Industry World Preview and Outlook to 2024

One of the things humans have been proven amazingly bad at is predicting. Whether it’s the roll of the dice in Vegas or the outcome of an election, we are often hilariously wrong. Yet predicting is what we all have to do, isn’t it? We need to foresee the chances of success in a corporate initiative, a personal relationship, or a financial investment.

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So all due credit to those who know how to crunch the numbers, examine the trends and regularly provide a fairly reliable view into the future.

Evaluate Pharma has been doing an admirable job of this for over a decade, and we are happy to excerpt the following from their World Preview 2019 and Outlook to 2024.

They cover all sectors of the industry, separately and together, highlighting drug sales, patent risk, R&D spend, global brand sales and market performance by therapy area. They look at how tech is affecting everything from production to supply chain to marketing; what will change with the emergence of gene therapy; what factors will impact pricing; machine learning and AI; the reimbursement vectors; the political winds; everything that makes this industry the roller-coaster ride of the economy. This gives us all a perspicacious insight into how we should direct our own energies, adjust our strategies, and plan for the road ahead.

If you were to boil down the trajectory of healthcare into a single word, it would probably be “innovation.” Of course, that’s a risky word, as fraught with risk as it is with promise. Where will all this innovation take us? Will we really reach $1.8T by 2024, as Evaluate suggests? Read on, and fasten your seatbelts. It’s going to be a bumpy flight.

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  • Oncology is the area with the largest proportion of clinical development spending, with 40% of total pipeline expenditure, and close to 20% market share of pharma sales in 2024
  • R&D spend is forecast to grow at a CAGR of 3.0% to 2024, lower than the CAGR of 4.2% between 2010 and 2018, partially driven by companies focusing on smaller indications with lower clinical development cost burden
  • Keytruda is set to be the top selling drug worldwide in 2024, as Humira loses its top spot due to the adalimumab biosimilar entry in the EU and the expected USA biosimilar competition from 2023
  • Should Bristol Myers-Squibb complete its intended acquisition of Celgene and forecast projections for a combined portfolio hold, the combined entity would be the 3rd largest pharmaceutical company, based on 2024 prescription sales
  • Vertex’s triple combination, VX- 659/VX-445 + Tezacaftor + Ivacaftor, is anticipated to be the most valuable project in the pharmaceutical industry pipeline with an NPV of close to $20B
  • Roche leads the way in biotechnology, with a forecasted $38.7B of biologic sales in 2024, despite a decrease in biotech market share of -5.4% owing to the effect of biosimilars
  • Johnson & Johnson is forecast to narrowly overtake Roche to be the biggest spender on pharmaceutical R&D in 2024

Worldwide Prescription Drug Sales (2010-2024)

Prescription drug sales CAGR for 2019 through 2024 three times that in 2010 through 2018; Orphan drug market to almost double.

Prescription drug sales for 2010 through 2018 grew at a CAGR of+2.3%. This can be compared to the forecast annual CAGR of +6.9% for 2019 through 2024, with expected sales to reach $1.18T. The growth rate for the prescription market in 2019 is forecast to be+2.0%, which depicts a decline in growth rate compared to 2018 (+5.0%). The Trump administration has been in the news for discussions related to changes to the prescription drug policy which could be implemented in early 2020. These changes could be challenging for pharmaceutical drug manufacturers, as it could affect drug prices in one of the largest markets in the world. On the positive side, the industry has seen the launch of Ultomiris (Alexion Pharmaceuticals) and Takhzyro (Takeda). Consensus forecasts indicate that $198B of sales are at risk between 2019 and 2024, with 2023 set to see the expiry of key patents for a number of biologics, including Humira and Stelara.

Figure 1: Worldwide Prescription Drug Sales (2010-2024)

Worldwide Prescription Drug Sales (2010-2024)

Both of these products are still forecast to retain spots within the world’s top 10 selling drugs in 2024. (Figure 1)

Worldwide Prescription Drug Sales in 2024: Top 10 Companies

Pfizer returns to top spot for worldwide sales of prescription-drugs in 2024.

