IQVIA Holdings Inc. (IQV) Earnings Call Transcript & Summary

Hello, and thank you all for attending today's webinar entitled, A New Dimension: Biopharma Market Dynamics at the Disease Level. My name is Sophie [indiscernible], and I lead the Global Market Insights marketing team here at IQVIA. In our webinar today, Helena Bayley, an analyst in the IQVIA EMEA Thought Leadership team will explore the value and volume trends of pharmaceutical products, providing insights that covers 6 disease areas derived from the newly launched MIDAS disease platform. Sporadically, our offering Management Director of MIDAS will then give a demonstration to show how MIDAS disease works and how it can support your needs. Following on from the presentation, the Q&A session will be led by Tom Woods from the EMEA Thought Leadership team. And the presenters will also be joined by Kapil Chaddha, our Customer Insight Director from the MIDAS team. [Operator Instructions] And finally, be aware that the webinar will be available on demand and can be accessed using the same audience link that was sent to you earlier. And now it is time to start our webinar. Over to you, Helena.

Thank you, Sophie, and good afternoon, everyone. As Sophie mentioned, I'm going to be exploring some of the dynamics within different therapy areas and indications and sharing some of the insights that MIDAS disease has helped us to develop. To start with, we'll look at an overview of some of the major therapy areas, including their global value and growth rates. We'll then investigate these therapy areas one by one with a particular focus on the indications and products that are driving growth and value. The therapy areas we'll cover are oncology, immunology, respiratory, endocrine and metabolic, cardiovascular and CNS. After that, we'll take a look at some of the dynamics in the generics and biosimilar sectors, again, focusing on individual indications. I'll then summarize my part of the webinar, and Sarah will then take a third demo of the MIDAS disease platform. So here, we have an overview of these key therapy areas. And we see that oncology and immunology are the 2 with the highest historical growth rates, although the growth of oncology has begun to decelerate, and the growth of immunology is also set to decelerate significantly in the coming years. On the other hand, the endocrine and metabolic, respiratory and CNS markets are seeing acceleration in their growth rates. We'll now look more closely at these individual therapy areas, starting with oncology, which is, of course, an area which has seen a lot of innovation in the last few years. In this chart, we're looking at the 5 cancers, which are highest in value globally, and we can see their trends in sales. And you will notice this chart goes up to 2022. We do have data for up to the second quarter of 2023. And for the purposes of this presentation, we're mainly going to be looking at full year's worth of data, so just up to 2022. Breast cancer is currently the highest value cancer worth $26 billion in 2022, and this is followed by non-small cell lung cancer, which has more than doubled in value during the last 5 years. It reached $22 billion in 2022. The third high-value cancer is multiple myeloma, and its sales are plateauing. But prostate cancer and kidney cancer are both continuing to grow in value. We can now look at this one level deeper and focus just on the breast cancer market. So this chart shows the global sales for the top 6 breast cancer products. And it's important to emphasize that these numbers here are the breast cancer sales only for each product. So we see that Ibrance or Palbociclib has become the market leader for breast cancer as well as $6.1 billion in 2022, which is more than twice that of any other breast cancer product. But 2 of these products are driving absolute growth in the breast cancer market. One of them is the verzenio or abemaciclib, and this grew at a rate of 85% in this market from 2021 to 2022. Verzenio was first approved by the FDA for some breast cancer indications in 2017, and it just received approval for several other breast cancer indications. Keytruda or pembrolizumab is the other products driving growth, and its growth rate in the breast cancer market was 690% from 2021 to 2022. Keytruda first received FDA approval for breast cancer in 2020, but it's also approved for many other indications now. And that split across indications is what we're going to look at now. So here, we compare Keytruda sales to those of OPDIVO or nivolumab. And these products are both checkpoint inhibitors. And specifically, we can look at the top 3 indications for these 2 drugs and their value shares. And just to clarify, we've chosen to show just the top 3 indications here, simplicity, and we've grouped all of the other indications together. But of course, we do have much more data available on MIDAS disease, which allows us to break this section down. For Keytruda, over 30% of its value is from the non-small cell lung cancer market which is a really significant share because Keytruda is approved for and used for very many different indications. After non-small cell lung cancer, the next biggest indications each have under a 10% value share of Keytruda. By contrast for OPDIVO, the sales are split