Paper Diagnostics Global Market Report 2024

Description

Paper Diagnostics Global Market Report 2024 from The Business Research Company provides strategists, marketers and senior management with the critical information they need to assess the market.

This report focuses on paper diagnostics market which is experiencing strong growth. The report gives a guide to the trends which will be shaping the market over the next ten years and beyond.

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Where is the largest and fastest growing market for paper diagnostics? How does the market relate to the overall economy, demography and other similar markets? What forces will shape the market going forward? The paper diagnostics market global report from the Business Research Company answers all these questions and many more.

The report covers market characteristics, size and growth, segmentation, regional and country breakdowns, competitive landscape, market shares, trends and strategies for this market. It traces the market's historic and forecast market growth by geography.

Scope

Markets Covered:

1) By Product: Dipsticks; Lateral Flow Assays: Paper Based Microfluidics
2) By Device Type: Monitoring Devices; Diagnostic Devices
3) By Application: Environmental Monitoring; Clinical Diagnostics; Food Quality Testing
4) By End-User: Home Healthcare; Assisted Living Healthcare Facilities; Hospital And Clinics
Companies Mentioned: Navigene; Siemens Healthcare GmbH; Arkray Inc.; Acon Laboratories Inc.; Chembio Diagnostic Systems Inc.
Countries: Australia; Brazil; China; France; Germany; India; Indonesia; Japan; Russia; South Korea; UK; USA; Canada; Italy; Spain
Regions: Asia-Pacific; Western Europe; Eastern Europe; North America; South America; Middle East; Africa
Time series: Five years historic and ten years forecast.
Data: Ratios of market size and growth to related markets, GDP proportions, expenditure per capita,
Data segmentations: country and regional historic and forecast data, market share of competitors, market segments.
Sourcing and Referencing: Data and analysis throughout the report is sourced using end notes.
Delivery format: PDF, Word and Excel Data Dashboard.

Executive Summary

Paper diagnostics stand as instruments employing cellulosic and paper-based materials to detect and quantify chemicals and bio-molecules affecting health. Widely employed across healthcare domains, including hospitals, medical practices, sports testing arenas, and prenatal clinics, these devices play a crucial role in health assessment.

The realm of paper diagnostics, key classifications include dipsticks, lateral flow assays, and paper-based microfluidics. A urine dipstick test, for instance, involves immersing a specific paper strip into a urine sample for analysis. These devices come in varied types, serving as both monitoring tools and diagnostic aids. Their applications span environmental monitoring, clinical diagnostics, and food quality assessments, catering to end-users such as home healthcare, assisted living facilities, as well as hospitals and clinics.

The paper diagnostics market research report is one of a series of new reports from The Business Research Company that provides paper diagnostics optical components market statistics, including paper diagnostics optical components industry global market size, regional shares, competitors with a paper diagnostics optical components market share, detailed paper diagnostics optical components market segments, market trends and opportunities, and any further data you may need to thrive in the paper diagnostics optical components industry. This paper diagnostics optical components market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.

The paper diagnostics market size has grown strongly in recent years. It will grow from $9.16 billion in 2023 to $10.01 billion in 2024 at a compound annual growth rate (CAGR) of 9.2%. The growth observed in the historic period can be primarily linked to the demand for accessible healthcare, readiness to address global health crises, the use of point-of-care testing for chronic conditions, and diagnostic applications tailored for resource-constrained environments. This growth was further driven by the need for quick results to facilitate timely decision-making and an amplified emphasis on preventive healthcare measures.

The paper diagnostics market size is expected to see strong growth in the next few years. It will grow to $14.49 billion in 2028 at a compound annual growth rate (CAGR) of 9.7%. The anticipated growth in the upcoming period is driven by advancements in paper-based biosensors and their integration with wearable health devices. The forecast also considers the expansion of personalized medicine, the burgeoning demand for telehealth services, and the need for early cancer detection methods. Furthermore, this growth is expected to be bolstered by the expansion of veterinary diagnostics and government initiatives focused on preventive healthcare. Key trends on the horizon encompass advancements in paper-based technologies, the convergence of technology in diagnostics, the proliferation of chronic disease management apps, the development of multiplexing capabilities, the use of microfluidics in paper devices, and the integration of smartphone technology.

