Diagnostics guide most of the decisions that shape a person’s care, says Lance Little, Roche Managing Director Asia-Pacific — and yet they command only a small fraction of what health systems spend. Closing that gap is one of the clearest opportunities in front of the Asia-Pacific region today.
Almost every meaningful decision in a person’s care begins with a question. What is this? How far has it progressed? Is the treatment working, or is it time to change course? The answers come from a test.
Those tests are the point in the care pathway at which I’ve spent my entire career. A sample becomes a result. A result informs a clinical decision.
Diagnostics are easy to overlook in the wider healthcare ecosystem, because they happen out of sight of the patient and their family. A tube travels to a laboratory. An analyser and a skillful expert produce a number. And on the strength of that information, someone’s life takes one path rather than another.
A patient’s diagnostic journey determines whether they’re screened in time. Whether a therapy is matched to their biology. Whether a hospital sends them home confident they’ll get better, or watches them return weeks later, sicker than before.
That journey deserves far more attention than it often gets. So let me make the case for it.
The value we overlook
Here’s a number worth starting with. Up to 70% of clinical decisions are informed by diagnostic testing.1 Screening, diagnosis, treatment, monitoring – the result of a test underpins it all.
Now here’s another number. In most health systems, diagnostics account for less than 2% of total healthcare spending.1
Think about that for a moment. Just 2% of the budget informs 70% of the decisions that save lives. When I first heard this, it changed how I think about where health value actually comes from.
We are, in effect, making the majority of care decisions on the strength of a very small line item. That’s a remarkable bargain or a serious underinvestment, depending on how you look at it.
I think it’s both at once. The instinct in most systems under financial pressure is to protect the most visible spend: therapies, procedures, hospital beds. Diagnostics, being cheaper and less visible, are easier to dismiss as a commodity to be squeezed.
That instinct is understandable. It’s also, I would argue, wrong. Testing is what tells you whether the high-cost intervention is the right one. It gives us the map for the journey ahead.
Get the diagnosis right, early, and everything downstream becomes more targeted, more efficient, and more humane. Get it wrong, or get it too late, and the cost lands somewhere: usually on the patient first, then the system.
A missed diagnosis is a bill that arrives later, along with substantial interest, in the form of advanced disease, avoidable inpatient stays, and treatments that might have worked if they’d been initiated sooner.
So when I talk about the value of diagnostics, I’m not talking about a technical speciality that concerns only laboratories. I’m talking about the foundation that good decisions are built on – across every step of a person’s health — from wellness, to diagnosis, to living well with a long-term condition.
The decision behind the decision
Let me make this concrete, because the argument only matters if it changes outcomes for real people. Take cervical cancer. It’s one of the most preventable cancers. And the tools to prevent it are well established: vaccination against the human papillomavirus (HPV), and regular screening.
What those tools can achieve together is genuinely striking. Modelling for low- and middle-income countries suggests that a comprehensive prevention programme, combining vaccination and screening, could avert around 5.2 million cases and 3.7 million deaths over the lifetimes of the women it reaches.2
Every one of those daughters, mothers and grandmothers could prevent a disease we already know how to stop. And screening is how we do so. Diagnostics catch what vaccination doesn’t. It identifies disease at the stage where it is most treatable.
The same principle reaches well beyond cancer. Consider multiple sclerosis (MS), a condition where the central challenge has long been uncertainty.
Is the disease progressing? Is the treatment holding it back? People living with MS often face substantial delays between the onset of symptoms, an initial consultation, and eventual diagnosis by a specialist healthcare professional.3 That uncertainty creates an enormous emotional burden.4
That’s beginning to change. We’re advancing the use of biomarkers like neurofilament light chain (NfL) – a protein released into the blood when nerve cells are damaged.5 Measured and tracked over time, NfL may give clinicians additional information and earlier insights into disease activity and neuroaxonal injury, supporting more informed clinical decision-making.5 A blood test can now empower healthcare professionals with deeper insights between routine MRI assessments.
Precision, made personal
If the first idea is that diagnostics inform decisions, the second is more ambitious. The right diagnostic can tailor the decision to the individual in front of you.
This is the heart of personalised medicine. Nowhere is it more consequential than in oncology. Two cancers that look identical under a microscope can be driven by entirely different genetic changes – and can respond to entirely different treatments. Precision testing reads that underlying biology.
Done well, it guides treatment selection for optimal care. It may reduce unnecessary exposure to treatments that are unlikely to benefit a patient. And it improves the odds that the first treatment — which in cancer care is often the treatment that matters most — is the right one.
I want to make the cost of the alternative very clear, because it’s easy to abstract away. Treating cancer without comprehensive molecular profiling means some patients may spend valuable time receiving therapies that are unlikely to benefit them.
Months they may not have. Precision testing is designed to spare people time that would otherwise be lost to ineffective treatment, by making treatment selection based on tumour biology from the outset.