much more evenly across the top 3 indications. The leader of these is kidney cancer, and it has a 22% value share of OPDIVO. We can also look briefly at some of these indications individually. So we find that within the non-small cell lung cancer market, Keytruda is the leading product, but its sales for this indication have plateaued in recent years. And Tagrisso is now the biggest driver of absolute growth in this indication. Meanwhile, for kidney cancer, Keytruda is one of several drugs driving growth. And in fact, Keytruda sales grew by 46% from 2021 to 2022. And as a result of this, Keytruda became the joint biggest drug in kidney cancer alongside OPDIVO in 2022. We now move on to immunology. And as before, we can look at trends in the value of individual indications. Here in our definition of immunology, we've included autoimmune indications and allergic inflammation, but we're excluding inflammatory respiratory indications. In the chart here, we're looking at the top 4 immunology indications, which are rheumatoid arthritis, psoriasis, Crohn's disease and psoriatic arthritis. And we've also included atopic dermatitis, because it's particularly fast-growing indication. And we've also decided to increase 2023 data here. So these numbers are MAT up to the second quarter of 2023. Within the rheumatoid arthritis market, adalimumab remains the leader, and it's growing in value at a rate of 11% year-on-year. In the U.S., Humira is driving this growth as it only lost patent protection earlier this year. But in Europe, adalimumab biosimilars entered the market back in 2018. Rinvoq is another notable growth driver in the RA market. Its sales are growing at a rate of 44% year-on-year. And although rinvoq was only approved by the FDA for RA in 2019, it's already the second largest driver of absolute growth behind adalimumab. Psoriasis is the indication which is driving absolute growth in immunology most strongly, and we'll look more closely at this in a moment. But meanwhile, for Crohn's disease, STELARA has been by far the biggest driver of absolute growth. And STELARA overtook adalimumab in 2022 to become the Crohn's disease market leader. Finally, atopic dermatitis has been growing at a significant rate over the last few years. And in fact, it was the second largest driver of absolute growth from 2021 to 2022 within immunology, despite its relatively small market size. Atopic dermatitis is dominated by dupixent but innovation in this indication is continuing. We saw that adtralza or [ apri ] was launched recently, and rinvoq has gained a license expansion for atopic dermatitis. Now we'll look briefly at the psoriasis market at the product level, and we see that it's a highly competitive market with many of the top psoriasis drugs increasing in value rapidly year-on-year. Again, in this chart, the value of each product is its value in the psoriasis market only. So STELARA or ustekinumab is currently the leading product, that's only just and 2 other products stand out as growth drivers in this market. Their first disease is skyrizi or risankizumab. And the second is tremfya or guselkumab, and these products have growth rates of 79% and 46% year-on-year, respectively. Now we turn to the next therapy area, which is respiratory. And I should mention that we have excluded COVID-19 products here. The global respiratory market grew substantially from 2021 to 2022 at a rate of 13%. However, a more detailed look at the dynamics reveals that sales for many of the higher value of respiratory illnesses dips during the pandemic, that is now making a strong recovery. I say examples of these include acute respiratory infections, allergic rhinitis and the common cold and cough. And therefore, last year's high growth rate is at least in part due to a bounce back after the pandemic. As known, COPD has consistently constituted over 50% of the respiratory market for the last 5 years and triple therapy and hemes such as Trelegy, driving growth in both these indications. Trelegy was approved by the FDA for COPD in 2017, and it gained a license expansion for asthma in 2020. So perhaps it's unsurprising that we find that asthma's responsible for an increasingly large percentage of Trelegy sales. And this percentage exceeded 40% in 2022. We see from the line chart that the asthma market has grown steadily in value and recently accelerated, whereas COPD plateaued in 2020. Innovative treatments for severe asthma have recently entered the market in the form of biologics, such as Nucala and Fasenra. And these products are at the intersection of respiratory and immunology. We can explore the endocrine and metabolic markets in a similar way. Diabetes dominates this market by value and growth rate of 14% from 2021 to 2022. This growth in diabetes is being driven by 5 molecules, all of which are for type-2 diabetes. Four of these molecules are shown on the right here, along with the former market leader, which is insulin glargine. Semaglutide, which is branded as Ozempic and Rybelsus for diabetes is one of the most significant growth drivers in the diabetes market. Semaglutide has, of course, also entered the obesity market under the brand name Wegovy. And this is an example of where the disease split in MIDAS disease is particularly useful, because we're