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Molecular Diagnostics in Infectious Disease Testing 2014 - Product Image

Molecular Diagnostics in Infectious Disease Testing 2014

  • ID: 3037909
  • September 2014
  • Region: Global
  • 451 Pages
  • TriMark Publications
The infectious disease space is the most dominant and profitable sector of molecular diagnostics

FEATURED COMPANIES

  • Abbott Laboratories
  • AutoGenomics, Inc.
  • EraGen Biosciences
  • Illumina, Inc.
  • Nanosphere
  • Siemens AG
  • MORE

This publications report describes the specific segment of the in vitro diagnostics market known as molecular diagnostics testing for infectious disease. In the current medical diagnostics market, molecular diagnostics in infectious disease testing offers one of the most promising areas for growth and innovation. The confluence of breakthroughs in genomics and proteomics-along with the development of microarray devices to measure analytes in the blood-has led to this revolutionary market development.

Specifically, molecular diagnostics offers the power of advanced analytical techniques to diagnose infectious diseases. Whereas before, the detection of many infectious agents was slow and expensive due to reliance upon culturing methods, researchers are now at the cusp of overcoming such limitations via the use of nucleic acid-mediated molecular diagnostics testing.

The purpose of this report is to describe the emerging field of molecular diagnostics in infectious disease testing. The infectious disease space is the most dominant and profitable sector of molecular diagnostics.

Topics covered in this study include: 1) the existing and emerging technologies in the field, 2) the U.S. and global market size for molecular diagnostic products and 3) the profiles of companies that are focusing on the molecular diagnostic sector.

The research examines drivers and restraints for sales growth, market share and technical trends. In addition, an in-depth analysis of the competitive situation of prominent market venders is provided with five-year sales forecasts.

The infectious disease space is the most dominant and profitable sector of molecular diagnostics

FEATURED COMPANIES

  • Abbott Laboratories
  • AutoGenomics, Inc.
  • EraGen Biosciences
  • Illumina, Inc.
  • Nanosphere
  • Siemens AG
  • MORE

1. Overview
1.1 Statement of Report
1.2 About This Report
1.3 Scope of the Report
1.4 Objectives
1.5 Methodology
1.6 Executive Summary

2. Introduction to Molecular Diagnostics for Infectious Disease Testing
2.1 Molecular Diagnostics Testing and Opportunities in the Infectious Disease Sector
2.2 The Infectious Disease Problem
2.3 Impact of the Human Genome Project on Molecular Diagnostics
2.4 Opportunities for Molecular and Clinical Diagnostics
2.4.1 Companion Diagnostics
2.5 Development of Molecular Diagnostics Testing Markets
2.6 Target-Based Gene Amplification
2.6.1 Polymerase Chain Reaction
2.6.2 Real-Time PCR
2.6.3 Nucleic Acid Sequence-Based Amplification
2.6.4 Next Generation Sequencing
2.6.4.1 Second Generation Sequencing
2.6.4.2 Whole Genome Sequencing (WGS)
2.6.4.3 Epigenomics
2.6.4.4 Bioinformatics and Next Generation Sequencing
2.6.4.5 Third Next Generation Sequencing
2.6.5 Market Drivers and Restraints
2.6.5.1 Market Drivers
2.6.5.2 Market Restraints
2.6.6 Market and Technology Trends
2.6.6.1 Market Trends
2.6.6 2 Technology Trends
2.6.7 Strategic Recommendations
2.7 PCR Reagents for Clinical Diagnostics

