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Evaluate Vantage Pharma, Biotech and Medtech 2020 in review Copyright © 2021 Evaluate Ltd. All rights reserved.
Evaluate Vantage Pharma, Biotech and Medtech 2020 in review
The pandemic ensured that 2020 was unlike any other year for biopharma and medtech companies. But, while these
sectors turned their collective attentions to vanquishing the novel coronavirus, the usual business of drug and device
development continued alongside.
This report is a round-up of Evaluate Vantage’s analyses of 2020 – from M&A, venture financing and IPO markets,
to the progress of the Covid-19 pipeline, all based on Evaluate data.
In many ways Covid-19 turbocharged an industry that was already riding fairly high. The financing climate had been
strong for a few years, but 2020 saw records broken in the venture and IPO worlds. With the spotlight on biopharma,
which made remarkably swift progress on a pipeline of pandemic therapies, investors rushed to inject money into
the sector.
This also resulted in ballooning stock market valuations, with many companies ending the year worth substantially
more than at the beginning. Those developing Covid-19 vaccines and treatments drove those gains, with several
small developers transformed into multi-billion-dollar enterprises. The vaccine developers Moderna, Biontech and
Novavax especially stand out.
Similar dynamics were seen in the medtech arena, with diagnostics companies benefiting in particular – both those
developing tests for Covid-19 and those working on liquid biopsy cancer tests. Such work appealed hugely to
investors in publicly traded companies and to venture backers alike.
M&A also held up remarkably well across the board, considering that for much of the year global travel was not
possible. But the world quickly adapted to virtual meetings, and a number of big transactions emerged, culminating
in Astrazeneca’s $39bn move on Alexion in December. The pandemic also provided the impetus for the biggest
deal in medtech last year – the $18.5bn merger of the telehealth groups Teladoc and Livongo.
Heady valuations have not noticeably curtailed deal-making, although this remains a concern heading into 2021.
When preclinical companies can easily achieve the sort of market cap more typically associated with later-stage
developers, some big and expensive disappointments seem inevitable.
When it comes to medtech M&A, however, 2021 has kicked off in spectacular fashion with deals worth more than
$10bn already arranged. Liquid biopsy and remote patient monitoring have already emerged as major trends to
watch in the coming year.
The main Covid-19 focus this year is set to switch from tests for the disease to the progress of vaccines and
therapeutics against the pandemic. And this is a fast-changing environment: in the days after this report was put
together, vaccines from Johnson & Johnson and Novavax generated encouraging phase III data. 2021 is shaping
up to be another wild ride.
Evaluate Vantage staff report – February 2021
2
Unless stated, all data are sourced to Evaluate and were accessed in January 2021
Contents
Introduction 2
Covid-19: Biopharma and medtech’s ongoing response 4
Pharma and Biotech 2020 in review 12
One victory for biopharma over the coronavirus in 2020 12
A big year for biotech flotations 16
Covid or not, venture financing breaks records 19
Astrazeneca shows megamergers were still possible in 2020 21
2020 drug approvals rise despite Covid-19 24
MedTech 2020 in review 26
A tale of two Covids for device makers 26
Medtech deal-making stands firm in difficult times 29
Medtechs rake in the venture cash 31
Astounding success greets newly public device makers 34
Focus on Covid-19 does not distract the FDA 36
3 Evaluate Vantage Pharma, Biotech and Medtech 2020 in review Copyright © 2021 Evaluate Ltd. All rights reserved.
4 Copyright © 2021 Evaluate Ltd. All rights reserved.Covid-19: Biopharma and medtech’s ongoing response
The pandemic was the dominant issue for biopharma – and indeed the whole world – in 2020.
The initial impact on the sector was seen in the world of clinical research, as global shutdowns
meant that much work ground to a halt. But this swiftly turned to a huge, collective effort to
develop vaccines and treatments for Covid-19.
More than 2,000 trials were suspended over the course of 2020. It is heartening to discover that around half of these
studies have since resumed.
In fact, the full data reveal a remarkably short-lived impact to biopharmaceutical research. The majority of studies
that remain on pause are observational or involve non-drug-based interventions. Only 54 industry-sponsored trials
remained suspended by January 2021, an Evaluate Vantage analysis found, a reassuringly small number for those
biopharma watchers concerned about the impact of the pandemic.
This is not to suggest that research escaped unscathed, and it seems likely that swathes of academic work,
particularly projects taking place in hospitals, were severely curtailed and remain disrupted. But commercial
biopharma companies have, in the main, managed to restart stalled projects.
Covid-19: Biopharma and medtech’s ongoing response
Source: Evaluate®. January 2021Clinical trial halts per month
Tria
l hal
ts
600
800
400
200
1000
0
Terminated
Suspended
Withdrawn
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec2019 2020
This analysis uses clinicaltrials.gov data, focusing on changes made to trial entries that concern the recruitment status
of a study. Those that were changed to suspended, terminated or withdrawn between January 2019 and December
2020 were identified.
A more detailed look at this data can be found here:
Clinical development
Vaccines offer the world an exit from the pandemic, and thus much of the focus has fallen on
these development efforts. As it stands in early 2021, mRNA-based projects from Biontech/
Pfizer and Moderna are being rolled out in many countries, while Astrazeneca is waiting to hear
whether it can add EU authorisation to its green light in the UK. Locally developed vaccines are
also available in Russia and China.
But other options are needed, and the table below highlights the most closely watched contenders. The progress
or otherwise of vaccines from J&J and Novavax will make a big difference to how the world looks 12 months from
now. These two groups are next in the queue to report data and seek approval, after which they could supply huge
quantities of shots in 2021.
Setbacks cannot be ruled out, unfortunately, and January 2021 saw Merck & Co scrap two early-stage candidates,
and a month earlier CSL had canned its project in phase I. Merck said efficacy could not match existing options,
while safety concerns caused the Australian biotech to pull the plug.
Development delays have also hit partners Sanofi and Glaxo, two of the world’s leading vaccine developers which
between them have the manufacturing capacity to help feed the huge global demand. Necessary reformulation
pushed back the potential launch of their project by six months to late 2021, the pharma giants said in December, an
estimate that feels like a best-case scenario.
All eyes will be on these projects waiting in the wings this year, in the hope that vaccine output can be massively
upscaled in 2021.
5 Copyright © 2021 Evaluate Ltd. All rights reserved.Covid-19: Biopharma and medtech’s ongoing response
Project Description Company Update
Comirnaty (BNT162b2) mRNA (2 dose) Pfizer/Biontech Global rollout underway.
mRNA-1273 mRNA (2 dose) Moderna Rollout in US underway, green light in Europe.
Sputnik V Adenovirus (2 dose) Gamaleya Research Institute/Russia
Rolling out in Russia
AZD1222 Chimp adenovirus (2 dose) Astrazeneca Rolling out in UK; under review in Europe; US trial due to report 2021
Ad26.COV2-S Adeno type 26 (1 & 2 dose) J&J Ph3 Ensemble (single dose) data due Jan 2021; Ensemble 2 (2-dose) recruiting, data due 2021.
NVX-CoV2373 Recombinant nanoparticle (2 dose) Novavax Data from UK ph3 and S Africa ph2b due Q1'21; US/Mexico ph3 data due Q2'21.
CVnCoV mRNA (2 dose) Curevac Herald, Europe ph2/3 data due Q1'21; Europe ph3 due 2021.
COVID-19 S-Trimer Trimerised fusion protein (2 dose) Clover/Glaxo Ph1 ongoing; ph2/3 due to start.
