ABOUT DATAMONITOR HEALTHCARE 2
About the Infectious & Respiratory Disease pharmaceutical analysis team 2
CHAPTER 1 EXECUTIVE SUMMARY 3
Objective of the analysis 3
Datamonitor insight into the systemic fungal infection market 4
Predictable, heavy losses continue but rejuvenation in sight 4
Patients, drugs, diagnostics and pathogens change market focus 4
Unmet need will require more inventive trial design to fulfil 5
Changing spectrum of clinical attractiveness 6
New blood in top ranks, but Pfizer will increase its lead 7
Contributing experts 8
Related reports 9
Upcoming related reports 9
CHAPTER 2 MARKET DEFINITION AND OVERVIEW 11
Market definition for this report 11
Current market situation 13
Geographical bias 16
High market concentration of brand sales 17
Key companies, strategies and approaches 19
Disease background 22
The fungal family tree - a history of succession 23
Pathogens and patients - linking immunocompromise to species 25
From Candida to Aspergillus and beyond - changing fungal epidemiology 27
The pathogens of the future: Fusarium and Scedosporium 29
Patients - drivers of demand 30
Transplant patients - driving the need for patient and pathogen-specific drug indications 33
Cancer - a core sector for years to come 35
HIV - HAART reducing demand, but facing increased azole resistance 37
Children and neonates - a dearth of basic information 38
The antifungal drug explosion - new challenges, new opportunities 40
Amphotericin B - saving lives 40
Ketoconazole - oral opportunities 41
Fluconazole - a pharmacological revolution 41
Caspofungin - a new class and a sign of things to come 42
Lipid amphotericins - setting the pharmacoeconomic standard 43
Diagnostics - shaping new management strategies 44
Conventional technologies - still invaluable tools 46
Molecular diagnostics: changing the outlook for drug use 48
Changing treatment paradigms: towards pre-emptive and targeted therapy 53
Prophylaxis - an indication under threat 53
Pre-emptive therapy - led by diagnostic advance 56
Empiric therapy - not enough any more 58
Directed therapy - the importance of specific and costly indications 59
Current unmet need - significant, numerous, and specific 60
Mortality 60
Pediatric data 62
More specific data and indications 62
Clinical trial design 63
Dealing with limited patient populations 64
Finding other ways of growing the sample size 64
Making sure the right patients are included 65
Confounding underlying disease 68
Making sure the group is comparable 68
Avoiding mortality (in all its forms) as an endpoint 69
Reconsidering trial duration: too short, or too long? 70
Adequately measuring diagnosis and response 71
Staying with the times: get molecular 72
CHAPTER 3 COUNTRY MARKET ASSESSMENTS 74
Seven major markets 74
Key facts 74
Opportunities and threats 78
Genericization of the first wave of safer drugs 79
Pharmacoeconomic analysis: influencing key decision makers 79
Which pathogen to look for next? 84
The commercial flipside: are antifungals worth it? 86
New treatment guidelines: The IDSA guidelines go international 89
United States 90
Key facts 90
Opportunities and threats 93
Broader FDA initiatives decrease time to market, but antibiotic scrutiny increases 94
DTC advertising - ideal for the acute sector, but not for antifungals 95
Pricing and reimbursement 96
Japan 100
Key facts 100
Opportunities and threats 104
The threat of foreign competition: enough to force domestic change? 105
Price cuts - still dominating pricing and reimbursement in Japan 106
Increasing uptake of generics 107
Lengthy approval process slows down access to the Japanese market 108
5EU 109
Key facts 109
Opportunities and threats 112
EMEA drug approval process harmonization 112
Smaller companies helped by European regulators 114
France 115
Opportunities and threats 117
Germany 119
Opportunities and threats 121
Italy 124
Opportunities and threats 126
Spain 129
Opportunities and threats 131
UK 134
Opportunities and threats 135
CHAPTER 4 DRUG ANALYSES AND FORECASTS 141
7MM overview 141
Regional contributions 141
