it needs |
| Scientific validity and analytical performance studies | Consultancies and laboratory groups | Medium, sample-heavy | Pass-through costs dilute gross margin; the study design is the value |
| Clinical performance evaluation | Diagnostics-focused CROs | Medium, site-heavy | Longest lead time in the chain; the step a deadline most easily breaks |
| Technical documentation assembly | All of the above | Lowest per hour, largest in volume | Where fixed-fee risk is concentrated and where automation is aimed |
| Notified body interaction and deficiency response | Firms with a track record | Highest, least price-sensitive | Unbilled in a fixed-fee contract and the reason fixed-fee contracts lose money |
| Post-market surveillance and re-certification | Incumbent provider | Low rate, high renewal | The annuity; five-year cap under Article 51(2), surveillance at least annually |
The unit economics are utilisation, not price
There is no capital in this business. The assets are qualified reviewers, a quality system of the provider’s own and a client list. That produces a specific economics: revenue is headcount multiplied by billable utilisation multiplied by rate, and every one of those three terms is constrained by something outside the provider’s control. Utilisation is constrained by the client’s submission calendar, which is now constrained by the IVDR transition dates. Rate is constrained by tendering, and public procurement of technical documentation services is priced per file with the second round of questions unpriced.
The consequence is that the sector’s margins are decided at the point of scope, not at the point of delivery. A firm that prices a Class D technical file on the assumption of one deficiency round and gets three has sold the engagement at a loss, and cannot recover it except by winning the next file. This is why the two fastest-growing lines in this report are the two that are least exposed to scope risk: biostatistics and software verification are sold as defined artefacts, and regulatory strategy is sold as time rather than as outcome. The line that carries the volume — documentation assembly at 46.0% of the market on a fixed-fee basis — is also the line that carries the losses.
Why the notified-body relationship is the only moat
Nineteen designated bodies, 3,083 applications and a queue that has taken three years to move from designation to a 57.70% certification rate. In that environment the scarce input is not a reviewer’s hour, it is a body’s willingness to schedule a manufacturer and its confidence that the file in front of it is complete. A provider that has taken a dozen files through one notified body without a second round has something a competitor cannot buy quickly: the reviewer knows the format, and the client is buying reduced variance rather than reduced price.
That is also why the moat is narrow and shallow. It is personal, it does not survive the reviewer leaving the notified body, and it does not transfer in an acquisition of anything except the people. A firm of forty reviewers that loses six of them to a competitor has lost the moat, which is the mechanism behind the sector’s acqui-hire consolidation discussed in the competitive landscape chapter.
Where the chain leaks value
Two places, both structural. The first is sample-heavy laboratory work, which is 10.0% of the market on a pass-through model: the provider buys the specimen analysis from a laboratory and marks it up, so gross margin is low and revenue is inflated relative to value added. The second is subcontracted reviewer capacity. During the 2023–2025 bottleneck, firms with more demand than headcount subcontracted the File work to freelance former notified-body assessors at rates that left almost nothing, and reported revenue growth with no margin growth. Neither leakage is visible in any published revenue line, which is the reason this report describes the chain by step and not by provider.
Activité d'investissement
Investment Activity
Capital intensity in this market is low and the investment story is correspondingly narrow: there is nothing to build, so the money buys people, and the price of people is set by retention rather than by revenue. That produces a very specific deal market — frequent and small, priced on a multiple of the profit a partner group generates, with little of the strategic premium a capability acquisition commands elsewhere in healthcare services.
What the deal market looks like
| Deal type | Rationale | Frequency | Character |
|---|---|---|---|
| Acqui-hire of a specialist consultancy | Add a device class or a notified-body relationship | Frequent | Twenty to forty reviewers at a time; retention terms two to three years |
| Platform roll-up under private equity | Assemble several firms under one quality system | Recurring | Delivery usually left unintegrated; cost synergy only |
| Laboratory group adding advisory capability | Sell validation alongside specimen testing | Occasional | Vertical, sample-led, lower multiple |
| Generalist CRO buying diagnostics depth | Bid a drug programme and its companion diagnostic together | Rare | Strategic premium; the only deal type that pays one |
We are not disclosing deal values, because the transactions in this field are private and the reported figures are undisclosed in most cases. What can be said structurally is that consideration is dominated by earn-out and retention rather than by upfront payment, which is a direct consequence of the mobility of the asset: a buyer who pays for revenue and loses the reviewers has bought a client list with no capacity to serve it.