Covid-19 vaccine project Recombinant protein (1 or 2 dose tbc) Sanofi/Glaxo Ph3 due to start 2021, pending development of new formulation.
Next steps for selected clinical-stage Covid-19 vaccines Source: Evaluate®, company statements. January 2021
In terms of gauging what sales of vaccines might look like, analysts covering big pharma companies have tended
to wait until proof of efficacy emerged before forecasting demand. Biotech analysts covering Novavax have put in
numbers ahead of data, illustrating the high expectations here.
As such, a reliable consensus is only available for the three products below. Lack of numbers for AZD1222 can
probably be explained by Astra’s pledge not to make a profit while a pandemic is declared, although it is still
uncertain whether this particular vaccine will get much use in the US.
6 Copyright © 2021 Evaluate Ltd. All rights reserved.Covid-19: Biopharma and medtech’s ongoing response
Source: Evaluate®. January 2021Vaccine demand: a sellside view
Ann
ual s
ales
WW
($bn
)
3
4
5
6
7
1
2
NVX-CoV2373 (Novavax)
mRNA-1273 (Moderna)
Comirnaty (Pfizer)
2020 2021 2022 2023 2024 2025 20260
7 Copyright © 2021 Evaluate Ltd. All rights reserved.Covid-19: Biopharma and medtech’s ongoing response
Antivirals
Much work is going into finding treatments for those already sick with the virus, with antivirals a
major focus. Veklury (remdesivir) is already available from Gilead, but mixed clinical data and the
absence of a mortality benefit mean that more effective options would be welcomed.
Merck and Ridgeback’s molnupiravir is the most advanced in development, with data from a small trial due in the next
few months and late-stage results later in the year. Pfizer has reportedly experienced delays recruiting patients into
early trials of its antiviral project, however, saying that clinical work is proving hard to run in overloaded hospitals.
The pharma giant is unlikely to be alone in experiencing these issues, and developmental timelines will be
scrutinised for all types of Covid therapies this year.
Product Company Update Trial ID
Veklury (remdesivir) Gilead Ph3 outpatient data and update on inhaled formulation Q1.
NCT04501952
NCT04539262
Molnupiravir (MK-4482; oral)
Merck (Ridgeback) Ph2 data pending; 2 ph2/3 trials recruiting, data H1'21.
NCT04405570 (Ph2)
NCT04575584 (Ph2/3)
NCT04575597 (Ph2/3)
PF-07304814 (IV) Pfizer Ph1b data pending; ph2/3 to start 2021. NCT04535167
AT-527 (oral) Roche/Atea Ph2 due H1'21; ph3 to start H1'21. NCT04396106
MP0420 and MP0423 (SC) Novartis/Molecular Partners First-in-human studies of MP0420 to begin November 2020.
The antiviral approach: projects to watch Source: Evaluate®, company statements. January 2021
Antibodies, and the rest
With two antibodies now available under emergency use authorisations in the US, it seems
pretty clear that MAbs have a role to play in treating Covid-19. The extent to which they will be
helpful is not yet known, however.
Both the Regeneron and Lilly products are available to treat non-hospitalised patients with mild-to-moderate disease
but attempts to show a benefit in severely ill patients have failed. As such, developers have turned their attention to
patients recently exposed to the virus, and preventative settings.
Lilly reported the first big win here in early 2021 in the Blaze-2 trial, which took place in nursing homes with at least
one confirmed case of Covid-19. Across residents and staff receiving bamlanivimab, there was a 57% reduction in the
risk of developing symptomatic Covid-19 compared with those receiving placebo; among residents alone the figure
rose to 80%.
8 Copyright © 2021 Evaluate Ltd. All rights reserved.Covid-19: Biopharma and medtech’s ongoing response
The fact that the available MAbs need to be infused presents a logistical problem, however, and products with more
convenient injected formulations presumably need to replicate these findings for this approach to really take off.
And with many developed countries focusing initial vaccination efforts on the elderly, particularly those in care
homes, real- world utilisation of any of these antibodies remains a big unknown.
Product Company Status Ongoing trials
Casirivimab and imdevimab (REGN-COV2)
Regeneron On the US market via EUA for high-risk patients with mild-to-moderate disease; further trials on going.
Subcutaneous formulation;
prevention;
confirmatory in mild to moderate;
hospitalised
Bamlanivimab Eli Lilly On the US market via EUA for high-risk patients with mild-to-moderate disease; further trials on going.
Hospitalised patients (monotherapy);
Tacit-R (academic trial);
ACTT-4 (+Veklury)
AZD7442 Astrazeneca Ph3 data in post and pre-exposure prophylactic settings Q1'21.
Storm Chaser
Provent
VIR-7831 Glaxo/Vir Ph3 data from high-risk outpatient trial due 2021.
NCT04545060
Product Company Status Ongoing trials
MK-7110 (CD24Fc) Merck (Oncoimmune) Recombinant fusion protein; full ph3 data in severely ill patients due Q1'21. NCT04317040
ABX464 Abivax Antiviral/anti-inflammatory agent; ph2/3 data from Mir-Age study in severely ill patients due Q2'21.
NCT04393038
SNG001 Synairgen Inhaled interferon; ph2 data in preventing disease progression in high-risk patients in home setting due Q2’21. Ph3 underway in Europe.
NCT04385095
Otilimab GSK Anti-GM-CSF Mab; ph2 Oscar trial in severe patients due H1'21. NCT04376684
Mavrilimumab (Kiniksa) Anti-GM-CSF MAb Mortality in severe Covid-19 patients with pneumonia and hyper- inflammation; data due H1’21 from phase II portion.
NCT04447469
Lenzilumab (Humanigen) Anti-GM-CSF MAb Time to recovery in severe or critical patients; topline data 2021. NCT04351152
RG7880 & RG6149 Roche Anti-IL 22 & anti-IL33 MAbs; ph2 data in severe patients due H1'20. NCT04386616
Antibody efforts: trials to watch Source: Evaluate®, company statements. January 2021
Other novel projects approaching readout Source: Evaluate®, company statements. January 2021
Much work is also going on beyond these core vaccine, antiviral and antibody approaches, and 2021 promises
several readouts.
Data are due in the next few months on the recombinant fusion protein MK-7110, formerly known as CD24Fc, that
Merck & Co obtained via its acquisition of Oncoimmune late in 2020 for a hefty $425m. Encouraging early signals
have raised hopes that a mortality benefit will emerge from the trial, which recruited severely ill patients, a group that
remains very hard to treat.
In fact much of the ongoing clinical work focuses on very sick patients in an attempt to reduce mortality rates in those
admitted to hospital.
At least three companies are undertaking work with anti-GM-CSF MAbs, a mechanism that has yet to yield much
data. A type of pro-inflammatory cytokine, GM-CSF has been found in some severely ill Covid-19 patients suffering
from cytokine release syndrome.
9 Copyright © 2021 Evaluate Ltd. All rights reserved.Covid-19: Biopharma and medtech’s ongoing response
Several other well-known immunosuppressive mechanisms are also being tested in hospitalised Covid-19 patients,
although for now it remains unclear which biological pathways are best targeted, and at what stage of the disease.
The anti-IL-6 MAbs, for example, have been widely investigated but, a recent success in the UK notwithstanding,
the failure of several robust trials to find clear signals of efficacy means that attention has turned elsewhere.
The Jak inhibitors too have yielded mixed results. Incyte’s Ruxcovid study of Jakafi failed in patients with Covid-19-
associated cytokine storm, but another Jak, Lilly’s Olumiant, is available under an emergency use authorisation in
the US to treat hospitalised patients requiring oxygen, ventilation or ECMO.