Corporate performance 151
Pfizer to remain the leader of the pack 153
Merck and Johnson and Johnson need new options 154
Astellas and Schering Plough: On the way up with simple propositions 155
Azoles 156
Key impact summary 157
Azole analysis - historical and future outlook and comparative forecasts 159
Azoles as a proportion of total market value 160
Regional variations: azole value slump limited to US 164
Class composition - currently marketed products, new and recent launches and generics 169
Textbook generic displacement 171
Generic incursion beginning to stabilize 175
Marketed product overviews 180
Diflucan (fluconazole) 181
Prodif (fosfluconazole) 185
Sporanox (itraconazole) 190
Nizoral (ketoconazole) 196
Noxafil (posaconazole) 201
Vfend (voriconazole) 212
Pipeline products 218
Isavuconazonium chloride (BAL8557) 218
Others [not forecast] 223
Echinocandins 229
Key impact summary 230
Echinocandin analysis - historical and future outlook 231
Echinocandins as a proportion of total market value 233
Class composition - new launches detract from the incumbent 237
Regional variations: Japan leads the way 239
Brand overview - a tale of two territories 243
Marketed product overviews 247
Cancidas (caspofungin) 247
Mycamine (micafungin) 256
Eraxis (anidulafungin) 263
Pipeline products [not forecast] 270
HMR-3270 (aminocandin) 271
Polyenes 272
Key impact summary 273
Polyene analysis - historical and future outlook 274
Polyenes as a proportion of total market value 276
Regional variations 279
Class composition 283
Brand overview 285
Marketed product overviews 290
Abelcet (Amphotericin B Lipid Complex) 290
AmBisome (liposomal AmB) 294
Other branded polyenes [not forecast] 300
Pipeline products 303
SinuNase & BiOral Amphotericin B (AmB Oral and Nasal cochleates) 303
NKTR-024 (amphotericin B inhalation powder) 306
Discontinued/withdrawn products 308
Others 309
Group overview 310
Others as a proportion of total market value 310
Regional sales composition 311
Branded versus generic and new launch composition 313
Pipeline products 316
Mycograb (efungumab) 316
Others [not forecast] 319
Forecast methodology 320
CHAPTER 5 FORECAST ASSUMPTIONS 321
Patent expiries and generic incursion 321
Approvals and launches 327
Other studies 332
New guidelines 339
BIBLIOGRAPHY 343
Presentations 343
Books 343
Journal papers 344
Epidemiology 344
Trial design and data 345
Cost efficacy 349
Diagnosis and Diagnostics 350
Presentations 353
Websites 354
Datamonitor reports 354
APPENDIX A - MARKET DATA AND MAJOR BRAND KEY FACTS 355
Summary systemic fungal disease market data 355
APPENDIX B - MARKET FORECAST DATA 357
Seven major markets 357
M5EU 361
US 364
Japan 366
France 368
Germany 371
Italy 373
Spain 376
UK 378
APPENDIX C 381
Contributing experts 381
Report methodology 381
About Datamonitor 381
About Datamonitor Healthcare 381
About the Infectious & Respiratory Disease analysis team 382
About the Antibacterials analysis team 383
Key therapy team members 384
Holger Rovini, Head of Respiratory and Infectious Diseases 384
Disclaimer 385
List of Tables
Table 1: Datamonitor product groupings for the systemic fungal infections market 12
Table 2: 7MM antifungal sales by region by volume and value (%), 2006 17
Table 3: Key players in the market for systemic fungal infection, 2007 19
Table 4: Antifungal volume sales leader board by rank, sales and share, 2006 21
Table 5: Antifungal value sales leader board by rank, sales and share, 2006 22
Table 6: Predominant and emerging opportunistic fungal pathogens of clinical significance, 2007 25
Table 7: Types of immunocompromise, causes and associated fungal pathogens 26
Table 8: Stratified risk groups for invasive Aspergillosis 30
Table 9: Examples of risk factors associated with invasive fungal infections 32
Table 10: Galactomannan testing for invasive aspergillosis in hematologic malignancy and allogeneic bone marrow transplant patients 49
Table 11: Nosocomial bloodstream infection organism distribution in the US, 2004 61
Table 12: Mortality due to invasive mycoses 61