As the top three continue to battle it out, EvaluatePharma® finds that Pfizer has once again pushed ahead of Novartis and Roche for the Worldwide Prescription Drug Sales number one spot in 2024.

Novartis is also due to jump up to the number two spot after exhibiting 2.3% CAGR between 2018-24 as opposed to Roche’s 0.8% CAGR.

Bristol-Myers Squibb has fallen out of the top 10 largely due to loss of Opdivo market-share to Keytruda and being beaten to the mega-merger table by Takeda with its acquisition of Shire in January 2019. As a result, Takeda leaps up seven places in the ranking between 2018 and 2024 with an impressive 10.8% CAGR.

Bristol-Myers Squibb is unlikely to be outside the top 10 for too long, however, as on January 3rd, 2019, the company announced a $74B acquisition of Celgene that it is yet to complete.

Figure 2: Worldwide Prescription Drug Sales in 2024

Worldwide Prescription Drug Sales in 2024

Figure 3: Top 10 Most Valuable R&D Projects (Ranked by Net Present Value)

Top 10 Most Valuable R&D Projects (Ranked by Net Present Value)

AstraZeneca has also shown impressive 7.7% CAGR, long promised by CEO Pascal Soriot, due to breakthroughs in the Chinese market and high sales of its oncology products Tagrisso and Lynparza, rather than M&A.

Only Takeda and AstraZeneca are able to increase market share between 2018 and 2024. The Top 10 Pharma companies showed -6.6% market share decline overall, with Roche alone contributing -1.4% to that figure. (Figure 2)

Top 10 Most Valuable R&D Projects (Ranked by Net Present Value)

Vertex’s triple combination, VX-659/VX-445 + Tezacaftor+ Ivacaftor, remains the most valuable project in the pharmaceutical industry pipeline.

Despite a wide spread of therapeutic areas represented in the top10, oncology has the highest number of candidates. Daiichi Sankyo prepares for its first regulatory submission of its HER2-targeting antibody drug conjugate, DS-8201 (backed by a collaboration agreement with AstraZeneca) – and this joins Liso-cel and sacituzumab govitecan in the most valuable oncology projects.

With Vertex Pharmaceuticals already dominating the cystic fibrosis space, its therapy combining ivacaftor (available as Kalydeco) and tezacaftor (available in combination with ivacaftor as Symdeko) withVX-445 or VX-659, another cystic fibrosis transmembrane regulator (CFTR) corrector, is looking to further reinforce the company’s position.

The list is dominated by largecap pharma companies, however, a couple of other projects from mid-cap companies join Vertex’s triplet. Immunomedics is looking to put its stamp on the oncology market with its antibody-drug conjugate sacituzumab govitecan. Meanwhile, the FDA has agreed to an accelerated approval pathway for GlobalBlood Therapeutics’ oral therapy, voxelotor, for sickle cell disease.

AbbVie is pushing its own JAK1 inhibitor, upadacitinib, into the rheumatoid arthritis and ulcerative colitis markets, and Eli Lilly its novel dual gastric inhibitory polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptor agonist combination, LY3298176, into the crowded diabetes drug market. In contrast, Novartis seeks return on investment with Zolgensma’s aunch into the spinal muscular atrophyspace – Novartis gained the gene therapy (previously AVXS- 101) when it acquired AveXis in May 2018. Novartis also eagerly awaits the approval of its wet agerelated macular degeneration (AMD) project, brolucizumab; the FDA is set to decide later in 2019.