3. Infectious Disease Diagnostics Molecular Testing Market
3.1 Market Overview
3.1.1 Overall Infectious Disease Market Analysis
3.2 NAT Molecular Diagnostics Market
3.3 Infectious Disease Molecular Diagnostic Testing Markets
3.3.1 HIV
3.3.1.1 Disease Background and Statistics
3.3.1.2 Measuring Viral Loads
3.3.1.3 Instruments and MDx Reagents
3.3.1.4 Method Comparisons
3.3.1.5 Market Size
3.3.1.5.1 HIV Diagnostic Testing
3.3.1.6 HIV Market Challenges and Strategic Recommendations
3.3.1.6.1 HIV Molecular Diagnostic Market History
3.3.1.7 Market Drivers and Restraints
3.3.1.7.1 Market Drivers
3.3.1.7.2 Market Restraints
3.3.1.8 Market and Technology Trends
3.3.1.8.1 Market Trends
3.3.1.8.2 Technology Trends
3.3.1.9 Strategic Recommendations
3.3.2 Hepatitis
3.3.2.1 Hepatitis B Virus
3.3.2.1.1 Hepatitis B Disease Background and Statistics
3.3.2.1.2 Instruments and Reagents for Hepatitis B Detection
3.3.2.1.3 Method Comparisons
3.3.2.1.4 Hepatitis B Market Size
3.3.2.1.5 HBV Market Challenges and Strategic Recommendations
3.3.2.1.5.1 Market Drivers and Restraints
3.3.2.1.5.1.1 Market Drivers
3.3.2.1.5.1.2 Market Restraints
3.3.2.1.6 Market and Technology Trends
3.3.2.1.6.1 Market Trends
3.3.2.1.6.2 Technology Trends
3.3.2.1.7 Strategic Recommendations
3.3.2.2 Hepatitis C Virus Testing
3.3.2.2.1 Disease Background and Statistics
3.3.2.2.2 Instruments and Reagents for Hepatitis C Detection
3.3.2.2.3 Method Comparisons for HCV Tests
3.3.2.2.4 Hepatitis C Market Size
3.3.2.2.4.1 HCV Market Share
3.3.2.2.5 HCV Market Challenges and Strategic Recommendations
3.3.2.2.5.1 Market Drivers and Restraints
3.3.2.2.5.1.1 Market Drivers
3.3.2.2.5.1.2 Market Restraints
3.3.2.2.5.2 Market and Technology Trends
3.3.2.2.5.2.1 Market Trends
3.3.2.2.5.2.2 Technology Trends
3.3.2.2.6 Strategic Recommendations
3.3.3 Human Papillomavirus
3.3.3.1 Disease Background and Statistics
3.3.3.2 Instruments and Reagents for HPV Detection
3.3.3.3 Method Comparison
3.3.3.4 HPV Market Size
3.3.3.4.1 North American Market
3.3.3.4.2 European Market
3.3.3.5 Market Challenges and Strategic Recommendations
3.3.3.5.1 Market Drivers and Restraints
3.3.3.5.1.1 Market Drivers
3.3.3.5.1.2 Market Restraints
3.3.3.5.2 Market and Technology Trends
3.3.3.5.2.1 Market Trends
3.3.3.5.2.2 Technology Trends
3.3.3.5.3 Strategic Recommendations
3.3.4 Influenza Viruses
3.3.4.1 Disease Background and Statistics
3.3.4.2 Instruments and Reagents for Influenza Detection
3.3.4.3 Method Comparisons
3.3.4.4 Influenza Market Size
3.3.4.5 Influenza Market Challenges and Strategic Recommendations
3.3.4.5.1 Market Drivers and Restraints
3.3.4.5.1.1 Market Drivers
3.3.4.5.1.2 Market Restraints
3.3.4.5.2 Market and Technology Trends
3.3.4.5.2.1 Market Trends
3.3.4.5.2.2 Technology Trends
3.3.4.5.3 Strategic Recommendations
3.3.5 STD Testing (Chlamydia/Gonorrhea Molecular Diagnostic Testing)
3.3.5.1 Chlamydia/Gonorrhea Molecular Diagnostic Testing Market Size
3.3.5.2 Competitive Structure and Market Share Analysis
3.3.5.2.1 Market Forecasts
3.3.5.2.1.1 Revenue Forecasts
3.3.5.3 Chlamydia Molecular Diagnostic Testing
3.3.5.3.1 Disease Background and Description
3.3.5.3.2 Product Analysis: Instruments and Reagents for Testing Chlamydia
3.3.5.3.3 Method Comparison
3.3.5.3.4 Chlamydia Molecular Diagnostic Testing
3.3.5.3.4.1 Revenue Forecasts
3.3.5.3.4.2 Market Challenges
3.3.5.3.4.2.1 Market Restraints
3.3.5.3.5 Market and Technology Trends
3.3.5.3.5.1 Market Trends
3.3.5.3.5.2 Technology Trends
3.3.5.3.5.3 Strategic Recommendations
3.3.5.4 Gonorrhea Molecular Diagnostic Testing
3.3.5.4.1 Disease Background and Description
3.3.5.4.2 Product Analysis: Instruments and Reagents
3.3.5.4.3 Method Comparison
3.3.5.4.4 Competitive Structure and Market Share Analysis
3.3.5.4.5 Market Forecasts
3.3.5.4.6 Market Challenges
3.3.5.4.6.1 Market Drivers
3.3.5.4.6.2 Market Restraints
3.3.5.4.7 Market and Technology Trends
3.3.5.4.7.1 Market Trends
3.3.5.4.7.2 Technology Trends
3.3.5.4.8 Strategic Recommendations
3.3.6 Tuberculosis
3.3.6.1 Disease Background and Description
3.3.6.2 Product Analysis: Instruments and Reagents
3.3.6.3 Method Comparison
3.3.6.4 Tuberculosis Market Size
3.3.6.5 Competitive Structure and Market Share Analysis
3.3.6.6 Market Forecasts
3.3.6.6.1 Revenue Forecasts
3.3.6.7 Market Challenges
3.3.6.7.1 Market Drivers
3.3.6.7.2 Market Restraints
3.3.6.8 Market and Technology Trends
3.3.6.8.1 Market Trends
3.3.6.8.2 Technology Trends
3.3.6.9 Strategic Recommendations
3.3.7 Methicillin-Resistant Staphylococcus aureus (MRSA)
3.3.7.1 Disease Background and Description
3.3.7.2 Product Analysis: Instruments and Reagents
3.3.7.3 Method Comparison
3.3.7.4 MRSA Market Size
3.3.7.5 Competitive Structure and Market Share Analysis
3.3.7.6 Market Forecasts
3.3.7.6.1 Revenue Forecasts
3.3.7.7 Market Challenges
3.3.7.7.1 Market Drivers
3.3.7.7.2 Market Restraints
3.3.7.8 Market and Technology Trends
3.3.7.8.1 Market Trends
3.3.7.8.2 Technology Trends
3.3.7.9 Strategic Recommendations
3.3.8 Vancomycin-Resistant Enterococci
3.3.8.1 Disease Background and Description
3.3.8.2 Product Analysis: Instruments and Reagents
3.3.8.3 Method Comparison
3.3.8.4 Competitive Structure and Market Share Analysis
3.3.8.5 Market Forecasts
3.3.8.5.1 Revenue Forecasts
3.3.8.6 Market Challenges
3.3.8.6.1 Market Drivers
3.3.8.6.2 Market Restraints
3.3.8.7 Market and Technology Trends
3.3.8.7.1 Market Trends
3.3.8.7.2 Technology Trends
3.3.8.8 Strategic Recommendations
3.3.9 Herpes Simplex Virus
3.3.9.1 Disease Background and Description
3.3.9.2 Product Analysis: Instruments and Reagents
3.3.9.3 Method Comparison
3.3.9.4 Market Forecasts
3.3.9.4.1 Market Drivers
3.3.9.4.2 Market Restraints
3.3.9.5 Market and Technology Trends
3.3.9.5.1 Market Trends
3.3.9.5.2 Technology Trends
3.3.9.6 Strategic Recommendations
3.3.10 C. difficile
3.3.10.1 Disease Background and Description
3.3.10.2 Product Analysis: Instruments and Reagents
3.3.11 Cytomegalovirus
3.4 Blood Screening
3.4.1 Product Analysis: Instruments and Reagents
3.4.2 Method Comparison
3.4.3 Blood Screening Market Size
3.4.4 Competitive Positions
3.4.5 Market Challenges and Strategic Recommendations
3.4.5.1 Market Drivers and Restraints
3.4.5.1.1 Market Drivers
3.4.5.1.2 Market Restraints
3.4.5.2 Market and Technology Trends
3.4.5.2.1 Market Trends
3.4.5.2.2 Technology Trends
3.4.5.3 Strategic Recommendations