The anticipated rise in heart disease cases is set to drive the paper diagnostics market. Heart disease, affecting the cardiovascular system, prompts the demand for sensitive microfluidic paper-based devices (PAD) capable of simultaneous detection of various cardiac biomarkers. This enables early and late-stage diagnoses of acute myocardial infarction, stimulating the demand for paper diagnostics. Statistics Canada's data from August 2023 revealed a notable surge in heart disease fatalities in Canada, reaching 17.7% (55,271 deaths) in 2021 from the 1.6% recorded in 2020, underlining the market's growth driven by increased heart disease prevalence.

The escalating number of cancer instances is poised to boost the paper diagnostics market. As cancer signifies abnormal cell growth, paper diagnostics play a crucial role in its early detection and monitoring. The devices offer swift and accessible testing methodologies for diagnosing and tracking cancer progression. The American Cancer Society's January 2022 journal projected an increase in new cancer cases and fatalities in the United States in 2022 compared to the previous year, highlighting the rising cancer instances and their influence on the paper diagnostics market.

Key players in the paper diagnostics market are focused on Point-of-Care (POC) test advancements. In August 2023, Mylab Discovery Solutions launched two rapid point-of-care tests for detecting dengue infections. The rapid gold test and high-accuracy dry luminescence assay test deliver results within 15-20 minutes sans the need for laboratory setup. These aids significantly support dengue screening programs in resource-limited areas, offering healthcare professionals precise tools for prompt diagnosis and effective disease management.

Major entities in the paper diagnostics market are introducing novel tests like the PrecivityAD2 blood test to enhance patient assessment. C2N Diagnostics unveiled the PrecivityAD2 blood test in August 2023, catering to clinical care, specifically addressing Alzheimer's disease and cognitive decline. This analytically and clinically validated assay measures specific plasma amyloid beta and tau peptide concentrations, accurately identifying Alzheimer's in patients with mild cognitive impairment or dementia. The test's performance statistics demonstrated high accuracy, exhibiting a 0.94 AUC and 88% accuracy in a study involving 583 patients with cognitive impairment, using amyloid PET as the reference standard.

In March 2023, Servier, a pharmaceutical group based in France, joined forces with QIAGEN, a German solutions provider, specializing in Sample to Insight capabilities, aimed at extracting valuable molecular insights from life's elemental building blocks. This strategic partnership between Servier and QIAGEN is focused on creating a companion diagnostic test for identifying IDH1 mutations in patients diagnosed with Acute Myeloid Leukemia (AML). The collaboration is a response to the pivotal clinical phase 3 data from the AGILE study, showcasing the exceptional outcomes of ivosidenib when combined with azacitidine for AML patients with IDH1 mutations.

Major companies operating in the paper diagnostics market report are Navigene, Siemens Healthcare GmbH, Arkray Inc., Acon Laboratories Inc., Chembio Diagnostic Systems Inc., Kenosha Tapes, GVS S.p.A, Abingdon Health, Micro Essential Laboratory Inc., Paperdrop Diagnostics, Monadnock Paper Mills Inc., Bio-Rad Laboratories Inc., Diagnostics for All Inc., Sysmex Corporation, Abcam Plc., Cytodiagnostics Inc., Abbott Inc., Alere Inc., NanoEntek Inc., BiognostiX, Mologic Ltd., Becton Dickinson and Company, BioFluidica, BioDot Inc., Biopico Systems Inc., BioMedomics Inc., BioPorto Diagnostics A/S, Danaher Corporation, EMD Millipore, EKF Diagnostics Holdings plc

North America was the largest region in the paper diagnostics market share in 2023. Asia-Pacific is expected to be the fastest-growing region in the forecast period. The regions covered in the paper diagnostics market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa.