Another recent setback was seen with Ultomiris, a trial of which was ended by Alexion after failing to find
efficacy signals. Still, the drug remains in academic trials, as do several of the Jak inhibitors and other novel
immunosuppressive agents.
Excluding dramatic findings with a cheaply available generic steroid, repurposing efforts have largely disappointed
so far. Novel approaches could still surprise, but the real hopes for a return to normality rest on clinical success with
the vaccine programmes, and of course their subsequent rollout.
Covid-19 tests and devices
Alongside biopharma, the coronavirus pandemic has also profoundly affected the medtech
industry – and the greatest impact has been on the diagnostics sector. Giants such as Roche,
Danaher and Abbott have developed multiple tests, and even diagnostics groups that
specialise in other types of testing, such as the cancer-focused Exact Sciences and Guardant
Health, have obtained authorisation for Covid-19 assays.
Overall, the FDA has granted emergency use authorisation for nearly 300 tests for Covid-19 infection and related
technologies, such as sample collection kits.
Product Company Status Ongoing trials
Ultomiris; Olumiant Alexion; Lilly To reduce disease severity in hospitalised patients, academic study, ph4 TACTIC-R.
NCT04390464
Jakafi Incyte To reduce mortality in ventilated patients, Incyte sponsored, ph3. NCT04377620
Olumiant Eli Lilly To reduce disease severity in hospitalised patients, Lilly study, ph3. NCT04421027
Farxiga, Volibris, EDP1815 Astrazeneca, generics, Evelo Biosciences
To reduce disease severity in hospitalised patients, academic study, ph2/3 TACTIC-E.
NCT04393246
Tavalisse (Rigel); Jakafi (Novartis)
Syk inhibitor; Jak 1&2 inhibitor
To reduce progression to severe pneumonia, academic study. NCT04581954
Otezla (Amgen); Firazyr (Takeda); cenicriviroc (Abbvie); razuprotafib (Aerpio)
PDE4 inhibitor; bradykinin B2 receptor antagonist; CCR2 & CCR5 receptor agonist; VE-PTP inhibitor.
Adaptive I-Spy Covid trial recruiting critically ill patients, agents tested + and vs remdesivir.
NCT04488081
Notable repurposing efforts still to read out Source: Evaluate®, company statements. January 2021
10 Copyright © 2021 Evaluate Ltd. All rights reserved.Covid-19: Biopharma and medtech’s ongoing response
With treatments arriving, the emphasis at the agency has quite rightly switched to evaluating and approving vaccines.
But new tests were still reaching the market right up to the end of 2020, with Nirmidas Biotech’s MidaSpot Covid-19
antibody test winning authorisation on New Year’s Eve.
While the first half of 2020 was all about RNA and antibody tests, for current and previous infections respectively, the
latter half of the year saw growing emphasis on new testing modalities.
Lateral flow antigen testing holds great promise for testing large numbers of people quickly and cheaply, but since
these tests are less sensitive than molecular assays they must be used repeatedly within a stable population if they
are to keep infections under control. The cost of repeated testing mounts up quickly, and the logistical challenges,
including of the subsequent contact tracing, are considerable.
T-cell-mediated immunity is, alongside antibody testing, a potentially highly useful technique for assessing immunity
to the coronavirus, both in people previously infected and those who have received a vaccine. Data backing this
approach are early but encouraging, and T-cell testing could yet become a part of efforts to assess the effectiveness
of vaccination regimens, and identify patients who need a booster.
50
250
0
100
150
200
Cum
ulat
ive
tria
l cou
nt
EUAs granted to Covid-19 tests Source: Evaluate®, FDA. January 2021
Antibody tests
Viral RNA tests
Other
Mar 2020 May 2020 Jul 2020 Sep 2020 Nov 2020 Jan 2021
The pace of test authorisations undeniably slackened during the autumn, however. As the vaccine rollout continues,
and hopefully accelerates under the new administration, demand for Covid-19 assays ought to shrink.
EUA = emergency use authorisation. Commercial tests only; cumulative figures.Note: “Other” includes 11 antigen tests, six home sampling kits, three saliva collection devices and three IL-6 tests.
11 Copyright © 2021 Evaluate Ltd. All rights reserved.Covid-19: Biopharma and medtech’s ongoing response
Device category No of EUAs
Blood purification devices 4
Continuous renal replacement therapy and haemodialysis devices 3
Decontamination systems for personal protective equipment 14
Infusion pumps 1
Remote or wearable patient monitoring devices 6
Respiratory assist devices 5
Ventilators and accessories 105
Personal protective equipment 216
Other medical devices 7
Total 361
Emergency authorisations for non-diagnostic Covid-19 devices Source: Evaluate®, FDA. January 2021
The striking preponderance of liquid biopsy companies as both recipients of venture cash and as acquisition targets
might also have been influenced by Covid-19. Since liquid biopsies can be conducted much more quickly and simply
than tissue biopsies, and often at the patient’s own home, the pandemic has boosted uptake.
Even after successful vaccination programmes Covid-19 could become a seasonal virus much like flu, and since
cancer patients are often immunocompromised there could be an ongoing argument for a form of cancer testing that
does not require doctor or hospital visits.
As well as tests, the FDA also granted EUAs to hundreds of other medical devices including ventilators and personal
protective equipment. From face shields to dialysis machines, hundreds of devices able to help prevent the disease’s
spread or treat those suffering from its effects were ushered into hospitals and other critical settings. Many people
will be hoping that this level of Covid-19-related regulatory activity will not be required in 2021, and FDA personnel
will surely be among them.
Pharma and Biotech 2020 in review
12 Copyright © 2021 Evaluate Ltd. All rights reserved.One victory for biopharma over the coronavirus in 2020
One victory for biopharma over the coronavirus in 2020
Covid-19 is far from beaten, but its threat to biopharma stocks last year has certainly been
neutralised. Despite a serious first-quarter wobble, global biopharma ended 2020 worth half
a trillion dollars more than when it started the year.
This analysis, tracking the performance of almost 600 global drug makers covered by EvaluatePharma, reveals
the waxing and waning of investor opinion throughout 2020. Thus, initial uncertainty over the pandemic turned
into extreme bullishness as the view spread that not only was Covid-19 not curbing business development, it was
providing biopharma with a stage on which it could shine.
Source: Evaluate®. January 2021The shifting valuation of global drug makers
Mar
ket c
ap c
hang
e ($
bn)
1k
2k
3k
4k
5k
6k
YE 2019 Market cap
$4,574bn
Q1 2020 change
-$448bn
Q2 2020 change
+$666bn
Q3 2020 change
-$7bn
Q4 2020 change
+$276bn
0
Doubts were expressed in the first quarter, when billions were wiped from global drug valuations. But an extraordinary
second quarter showed investors embracing the new reality, while a strong end to the year, driven by some clinical data
and M&A, ensured that 2020 finished firmly green.
The exceptionally bullish second quarter, during which biopharma market valuations put on a combined $666bn,
mirrored biotech’s success in raising private money: venture capital financing nearly hit $6bn during this three-
month period.