Two of Celgene’s acquired assets make it to the list: ozanimod, an immunomodulator in development for multiple sclerosis, ulcerative colitis and Crohn’s disease, and Liso-cel, its CAR-T cell therapy. They originated from Receptos and Juno Therapeutics respectively, however these projects look likely to change hands again if Bristol-Myers Squibb closes its acquisition of Celgene. (Figure 3)

Worldwide R&D Spend by Pharma & Biotech Companies 2010-2024

Forecast worldwide R&D CAGR lower in 2018 through 2024, and proportion of R&D spend to pharmaceutical revenue to reduce. Worldwide pharmaceutical R&D spend totalled $179B in 2018, representing an increase of +6.5% on the previous year. Going forward, R&D spend is forecast to grow at a CAGR of 3.0% between2018 and 2024. This is comparable with a CAGR of 4.2% between 2010 and 2018, with an average proportion of R&D spend to pharmaceutical revenue for the same period of 19.8%, compared to 20.2% for 2018-24.

Despite an initial peak in 2019, the proportion of R&D spend to pharmaceutical revenue falls quickly in subsequent years. This reduction in R&D spend could be an indication that companies are investing now to improve their future R&D efficiencies. Use of real world data combined with machine learning techniques in addition to collaborative R&D programs, are a few of the initiatives being employed by companies to help them stay one step ahead in an era demanding more patient-targeted drug development. Similarly, this reduction in R&D spend could be an indication that less revenue is being directed towards replenishing pipelines. (Figure 4)

Worldwide Prescription Drug & OTC Sales by Therapy Area in 2024

Merck & Co. expected to remain largest oncology player in 2024 with Keytruda.

Oncology prevails as the leading therapy segment in 2024, with a 19.4% market share and sales reaching $237B, driven in large by the PD-1 inhibitors Keytruda and Opdivo, as well as Pfizer’s Ibrance and AstraZeneca’s Tagrisso. The immunosuppressants space also continues to see a high level of growth, with the market’s largest CAGR through 2024 of 16.9%, driven by an increase in the incidence of chronic diseases and the use of immunotherapeutic agents in clinical development for other therapy areas. Elsewhere, biosimilars are beginning to make their mark on the anti-rheumatic segment, which is expected to see a decline in its CAGR as we enter 2024, with sales dipping to $55B despite the high drive in sales from JAK inhibitors; upadacitinib and Xeljanz. (Figure 5)

Figure 4: Worldwide R&D Spend by Pharma and Biotech Companies 2010-2024

Worldwide R&D Spend by Pharma and Biotech Companies 2010-2024

Figure 5: Worldwide Rx Drug and OTC Sales by Therapy Area in 2024

Worldwide Rx Drug and OTC Sales by Therapy Area in 2024

Figure 6: Top 10 Selling Products in the World in 2024

Top 10 Selling Products in the World in 2024

2024: Top 10 Selling Products in the World

Keytruda knocks Humira off the top spot; Revlimid falls out of top 3.

A $1.5B increase in sales for Humira ensured AbbVie’s blockbuster remained the top selling product worldwide in 2018. However, following a number of biosimilar launches in Europe and biosimilars set to hit the US in 2023, the 2024 EvaluatePharma® consensus forecast for Humira has decreased by $2.8B compared to last year’s report. This decrease, coupled with a strong year for Keytruda in product sales, positive data from ongoing clinical trials and further FDA approvals, will allow Keytruda to take the number one spot for 2024 forecasted sales. As a result of this, Keytruda is forecasted to widen the sales gap between its competitor Opdivo to over $5B in 2024. Sitting just outside of the top 3, with predicted 2024 sales of $11.3B, the checkpoint inhibitor Opdivo continues to have strong sales in the anti-neoplastic MAbs segment, despite contrasting analyst views with regards to its trajectory as we move towards 2024. Falling out of the top 3 and down the rankings, worldwide sales of Revlimid are expected to fall with a CAGR of -3.2% between 2018 and 2024 to $8.1B, with generic versions expected to hit the US market in 2022. Gilead’s Biktarvy continues to outshine all other HIV medications and climbs a place to sit in the top10 this year, boasting an impressive CAGR of +34.4% going into 2024 and sales of $7.0B. (Figure 6)


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