The countries covered in the paper diagnostics market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.

The paper diagnostics market consists of sales of paper diagnostics for commercial colorimetric tests, and LFA (lateral flow assay) paper-based testing. Values in this market are 'factory gate' values, that is the value of goods sold by the manufacturers or creators of the goods, whether to other entities (including downstream manufacturers, wholesalers, distributors, and retailers) or directly to end customers. The value of goods in this market includes related services sold by the creators of the goods.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.

Product Code: r12941

1. Executive Summary

2. Paper Diagnostics Market Characteristics

3. Paper Diagnostics Market Trends And Strategies

4. Paper Diagnostics Market - Macro Economic Scenario

4.1. Impact Of High Inflation On The Market
4.2. Ukraine-Russia War Impact On The Market
4.3. COVID-19 Impact On The Market

5. Global Paper Diagnostics Market Size and Growth

5.1. Global Paper Diagnostics Market Drivers and Restraints
- 5.1.1. Drivers Of The Market
- 5.1.2. Restraints Of The Market
5.2. Global Paper Diagnostics Historic Market Size and Growth, 2018 - 2023, Value ($ Billion)
5.3. Global Paper Diagnostics Forecast Market Size and Growth, 2023 - 2028, 2033F, Value ($ Billion)

6. Paper Diagnostics Market Segmentation

6.1. Global Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
Dipsticks
Lateral Flow Assays: Paper Based Microfluidics
6.2. Global Paper Diagnostics Market, Segmentation By Device Type, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
Monitoring Devices
Diagnostic Devices
6.3. Global Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
Environmental Monitoring
Clinical Diagnostics
Food Quality Testing
6.4. Global Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
Home Healthcare
Assisted Living Healthcare Facilities
Hospital And Clinics

7. Paper Diagnostics Market Regional And Country Analysis

7.1. Global Paper Diagnostics Market, Split By Region, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
7.2. Global Paper Diagnostics Market, Split By Country, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

8. Asia-Pacific Paper Diagnostics Market

8.1. Asia-Pacific Paper Diagnostics Market Overview
Region Information, Impact Of COVID-19, Market Information, Background Information, Government Initiatives, Regulations, Regulatory Bodies, Major Associations, Taxes Levied, Corporate Tax Structure, Investments, Major Companies
8.2. Asia-Pacific Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
8.3. Asia-Pacific Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
8.4. Asia-Pacific Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

9. China Paper Diagnostics Market

9.1. China Paper Diagnostics Market Overview
9.2. China Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F,$ Billion
9.3. China Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F,$ Billion
9.4. China Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F,$ Billion

10. India Paper Diagnostics Market

10.1. India Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
10.2. India Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
10.3. India Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

11. Japan Paper Diagnostics Market

11.1. Japan Paper Diagnostics Market Overview
11.2. Japan Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
11.3. Japan Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
11.4. Japan Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

12. Australia Paper Diagnostics Market

12.1. Australia Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
12.2. Australia Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
12.3. Australia Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

13. Indonesia Paper Diagnostics Market

13.1. Indonesia Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
13.2. Indonesia Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
13.3. Indonesia Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

14. South Korea Paper Diagnostics Market

14.1. South Korea Paper Diagnostics Market Overview
14.2. South Korea Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
14.3. South Korea Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
14.4. South Korea Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

15. Western Europe Paper Diagnostics Market

15.1. Western Europe Paper Diagnostics Market Overview
15.2. Western Europe Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
15.3. Western Europe Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
15.4. Western Europe Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

16. UK Paper Diagnostics Market

16.1. UK Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
16.2. UK Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
16.3. UK Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

17. Germany Paper Diagnostics Market

17.1. Germany Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
17.2. Germany Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
17.3. Germany Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

18. France Paper Diagnostics Market

18.1. France Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
18.2. France Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
18.3. France Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

19. Italy Paper Diagnostics Market

19.1. Italy Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
19.2. Italy Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
19.3. Italy Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