4. Molecular Diagnostic Testing Technology for Infectious Disease Testing
4.1 Infectious Disease Diagnostic Tests
4.1.1 Molecular Diagnostic Tools Solutions
4.1.2 Technology of Gene Expression Analysis
4.1.2.1 Amplification and Detection of RNA
4.1.2.2 Analysis of Multiple Genes
4.1.2.3 Advanced Information Technology
4.2 Use of Molecular Tests in Infectious Disease
4.2.1 Molecular Screening
4.2.2 Early Detection
4.2.3 Detection of Specific Resistance Genes and Viral Loading Tests
4.2.4 Pharmacogenomics and Personalized Medicine in Molecular Diagnostic Infectious Disease Testing
4.2.5 Molecular Strain Typing
4.3 Cost of Molecular Diagnostic Testing
4.4 Use of Multiplex PCR Tests
4.4.1 Advantages of Multiplex PCR
4.4.2 Applications of Multiplex PCR
4.5 Next-Generation Sequencing
4.6 Patient Flow Software
4.7 Digital PCR
4.8 LAMP
4.9 Ion Proton System for Gene Sequencing
4.10 xMap Technology (Luminex)

5. Business
5.1 Technology and Market Trends
5.1.1 Technology Trends
5.2 M&A Activity
5.3 Partnerships
5.4 Competitive Analysis
5.4.1 Primary Competitors
5.4.2 Industry Challenges and Strategic Recommendations
5.4.3 Commercialization of Molecular Diagnostic Products
5.5 Intellectual Property Rights
5.5.1 New Patents
5.5.2 Current Patent Disputes
5.6 Opportunities and Strategic Recommendations
5.6.1 The Key Technical Opportunities with Significant Market Appeal in the Molecular Diagnostic Space in the Next Five Years
5.6.2 Developments for Molecular Diagnostic Instrumentation Products
5.6.3 Market Penetration Strategies for Infectious Disease Testing
5.7 Business Models and Requirements for a Successful Molecular Diagnostics Infectious Disease Products Industry
5.7.1 Scope of This Section
5.7.2 The Success Achieved by the Molecular Diagnostics Infectious Disease Products
5.7.3 Business Models in Molecular Diagnostics Infectious Disease Products
5.7.4 SWOT Comparison of Business Models for Molecular Diagnostic Infectious Disease Testing
5.7.5 Commercial Manufacturing of Molecular Diagnostics Infectious Disease Products: Requirements
5.7.5.1 Elements of Commercial Manufacturing
5.7.5.1.1 Regulatory Requirements
5.7.5.1.2 Manufacturing Process Scale
5.7.5.1.3 In-House Manufacturing
5.7.5.2 Contract Manufacturing: Commercial and Academic
5.7.6 Sales and Marketing Strategies for Infectious Disease Tests
5.8 Companion Diagnostics Development in Partnership with a Pharmaceutical Company
5.8.1 Description of Business Model
5.8.2 Anti-Infective Pharmaceutical Market

6. Reimbursement and Billing Landscape for Molecular Diagnostics Testing for Infectious Disease
6.1 Overview
6.1.1 Gap Filling
6.2 Trends in Reimbursement Practice
6.2.1 Medicare Reimbursement Threats
6.2.2 Analysis of ROI for Molecular Diagnostic Tests for Infectious Disease Using Current Medicare Reimbursement Rules
6.3 Trends in Patient Care and Reimbursement
6.4 Revenue Threats
6.4.1 Medicare Payment Exceptions
6.4.2 Three Areas for Denial of Claims
6.5 Billing Rules
6.5.1 Medicare Billing Procedures
6.5.2 Medicare CPT Coding Rules for Molecular Diagnostic Infectious Disease Testing
6.5.3 Infectious Disease Billing Strategies

7. Regulatory Requirements
7.1 Food and Drug Administration
7.2 CLIA Regulations
7.3 Clinical Laboratory Improvement Act
7.4 State Licensing for Service Laboratories
7.5 IVDMIAs
7.6 FDA Draft Guidance on In Vitro Companion Diagnostic Devices
7.7 510(k) Clearance
7.8 Pre-Market Approval
7.8.1 Pre-Market Approval Application
7.9 Analyte Specific Reagents
7.9.1 Laboratory Developed Tests
7.10 What Regulatory Guidance is Needed for Companion Biomarkers?
7.11 U.S. Patent and Trademark Office
7.12 IRB Approval in Clinical Trials
7.13 CE Marking and the European In Vitro Diagnostic Device Directive
7.14 De Novo Classification
7.15 Research Use Only Reagents
7.16 FDA Recommendations on MRSA and SA Testing

8. Business Decisions using Molecular Diagnostic Tests in Infectious Disease Testing
8.1 What are Key Opportunities in Infectious Disease Testing Development and Commercialization?
8.2 What are the Current Obstacles for Molecular Diagnostic Infectious Disease Testing Implementation?
8.3 How do Business Strategies, Such as Those Relating to Acquisition, Drive Molecular Diagnostic Strategies?
8.4 How might Novel Infectious Disease Molecular Diagnostic Test Development Lead to Acquisition Strategies and their Implications for Deal Making?
8.5 How can Molecular Diagnostic Tests Increase Value in an Associated Drug Marketing Plan?
8.6 Which Types of Infectious Disease Molecular Diagnostic Testing should be Developed by Diagnostic Companies at Various Stages in the Development Pipeline?
8.7 How can Regulatory Oversight Drive Approval and Adoption of New Technologies?
8.8 What are the Noteworthy Deals?
8.9 Who are the Acquirers?
8.10 Who are the Target Companies?
8.11 How will Platform Technology Companies Enter the Space?
8.12 Will Pharma Integrate with Diagnostics?
8.13 How do Platform Technology Companies Position Themselves for Diagnostics Development?
8.14 Evaluate How Partnering and M&As will Alter the Competitive Landscape
8.15 Predict How FDA Regulations will Impact New Diagnostic Tests
8.16 How can Big Pharma and Diagnostic Companies Co-Develop Biomarkers in a Model for Regulatory Acceptance?
8.17 How to Maximize Business Development Through Biomarker Strategies?
8.18 What is the Best Type of Business Model for Developing Genetic Biomarkers for Infectious Disease?
8.19 How Best have Genetic Biomarkers Provided the Most Benefit in Infectious Disease Testing?
8.20 What are the Most Innovative Methods in Development of Molecular Diagnostic Biomarkers?
8.21 What are the Best Values for Genetic Biomarkers in Drug Development and in Diagnostics?