Table 13: 7MM antifungal leading brands by value sales ($m), 2006 and CAGR growth, 2002-06 77
Table 14: 7MM leading antifungal brands by volume sales (SUm), 2006 and CAGR growth, 2002-06 77
Table 15: 7MM pportunities and threats in the antifungals market, 2007 78
Figure 23: Healthcare spending as a proportion of GDP in the 7MM, 2004 81
Table 16: The pharmacoeconomics of prophylaxis 83
Table 17: Definition for Immune Reconstitution Inflammatory Response in Mycoses 86
Table 18: US leading antifungal brands by value sales ($m), 2006 and CAGR growth, 2002-06 92
Table 19: US leading brands by volume sales (SUm), 2006 and CAGR growth, 2002-06 92
Table 20: United States: summary of opportunities and threats in the antifungals market, 2007 93
Table 21: Japan leading brands by value sales ($m), 2006 and CAGR growth, 2002-06 103
Table 22: Japan leading brands by volume sales 2006 (SUm) and CAGR growth, 2002-06 103
Table 23: Japan: summary of opportunities and threats in the antifungals market, 2007 104
Table 24: 5EU leading antifungal brands by value sales ($m), 2006 and CAGR growth, 2002-06 111
Table 25: 5EU leading antifungal brands by volume sales (SUm), 2006 111
Table 26: 5EU Opportunities and Threats in the antifungals market, 2007 112
Table 27: France leading antifungal brands by value sales ($m), 2006 and CAGR growth, 2002-06 115
Table 28: France leading antifungal brands by volume sales (SUm), 2006 116
Table 29: France: opportunities and threats in the antifungals market, 2007 117
Table 30: Germany leading antifungal brands by value sales ($m), 2006 and CAGR growth, 2002-06 120
Table 31: Germany leading antifungal brands by volume sales (SUm), 2006 and CAGR growth, 2002-06 120
Table 32: Germany: opportunities and threats in the antifungals market. 2007 121
Table 33: Italy leading antifungal brands by value sales ($m), 2006 and CAGR growth, 2002-06 125
Table 34: Italy leading brands by volume sales 2006 (SUm) and CAGR growth, 2002-06 125
Table 35: Italy: opportunities and threats in the antifungal market, 2007 126
Table 36: Spain leading brands by value sales ($m), 2006 and CAGR growth, 2002-06 129
Table 37: Spain leading brands by volume sales (SUm), 2006 and CAGR growth, 2002-06 130
Table 38: Spain: opportunities and threats in the antifungal market, 2007 131
Table 39: UK leading brands by value sales ($m), 2006 and CAGR growth, 2002-06 134
Table 40: UK leading brands by volume sales (SUm), 2006 and CAGR growth, 2002-06 134
Table 41: UK opportunities and threats in the antifungal market, 2007 135
Table 42: 7MM antifungal sales - indexed volume and value sales and average pricing, 2002-06 143
Table 43: Forecast 7MM antifungal sales by volume, value and region, 2006-2016 145
Table 44: Forecast new launches, existing products and generics by regional contribution, and CAGR (2006-16) 147
Table 45: Forecast regional sales by new launch, existing product and generic contribution, and CAGR (2006-16) 150
Table 46: Ranking and shares 2006/16 - Key players by volume and value 152
Table 47: Market growth by key player, volume and value sales, 2006-16 153
Table 48: Indexed 7MM azole class sales versus rest of antifungal market, 2002-06 162
Table 49: Forecast 7MM azole class sales versus rest of antifungal market sales, 2006-2016 164
Table 50: Indexed azole class sales by region, 2002-06 167
Table 51: Forecast azole class sales by region, 2006-2016 169
Table 52: Forecast 7MM azole sales - new launches, existing products and generics, 2006-2016 171
Table 53: Indexed 7MM azole class sales - key brands and generics, 2002-06 173
Table 54: Forecast 7MM azole class sales - key brands and generics, 2006-2016 175
Table 55: Indexed 7MM generic azole volume and value sales, 2002-06 178
Table 56: Forecast 7MM azole generic sales by molecule and combined brands, 2006-2016 180
Table 57: Diflucan: Key facts 181
Table 62: Noxafil (posaconazole) trial data overview, 2007 210
Table 69: Indexed 7MM echinocandin class sales versus rest of antifungal market by volume and value, 2002-06 235
Table 70: Forecast 7MM echinocandin class sales versus rest of antifungal market by volume and value, 2006-2016 237