Why capital does not flow in
The absence of a capital requirement cuts both ways. It makes entry cheap, which caps concentration and therefore caps returns. It also means there is no asset to finance: no plant, no instrument fleet, no installed base to securitise. A lender has nothing to take security over except receivables and the employment contracts of people who can resign.
The consequence is that this market has never attracted infrastructure capital and probably cannot. What it attracts is private equity with a services thesis and a three-to-five-year hold, and the exit is either a sale to a larger platform or a sale to the generalist CRO that wants the diagnostics depth. Neither exit requires the business to have grown faster than the market — only to have held its people.
The one investment that changes the economics
Automation of documentation assembly is the only capex line in this report, and it is small. It is also the only lever that moves margin without moving price, because the binding cost is reviewer hours and the largest line in the market is the most templatable one. A provider that halves the hours per technical file doubles contribution margin on 46.0% of the market.
The strategic problem is that the same automation is available to the client. Every hour removed from assembly is an hour a manufacturer can consider insourcing, which is why the investment makes sense at the level of a single firm and is margin-dilutive at the level of the market. We treat it as rising investment activity with a deflationary effect on the documentation line, and that is reflected in the 7.98% growth we assign to it against 8.60% for the software and data lines where automation substitutes rather than replaces the provider.
Technologie et innovation
Technology and Innovation
The technology that matters in this market belongs to the client, not to the provider. A diagnostics manufacturer’s innovation decides how much evidence has to be generated; a services provider’s innovation decides only how cheaply that evidence can be documented. Understanding that asymmetry explains both why the sector grows and why it will never earn a technology multiple.
The change that created the market: from document to evidence
Under Directive 98/79/EC, a manufacturer assembled a technical file that demonstrated the device worked. Under Regulation (EU) 2017/746 the requirement is a performance evaluation with three separately assessable limbs — scientific validity, analytical performance and clinical performance — each of which must be evidenced, not asserted. That single change converted a documentation task into a research task, and it is the origin of the whole outsourcing wave this report sizes. A manufacturer can write a file with its own staff. It cannot, at the same time, run a clinical performance evaluation across enough sites to satisfy a notified body under a hard transition date, which is why the work went out of the building.
Where the innovation is actually being bought
Three categories, in descending order of price and ascending order of volume.
Software lifecycle and cybersecurity evidence. IEC 62304 lifecycle files, IEC 81001-5-1 security documentation and the validation of any algorithm that influences a result. This is the fastest-growing line in the market at 8.60%, from USD 610 million to USD 1,180 million, and the mechanism is simply that there is more software in a diagnostics device every year and the evidence requirement is per-unit-of-software, not per-revenue. An analyser with a new middleware release is a new validation object.
Bioinformatics pipeline validation. An NGS or metagenomic test is a wet-lab method wrapped around a computational method, and the notified body assesses both. Validating a variant-calling pipeline, documenting reference databases, and evidencing limit-of-detection for a computational step is a service that barely existed before 2022 and is now a standard line item on a Class C or Class D file.
Companion diagnostics co-development. Seventeen per cent of this market, and the only part of it funded from a pharmaceutical budget rather than a diagnostics budget. The technology problem is one of timing: a drug programme needs an assay locked before a phase III protocol can be written, and the diagnostic is often still in feasibility at that point. Providers are paid to compress that sequence, and the work is priced against the value of the trial rather than against the cost of the assay.