9. Economics of Anti-Microbial Drug Resistance: The Persistent Need for Antibacterials
9.1 Resistance and Antibiotic Usage
9.2 Infection Control Programs

10. Company Profiles
10.1 Abbott Laboratories
10.2 AdvanDx
10.3 Affymetrix
10.4 Arcxis Biotechnologies
10.5 Asuragen, Inc.
10.6 AutoGenomics, Inc.
10.7 Becton, Dickinson and Company
10.8 bioMérieux
10.9 Biocartis
10.10 BioHelix Corporation (now part of Quidel)
10.11 bioTheranostics
10.12 Cepheid
10.13 EraGen Biosciences
10.14 GenMark Diagnostics, Inc.
10.15 Genomix Biotech
10.16 Gen-Probe, Inc. (now known as Hologic Gen-Probe)
10.17 Genomica S.A.U.
10.18 Great Basin Corporation
10.19 Illumina, Inc.
10.20 Life Technologies (Thermo Fisher Scientific)
10.21 Luminex Corp.
10.22 Mobidiag
10.23 Myconostica
10.24 Myriad Genetics, Inc.
10.25 Nanosphere
10.26 NorDiag ASA (The DiaSorin Group)
10.27 Qiagen N.V.
10.28 Quidel
10.29 Roche Diagnostics (Roche Ltd.)
10.30 SACACE
10.31 Seegene
10.32 Siemens AG
10.33 SIRS-Lab
10.34 TrimGen
10.35 TrovaGene
10.36 Veredus Laboratories
10.37 Veridex, LLC (Janssen Diagnostics, LLC)

Appendix 1: Draft Guidance for Industry and Food and Drug Administration Staff—Establishing the Performance Characteristics of Nucleic Acid-Based In Vitro Diagnostic Devices for the Detection and Differentiation of Methicillin-Resistant Staphylococcus aureus (MRSA) and Staphylococcus aureus (SA)
Appendix 2: Molecular Diagnostic Instruments with Combined Functions—Draft Guidance for Industry and Food and Drug Administration Staff
Appendix 3: Applications for Molecular Testing

LIST OF FIGURES:

Figure 2.1: Relationship of DNA Testing to Key Areas of Clinical Diagnosis
Figure 2.2: Finding Genes with Microassays
Figure 2.3: The Use of Microassays for Studying Gene Expression
Figure 2.4: Overall Structure of Nucleic Acid Testing Market
Figure 3.1: Global Market for Molecular Diagnostics, 2009-2020
Figure 3.2: Global Market for Molecular Diagnostics Testing, 2013
Figure 3.3: Share of Molecular Diagnostics Testing by Testing Type, 2013
Figure 3.4: Key Players Market Share in Global Molecular Diagnostics Testing Markets, 2013
Figure 3.5: Global Market for Infectious Disease Treatments, 2008-2014
Figure 3.6: Global Revenue for Molecular Diagnostics Testing for Infectious Disease, 2009-2020
Figure 3.7: U.S. Market Revenue for Molecular Diagnostics Testing for Infectious Disease, 2009-2020
Figure 3.8: Infectious Disease Testing Revenue Market Share of the Total U.S. Molecular Diagnostics Market, 2012 and 2018
Figure 3.9: European Market Revenue for Molecular Diagnostics Testing for Infectious Disease, 2009-2020
Figure 3.10: Japanese Market Revenue for Molecular Diagnostics Testing for Infectious Disease, 2009-2020
Figure 3.11: Rest of World (ROW) Market Revenue for Molecular Diagnostics Testing for Infectious Disease, 2009-2020
Figure 3.12: Infectious Disease Testing Revenue Market Share by Region, 2013 and 2020
Figure 3.13: Total Global Infectious Disease Molecular Diagnostics Markets, 2013
Figure 3.14: Total U.S. Infectious Disease Molecular Diagnostics Markets, 2013
Figure 3.15: Total Global Infectious Disease Molecular Diagnostics Markets, 2020
Figure 3.16: Total U.S. Infectious Disease Molecular Diagnostics Markets, 2020
Figure 3.17: Global Trend of HIV Infection, 1991-2012
Figure 3.18: Number of People Living with HIV, Newly Infected with HIV and Number of AIDS Deaths in the World, 1990-2012
Figure 3.19: Worldwide Rate of New HIV Cases, 1990-2012
Figure 3.20: Percentage of Adult Population in African Countries with HIV, 2011
Figure 3.21: Ethnic Distribution of AIDS Patients in the U.S., 2011
Figure 3.22: Global View of HIV Infection, 2009
Figure 3.23: Ten Best Selling AIDS Drugs in the U.S., 2011
Figure 3.24: U.S. Rates for New HIV Cases, 2011
Figure 3.25: U.S. Rates for New HIV Cases in Men, 2010
Figure 3.26: U.S. Rates for New HIV Cases in Women, 2010
Figure 3.27: Proposed HIV Testing Algorithm
Figure 3.28: Distribution of HIV Molecular Diagnostic Testing by Purpose
Figure 3.29: Estimated Market for Global HIV Molecular Diagnostic Testing, 2011-2020
Figure 3.30: Estimated Market for U.S. HIV Molecular Diagnostic Testing, 2011-2020
Figure 3.31: Market Share Viral Load HIV Molecular Diagnostic Testing
Figure 3.32: Geographic Distribution of Chronic HBV Infection
Figure 3.33: Incidence of Acute Hepatitis B by Age Group—U.S., 2000-2011
Figure 3.34: Global Prevalence of Hepatitis C
Figure 3.35: Primary Causes of Chronic Liver Disease
Figure 3.36: Incidence of Acute Hepatitis C by Age Group—U.S., 2000-2011
Figure 3.37: Hepatitis C Infection by Source
Figure 3.38: Growth and Projections of HCV Therapies by Drug Class, 2008 and 2013
Figure 3.39: U.S. Market Share of HCV Molecular Diagnostic Market, 2013
Figure 3.40: Global Market Share (Excluding U.S.) of HCV Molecular Diagnostic Market, 2013
Figure 3.41: Rate of New Cases and Deaths of Cervical Cancer by Age Group Worldwide, 1980-2010
Figure 3.42: Hybrid Capture 2 (HC2) versus PCR—Analytical Sensitivity and Clinical Sensitivity
Figure 3.43: Basic Steps in Hybrid Capture 2 Technology
Figure 3.44: U.S. Market Share of HPV Molecular Diagnostic Market, 2013
Figure 3.45: Global Market Share (Excluding U.S.) of HPV Molecular Diagnostic Market, 2013
Figure 3.46: Market Share Estimates for Molecular Diagnostic HPV Testing, 2013
Figure 3.47: Number of Reported and Confirmed Cases of Influenza by Virus Sub-Type Worldwide, 2013
Figure 3.48: Distribution of H1N1 Flu in the U.S., 2013
Figure 3.49: H1N1 Confirmed and Probable Case Rate in the U.S., By Age Group
Figure 3.50: U.S. Rates of Sexually Transmitted Diseases, 1940-2012
Figure 3.51: U.S. Market Share of Chlamydia/Gonorrhea Molecular Diagnostic Market, 2013
Figure 3.52: Global Market Share (Excluding U.S.) of Chlamydia/Gonorrhea Molecular Diagnostic Market, 2013
Figure 3.53: Chlamydia Infection Rates: Total and by Gender: U.S., 1989-2012
Figure 3.54: Chlamydia U.S. Prevalence by Age Group and Race/Ethnicity
Figure 3.55: U.S. and Outlying Areas Gonorrhea Infection Rates, 1941-2012
Figure 3.56: U.S. Gonorrhea Infection Rates by Race/Ethnicity, 2007-2012
Figure 3.57: Pipeline for TB Diagnostics, 2005-2015
Figure 3.58: The Development Pipeline for New TB Drugs, July 2012
Figure 3.59: Number of Tuberculosis Cases Among U.S. and Foreign-Born Persons in the U.S., 1993-2012
Figure 3.60: Rate of Tuberculosis Cases Among U.S- and Foreign-Born Persons in the U.S., 1993-2012
Figure 3.61: Rate of Tuberculosis Cases by State/Area in the U.S., 2012
Figure 3.62: U.S.-Born Tuberculosis Cases by Ethnicity, 2012
Figure 3.63: Reported Tuberculosis Cases in the U.S., 1983-2012
Figure 3.64: Global Market Share of Tuberculosis Molecular Diagnostic Testing
Figure 3.65: Global Market Share of Tuberculosis Molecular Diagnostic Testing by Region, 2012
Figure 3.66: Incidence Rates of Invasive MRSA Infections by Age
Figure 3.67: MRSA Trends According to Patient Location, 1998-2005
Figure 3.68: Incidence of Healthcare-Associated MRSA Infections, 2005-2008
Figure 3.69: U.S. Market Share of MRSA Molecular Diagnostic Market, 2013
Figure 3.70: Global Market Share (Excluding U.S.) of MRSA Molecular Diagnostic Market, 2013
Figure 3.71: Global Frequency of Vancomycin-Resistant Enterococci, 2006
Figure 3.72: U.S. Market Share of VRE Molecular Diagnostic Market, 2013
Figure 3.73: Estimated Market for Global Blood Screening Product Sales, 2007-2020
Figure 3.74: Blood Screening Product Market Share by Company, 2013
Figure 4.1: Using DNA Microassays to Measure Gene Expression
Figure 4.2: Schematic of Molecular Diagnostics for Studying Gene Expression in Patients
Figure 4.3: Personalized Medicine in Treatment of Infectious Disease
Figure 5.1: FDA Co-Developed Products as a Model for Collaboration
Figure 5.2: Market Growth of Molecular Diagnostic Infectious Disease Tests
Figure 5.3: Segmentation of the Biomarker Development Market
Figure 5.4: Global Distribution of Anti-Infective Agent Sales by Geography
Figure 5.5: Leading Companies in Anti-Infectives Market Share, 2013
Figure 6.1: Reimbursement for Diagnostics in Healthcare Decision Making
Figure 9.1: Global Multidrug Susceptibility in Pseudomonas aeruginosa
Figure 9.2: Global Frequency of Vancomycin-Resistant Enterococci, 2006

LIST OF TABLES:

Table 1.1: Market Trends in Infectious Disease DNA Testing
Table 1.2: Molecular Diagnostics Infectious Disease Market: Market Drivers Ranked in Order of Impact
Table 1.3: Molecular Diagnostics Infectious Disease Market: Market Restraints Ranked in Order of Impact
Table 1.4: Strategic Recommendations on Molecular Diagnostic Sector Business Functions
Table 2.1: Top Ten Causes of Death Worldwide, 2012
Table 2.2: The Most Prevalent Infectious Diseases Worldwide
Table 2.3: Annual Rates of Global Infectious Diseases
Table 2.4: Emerging Molecular Diagnostic Technologies
Table 2.5: Automated Molecular Diagnostics Platforms for Infectious Disease Testing
Table 2.6: Companies Marketing Multiple Products in Molecular Diagnostics Infectious Disease Sector
Table 2.7: FDA-Approved Molecular Diagnostic Commercial Kits for the Detection of Infectious Agents
Table 2.8: Global and U.S. Major Infectious Disease Market Size (Estimated Infected Persons)
Table 2.9: Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 2.10: Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 2.11: Attractive Growth Areas for Molecular Diagnostic Testing
Table 2.12: NAT Labs in U.S. and Five European Markets
Table 3.1: Global Market for Molecular Diagnostics Testing, 2009-2020
Table 3.2: U.S. Market for Molecular Diagnostics Testing, 2009-2020
Table 3.3: European Market for Molecular Diagnostics Testing, 2009-2020
Table 3.4: Japanese Market for Molecular Diagnostics Testing, 2009-2020
Table 3.5: Summary of Molecular Diagnostics Testing Sectors
Table 3.6: Share of Molecular Diagnostics Testing by Testing Type, 2013
Table 3.7: Key Players and Market Share in Global Molecular Diagnostics Testing Market, 2013
Table 3.8: Revenue Model for Molecular Diagnostics Testing
Table 3.9: Molecular Infectious Disease Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.10: Molecular Infectious Disease Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.11: Global Revenue for Molecular Diagnostics Testing for Infectious Disease, 2009-2020
Table 3.12: U.S. Market Revenue for Molecular Diagnostics Testing for Infectious Disease, 2009-2020
Table 3.13: European Market Revenue for Molecular Diagnostics Testing for Infectious Disease, 2009-2020
Table 3.14: Japanese Market Revenue for Molecular Diagnostics Testing for Infectious Disease, 2009-2020
Table 3.15: Rest of World (ROW) Market Revenue for Molecular Diagnostics Testing for Infectious Disease, 2009-2020
Table 3.16: Molecular Diagnostic Markets for Infectious Disease Testing, 2013
Table 3.17: Molecular Diagnostic Markets for Infectious Disease Testing, 2020
Table 3.18: Business Factors Influencing Advanced Infectious Disease MDx Testing Services
Table 3.19: Global Summary of the HIV/AIDS Epidemic, 2012
Table 3.20: Global HIV Statistics, 2012
Table 3.21: HIV Resistance Testing Recommendations
Table 3.22: Summary of Assays for HIV Viral Load Testing
Table 3.23: Commercially Available Molecular Diagnostic Products for HIV Assay
Table 3.24: Global Market for Molecular Diagnostic HIV Testing, 2007-2013
Table 3.25: U.S. Market for HIV Molecular Diagnostic Testing, 2007-2013
Table 3.26: Global Market for Molecular Diagnostic HIV Diagnostic Testing, 2014-2020
Table 3.27: U.S. Market for Molecular Diagnostic HIV Diagnostic Testing, 2014-2020
Table 3.28: Global Market for HIV Viral Load Diagnostic Testing, 2007-2013
Table 3.29: U.S. Market for HIV Viral Load Diagnostic Testing, 2007-2013
Table 3.30: Global Market for HIV Viral Load Diagnostic Testing, 2014-2020
Table 3.31: U.S. Market for HIV Viral Load Diagnostic Testing, 2014-2020
Table 3.32: HIV Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.33: HIV Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.34: Clinical Application of Quantitative HBV DNA Testing
Table 3.35: Lower Detection Limits of HBV DNA Assays
Table 3.36: Summary of Molecular Diagnostic Assays for Testing HBV
Table 3.37: Global Market for HBV Diagnostic Testing, 2000-2013
Table 3.38: U.S. Market for HBV Diagnostic Testing, 2000-2013
Table 3.39: Global Market for HBV Diagnostic Testing, 2014-2020
Table 3.40: U.S. Market for HBV Diagnostic Testing, 2014-2020
Table 3.41: HBV Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.42: HBV Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.43: Hepatitis B Facts
Table 3.44: U.S. HCV Statistics
Table 3.45: Worldwide Rate of HCV Cases
Table 3.46: Efficiency of Available HCV Screening Tests
Table 3.47: Commercially Available Molecular Diagnostic Products for HCV Assay
Table 3.48: Global Market for DNA HCV Diagnostic Testing, 2005-2013
Table 3.49: U.S. Market for DNA HCV Diagnostic Testing, 2005-2013
Table 3.50: Global Market for NAT HCV Diagnostic Testing, 2014-2020
Table 3.51: U.S. Market for NAT HCV Diagnostic Testing, 2014-2020
Table 3.52: Major Companies Marketing HCV Molecular Diagnostic Tests: Market Size and Share, 2013
Table 3.53: HCV Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.54: HCV Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.55: Recommendations for HCV Diagnostic Testing
Table 3.56: Number of Pap Smears Performed by Country, 2009
Table 3.57: Number of Deaths from Cervical Cancer by Region in 2012
Table 3.58: Qiagen’s Digene HC2 High-Risk HPV DNA Test
Table 3.59: Commercially Available Molecular Diagnostic Products for HPV Assay
Table 3.60: Major Companies Marketing HPV Molecular Diagnostic Tests: Market Size and Share, 2013
Table 3.61: Global Market for HPV Molecular Diagnostic Testing, 2007-2013
Table 3.62: U.S. Market for HPV Molecular Diagnostic Testing, 2007-2013
Table 3.63: Global Market for HPV Molecular Diagnostic Testing, 2014-2020
Table 3.64: U.S. Market for HPV Molecular Diagnostic Testing, 2014-2020
Table 3.65: HPV Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.66: HPV Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.67: Commercially Available Molecular Diagnostic Products for Influenza Assay
Table 3.68: Global Market for Molecular Influenza Diagnostic Testing, 2007-2013
Table 3.69: U.S. Market for DNA Influenza Diagnostic Testing, 2007-2013
Table 3.70 Global Market for Influenza Molecular Diagnostic Testing, 2014-2020