20. Spain Paper Diagnostics Market

20.1. Spain Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
20.2. Spain Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
20.3. Spain Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

21. Eastern Europe Paper Diagnostics Market

21.1. Eastern Europe Paper Diagnostics Market Overview
21.2. Eastern Europe Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
21.3. Eastern Europe Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
21.4. Eastern Europe Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

22. Russia Paper Diagnostics Market

22.1. Russia Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
22.2. Russia Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
22.3. Russia Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

23. North America Paper Diagnostics Market

23.1. North America Paper Diagnostics Market Overview
23.2. North America Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
23.3. North America Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
23.4. North America Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

24. USA Paper Diagnostics Market

24.1. USA Paper Diagnostics Market Overview
24.2. USA Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
24.3. USA Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
24.4. USA Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

25. Canada Paper Diagnostics Market

25.1. Canada Paper Diagnostics Market Overview
25.2. Canada Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
25.3. Canada Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
25.4. Canada Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

26. South America Paper Diagnostics Market

26.1. South America Paper Diagnostics Market Overview
26.2. South America Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
26.3. South America Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
26.4. South America Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

27. Brazil Paper Diagnostics Market

27.1. Brazil Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
27.2. Brazil Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
27.3. Brazil Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

28. Middle East Paper Diagnostics Market

28.1. Middle East Paper Diagnostics Market Overview
28.2. Middle East Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
28.3. Middle East Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
28.4. Middle East Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

29. Africa Paper Diagnostics Market

29.1. Africa Paper Diagnostics Market Overview
29.2. Africa Paper Diagnostics Market, Segmentation By Product, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
29.3. Africa Paper Diagnostics Market, Segmentation By Application, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion
29.4. Africa Paper Diagnostics Market, Segmentation By End-User, Historic and Forecast, 2018-2023, 2023-2028F, 2033F, $ Billion

30. Paper Diagnostics Market Competitive Landscape And Company Profiles

30.1. Paper Diagnostics Market Competitive Landscape
30.2. Paper Diagnostics Market Company Profiles
- 30.2.1. Navigene
  - 30.2.1.1. Overview
  - 30.2.1.2. Products and Services
  - 30.2.1.3. Strategy
  - 30.2.1.4. Financial Performance
- 30.2.2. Siemens Healthcare GmbH
  - 30.2.2.1. Overview
  - 30.2.2.2. Products and Services
  - 30.2.2.3. Strategy
  - 30.2.2.4. Financial Performance
- 30.2.3. Arkray Inc.
  - 30.2.3.1. Overview
  - 30.2.3.2. Products and Services
  - 30.2.3.3. Strategy
  - 30.2.3.4. Financial Performance
- 30.2.4. Acon Laboratories Inc.
  - 30.2.4.1. Overview
  - 30.2.4.2. Products and Services
  - 30.2.4.3. Strategy
  - 30.2.4.4. Financial Performance
- 30.2.5. Chembio Diagnostic Systems Inc.
  - 30.2.5.1. Overview
  - 30.2.5.2. Products and Services
  - 30.2.5.3. Strategy
  - 30.2.5.4. Financial Performance

31. Global Paper Diagnostics Market Competitive Benchmarking

32. Global Paper Diagnostics Market Competitive Dashboard

33. Key Mergers And Acquisitions In The Paper Diagnostics Market

34. Paper Diagnostics Market Future Outlook and Potential Analysis

34.1 Paper Diagnostics Market In 2028 - Countries Offering Most New Opportunities
34.2 Paper Diagnostics Market In 2028 - Segments Offering Most New Opportunities
34.3 Paper Diagnostics Market In 2028 - Growth Strategies
- 34.3.1 Market Trend Based Strategies
- 34.3.2 Competitor Strategies

35. Appendix

35.1. Abbreviations
35.2. Currencies
35.3. Historic And Forecast Inflation Rates
35.4. Research Inquiries
35.5. The Business Research Company
35.6. Copyright And Disclaimer