13 Copyright © 2021 Evaluate Ltd. All rights reserved.One victory for biopharma over the coronavirus in 2020
Source: Evaluate®. January 2021Absolute market cap gains and losses, by size bracket
Mar
ket c
ap m
ovem
ent (
$bn
)
-200
-100
100
200
300
Q1 2020 Q2 2020 Q3 2020 Q4 2020-300
0
25bn+
Bigpharma
250m-5bn
5bn-25bn
Source: Evaluate®. January 2021Percentage market cap gains and losses, by size bracket
% o
f mar
ket c
ap to
tal
-10%
10%
20%
30%
40%
-20%
0%
25bn+
Bigpharma
250m-5bn
5bn-25bn
Q1 2020 Q2 2020 Q3 2020 Q4 2020
True enough, there was another small wobble in the third quarter, but a more granular analysis reveals this to have been
down to quarterly collapses in the share prices of Bayer, over the continuing Monsanto acquisition fallout, and Gilead.
Gilead is an interesting case in point. Its stock had initially surged on hopes that the antiviral Veklury could treat
Covid-19. The reality turned out to be rather different, and the shares sold off, as two major acquisitions failed to
dispel investor concerns about future growth.
14 Copyright © 2021 Evaluate Ltd. All rights reserved.One victory for biopharma over the coronavirus in 2020
In terms of individual gainers, those working on Covid-19 treatments and vaccines feature widely in 2020’s biggest
risers table. Beneficiaries stretch from big caps like Lilly and Regeneron, which have antibody products already on
the US market, to smaller groups like the vaccine maker Biontech.
South Korea’s Shin Poong is one of the year’s biggest gainers percentage wise; the company’s work on a
repurposed malaria drug caused its stock to surge. However, the vaccine developer Novavax, a firm that started
2020 with a market cap of only $100m, is probably the success story of the year.
Company Share price gain
Market cap gain ($bn)
Market cap at Dec 2020 ($bn)
Big pharma
Lilly ($) 28% 35.3 161.5
Abbvie ($) 21% 58.2 189.2
Johnson & Johnson ($) 8% 30.4 414.3
Big drug makers (+$25bn)
Lonza (SFr) 61% 20.0 46.4
Merck KGaA (€) 33% 20.9 71.3
Regeneron ($) 29% 10.1 50.7
Mid-caps ($5-25bn)
Moderna ($) 434% 34.8 41.3
Biontech ($) 126% 12.0 19.6
Celltrion (KRW) 98% 22.7 42.4
Small caps ($250m-5bn)
Shin Poong (KRW) 1,613% 5.4 5.7
Cytodyn ($) 439% 2.8 3.2
Denali ($) 381% 8.4 10.0
Arising from the micro caps… (<$250m)
Novavax ($) 2,702% 7.6 7.7
Seres Therapeutics ($) 661% 2.0 2.2
Adaptimmune ($) 349% 0.7 0.8
Biggest share price gainers of 2020 Source: Evaluate®. January 2021
On the fallers’ side, any year contains a number of blow-ups in this high-risk sector, though investors in Amarin and
Galapagos will be particularly sore; a surprise patent loss and unexpected R&D setbacks respectively caused the pain.
Glaxo’s decline is also notable; the stock has been battered by concerns about cash flow and dividends,
compounded by a weak R&D strategy that took a big knock in the opening weeks of 2021. It is barely credible that
Moderna’s market cap is over half of Glaxo’s, a stark statistic that speaks to stock market frothiness, but that should
also make executives at the now not-so-big pharma shift uncomfortably.
Note: Market cap brackets set as of Jan 1, 2020.
15 Copyright © 2021 Evaluate Ltd. All rights reserved.One victory for biopharma over the coronavirus in 2020
Company Share price loss
Market cap loss ($bn)
Market cap at Dec 2020 ($bn)
Big pharma
Glaxosmithkline (£) -25% -24.9 87.4
Merck & Co ($) -12% -24.6 207.0
Bristol Myers Squibb ($) -10% -10.1 140.4
Big drug makers (+$25bn)
Bayer (€) -34% -19.2 56
Fresenius (€) -24% -10.4 20.3
Biogen ($) -17% -15.9 37.7
Mid-caps ($5-25bn)
Amarin ($) -76% -5.8 1.9
Galapagos (€) -57% -7.1 6.2
Reata ($) -40% -3.2 7.4
Small caps ($250m-5bn)
Aprea Therapeutics (SKr) -90% -0.9 0.1
Tricida ($) -81% -1.5 0.4
Nextcure ($) -81% -1.0 0.3
Biggest share price fallers of 2020 Source: Evaluate®. January 2021
Note: Market cap brackets set as of Jan 1, 2020.
For more detailed analyses see these articles:
16 Copyright © 2021 Evaluate Ltd. All rights reserved.A big year for biotech flotations
10%
-20%
-10%
0%
Source: Evaluate®. January 2021Tracking demand for IPOs
Ave
rage
pre
miu
m/d
isco
unt t
o flo
at r
ange
2016
Q1 Q2 Q3 Q4
2017
Q1 Q2 Q3 Q4
2018
Q1 Q2 Q3 Q4
2019
Q1 Q2 Q3 Q4
2020
Q1 Q2 Q3 Q4-30%
-11
-19
-10
0-1
-2 -2
-6
-2
2
-1
-18
-5
-3
0
-8
4
8
6
Year
4
Average premium/discount to float range
A big year for biotech flotations
With the final numbers in, the excesses of 2020 are laid bare. An astonishing $12.7bn was
raised last year by young drug developers via IPOs, a figure that outstrips previous records
by a long way.
The number of companies that went public is also high, although not remarkably so. But those that did float managed
to amass huge sums, taking full advantage of the cash flowing readily into the sector.
Whether this largesse continues in 2021 is the burning question for IPO investors, and for now there are few signs of
diminishing appetites.
These analyses concern pure-play drug developers only.
The chart above illustrates how investor interest in biotech soared last year, with all listing companies managing to
float at or above the initial prices proposed by bankers. Many pulled off upsized offerings, selling substantially more
shares than planned at valuations inflated by huge demand.
17 Copyright © 2021 Evaluate Ltd. All rights reserved.A big year for biotech flotations
6
1.5
3
4.5
Am
ount
rai
sed
($bn
)
IPO
cou
nt
32
24
8
16
0
Amount raised ($bn)
IPO count
2016
Q1
0.59
Q2
0.68
Q3
0.54
Q4
2017
Q1
0.45
Q2 Q3
0.99
Q4
1.38
0.46
2018
Q1 Q2
2.25
1.03
Q3
1.91
Q4
1.84
2019
Q1
1.23
Q2 Q3 Q4
2020
Q1
1.51
Q2 Q3 Q4
3.21
1.05
1.95
0.60
0
10
17
12
6
8
16
12
14 14
2120
13 13
21
7
14
9
18
26
Year
23
1.26
3.28
4.69
Source: Evaluate®. January 2021Biotech IPOs by quarter on western exchanges
That trend has continued so far in 2021: The Chinese Car-T play Gracell Biotechnologies bumped up its offering by
25% to raise $209m, while the targeted oncology company Cullinan banked $250m after upsizing its offering and
pricing above range.
At time of writing Sana Biotechnology, a Hans Bishop-backed company, was poised to float. Despite having an
entirely preclinical pipeline, which is unlikely to move into the clinic before 2022 at the earliest, a multi-billion-dollar
valuation at IPO looks likely.
Of course, this huge demand also creates huge expectations, and the pressure is on for new issues to perform this
year. The track record of these freshly floated drug developers will be a major influence on investor appetite in the
coming months.
A more detailed look at 2020’s stats shows just how impressive last year was. The average amount raised per
IPO easily set a record, with a staggering 55 companies raising more than $100m, and 35 of these bringing in
over $200m.