able to look at the sales of this molecule in each indication individually. Semaglutide grew at a rate of 79% from 2021 to 2022 in the diabetes market. And therefore, even though it's launched relatively recently, it's already a leading diabetes product. Trulicity or dulaglutide is another GLP-1 agonist, and it's currently the market leader for diabetes. Its sales have grown consistently during the last 5 years, demonstrated by its 5-year CAGR of 42%. Two of the main drivers within the diabetes market are SGLT2 inhibitors. And these are Jardiance or empagliflozin and Forxiga or dapagliflozin. For Jardiance, sales increased consistently during the last 5 years, whereas for Forxiga, the sales have picked up more recently. And finally, the newest driver of the diabetes market is Mounjaro. This product was launched in the U.S. in just June 2022, and therefore, it's not shown on this chart, but it's had a standout launch. Its first few months of sales alone were over $2 billion for roughly the second half of 2022, and that makes it the fourth largest driver of absolute growth in the diabetes market for 2022 as a whole. We're going to look briefly at obesity now. So obesity's growing value after a striking rate of 69% from 2021 to 2022. The obesity market is heavily dominated by Semaglutide, which is branded as Wegovy here. And this product's obesity sales are increasing at a rate of 92% year-on-year. Significantly, Wegovy has been shown to [ use ] not just a weight loss but also to improved cardiovascular outcomes, and this was in August. And finally, Saxenda has the second largest share of the obesity market, and it's growing at 45% year-on-year. Two of these of these diabetes drugs have recently entered the cardiovascular market, specifically, they're now approved for heart failure. And these drugs are Forxiga and Jardiance. Again, this illustrates the utility of the disease split in MIDAS disease when we're looking at products like these that are expanding to multiple indications and even multiple therapy areas. In the heart failure market, Forxiga and Jardiance are growing rapidly in value at rates of 93% and 58% year-on-year, respectively. [indiscernible] does still heavily dominate this market. [indiscernible] has been driving growth in heart failure strongly for years and continues to do so. Direct oral anticoagulants or DOACs, are responsible for the growth in several other cardiovascular indications. In the atrial fibrillation market, which is shown on the right here, we see that 2 DOACs are the well-established leaders. One of this is Eliquis or apixaban and the other is Xarelto or rivaroxaban. This Eliquis is growing faster, and it became the market leader in 2022. Lixiana or edoxaban is another DOAC, and this is the third biggest product in the atrial fibrillation market. DOACs are very dominant in other indications, too, including the embolism thrombosis market and the pulmonary embolism market. And for both of these markets, Eliquis is the highest value product. It's got roughly a 70% value share of these markets and a double-digit growth rate. Eliquis is followed by Xarelto, which has around a 20% share of each market and a single-digit year-on-year growth. Finally, we turn to the CNS market. This therapy area has been growing more slowly than the pharmaceutical market as a whole with our 2017 to 2022 CAGR of 3%. That growth is now accelerating. Multiple sclerosis or MS was worth $24 billion globally in 2022, and this dominates the CNS market. Despite the MS market being weighed down by generics, 2 anti-CD20 monoclonal antibody therapies are growing rapidly here. One of these is a Ocrevus, which is the MS market leader. And the second is kesimpta, which was approved by the FDA more recently in 2020 and grew at a rate of 170% from 2021 to 2022. Migraine therapies were worth $12 billion in 2022, making the migraine market the second largest within CNS in value terms, just marginally ahead of ADHD and depression. Migraine has been a consistent growth driver since 2018 due to many products entering the market. And some of these are shown on the right here. Vydura or Nurtec, which is Rimegepant is a notable example. It's an oral CGRP antagonist which was approved by the FDA in 2020, and it's already become the market leader for migraine with a year-on-year growth rate of over 100%. Ubrelvy or Ubrogepant is another oral CGRP antagonist, and this has also had a very successful launch. So far, we've analyzed some key trends in value in many therapy areas, and these are naturally dominated by branded products. So now I'm going to spend the last few minutes on generics and biosimilars and investigate some trends in volume. Generics Germany constitute around 80% of each major therapy area by volume, with the original branded products making the remaining 20%. For most therapy areas, the market shares of generics have been certainly increasing over recent years. But for oncology, the volume share of generics is actually falling. Oncology is also the outlier in terms of the value share that generics have. This value share was just 12% in 2022, which reflects the high cost of some of the innovative oncology therapies. We now focus on a specific example of a product and its generics. So here, we're looking at the trends in volume