We have real-world evidence for this, close to home. The ASPiRATION study, launched in Australia in 2020 and expanded the following year, set out to answer a simple but important question: does profiling a tumour’s full genomic makeup lead to better treatment choices than the standard approach?6
Its real-world data confirmed that comprehensive genomic profiling (CGP) – reading a wide panel of genetic alterations at once – guided more patients with advanced non-small cell lung cancer (NSCLC) towards the targeted therapies and immunotherapies that is appropriate for their specific tumour profile(ref).6 Better matching. Better selection. Better outcomes.
The priority now is access. A test that’s only accessible to a small number of patients will ultimately help few people. So we’re working to expand comprehensive genomic profiling across the Asia-Pacific region – supporting oncologists to match patients to the therapies most likely to help them, based on the unique biology of their cancer.
I want to be honest about why this matters so much for our region. The Asia-Pacific region’s health systems are highly diverse, spanning some of the best-resourced and most under-resourced settings in the world.
Here, there’s a risk that precision medicine’s benefits are concentrated in a handful of major centres, and the gap between them and everyone else widens. Extending access is how we make sure the promise of personalised care reaches beyond the fortunate few: it’s how we create a standard of care rather than a privilege of postcode.
The economics of seeing early
There is a persistent belief that better diagnostics mean higher costs. The evidence points firmly to the opposite conclusion. Used well, diagnostics are among the most reliable ways to bring long-term costs down, because a timely, accurate result prevents the expensive events that follow a missed or delayed one.
Hepatitis C shows this at scale. It’s a viral infection we can now cure, and yet millions live with it undiagnosed. Left untreated, the infection damages the liver over years with no symptoms, leading to failure, cancer and early death.7
The tragedy is the gap between what is possible and what is happening: a curable disease, still killing people, largely because they were never tested.
The World Health Organization has set targets to eliminate it as a public health threat by 2030. Scaling up testing and treatment to meet those targets was estimated to prevent 2.1 million hepatitis C-related deaths and 10 million new infections worldwide between 2018 and 2030 – with a net economic benefit of 22.7 billion US dollars by the end of that period.8 This is prevention and cure, both paying for themselves several times over.
I find the detail beneath that global figure even more persuasive. It comes from our own work at Roche. In Pakistan, one of the economies most affected by hepatitis C, we modelled what a centralised testing approach would deliver at national scale, across roughly 25 million screening tests a year.
Compared with a point-of-care strategy, the centralised approach would identify 142,406 more infections in a single year, and improve the correct classification of individuals by 0.57%. It would also reduce the total annual cost of testing by 7.68 million US dollars.9
That’s more people found. More people classified correctly. Less money spent doing so. It’s what efficient diagnostics look like when we get the accounting right.
The pattern repeats in chronic disease, where the region carries a heavy, growing and unsustainable burden. Take heart failure, a leading cause of hospital admission across the Asia-Pacific region. The period just after a patient is discharged is a dangerous one, and readmissions are common, distressing and costly.
Evidence from the STRONG-HF study showed that intensive, closely monitored care in that window – with treatment guided and adjusted using biomarker measurements – cut the risk of death or heart-failure readmission at 180 days from around 23% to about 15%, and improved patients’ quality of life.10
Read that again: a large share of those returns to hospital were preventable, and the thing that prevented them was measurement. A better-managed patient is one who stays home.
That’s better for them and their family, and it eases a burden that hospital systems across the region feel every single day.
A foundation worth building
Step back from the individual examples and a single idea connects them. Diagnostics are the infrastructure that clinical decisions are built on.
When that infrastructure is strong – accessible, accurate, and well-integrated into the delivery of care – everything downstream is more effective. When diagnostic capability is weak or unevenly distributed, the whole system inherits the uncertainty, and patients pay for it.
For the Asia-Pacific region, this is the opportunity I care about most. We have extraordinary diversity here: in geography, in resources, in health infrastructure, and in the diseases that press hardest on each population. Our populations are ageing, and the burden of chronic disease is rising with them.
That diversity and that pressure are precisely why a strong diagnostics foundation matters so much. It’s what makes healthcare more equal, giving a person in a rural province access to the same quality of answer as someone in a capital city. It’s what makes healthcare more efficient, directing scarce resources to where they will do the most good. And it’s what makes healthcare more personal, meeting each patient where they are, as an individual, rather than as a statistical average.
None of this is a distant vision. The tools already exist. The evidence has long been established. What remains is the will to treat diagnostics as the strategic asset they are, and to invest accordingly in that moment where a sample becomes a result, and a result becomes the right decision, at the right time, for the right person.
I have spent my career convinced that this is where a great deal of health value is won or lost. That 2% spend, it turns out, will determine the future of care. If we build that foundation well, and build it everywhere, the whole of the Asia-Pacific region will be healthier for it — giving many millions of people more time with their families in good health.
If this resonated with you, I’d be very grateful if you shared it with a colleague – and I’d love to hear how you see the value of diagnostics in your own work. Let’s keep the conversation going.