Table 3.71: U.S. Market for Influenza Molecular Diagnostic Testing, 2014-2020
Table 3.72: Influenza Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.73: Influenza Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.74: Global Market for Molecular Diagnostic Chlamydia/Gonorrhea Diagnostic Testing, 2000-2013
Table 3.75: U.S. Market for Molecular Diagnostic Chlamydia/Gonorrhea Diagnostic Testing, 2000-2013
Table 3.76: Major Companies Marketing Chlamydia/Gonorrhea Molecular Diagnostic Tests: Market Size and Share, 2013
Table 3.77: Global Market for Chlamydia/Gonorrhea Diagnostic Testing, 2014-2020
Table 3.78: U.S. Market for Chlamydia/Gonorrhea a Diagnostic Testing, 2014-2020
Table 3.79: U.S. Chlamydia Infection Rates, 1985-2012
Table 3.80: U.S. Chlamydia Statistics
Table 3.81: Commercially Available Molecular Diagnostic Products for Chlamydia Assay
Table 3.82: Global Market for Chlamydia Molecular Diagnostic Testing, 2014-2020
Table 3.83: U.S. Market for Chlamydia Molecular Diagnostic Testing, 2014-2020
Table 3.84: Chlamydia Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.85: Chlamydia Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.86: U.S. Gonorrhea Statistics
Table 3.87: Commercially Available Molecular Diagnostic Products for Gonorrhea Assay
Table 3.88: Major Companies Marketing/Gonorrhea Molecular Diagnostic Tests: Market Size and Share, 2013
Table 3.89: Gonorrhea Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.90: Gonorrhea Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.91: Commercially Available Molecular Diagnostic Assays for Testing TB
Table 3.92: Global Market for Tuberculosis Molecular Diagnostic Testing, 2005-2013
Table 3.93: U.S. Market for Tuberculosis Molecular Diagnostic Testing, 2005-2013
Table 3.94: Global Market Share of Tuberculosis Molecular Diagnostic Testing by Region, 2013
Table 3.95: Global Unit Sales of Tuberculosis Molecular Diagnostic Testing by Region, 2013
Table 3.96: Comparative U.S. Claim Charges for TB Testing by Type, 2013
Table 3.97: Global Testing for TB by Testing Type, 2013
Table 3.98: Global Testing for TB by Testing Reason, 2013
Table 3.99: Global Market for Tuberculosis Molecular Diagnostic Testing, 2014-2020
Table 3.100: U.S. Market for Tuberculosis Molecular Diagnostic Testing, 2014-2020
Table 3.101: Tuberculosis Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.102: Tuberculosis Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.103: Leading Tuberculosis Therapeutic R&D Candidates
Table 3.104: Commercially Available Molecular Diagnostic Products for MRSA Assay
Table 3.105: Global Market for MRSA Diagnostic Testing, 2005-2013
Table 3.106: U.S. Market for MRSA Diagnostic Testing, 2005-2013
Table 3.107: Major Companies Marketing MRSA Molecular Diagnostic Tests: Market Size and Share, 2013
Table 3.108: Global Market for MRSA Molecular Diagnostic Testing, 2014-2020
Table 3.109: U.S. Market for MRSA Molecular Diagnostic Testing, 2014-2020
Table 3.110: MRSA Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.111: MRSA Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.112: In Vitro Susceptibility of Staphylococci to New Agents in Development
Table 3.113: Commercially Available Molecular Diagnostic Products for VRE Assay
Table 3.114: Global Market for VRE Diagnostic Testing, 2005-2013
Table 3.115: U.S. Market for VRE Diagnostic Testing, 2005-2013
Table 3.116: Major Companies Marketing VRE Molecular Diagnostic Tests: Market Size and Share, 2013
Table 3.117: Global Market for VRE Molecular Diagnostic Testing, 2014-2020
Table 3.118: U.S. Market for VRE Molecular Diagnostic Testing, 2014-2020
Table 3.119: VRE Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.120: VRE Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.121: Global Market for HSV Molecular Diagnostic Testing, 2013-2018
Table 3.122: HSV Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.123: HSV Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 3.124: Transmission-Related Disease Screening from Blood Donor Pools
Table 3.125: Principal Blood Screening Products of Hologic Gen-Probe for HIV Assay
Table 3.126: Global Market for Molecular Diagnostics in Blood Screening, 2007-2020
Table 3.127: U.S. Market for Molecular Diagnostics in Blood Screening, 2007-2020
Table 3.128: Major Companies Marketing Blood Screening Molecular Diagnostic Tests: Market Size and Share, 2012
Table 3.129: Blood Screening Molecular Diagnostics Market: Market Drivers Ranked in Order of Impact
Table 3.130: Blood Screening Molecular Diagnostics Market: Market Restraints Ranked in Order of Impact
Table 4.1: Key Elements for Business Competition in Molecular Diagnostic Testing for Infectious Disease
Table 4.2: Key Elements for Future Success in Molecular Testing for Infectious Disease
Table 4.3: Examples of Personalized Medicine in Treatment of Infectious Disease
Table 4.4: Molecular Methods for Epidemiologic Typing of Microorganisms
Table 4.5: Drivers of Molecular Diagnostic Methods for Infectious Disease Testing in the Clinical Setting
Table 4.6: Barriers to Molecular Diagnostic Methods for Infectious Disease Testing in the Clinical Setting
Table 5.1: Technology Trends in Molecular Diagnostic Infectious Disease Testing
Table 5.2: Clinical Testing Trends in Molecular Diagnostic Infectious Disease Testing
Table 5.3: Business Market Trends in Molecular Diagnostics Infectious Disease Testing
Table 5.4: Expected Changes in Healthcare
Table 5.5: Lab Customer Feedback for Automated Molecular Diagnostic Instruments
Table 5.6: Molecular Diagnostics Infectious Disease Market: Market Drivers Ranked in Order of Impact
Table 5.7: Molecular Diagnostics Infectious Disease Market: Market Restraints Ranked in Order of Impact
Table 5.8: Advantages of European Markets for Molecular Diagnostic Testing
Table 5.9: European Sales Percentage of Most Common Molecular Diagnostic Tests by Analyte Type
Table 5.10: Disadvantages of European Markets for Molecular Diagnostic Testing
Table 5.11: Summary of Recent M&A Activity in the Molecular Diagnostics Sector
