The relative absence of blockbuster M&A within medtech in 2018, compared with recent years, does not mean that consolidation of the industry – and of providers and payers – will not continue apace in 2019 and beyond. In fact, it is written – if not in the stars then possibly in digital coding – that there will be fewer and bigger entities at the top end of the ecosystem of medtech stakeholders. And rising demand will be met more and more by digital tools and functionalities.

Sanofi and Gilead moved down in the rankings of Scrip's top 100 pharmaceutical companies, based on 2017 pharma sales, while Johnson & Johnson, GSK and AbbVie moved up. Shire joined the top 20 just as it is about to be consumed by Takeda.

Scrip's latest rankings of the top 100 revenue earners in the medical technology industry, published in Outlook 2019, show the groups leading the global market tightening their grip further in 2017. This was partly a function of providers choosing to partner more and more with fewer suppliers who can offer a wider provision of services. But it was steady as she goes for most of the multinational medtechs, with some major exceptions, and there will be more M&A reflected in next year's rankings, based on 2018 revenues.

With a challenging new decade of scientific discovery looming, 2019 is the positioning year for biopharma to make value, transparency, information and culture work seamlessly to achieve innovations that matter to patients, payers and society.

The recent upsurge in cases of high drug prices being pursued by competition authorities in Europe could help to lay down some markers for judging what is an “excessive” price in future. At the same time, Brexit could see the UK and the EU begin to drift apart in terms of how they apply competition law to pricing issues.

Cardiovascular diseases are responsible for 30% of worldwide deaths, and about 25% of the global population experiences mental illness each year. The negative impact of these conditions on society remain substantial. Development of digital tools to provide support to high-risk groups and patients, healthcare providers, and communities in general, is an area of significant opportunity.

Poseida and Legend/Janssen aim to develop CAR-T therapies with improved efficacy and safety, and both programs delivered updates at ASH for BCMA-targeting CAR-T candidates in multiple myeloma that could challenge Celgene/bluebird's lead in this field.

Drug companies are complying with their obligation to submit clinical trial results to the US-based ClinicalTrials.gov database, but major errors in their submissions prevent the results from being uploaded in a timely manner.

Some of the most anticipated data at ASH are for therapies targeting BCMA in multiple myeloma, including a next-gen CAR-T from bluebird and Celgene as well as Amgen's novel BiTE, but an update from China's Legend Biotech and J&J could steal the show.