With demand so high it is not surprising that these start-ups are raising what they can, while they can. But there are
quite literally huge downsides to the valuations that are being set and, as experienced biotech investors know, the
failure rate in this industry is high.
18 Copyright © 2021 Evaluate Ltd. All rights reserved.A big year for biotech flotations
Year No. of IPOs Amount raised ($bn)
Avg. amount raised ($m)
No. raising >$100m
2020 76 12.7 167 55
2019 55 4.9 88 17
2018 68 7.2 106 31
2017 50 3.9 77 15
2016 45 2.3 51 3
2015 78 5.1 65 17
Biotech IPO market by year Source: Evaluate®. January 2021
For more detailed analyses see these articles:
19 Copyright © 2021 Evaluate Ltd. All rights reserved.Covid or not, venture financing breaks records
8
2
3
1
4
6
7
5
Source: Evaluate®. January 2021Quarterly biopharma VC rounds
Com
bine
d in
vest
men
t ($
bn)
Num
ber
of r
ound
s2016
Q1
2.782.43 2.39
2.84 2.97
Q2 Q3 Q4
2017
Q1 Q2 Q3 Q4
2018
Q1 Q2 Q3 Q4
2019
Q1 Q2 Q3 Q4
2020
Q1 Q2 Q3 Q4
Year
2.17
4.10
4.304.34
3.773.42
4.75
5.73
4.884.78124
137
128
108
120
155
140
106
127
117
137
115 112
121
111
98105
118
108
0
200
50
75
25
100
150
175
125
0
3.843.60
97
3.964.73
5.01
$50m - $100m
$100m+ Other rounds
Count
Covid or not, venture financing breaks records
A year that started with cautious optimism over biotech venture financing has wound up
breaking records. Private biotechs ended 2020 having raised just under $20bn, eclipsing even
the boom year of 2018, the latest EvaluatePharma data reveal.
Full-year totals seem to have blown even the rosiest expectations out of the water. The numbers are so stunning that
it is difficult to find negative trends. If there is one it is that 2020’s absolute number of VC rounds was around the 450
mark, despite the record-breaking total cash raised; this is lower than 2017’s 528, and even than the 492 rounds in
2014, when only a total $7.2bn was raised.
This analysis includes only companies developing human therapeutics.
The clear trend is towards ever bigger venture rounds. Indeed, the average financing per round last year came in at
nearly $45m, almost $10m higher than the average in 2019.
This rising average was driven by a few truly monstrous individual company raises. The secretive cell therapy player
Lyell Immunopharma topped the first quarter with a $493m raise, while June saw Sana close an astounding $700m
series A round; both companies are linked to Hans Bishop, the former chief executive of Juno.
20 Copyright © 2021 Evaluate Ltd. All rights reserved.Covid or not, venture financing breaks records
Year Investment ($bn)
Financing count
Avg per financing ($m)
No of rounds ≥$50m
No of rounds ≥$100m
2020 19.99 448 44.63 154 59
2019 15.12 435 34.76 119 38
2018 17.89 481 39.06 130 38
2017 13.21 528 27.4 76 19
2016 10.44 493 22.51 52 15
Annual biopharma venture investments Source: Evaluate®. January 2021
It was Sana that pushed the second-quarter VC funding total above $5bn – the first time that quarterly total had
been breached in the current cycle. And it was only because of Sana that the third and fourth quarters looked like
a retrenchment; in reality, of course, each period brought in nearly $5bn of private cash.
It seems likely that once all the numbers are in – there are typically a few small rounds that are not announced
until some time after closing – the 2020 VC total will exceed $20bn. What does 2021 do for an encore?
For a more detailed analysis see this article:
21 Copyright © 2021 Evaluate Ltd. All rights reserved.Astrazeneca shows megamergers were still possible in 2020
Astrazeneca shows megamergers were still possible in 2020
It might not have been the biggest year for biopharma acquisitions but, despite a global
pandemic and rising asset prices, 2020 still managed to pull off a respectable transaction haul.
There had been concerns after a very flat first half but 2020 actually compares favourably to more normal years,
largely thanks to Astrazeneca, Gilead and Bristol Myers Squibb.
100
20
30
10
40
60
80
90
70
50
Source: Evaluate®. January 2021Combined M&A deal values
Val
ues
($bn
)
2016
Q1
44.6
22.8
31.4
9.6
40.7
Q2 Q3 Q4
2017
Q1 Q2 Q3 Q4
2018
Q1 Q2 Q3 Q4
2019
Q1 Q2 Q3 Q4
2020
Q1 Q2 Q3 Q4
Year
4.3
10.3 10.8
92.2
86.5
49.2
7.5 7.7
40.6
73.7
0
8.111.3
20.1
38.4
91.1Mega-mergers ($30bn+)
Company takeouts Other M&A deals
As well as straight company takeouts, this analysis also counts minority and majority stake purchases, acquisitions
of business units, reverse mergers and options; these are aggregated in “other deals”. The numbers also only
concern deals between dedicated drug makers and do not cover licensing transactions.
One of the continuing themes of the year, and indeed past years, was the fall in total transaction volumes. While
straight company takeouts staged a comeback this year, the total number of M&A deals was among the lowest
on record.
80
20
30
10
40
60
70
50
Source: Evaluate®. January 2021Quarterly M&A deal counts
Dea
l cou
nt
2016
Q1
56
46
53
48
72
Q2 Q3 Q4
2017
Q1 Q2 Q3 Q4
2018
Q1 Q2 Q3 Q4
2019
Q1 Q2 Q3 Q4
2020
Q1 Q2 Q3 Q4
Year
31
51
45 46
35
51
3335
4341
0
464444
46 46
Mega-mergers ($30bn+)
Company takeouts Other M&A deals
After disappointing activity in the first two quarters, as the world got to grips with new ways of working, deal volumes
and values alike picked up in the second half. Indeed, the final quarter saw the year’s biggest deal, Alexion’s $39bn
takeover by Astrazeneca.
The transaction was not only 2020’s sole mega-merger, it also went a long way to saving the year from being
distinctly pedestrian in terms of deal size. The other big spender in 2020 was Gilead, which was one of the few
multiple purchasers, having pulled out its chequebook for Immunomedics and Forty Seven, for a combined $26bn.
The Gilead deals also stand out because of the premiums paid to win those targets, at 110% and 111% respectively,
unusually large for transactions of that size. But asset prices have been high for the past couple of years, the graph
over the page shows.
With smaller developers flush with cash there is little expectation that asset prices will dip in 2021.
22 Copyright © 2021 Evaluate Ltd. All rights reserved.Astrazeneca shows megamergers were still possible in 2020
Source: Evaluate®. January 2021Paying a premium for biopharma buyouts
Ave
rage
pre
miu
m (%
)
100%
125%
75%
50%
150%
25%2016 2017 2018 2019 2020
R&D-stage
All companies
Commercial-stage
For more detailed analyses see these articles:
23 Copyright © 2021 Evaluate Ltd. All rights reserved.Astrazeneca shows megamergers were still possible in 2020
24 Copyright © 2021 Evaluate Ltd. All rights reserved.2020 drug approvals rise despite Covid-19
2020 drug approvals rise despite Covid-19
In a year featuring high-profile rejections and Covid-19-related inspection delays, the number
of new drug approvals might have been expected to decline. Not so. Despite everything that
happened in 2020, there were more US green lights last year than in 2019.
Over the course of 2020 the agency approved 57 novel medicines with a fifth-year sales potential of $21.6bn,
according to an Evaluate Vantage analysis of EvaluatePharma data – numbers that hold up well against the
pre-pandemic years.