What is not innovative, and why that is the point
The regulatory consultancy itself is a mature, labour-intensive professional service. Its process innovation is templating, reusable document architecture and increasingly automated drafting, and every one of those compresses the price of the largest line in this report. That is the tension at the centre of the market’s economics: the same tooling that lets a provider serve more files per reviewer is the tooling that lets the client insource, and the line at greatest risk from automation is documentation assembly, at 29.05% of the base.
Our assessment is medium innovation intensity, low patent activity and a mature technology stage, and those are the correct settings rather than pessimistic ones. The intellectual property in this field sits in the client’s device. The provider sells a repeatable process executed by qualified people, and the durable advantage is a track record with a notified body rather than a platform. Any provider claiming otherwise is monetising a transition deadline rather than a capability.
One technology shift with a structural consequence
The move of molecular testing toward CLIA-waived and near-patient formats, documented in our infectious disease diagnostics report, changes the evidence burden rather than reducing it. A waived device needs usability evidence, lay-user studies and a different risk analysis, and the total documentation is not smaller — it is differently shaped. That is why point-of-care growth has not reduced services demand, and why the services market does not track the fate of any single platform.
Risque de marché
Market Risk
The largest risk in this market is not competitive and it is not technological. It is that the demand has an expiry date, and that the industry supplying it has no mechanism to create new demand once the deadline passes. Below, the four risks that actually move the number, with the level we assign each.
| Risk | Level | Mechanism | Exposure |
|---|---|---|---|
| Transition calendar ends | High | Class D closes 2027, Class C 2028, Class B and A sterile 2029; transition work is not repeatable | 34.93% of the increment sits in the regulatory line |
| Deadline extension | Medium | A third extension defers rather than destroys; shows up as a worse growth shape | Downside case USD 8,700m at 4.93% |
| Reviewer supply | Medium | The productive asset is people who can be hired away; wage inflation during the bottleneck | Whole market; margin, not revenue |
| Insourcing reversal | High | Manufacturers rebuilding internal regulatory functions after clearing a portfolio | Documentation and assay development lines |
| Fee compression from tendering | Medium | Fixed-fee procurement with unbilled deficiency rounds | 46.0% of the base on a fixed-fee model |
| Regulatory direction of travel | Medium | Deregulatory action removes conversion pipelines, as the LDT vacatur did in the United States | North America, 41.0% of the base |
The one that matters: a calendar is not a market
Transition work is a one-off. A device certified by 31 December 2027 does not need certifying again by 31 December 2027. What follows is re-certification under Article 51(2), and re-certification is explicitly not a repetition of initial certification: it is a narrower assessment against the same technical file, priced lower and delivered in fewer hours. Our 2030 growth rate of roughly 4.6% is that transition, and the 2031 re-acceleration to 6.9% and above is the five-year renewal wave arriving on an installed base that grew by more than half during the transition.
The honest statement of this risk is that the market’s 6.91% is an average of two quite different businesses: a transition business growing at 8% that ends, and a surveillance and re-certification annuity growing at 4% to 5% that does not. An investor underwriting the 6.91% without seeing the shape is underwriting the transition and calling it a trend.
What is not a risk, despite appearances
Consolidation of the client base. Diagnostics manufacturer concentration has risen for a decade and has not reduced services spend, because the consolidated entity has more devices in its portfolio and therefore more files to certify. A larger client is a larger order book, not a smaller one.
Technological substitution. The substitution risk we score high is not a technology that replaces the service. It is the client’s own capacity replacing it, and it is high because the barrier to insourcing is organisational rather than technical — a manufacturer that has bought forty technical files has learnt how they are made.
Geopolitical and jurisdictional exposure
We score geopolitical exposure medium. The market is a professional service with no physical supply chain and no tariff exposure, so the usual transmission channels do not apply. The jurisdictional exposure is real and different: the two largest regulatory regimes are diverging, with the European Union tightening through IVDR and the United States loosening on laboratory developed tests. A provider with capability concentrated in one regime carries a policy risk that has nothing to do with its own execution, which is why the European work is growing faster than the American in our regional construction and why North America’s 41.0% share should not be read as a stable share of the increment.
