The Pandemic Built the Point-of-Care Channel and the Channel Is Now Repricing

The fastest-built channel in diagnostics is now its slowest segment

Rapid antigen and point-of-care testing is USD 4,300 million in 2025 in our construction of the infectious disease diagnostics field, rising to USD 5,500 million in 2033. That is 3.12 per cent a year — the slowest of the field’s seven segments, against a field CAGR of 4.85 per cent.

The second slowest is serology and immunoassay pathogen detection at 3.21 per cent. Together those two carry 33.83 per cent of the 2025 base and only 20.88 per cent of the increment. Read that from the other direction and the shape of this field is obvious: its growth is not coming from the tests that read a sample quickly and cheaply at the point of care. It is coming from the ones that read it expensively elsewhere.

That is not a story about demand collapsing. It is a story about a base.

Abbott published the reset in one line

Abbott’s COVID-19 testing sales fell from USD 747 million to USD 297 million in a single year — a 60.2 per cent decline. That is the arithmetic of a pandemic test franchise expiring, and it is large enough to move a division: Abbott’s Rapid Diagnostics revenue still fell 18.1 per cent overall, with the United States down 20.8 per cent.

This is the vendor that built the point-of-care infectious disease channel — the installed reader base, the CLIA-waived clearances, the retail and pharmacy footprint, the distribution into settings that never had a laboratory. It is now reporting the year in which that channel’s anchor product stopped being an anchor.

What matters analytically is that the remaining business is smaller and differently shaped. A COVID test was a high-volume, low-price, single-analyte, self-limiting product. What replaces it is a menu question: influenza and RSV on the same device, strep, a respiratory panel, a waived molecular assay. Each of those is more valuable per test and much harder to sell per unit, because the buyer is now choosing between a device and a send-out rather than between two brands of the same thing.

Cepheid shows what the other side of the channel looks like

Danaher’s Diagnostics segment grew 1.5 per cent core in the same period, and Cepheid ran roughly USD 500 million of respiratory testing in a single quarter. That is not a point-of-care business in the retail sense — it is a near-patient molecular business sited in hospitals and clinics, and it is where respiratory volume actually settled once the pandemic testing sites closed.

The lesson generalises: the volume did not disappear, it relocated to whichever setting already had a molecular instrument and a reason to keep it loaded. Placements are the durable asset in this channel, not clearance counts. Qiagen’s diagnostic solutions line grew 7 per cent to USD 803.1 million with more than 5,200 QIAstat-Dx placements, and bioMérieux’s SPOTFIRE grew 84 per cent — small numbers moving very fast, on the same principle.

Roche is walking in the front door

Roche Diagnostics grew 2 per cent CER on 53 new tests, and among them is a CLIA-waived 15-minute Bordetella PCR. A waived molecular test is not a line extension. It is a deliberate entry into the channel Abbott built, made by a company whose strength is the central laboratory and whose menu is the widest in the industry.

The strategic logic is uncomfortable for the incumbent. Roche already owns the send-out that a point-of-care test competes with. If a clinic adopts a waived molecular assay, Roche keeps the episode whether it is solved at the bench or in the lab. For a pure-play point-of-care vendor, the waived test is the whole revenue. That asymmetry means the channel can be won by someone who does not need to win it.

Why a waived test moves the price as well as the setting

A test’s price is set by whatever schedule its code sits on. Move an assay from the laboratory’s menu to the waived-test channel and you have not just changed the setting — you have changed which schedule pays for it, and therefore who sets the price and who absorbs the next cut.

That is why the channel reset matters more than the segment’s 3.12 per cent suggests. Across this field, constant-menu price runs at −2.10 per cent a year while mix contributes +1.49, netting −0.61 on revenue per test. A channel that shifts volume toward waived molecular work shifts it toward the part of the menu where the mix effect is strongest — and toward the part where the payer’s price setting is least negotiable, because a waived test has no laboratory professional component to argue about.

In the 2027 preliminary fee schedule, molecular pathology codes fall 22 per cent and microbiology codes 19.3 per cent, phased in at 15 per cent a year through 2029. A vendor that migrates volume into that channel is trading a lab-menu price for a schedule price in the same year both are being cut.

What to watch, and what we are not claiming

Three things, in order of evidential weight: whether Abbott’s non-COVID rapid diagnostics returns to growth once the comparison base is clean; whether the placement numbers at Qiagen and bioMérieux convert into a respiratory menu that holds price; and whether waived molecular clearances from lab-channel vendors start displacing dedicated point-of-care instruments at the clinic level rather than supplementing them.

The volume series in this analysis — 6,000 million tests in 2025 to 9,200 million in 2033 — is modelled from the revenue construction, not disclosed by any participant. The direction of the revenue-per-test finding follows from the mix arithmetic and holds; the absolute level should be read as a construct, as we state in the report.

Company results here are reported as published, on a unified FX basis of EUR 1.13, CHF 1.15 and JPY 148 to the dollar, so nothing in this piece needs restating against a different rate.

The full construction — seven segments, thirteen vendor pools, 59.65 per cent attributed — is in Global Infectious Disease Diagnostics Market, 2026–2033. The point-of-care channel is sized across all diagnostic disciplines in Global Point-of-Care Testing, and the volume-without-revenue mechanism is set out in the immunoassay report.

Companion reading

Three other pieces sit on the same construction. The Largest Application Area in Diagnostics Has No Leader sets out why no vendor holds twelve per cent of this field, and what a fragmented supplier base does to administered price. The Two Families Infectious Disease Tests Are Paid In Were Both Cut follows the channel’s realised price into the 2027 schedule, where molecular pathology falls 22 per cent and microbiology 19.3 per cent. The Largest Risk to Infectious Disease Diagnostics Is a Budget Line, Not a Competitor shows why the widest downside in the forecast is an appropriation rather than a competitor.