Table 71: Forecast 7MM echinocandin sales - new launches, existing products and generics 2006-2016 239
Table 72: Indexed echinocandin class volume and value sales by region, 2002-06 241
Table 73: Forecast 7MM echinocandin sales by region, 2006-2016 243
Table 74: Key echinocandin brands - indexed 7MM volume and value sales, 2002-06 245
Table 75: Forecast 7MM echinocandin brand and combined generic sales, 2006-2016 247
Table 80: Indexed 7MM polyene class sales versus rest of antifungal market, 2002-06, 2002-06 277
Table 81: Forecast 7MM polyene sales versus rest of antifungal market by volume and value sales, 2006-2016 279
Table 82: Indexed 7MM polyene class sales by region, 2002-06 281
Table 83: Forecast 7MM polyene volume and value sales by region, 2006-2016 283
Table 84: Forecast 7MM polyene sales - new launches, existing products and generics, 2006-2016 285
Table 85: Indexed 7MM polyene class volume and value sales - key brands and generics, 2006 287
Table 86: Forecast 7MM volume and value polyene brand sales and combined generics, 2006-2016 289
Table 89: Other amphotericin B products 301
Table 92: Indexed 7MM other class volume and value sales versus rest of antifungal market, 2002-06, 310
Table 93: Indexed Other 7MM volume and value sales by region, , 2002-06 311
Table 94: Forecast 7MM volume and value sales of other antifungals by region, 2006-2016 312
Table 95: Indexed 7MM combined other branded products volume and value sales versus combined generic products, 2002-06 313
Table 96: Forecast 7MM volume and value Other brand sales and combined generics, 2006-2016 315
Table 98: Abelcet patent expiry, 2007-2016 321
Table 99: AmBisome patent expiry, 2007-2016 321
Table 100: Caspofungin patent expiry, 2007-2016 322
Table 101: Diflucan generic incursion, 2007-2016 323
Table 102: Eraxis patent expiry, 2007-2016 323
Table 103: Mycamine patent expiry, 2007-2016 324
Table 104: Noxafil patent expiry I, 2007-2016 325
Table 105: Vfend patent expiry I, 2007-2016 325
Table 106: BioOral (amphotericin B cochleate) Launch, 2007-2016 327
Table 107: SinuNase (amphotericin B cochleate) Launch, 2007-2016 327
Table 108: BAL8557 Launch, 2007-2016 328
Table 109: Eraxis: launch, 2007-2016 329
Table 110: Mycamine: launch, 2007-2016 329
Table 111: Mycograb: launch, 2007-2016 330
Table 112: Noxafil: Intravenous formulation launch, 2007-2016 332
Table 113: Cancidas pharmacoeconomic studies: Caspofungin versus AmB - cost-efficacy, suspected fungal infection/neutropenic fever 332
Table 114: Cancidas trials: prophylaxis, high-risk liver transplant/leukemia, 2007-2016 333
Table 115: Cancidas trials: prophylaxis/pre-emptive indications, candidiasis/aspergillosis, 2007-2016 334
Table 116: Cancidas trials: prophylaxis/pre-emptive indications, critical care indications, 2007-2016 335
Table 117: Cancidas trials: therapeutic Phase II trial data, pediatric febrile neutropenia I, 2007-2016 336
Table 118: Eraxis trial data: Anidulafungin/Voriconazole combination trial, 2007-2016 337
Table 119: Mycamine trial data: Micafungin/Voriconazole combination trial in Aspergillus, 2007-2016 338
Table 120: New IDSA Guidelines - Aspergillus, 2007 339
Table 121: New IDSA Guidelines - Blastomycosis/Sporotrichosis/Histoplasmosis, 2007 340
Table 122: New IDSA Guidelines - Candidiasis, 2007 340
Table 123: New IDSA Guidelines - Endemic mycoses, 2007 341
Table 124: New IDSA Guidelines - Prophylaxis, 2007 342
Table 125: Summary Market Data 355
Table 126: Seven major market systemic fungal infection drug sales ($m) forecasts, 2007-16 357
Table 127: M5EU systemic fungal infection drug sales ($m) forecasts, 2007-16 361
Table 128: US systemic fungal infection drug sales ($m) forecasts, 2007-16 364
Table 129: Japan systemic fungal infection drug sales ($m) forecasts, 2007-16 366
Table 130: France systemic fungal infection drug sales ($m) forecasts, 2007-16 368
Table 131: Germany systemic fungal infection drug sales ($m) forecasts, 2007-16 371
Table 132: Italy systemic fungal infection drug sales ($m) forecasts, 2007-16 373