The chart below looks at the total commercial potential of last year’s NMEs given the greenlight by both CDER
and CBER divisions. The $21.6bn figure includes just six drugs expected to become blockbusters, and only one –
Horizon’s thyroid eye disease therapy Tepezza – that is forecast to bring in over $2bn in the US by 2025.
Source: Evaluate®. January 2021FDA approval count vs. 5th year US sales
US
sal
es 5
th y
ear
post
app
rova
l ($
bn)
Tota
l NM
Es +
bio
logi
cals
app
rove
d
5
10
15
20
25
35
30
60
50
40
30
20
10
0
US sales 5th year post approval ($bn)
Novel NMEs and biologicals approved
Year
2019
30.3
201 1
11.8
2012
12.7
2013
14.2
2014
26.9
2015
26.7
2016
10.3
2017
33
42
32
49
56
2018
23.4
25
54
34.4
61
2020
21.6
0
49
57
The FDA also granted these approvals faster than it did in 2019: last year’s mean time to approval was 11.2 months,
compared with 12.3 months the previous year. This was largely down to the 23 projects in 2020 that were assessed
under priority review, and made it to market in an average of 7.3 months – speedier than every year in the last decade.
Given that approval of several projects has been delayed due to travel restrictions, is seems unlikely that next year’s
figures will look as good. High-profile hold-ups include Bristol’s liso-cel and Novartis’s inclisiran, which is branded in
Leqvio in Europe.
Source: Evaluate®. January 2021CDER+CBER average approval times
Ave
rage
rev
iew
tim
e (m
onth
s)
5
10
15
20
25
0
Standard reviews
Breakthrough therapy reviews
Priority reviews
PDUFA IV PDUFA VIPDUFA V
2011(n=33)
2012(n=42)
2013(n=32)
2014(n=49)
2015(n=56)
2016(n=25)
2017(n=54)
2018(n=61)
2019(n=49)
2020(n=57)
But things could have been worse. After the rejections of Gilead/Galapagos’s Jak inhibitor filgotinib and Biomarin’s
haemophilia A gene therapy valrox in the summer, there had been fears among industry watchers that the FDA was
finally baring its teeth. The latest data suggests that the agency is as friendly to biopharma as ever.
For a more detailed analysis see this article:
25 Copyright © 2021 Evaluate Ltd. All rights reserved.2020 drug approvals rise despite Covid-19
Medtech 2020 in review
26 Copyright © 2021 Evaluate Ltd. All rights reserved.A tale of two Covids for device makers
Stock index % change in 2020
Thomson Reuters Europe Healthcare (EU) 6%
Dow Jones U.S. Medical Equipment Index 22%
S&P Composite 1500 HealthCare Equipment & Supplies 17%
Indices
A tale of two Covids for device makers
A look at medtech stocks’ performance at the half-year point revealed a stark delineation
between those companies whose devices were of use in treating or diagnosing Covid-19 and
those whose businesses had suffered from the pandemic and its associated lockdowns.
Six months on and the picture is blurrier, though Covid-19 was still a huge influence on device makers. Overall, the
more established end of the sector is in a better position than it was in the summer, with the most successful big-cap
companies seeing their share prices more than double. Even greater gains were seen among smaller companies –
but so were greater losses.
Indices of medical device stocks point to the broader recoveries occurring across stock markets. They do not show
the sorts of gains medtech companies saw in pre-pandemic 2019, but the second half of 2020 allowed a palpable
improvement from the first.
Of all the big-cap companies, Teladoc saw its share price increase the most – indeed, it was not even in the big cap
cohort at the start of 2020. The various quarantine measures put in place starting from the spring of 2020 ensured
that demand soared for the remote health consultation services that Teladoc provides .
The acquisition of Livongo in August – at $18.5bn, last year’s largest medtech deal – prompted Teladoc’s stock to
fall slightly. But the group soon recovered as investors digested the possibilities of adding a company whose
business model signs up entire companies at a swoop. Livongo’s own share price had grown by 200% across the
first half of 2020.
Align Technology’s stock jumped 35% when its third-quarter earnings came in more than four times higher than
analysts had been expecting.
The Covid-19 angle here, Align’s chief executive Joseph Hogan explained, was the “Zoom effect”. People working
remotely, staring at their own image in videoconference software, took more notice of their dental imperfections
– and, because these white-collar workers had hung on to their jobs but spent less on holidays, commuting and
socialising, they had the cash to do something about it.
27 Copyright © 2021 Evaluate Ltd. All rights reserved.A tale of two Covids for device makers
Share price 12-mth change
Market cap at Dec 31 ($bn)
Market cap 12-mth change ($bn)
Top 5 risers
Teladoc Health ($) 139% 29.0 23.0
Novocure ($) 105% 17.6 9.2
Align Technology ($) 92% 42.1 20.1
Abiomed ($) 90% 14.7 6.9
West Pharmaceutical Services ($) 88% 20.9 9.8
Top 5 fallers
Boston Scientific ($) (20%) 51.5 (11.6)
Becton Dickinson ($) (13%) 68.6 (5.0)
Smith & Nephew ($) (12%) 18.5 (2.5)
Hitachi (¥) (12%) 37.4 (4.0)
Dentsply Sirona ($) (7%) 11.4 (1.1)
Large cap ($10bn+) medtech companies: top risers and fallers in 2020 Source: Evaluate®. January 2021
The fate of small and medium-sized medtech players last year largely hinged on their ability to avoid the worst of
the fallout from the pandemic. Two of the risers, Seegene and Meridian Bioscience, are developers of Covid-19
diagnostics or reagents. Meanwhile, the Swedish group Sedana was buoyed by an increase in demand for its
anaesthetic delivery technology.
Irhythm might be the only mid-size company whose share price change had nothing to do with Covid-19. In early
August its stock leapt 33% after the Centers for Medicare and Medicaid proposed new reimbursement codes for
long-term electrocardiogram monitoring. Irhythm’s Zio, a wearable heart monitor for detecting arrhythmias, would
be covered by these, and the decision was expected to drive sales growth.
Four months later the CMS reversed its decision, deciding not to finalise the new pricing, and Irhythm dropped a
quarter of its value. Fortunately it had an ace up its sleeve, announcing the appointment of Mike Coyle as chief
executive, following the retirement of Kevin King. Mr Coyle was formerly the leader of Medtronic’s highly successful
cardiovascular division, and investors’ collective delight permitted Irhythm to exit 2020 at close to a record high.
But the first half of 2021 could be another difficult period for medtechs. Despite the promise of newly approved
vaccines, the coronavirus continues to spread at a horrifying rate in many areas. Quarantine measures are once
more being instituted, and hospitals and doctors’ offices, close to capacity, are putting off less urgent surgeries
and appointments.
