Introduction Maureen Riordan Principal Analyst, Deals Intelligence Deanna KamienskiPrincipal Analyst, Deals Intelligence In the medtech industry, financing activity sawa decline in both dollars and deal volume in2023 ($8.9 billion for 300 deals vs. $13 billionfor 356 deals in 2022). M&A activity wasparticularly strong, with seven separate billion-dollar-plus acquisitions; however, total 2023medtech M&A spend was $26.5 billion from 80deals, decreasing from $34.3 billion from 92deals in 2022. During 2023, the biopharma industry achieveda total potential deal value (PDV) of$186.9 billion across 718 alliances. While dealvolume for alliances saw a substantial drop in2023, the overall aggregate value was $10 billionmore than 2022. Once again, oncology was themost active therapeutic area for partnering,with deals focused on antibody drug conjugates(ADCs) leading the way. This report provides an overview of alliance,merger and acquisition, and financing dealactivity across the worldwide biopharma,medical device, and in vitro diagnosticsindustries during 2023 as reported byBiomedtracker. The overall data is presentedacross deal types, therapy areas, and paymentor financing structures. The top deals by dollarvalue in each space are closely detailed. Notethat PDV is defined as the sum of disclosedup-front payment(s) plus any announcedor received pre- or post-commercializationmilestone payment(s). Similarly, merger and acquisition volumesshowed a slight decrease (7%) from the previousyear, with 135 deals together valued at$158.2 billion, but the aggregate deal value rosesignificantly (83%) from 2022. The M&A valueswere also significantly higher than in 2022largely due to 27 deals having values of a billiondollars or greater, four of which were morethan $10 billion. Acquisitions of ADC-focusedcompanies were also prominent in 2023. Biopharma financing, which brought in anaggregate $74.2 billion, also saw a decline inthe number of transactions (936 vs. 960 in 2022)but exceeded overall 2022 values ($66.6 billion)by 11%, with the average deal value increasingby 14%. 2023 D eal-Making R oundup Biopharma Alliances a collaboration between Merck and DaiichiSankyo, worth up to $22 billion (making up29% of the Q4 total PDV). The 2023 aggregatealliance dollars increased by 5% in value over2022’s $178.3 billion, but the 2023 full-yearbiopharma alliance deal volume showed an 18%decline versus 2022’s 880 transactions. Biopharma alliances for 2023 reached a totalPDV of $186.9 billion from 718 transactions (291with disclosed values) [Figure 1]. In terms ofdeal volume, Q1 was the most active quarterof the year, with 208 transactions. In relationto PDV, Q4 was the highest at $75.4 billion,and had the highest-valued deal of the year: 2023 D eal-Making R oundup In the largest alliance of the year, DaiichiSankyo and Merck penned a potential $22billion deal involving three of Daiichi’s DXdADCs: patritumab deruxtecan, ifinatamabderuxtecan, and raludotatug deruxtecan[Table 1]. The companies will jointly developand commercialize the candidates worldwide,except in Japan where Daiichi maintainsexclusive rights. Patritumab deruxtecan wasgranted Breakthrough Therapy Designation bythe FDA in December 2021 for EGFR-mutated locally advanced or metastatic non-small celllung cancer with disease progression on orafter treatment with a third-generation tyrosinekinase inhibitor and platinum-based therapies.BLA submission in the US is planned by theend of March 2024 for patritumab deruxtecan.Ifinatamab deruxtecan is in Phase II forpreviously treated extensive-stage small celllung cancer, and raludotatug deruxtecan is in afirst-in-human Phase I trial for ovarian cancer. 2023 D eal-Making R oundup 2023 D eal-Making R oundup For 2023 overall, deals with an announcedmilestone accounted for 75% of the total PDVin the 196 deals in which the milestone wasdisclosed, while up-fronts made up just 10%of the total PDV in the set of 200 for which theup-front amount was disclosed [Figure 2]. Therewere 48 deals in all with disclosed potentialfuture payments of a billion dollars or more; theMerck/Daiichi Sankyo collaboration deal wasat the top with its up to $16.5 billion in possible milestones, making up the bulk of the deal’svalue. Of the transactions with disclosed values,there were four deals with the up-front amountexceeding a billion dollars. After Merck/DaiichiSankyo, with its $4 billion up-front amount,the next highest was Bausch & Lomb’s $1.75billion payment for Novartis’ dry eye ophthalmicsolution Xiidra (lifitegrast), accounting for 70%of the deal’s total $2.5 billion PDV. 2023 D eal-Making R oundup Oncology was the most active therapeutic areafor partnering during 2023, with 284 deals (40%of all partnerships) having at least one assetin this disease area [Figure 3]. Oncology wasfollowed by deals with no therapy area specified and neurology (with 97 and 93 deals apiece,respectively). Autoimmune/immunology was thesubject of 65 alliances, rep