Table 133: Spain systemic fungal infection drug sales ($m) forecasts, 2007-16 376
Table 134: UK systemic fungal infection drug sales ($m) forecasts, 2007-16 378
List of Figures
Figure 1: Pharmaceutical sales by therapy area across the seven major markets ($ billion) 14
Figure 2: Indexed 7MM antifungal market sales by class, 2002-06 15
Figure 3: Performance of the US, 5EU and Japan antifungal markets, 2002-06 16
Figure 4: Key brand share of the antifungal market, 2006 18
Figure 5: Key player shares of core branded antifungal sales (%), 2006 20
Figure 6: The changing paradigms of the antifungals market, 1950s-2000s 23
Figure 7: Changing spectrum of invasive candidiasis species: episodes per 1,000 admissions, 1988-1992 28
Figure 8: Changing spectrum of invasive moulds: incidence per 1,000 patient days, 2000-03 28
Figure 9: Implications of changes in the management of underlying conditions 31
Figure 10: Milestones in organ transplant, 1950s-2000s 33
Figure 11: Timeline of fungal infection risk in solid organ transplant recipients 34
Figure 12: Availability of neonate data for fluconazole 39
Figure 13: The antifungal drug explosion - drug development since the 1950s 40
Figure 14: Cellular targets of antifungal classes 43
Figure 15: Increased hospital costs associated with Candidemia 45
Figure 16: (1-3) ß-D-Glucan as a marker for invasive mycoses - cutting the time to diagnosis 51
Figure 17: Fungal infection as a continuum and therapeutic options 53
Figure 18: Questioning the value of Noxafil as an aspergillosis prophylactic 55
Figure 19: Prophylaxis, empiric and pre-emptive therapy in the context of duration of neutropenia 57
Figure 20: Unmet need in invasive fungal disease - high Candida Blood Stream Infection mortality in high-risk patient groups, 2007 60
Figure 21: Suboptimal diagnosis and outcome measurement reduces potential trial participant population in invasive aspergillosis 67
Figure 22: 7MM antifungal sales by leading brands versus rest of market by indexed value and volume sales and average price, 2002-06 76
Figure 24: Key pricing controls used globally, 2006 82
Figure 25: Net Present Value - why the antifungal pipeline differs from other infectious disease paradigms 87
Figure 26: Antifungal treatment scenarios - more creative trials with major clinical appeal 89
Figure 27: US antifungal sales by leading brands versus rest of market by indexed value and volume sales and average price, 2002-06 91
Figure 28: Decrease of FDA's mean total approval time, 1995-2005 94
Figure 29: Generic impact of fluconazole and itraconazole patent expiries versus other generic and branded sales on the US antifungals market, 2002-06 98
Figure 30: Japanese sales by leading brands versus rest of market by indexed value and volume sales and average price, 2002-06 102
Figure 31: 5EU sales by leading antifungal brands versus rest of market by indexed value and volume sales and average price, 2002-06 110
Figure 32: 7MM antifungal sales by region: - indexed volume and value sales and average pricing, 2002-06 142
Figure 33: Forecast 7MM antifungal sales by volume, value and region, 2006-2016 144
Figure 34: Forecast new launches, existing products and generics by regional contribution, and CAGR (2006-16) 146
Figure 35: Forecast 7MM antifungals sales by region - new launch, existing product and generic contribution, 2006-2016 149
Figure 36: Key events impacting the azole class, s2002-2016 157
Figure 37: Events impacting Azole class members, 2007-2016 158
Figure 38: Indexed 7MM azole class sales versus rest of antifungal market sales , 2002-06 161
Figure 39: Forecast 7MM azole class sales versus rest of antifungal market, 2006-2016 163
Figure 40: Indexed 7MM azole sales by region, 2002-062002-06 166
Figure 41: Forecast 7MM azole class sales by region, 2006-16 168
Figure 42: Forecast 7MM azole sales - new launches, existing products and generics, 2006-2016 170
Figure 43: Indexed 7MM azole class sales - key brands and generics, 2002-06 172
Figure 44: Forecast 7MM azole class sales - key brands and generics, 2006-2016 174