Share price 12-mth change
Market cap at Dec 31 ($m)
Market cap 12-mth change ($m)
Top 5 risers
Microport Scientific ($) 358% 9,786 7,878
Irhythm Technologies ($) 248% 6,849 5,036
Seegene (KRW) 530% 4,425 3,746
Sedana Medical (SKr) 153% 895 579
Meridian BioScience ($) 106% 806 418
Top 5 fallers
Livanova (£) (14%) 3,218 (433)
Nuvasive ($) (27%) 2,889 (1,136)
Inogen ($) (35%) 988 (515)
Natus Medical ($) (39%) 679 (446)
Accelerate Diagnostics ($) (55%) 432 (491)
Other significant risers and fallers in 2020 (ranked on market cap) Source: Evaluate®. January 2021
28 Copyright © 2021 Evaluate Ltd. All rights reserved.A tale of two Covids for device makers
For more detailed analyses see these articles:
Source: Evaluate®. January 2021Medtech M&As over the last decade – number and values of deals closed
Tota
l dea
l val
ue ($
bn)
Dea
l cou
nt
20
40
60
80
120
100
140
160
275
300
175
200
225
250
150
125
100
Total deal value ($bn)
Deal count
Year
2010
25.4
2011
59.6
2012
44.9
2013
23.3
2014
43.6
2015
128.2
2016
49.6
2017
98.6
2019
49.9
2018
29.0
274278
247239
230
251
263
213
2020
27.3
219
0
111
172
29 Copyright © 2021 Evaluate Ltd. All rights reserved.Medtech deal-making stands firm in difficult times
Medtech deal-making stands firm in difficult times
The remarkable thing about medtech business development trends across 2020 is how
resilient deal values have been under truly extraordinary circumstances. Transactions worth
a total of $27.3bn were completed last year – a highly respectable total, scarcely behind the
$29bn figure for 2018.
While Covid-19 appears to have had little effect on the overall sums spent, it has depressed deal-making activity in
terms of the numbers of signatures on dotted lines. Just 111 acquisitions were closed in 2020. For the purposes of this
report, the term encompasses business unit purchases and majority stakes as well as outright company purchases.
Public companies are enjoying persistently high valuations, and free-flowing capital in the venture markets means the
same is true of private groups. This is likely putting some potential buyers off, cutting the numbers of deals, while also
ensuring that when deals do go ahead the purchaser pays top dollar.
And one of these will go down in the hall of fame. At $18.5bn, Teladoc’s purchase of Livongo is the largest deal of
2020 and the sixth largest pure-play medtech acquisition of all time. Acquisitions in the telehealth area were always
on the cards, this being one of the fastest-growing forms of medical technology, but the lockdown and quarantine
regimes necessitated by the pandemic provided the impetus for the tie-up.
Source: Evaluate®. January 2021Medtech M&As by size – number of deals closed over the last decadeN
umbe
r of
dea
ls
10
20
30
40
50
60
70
80
110
90
100
120
130
140
Year
2010
5
38
91
2011
11
46
77
2012
6
40
76
2013
4
35
66
2014
8
47
60
2015
18
32
70
2016
12
33
67
2017
19
31
51
2018
8
42
43
2019
13
31
42
2020
4
15
21
0
$0-100m
$100m-$1bn
$1bn+
30 Copyright © 2021 Evaluate Ltd. All rights reserved.Medtech deal-making stands firm in difficult times
Note: Only includes deals with known value.
The coming year ought to see a return to more M&A deal-making, should vaccine rollouts go as hoped. There will
certainly be appetite for deals: the groups negatively affected by hospitals prioritising Covid-19 patients, such as
those active in the orthopaedics and cardiology arenas, will be keen to catch up by buying high-growth businesses.
Completion date
Acquirer Target Value ($bn) M&A focus Evaluate Vantage coverage
Oct 30 Teladoc Health Livongo 18,500 Diabetic care, healthcare IT and patient monitoring
Teladoc bets $18.5bn that Covid-19 will change the world for good
Nov 11 Stryker Wright Medical Group 5,400 Orthopaedics Wright and Stryker embark on a joints venture
Oct 2 Invitae Archer DX 1,400 In vitro diagnostics Invitae ends medtech merger drought with ArcherDX deal
Dec 31 Dentsply Sirona Byte 1,040 Dental Dentsply sees clear advantages to $1bn Byte deal
Nov 18 Steris Key Surgical 850 General hospital & healthcare supply
Steris turns the Key on 2020’s fifth biggest buy
Top 5 deals closed in 2020 Source: Evaluate®. January 2021
31 Copyright © 2021 Evaluate Ltd. All rights reserved.Medtechs rake in the venture cash
For a more detailed analysis see this article:
Medtechs rake in the venture cash
Looking at the cash raised by private medical device companies last year you would be hard
pressed to find any evidence of a pandemic at all. Venture investors poured $6.4bn into the
sector, with the particularly strong performance in the second half putting the total markedly
above 2019’s.
And some of the very biggest investments have already paid off handsomely. The liquid biopsy developers Grail
and Thrive hooked nine-figure rounds and were promptly bought for billions of dollars each, by Illumina and Exact
Sciences respectively. The VCs backing their fellow cancer blood test specialists Freenome and Caris Life Sciences
doubtless also had takeovers in mind.
Source: Evaluate®. January 2021Medtech VC investment, 2015-2020
Inve
stm
ent (
$bn
)
Fina
ncin
g co
unt
2.4
2.0
1.6
1.2
0.8
0.4
2.8
3.2
Investment ($bn)
Financing count
Year
2015
Q1
0.9
Q2
1.1
Q3 Q4
2016
Q1
1.4
Q2 Q3
1.0
Q4
1.0
2017
Q1
2.9
Q2
1.5
Q3
1.6
Q4
2018
Q1
2.1
Q2
1.7
Q3 Q4
2019 2020
Q1 Q2 Q3 Q4
1.1
1.2
1.2
2.2
Q1 Q2 Q3 Q4
1.7
1.9
1.2
1.5
1.0
1.6
1.0
1.4
1.0
1.1
120
100
80
60
40
20
140
160
0
117
79
94 92
79
9084
107
79
72
54
65
76
68
59 6055
51
107
55
35
61
30
50
0
32 Copyright © 2021 Evaluate Ltd. All rights reserved.Medtechs rake in the venture cash
In fact diagnostics companies dominate the top 10 rounds. In addition to the four liquid biopsy groups, Everlywell,
Karius and Oxford Nanopore Technologies – two of which are working on tests for Covid-19 – also enjoyed sizeable
cash injections. Diagnostics developers, with their relatively cheap and easily scalable technology, are always
appealing to VCs, but 2020 was something special.
The biggest round of 2020, however, did not go to a testing company. Nearly two years after the $1bn investment
that put it on top of 2019’s leaderboard, Verily obtained $700m from current investors, including its majority owner,
Alphabet, as well as Silver Lake, Temasek and the Ontario Teachers’ Pension Plan.
Date Company Investment ($m) Round Focus
Dec 17 Verily 700.0 Undisclosed Diabetic care; ophthalmics; patient monitoring
May 6 Grail 390.0 Series D In vitro diagnostics - liquid biopsy
Aug 26 Freenome 270.0 Series C In vitro diagnostics - liquid biopsy
Jul 29 Thrive Earlier Detection 257.0 Series B In vitro diagnostics - liquid biopsy
Oct 27 Caris Life Sciences 235.0 Undisclosed In vitro diagnostics - liquid biopsy
Dec 3 Everlywell 175.0 Series D In vitro diagnostics - various, inc Covid-19
Feb 24 Karius 165.0 Series B In vitro diagnostics - infectious disease
Mar 6 Insightec 150.0 Series F Diagnostic imaging
Jan 2 Oxford Nanopore Technologies 144.5 Undisclosed In vitro diagnostics - various, inc Covid-19
Feb 4 Outset Medical 125.0 Series E Nephrology
Top 10 VC rounds of 2020 Source: Evaluate®. January 2021
Verily’s history of vast fundraisings is emblematic of another trend that predates Covid-19: deals are getting bigger.