Paysage réglementaire
Regulatory Landscape
In most markets the regulator sets the terms of competition. In this one the regulator sets the size of the market, and the size is currently determined by a queue.
The capacity arithmetic
The European Commission’s own survey of the transition to Regulation (EU) 2017/746, covering the position to 30 June 2025, records 3,083 applications lodged and 1,779 certificates issued. That is a 57.70% certification rate on a stock of applications that includes withdrawn, refused and transferred files — and it leaves 1,304 matters undecided. The same survey records 17 designated notified bodies. By 21 October 2025, following the designation of SGS FIMKO, NANDO listed 19.
Read that as an economist rather than as a compliance officer. The supply of certification has grown by two bodies in a period when the number of devices requiring certification has risen by more than a thousand applications. A manufacturer that faces that queue has three options: wait, reduce scope, or buy help. The first two are why devices get withdrawn from the European market; the third is the demand this report sizes. The constraint on this market is not how many manufacturers want to comply, it is how few reviewers can say yes.
The calendar that drives the forecast
| Milestone | Date | Consequence for services demand |
|---|---|---|
| Quality management system compliant with Article 10(8) | 26 May 2025 | QMS remediation work, largely complete |
| Notified body application — Class D | 26 May 2025 | Class D files already in the queue; the front-loading has happened |
| Signed notified body agreement — Class D | 26 September 2025 | Late-stage negotiation support; the last easy revenue in the Class D cycle |
| Class D certification deadline | 31 December 2027 | Peak technical documentation and deficiency-response work |
| Class C certification deadline | 31 December 2028 | The largest single cohort by device count; the 2027–2028 bulge |
| Class B and Class A sterile deadline | 31 December 2029 | High volume, low value per file; the tail of the transition |
| Certificate renewal | Five-year cap, Article 51(2) | Re-certification wave from 2030; narrower and cheaper than initial certification |
| Surveillance audit | At least every twelve months, Annex VII | The annuity; grows with the installed base, not with the calendar |
Two features of this table matter more than the dates. The first is that the deadlines are staggered, which spreads the work over five years and prevents a single-year spike — it is why our path has three high-growth years rather than one. The second is that Article 51(2) caps validity at five years and MDCG 2019-6 Rev5 confirms that re-certification is not a repetition of initial certification. That is the difference between a market that ends in 2029 and one that steps down into a smaller annuity, and it is the single most important regulatory fact in this report.
The United States, and a pipeline that did not appear
On 6 May 2024 the FDA published a final rule amending 21 CFR 809.3(a) to bring laboratory developed tests explicitly within the definition of in vitro diagnostic products. On 31 March 2025 the Eastern District of Texas vacated that rule in American Clinical Laboratory Association v. FDA and remanded the matter. On 19 September 2025 the agency published a final rule reverting the regulation to its pre-2024 text. As of that date, the conversion of laboratory developed tests into cleared or approved IVDs is not a regulatory requirement.
That subtraction is larger than it looks. A laboratory converting a test into a 510(k) or De Novo submission buys a technical file, a clinical validation, a quality system and a submission strategy — the full stack of this market’s services, from a client that had never bought them before. The pipeline existed for roughly ten months as an expectation and never became an order book. Our North American number reflects its absence rather than its delay.
The adjacent regimes that create incremental work
Companion diagnostics. A test that directs a therapy is assessed as part of two regulatory processes at once, and the diagnostic developer in a pharmaceutical programme faces a device pathway and a drug timeline. Seventeen per cent of this market is that work.
Health technology assessment. Regulation (EU) 2021/2282 became applicable on 12 January 2025, with joint clinical assessment starting on new cancer medicines and advanced therapy medicinal products. It does not directly regulate diagnostics, but it changes the evidence a manufacturer assembles for a companion diagnostic, and evidence assembly is what is being sold.
China and Japan. NMPA and PMDA registration remain national, unreconciled with the European technical file, and consequently generate duplicative documentation. That duplication is 7.5% and 5.5% of this market respectively, and it is the one part of the field that a European provider cannot serve from Europe.