Table 5.12: Summary of Recent M&A Activity Molecular Diagnostics Sector by Selected Company
Table 5.13: High Value Opportunities in Collaborative and Strategic Partnerships
Table 5.14: Principal Competitive Factors in the Molecular Diagnostics Infectious Disease Testing Market
Table 5.15: Molecular Diagnostics Infectious Disease Testing Market: Strategic Recommendations on Molecular Diagnostic Sector Business Functions
Table 5.16: Molecular Diagnostics Infectious Disease Market: Impact of Top Industry Challenges in the U.S.
Table 5.17: Documents for Protecting Intellectual Property Rights
Table 5.18: Recent Patents Related to PCR, Nucleic Acid Amplification and Sample Prep
Table 5.19: Specific Opportunities for Automated Instrumentation and Reagent Systems in Molecular Diagnostics for Infectious Disease Testing
Table 5.20: Roche PCR Licenses
Table 5.21: Global Sales of Hologic Gen-Probe by Geographic Area, 2008-2013
Table 5.22: The Required Elements of a Manufacturing Facility
Table 5.23: CMO Qualification Audit: Points to Investigate
Table 5.24: Strategies and POA for Marketing Infectious Disease Diagnostic Products
Table 5.25: Key Elements of Molecular Diagnostic Companies Marketing Plan
Table 5.26: Utility of Biomarkers as Companion Diagnostics to Drug Development
Table 5.27: Top Ten Biotech and Pharmaceutical Companies Based on Revenues, 2013
Table 5.28: Global Top Ten Selling Vaccines, 2013
Table 5.29: Medicine in Development for Infectious Diseases, 2013
Table 5.30: Selected Medicine in Development for Infectious Diseases, 2013
Table 6.1: Factors Determining Third-Party Payment for Molecular Diagnostic Tests for Infectious Disease
Table 6.2: CPT Codes for Molecular Diagnostic Infectious Disease Testing
Table 6.3: New CPT Codes for Respiratory Virus Detection
Table 7.1: Regulatory Rules that Affect the Ability of a Diagnostic Testing Reagent Company to Conduct Business
Table 7.2: Strengths of the 510k Process
Table 7.3: Drawbacks of the 510k Process
Table 7.4: Focus Areas for the FDA Critical Path Initiative
Table 8.1: Effect of Regulation on Molecular D Infectious Disease Market Technology Platforms, 2007 and 2015
Table 8.2: Companies Utilizing New, Cutting-Edge Technologies to Develop, Validate and Market Molecular Tests for Clinical Use in Infectious Disease Management
Table 8.3: Impediments to Incorporating Promising Molecular Tests into Clinical Practice
Table 8.4: New Molecular Diagnostics Tests Showing the Most Promise for Approval
Table 8.5: Alliances Showing the Greatest Synergy in bringing Molecular Diagnostics Tests to Market
Table 8.6: Shared Technologies Driving the Most Encouraging Molecular Diagnostic Development
Table 10.1: Major GeneChip Instrument Products
Table 10.2: Major GeneChip Array and Reagent Products
Table 10.3: Gene Titan Products
Table 10.4: Gene Atlas Products
Table 10.5: Diagnostic Segment—Net Sales by Geographic Region, 2012 and 2013
Table 10.6: Myriad Molecular Diagnostic Revenues, 2012-2013
Table 10.7: Roche Group Financial Figures—Net Sales by Business Sector, 2008-2013
Table 10.8: Roche Group Diagnostics Division—Net Sales by Geographic Region, 2012 and 2013
Table 10.9: Roche Group Financial Figures—Net Sales by Diagnostics Sub-Division, 2008-2013
Table A1.1: MRSA/SA Strains for Analytical Sensitivity (LoD) and Inclusivity Studies obtained from the CDC
Table A1.2: MRSA Strains (known Clinical Associated Strains) Obtained from the Network on Antimicrobial Resistance in Staphylococcus aureus (NARSA) for Analytical Sensitivity (LoD) and Inclusivity Studies
Table A1.3: MRSA Strains (Clinical Isolates and Isolates Obtained from Public and Private Collections) for Analytical Sensitivity (LoD) and Inclusivity Studies
Table A1.4: Examples of Microorganisms (Non-Staphylococci Strains of Various Bacterial and Yeast Species and Viruses) Recommended for Analytical Specificity (Cross-Reactivity) Studies for Devices that are Indicated for Testing Nasal Swab Specimens Collected from Patients at Risk for MRSA Colonization
Table A1.5: Examples of Coagulase Negative Staphylococci (CNS) from Public and Private Collections (Including Methicillin-Resistant Staphylococcus epidermidis (MRSE), Methicillin-Resistant Coagulase Negative Staphylococci (MRCoNS) and Methicillin-Sensitive Coagulase Negative Staphylococci (MSCoNS) Recommended for Analytical Specificity (Cross-Reactivity) Studies for Devices that are Indicated for Testing Nasal Swab Specimens Collected from Patients at Risk for MRSA Colonization
Table A1.6: Examples of Substances Recommended for an Interference Study for Nasal Swab Specimens
Table A1.7: Examples of Substances Recommended for an Interference Study for Skin and Soft Tissue Infection Swab Specimens
Table A3.1: FDA-Approved Molecular Diagnostic Tests for Infectious Diseases
Table A3.2: Noncommercial Nucleic Acid-Based Tests for Clinically Important Viral and Bacterial Pathogens
Table A3.3: Molecular Methods for Detecting Antimicrobial Resistance
Table A3.4: Genotypic Methods for Epidemiologic Typing of Microorganisms
Table A3.5: Reduction in Number and Cost of Nosocomial Infections through Collaborative Efforts of Infection Control, Clinical Microbiology and Molecular Typing Laboratories

The infectious disease space is the most dominant and profitable sector of molecular diagnostics

- Abbott Laboratories
- AdvanDx
- Affymetrix
- Arcxis Biotechnologies
- Asuragen, Inc.
- AutoGenomics, Inc.
- Becton, Dickinson and Company
- bioMérieux
- Biocartis
- BioHelix Corporation (now part of Quidel)
- bioTheranostics
- Cepheid
- EraGen Biosciences
- GenMark Diagnostics, Inc.
- Genomix Biotech
- Gen-Probe, Inc. (now known as Hologic Gen-Probe)
- Genomica S.A.U.
- Great Basin Corporation
- Illumina, Inc.
- Life Technologies (Thermo Fisher Scientific)
- Luminex Corp.
- Mobidiag
- Myconostica
- Myriad Genetics, Inc.
- Nanosphere
- NorDiag ASA (The DiaSorin Group)
- Qiagen N.V.
- Quidel
- Roche Diagnostics (Roche Ltd.)
- SACACE
- Seegene
- Siemens AG
- SIRS-Lab
- TrimGen
- TrovaGene
- Veredus Laboratories
- Veridex, LLC (Janssen Diagnostics, LLC)

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