14 of the deals done last year were worth $100m or more, equalling the record set in 2018. And syndicates can
be vast: there were no fewer than 23 participants in Freenome’s $270m series C.
There is safety in numbers, of course, but it is to be hoped that VCs regain the ability to see the advantages of earlier,
riskier investments as the pandemic winds down. That said, it is difficult to argue with the case studies provided by
Grail and Thrive.
33 Copyright © 2021 Evaluate Ltd. All rights reserved.Medtechs rake in the venture cash
10
20
30
0
Source: Evaluate®. January 2021Bigger and better? – Average size of medtech VC deals, 2010-20
Ave
rage
siz
e ($
m)
40
Year
2010
10.0
2011
8.8
2012
8.8
2013
8.8
2014
10.4
2015
11.1
2016
12.8
2017
22.6
2018
23.8
2019 2020
37.4
25.1
For a more detailed analysis see this article:
34 Copyright © 2021 Evaluate Ltd. All rights reserved.Astounding success greets newly public device makers
Astounding success greets newly public device makers
Medical device companies listing in 2020 raised a highly respectable total of $2.3bn, an
impressive figure for what was a difficult year. Intriguingly, the action coincided with the height
of the Covid-19 pandemic, though none of the companies going public was specifically involved
with diagnosing or treating the disease.
So keen were investors on healthcare stocks that not one of the 10 largest medtech IPOs needed to price at a
discount, and some managed double-digit premiums. Moreover, all but one have enjoyed valuation growth since,
with six of the top 10 more than doubling their market cap by the end of the year.
Source: Evaluate®. January 2021Medtech IPOs, 2015-2020
Tota
l dea
l val
ue ($
m)
Num
ber
of d
eals
1,000
800
600
400
200
1,200 Total deal value ($m)
No of deals
Year
2015
Q1
207.
8
Q2
384.
5
Q3 Q4
2016
Q1
47.9
Q2 Q3
92.8
Q4
208.
3
2017
Q1
24.9
Q2
86.2
Q3
7.1
Q4
2018
Q1
263.
9
Q2
376.
2
Q3 Q4
2019 2020
Q1 Q2 Q3 Q4
1075
.8
108.
0
1182
.6
151.8
Q1 Q2 Q3 Q4
890.
8
545.
6
799.
1
695.
4
258.
8
123.
3
479.
9
56.9
172.
0
10
8
6
4
2
12
0
8
5
3
2
4
2
4
1
5
1
3
6
8
5
10
3
5 55
1
5
2
7
6
0
16.0
Cutting the listings data by quarters shows a clear lull in offerings as 2019 turned into 2020. But after the first quarter
of last year ended, just as it was becoming clear that Covid-19 had reached the West and was going to pose major
problems, IPOs came roaring back.
The graph above excludes IPOs that raised $1bn or more, to reflect the environment for younger groups in search of
growth capital.
35 Copyright © 2021 Evaluate Ltd. All rights reserved.Astounding success greets newly public device makers
Mega-floats are becoming an annual tradition in the device sphere. The select group that comprises Convatec, Siemens
Healthineers and Smiledirectclub was expanded to include Sotera Health, whose $1.2bn offering in November went out
at a modest premium. Stock in the group, which is active in the areas of sterilisation, lab testing and radioisotopes, has
done acceptably since – though arguably somewhat disappointingly compared with its fellows.
Date Company Focus Amount raised ($m)
Discount/ premium
Share price change to Dec 31
Nov 21 Sotera Health General hospital and healthcare supply 1,233 7% 19%
Sep 16 Outset Medical Nephrology 278 17% 111%
Jun 19 Genetron Holdings In vitro diagnostics 256 28% (13%)
Jun 12 Burning Rock Biotech In vitro diagnostics 223 14% 40%
Oct 2 Pulmonx Anaesthesia & respiratory 219 9% 263%
Aug 7 Acutus Medical Cardiology 183 6% 60%
Aug 21 Nano-X Imaging Diagnostic imaging 165 0% 154%
Oct 16 Eargo Ear, nose & throat 163 20% 149%
May 22 Inari Medical Cardiology 156 9% 359%
Sep 21 Implantica Gastroenterology; urology 152 0% 114%
Top 10 medtech IPOs of 2020 Source: Evaluate®, company websites. January 2021
All listings on the Nasdaq, except Implantica on Nasdaq First North.
The undisputed leader of the class of 2020, however, is Inari Medical. The company has two FDA-cleared products
designed to remove large emboli and thrombi from the peripheral vasculature, and managed to achieve profitability
within a year of entering the market. On its first day on Nasdaq the stock closed up 124%, and has done remarkably
well since. Inari’s market cap currently sits at $4.7bn.
For a more detailed analysis see this article:
36 Copyright © 2021 Evaluate Ltd. All rights reserved.Focus on Covid-19 does not distract the FDA
Focus on Covid-19 does not distract the FDA
Not bad, considering. The number of innovative medical devices approved or cleared by the
US FDA over the course of 2020 remained pretty steady from the year before, despite the
Covid-19 pandemic putting huge pressure on the agency to get new products and diagnostics
to market swiftly via a new regulatory path: the emergency use authorisation.
At 37, the number of first-time premarket approvals, which are granted to high-risk innovative medical technologies,
just pipped 2019’s figure of 35, and de novo 510(k) clearances, granted to low-risk products, held constant at 22.
Source: Evaluate®. January 2021US device approvals over the past decade
Num
ber
of F
DA
app
rova
ls
10
20
30
40
50
60
0
Year
Number of de novos
Number of PMAs
2010 2011 2012
3
22
10
44
13
41
2013
18
23
2014
28
33
2015
18
51
2016
26
40
2017
31
51
2019
22
35
2020
22
37
2018
44
35
But these approvals were clustered in particular therapeutic areas. Devices in just six different therapeutic
classifications were granted PMAs in 2020, versus nine different areas in both 2019 and 2018.
And diagnostics are way out in front. 23 different high-risk and seven low-risk assays were approved or cleared last
year, 62% and 32% of the total PMAs and de novos respectively. None of these was for Covid-19 – the only route to
market for coronavirus tests in 2020 was via emergency authorisation.
37 Copyright © 2021 Evaluate Ltd. All rights reserved.Focus on Covid-19 does not distract the FDA
EvaluateMedTech classification Number of PMAs
Average approval time (mths)
Number of de novos
Average approval time (mths)
Cardiology 9 14.9 3 12.0
Diagnostic imaging - - 1 5.4
Dental - - 1 12.9
Gastroenterology - - 1 6.9
In vitro diagnostics 23 12.2 7 9.0
Nephrology - - 2 15.0
Neurology 1 9.6 2 3.7
Ophthalmics 1 5.9 2 10.0
Orthopaedics 2 9.3 2 11.8
Urology 1 30.0 1 10.8
Total 37 - 22 -
Average 12.9 9.8
2020’s approvals by therapy area Source: Evaluate®, FDA. January 2021
Instead they were mostly for other sorts of infections. The Italian company Diasorin gained PMAs for a host of
hepatitis B and C diagnostics, and tests for HIV and human papillomavirus were also represented. A breath test for
H pylori developed by the Emirati group Arj Medical rounded out the infection diagnostics.
The other seven diagnostics approved are designed to detect, or guide the treatment of, cancer. The most notable
here were the two liquid biopsies, from Guardant Health and Roche, which gained their PMAs three weeks apart in
the summer. More cancer test approvals should be expected in the coming year, too.
For a more detailed analysis see this article:
Additional complimentary copies of this report can be downloaded at: www.evaluate.com/2020Review
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