Figure 45: Indexed 7MM generic azole volume and value sales, 2002-06 177
Figure 46: Forecast 7MM azole generic sales by molecule and combined brands, 2006-2016 179
Figure 47: Diflucan 7MM key metrics - indexed volume and value sales, and average pricing, 2002-06 182
Table 58: Prodif: Key facts 185
Figure 48: Prodif 7MM key metrics - indexed volume and value sales, and average pricing, 2002-06 187
Table 59: Sporanox: Key facts 190
Figure 49: Sporanox 7MM key metrics - indexed volume and value sales, and average pricing, 2002-06 192
Table 60: Nizoral: Key facts 197
Figure 50: Nizoral 7MM key metrics - indexed volume and value sales, and average pricing, 2002-06 199
Table 61: Noxafil: Key facts 201
Figure 51: Noxafil 7MM key metrics - indexed volume and value sales, and average pricing, 2002-06 203
Table 63: Vfend: Key facts 212
Figure 52: Vfend 7MM key metrics - indexed volume and value sales, and average pricing 2002-06 214
Table 64: Isavuconazonium chloride: Key facts 218
Table 65: UR-9825: Key facts 223
Table 66: E1224: Key facts 225
Table 67: Ravuconazole: Key facts 227
Table 68: SSY-726: Key facts 228
Figure 53: Key events impacting the echinocandin class events, 2001-2016 230
Figure 54: Events impacting echinocandin class members, 2007-2016 231
Figure 55: Indexed 7MM echinocandin sales versus rest of antifungal market sales, 2002-06 233
Figure 56: Forecast echinocandin sales versus rest of antifungal market 7MM by volume and value, 2006-2016 236
Figure 57: Forecast 7MM volume and value echinocandin sales -new launches, existing products and generics, 2006-2016 238
Figure 58: Total echinocandin sales by region, , 2002-06 240
Figure 59: Forecast 7MM echinocandin sales by region, 2006-2016 242
Figure 60: Key echinocandin brands and generics - indexed 7MM sales, 2002-06 244
Figure 61: Forecast 7MM echinocandin brand and combined generic sales, 2006-2016 246
Table 76: Cancidas: Key facts 247
Figure 62: Cancidas 7MM key metrics - indexed volume and value sales and average pricing, 2002-06 249
Figure 63: Indexed US branded echinocandin volume and value sales, 2002-06 252
Table 77: Mycamine: Key facts 256
Figure 64: Mycamine 7MM key metrics - indexed volume and value sales and average pricing, 2002-06 258
Figure 65: Indexed US echinocandin wholesale pricing tactics by quarter, Q2 2005-Q2 2007 260
Table 78: Eraxis: Key facts 263
Figure 66: Eraxis 7MM key metrics - indexed volume and value sales, and average pricing 2002-06 265
Figure 67: Indexed first five quarter volume and value sales, Mycamine versus Eraxis, Q2 2005-Q2 2006 267
Table 79: HMR-3270: Key facts 271
Figure 68: Key events impacting the polyene class, 2002-2014 273
Figure 69: Events impacting polyene class members, 2007-2016 274
Figure 70: Indexed 7MM polyene class sales versus rest of antifungal market, 2002-06 276
Figure 71: Forecast 7MM polyene sales versus rest of antifungal market: key metrics - volume and value sales and average pricing, 2006-2016 278
Figure 72: Indexed 7MM polyene class sales by region, 2002-06 280
Figure 73: Forecast 7MM volume and value polyene sales by region, 2006-2016 282
Figure 74: Forecast 7MM polyene sales - new launches, existing products and generics, 2006-2016 284
Figure 75: Indexed 7MM polyene class sales - key brands and generics, 2006- 286
Figure 76: Forecast 7MM volume and value polyene brand sales and combined generics, 2006-2016 288
Table 87: Abelcet: Key facts 290
Figure 77: Abelcet 7MM key metrics - indexed volume and value sales and average pricing 2002-06 292
Table 88: AmBisome: Key facts 294
Figure 78: AmBisome 7 Major Markets key metrics - indexed volume and value sales and average pricing 2002-06 297
Figure 79: AmBisome - indexed volume sales by region, 2002-06 299
Table 90: SinuNase & BiOral Amphotericin B - Amphotericin B Oral and Nasal cochleates: Key facts 303
Table 91: NKTR-024 - amphotericin B inhalation powder: Key facts 306
Figure 80: Forecast 7MM volume and value Others brand sales and combined generics, 2006-16 314
Table 97: Mycograb: Key facts 316