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Original research
Postmortems on diagnostic testing start-ups: reports of commercial successes and failures and the case of the Zombie life science company
  1. John Peabody1,2,
  2. Trever Burgon1,
  3. David Paculdo1,
  4. Othman Ouenes1,
  5. Enrico de Belen1,
  6. Mike Richey3,
  7. Richard M Thayer3,
  8. Mickey Urdea3
  1. 1 QURE Healthcare, San Francisco, California, USA
  2. 2 College of Medicine, University of California San Francisco, San Francisco, California, USA
  3. 3 Halteres Associates, Berkeley, California, USA
  1. Correspondence to Dr John Peabody, QURE Healthcare, San Francisco, CA 94133, USA; jpeabody{at}


Background From 2014 to 2017, more than 1000 diagnostic companies were launched, securing more than US$10 billion in investment.

Methods We performed an in-depth exploration of 28 diagnostic companies to differentiate successful and failed startups, plus a third ‘Zombie’ state where companies have achieved financial solvency but without long-term viability.

Results From these data, we created a five-phase, 13-item framework indicating the corporate health of a diagnostic company as it progresses from conception to commercialisation. We found 6 successful companies, 14 failures and 8 Zombies. On a scale of 0–26 points (two points per item), successful companies averaged 24.5 points (range 22–26), failures averaged 4.5 (range 0–16) and Zombies averaged 12.3 (range 3–23) (p<0.001). To determine if there was any predictivity to this framework, we looked at only the first two phases (concept and feasibility/planning) of progress and found a distinct gradient in success potential based solely on these first two phases.

Conclusion Our five-phase framework generated a score that could predict diagnostic companies more likely to successfully and sustainably enter the market from those more likely to fail.

  • diagnostics
  • economics
  • inventions

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  • Contributors JP and MU designed and planned the study. MU, MR and RMT initiated the study implementation and data gathering. DP and EdB analysed the data. TB and OO drafted the original manuscript. All authors contributed to the revision of the manuscript and approved its final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.