for the combination inhaler Seretide and its generics in the EU4, U.K. and U.S. This chart shows the volume of these products for arsenide COPD. And here, we've chosen to show the MAT figures, which got the second quarter of 2023. Seretide's patent expired in the U.S. in 2010 and in Europe in 2013. Its volume has been falling, but is actually still greater than that of all its generics combined. Sirdupla is the leading generic in this market, but its volume has been falling since 2020 due to many new generics having been launched. Now we move on to biologics, and we start with infliximab, which is sold either as Remicade or as a biosimilar of Remicade. And here, we focus on Crohn's disease, which is infliximab's top indication by volume. There's considerable variation in the volume split between Remicade and biosimilars across these 5 major geographical markets. In the EU4 and U.K., biosimilars heavily dominate infliximab volume for Crohn's disease. But in the U.S., this is close to a 50-50 split, even though infliximab [indiscernible] this end market there in 2018. In Japan and China, Remicade dominates. We're now going to look at the relative volumes of 3 key biologics, these Humira, Enbrel and Remicade and [indiscernible] biosimilars. In particular, we focused on their relative volumes in the rheumatoid arthritis and psoriatic arthritis markets. So in the RA market, Humira and Enbrel have much larger volumes in their respective biosimilars, whereas for psoriatic arthritis, there's more even split between the original brands and the biosimilars for Humira and Enbrel. For both, RA and psoriatic arthritis, the volume of Remicade biosimilars is almost equal to [indiscernible] Remicade itself. And we're seeing that in both of these indications, each biosimilar is accounting for an increasingly large volume share year-on-year. Finally, we can take an even closer look at the psoriatic arthritis market in the EU4 and U.K. and focus just on Humira and its biosimilars and compare the volumes of individual products. In these countries, adalimumab biosimilars entered the market in 2018, and they've been growing steadily in volumes since then. In 2022, Humira accounted for just 24% of total adalimumab volume for psoriatic arthritis in these countries. And amgevita has consistently been the leading adalimumab biosimilar product in terms of volume. In 2022, amgevita overtook Humira, as we can see on the left. And Imraldi has now plateaued, despite its notable launch. [ Hermos ] and Idacio are currently driving growth here, with year-on-year growth rates of 35% and 122%, respectively. This is a competitive market, which is evident from the chart on the right, showing the leading biosimilar products. And initially, there are further -- there have been further recent approvals of new biosimilars by the EMEA recently. Now that we've examined some key trends in so many different markets. The question is, why should we care about the dynamics at the disease level? As multi-indicationalty becomes increasingly common, we believe that being able to understand the dynamics within individual indications is a strategic advantage. Firstly, it enables enhanced forecasting precision, because it allows us to predict market trends for a specific indication based on the recent trends in that indication. And secondly, we can assess the performance of competing products including any one product's performance across its various indications. And finally, understanding dynamics at the disease level is clearly a valuable tool for identifying and prioritizing new opportunities. If you'd like to learn more about the insights from MIDAS disease that we've seen today, you can find the first 2 articles of a 4-part series on our website. The series is called Immune Dimension MIDAS Disease Insights. And the remaining articles in series will be published in the next couple of weeks. And with that, I want to thank you all for listening, and I'll now hand over to Sarah, who will take us through a demo of the MIDAS disease offering. Thank you, Sarah, and over to you.

Thanks very much, Helena for those great insights. So the last section of the webinar before we move on to Q&A really focuses in on firstly, an introduction to MIDAS disease and how it can be used to analyze disease dynamics at various levels of granularity within MIDAS. And we'll look at a few examples through an offline demo of how that segmentation can be used, specifically focusing on adalimumab, so in the immunology space and nivolumab for oncology. So for those of you on the call who may not be familiar with or may not have previously used MIDAS data itself, essentially, MIDAS is IQVIA's gold standard, syndicated, globally harmonized data set, available across 93 countries, which really allows users to track sales value and volume performance at various levels of granularity, actually right down to [ PAC ] SKU level. And it covers about 95% of the global pharmaceutical market in value terms. Now with the launch of MIDAS disease, which actually we launched in July this year, what you can now do is split sales of a drug by country and now by disease, which is obviously highly relevant in disease areas where multi-indication products are common, and Helena just showcased some of these areas within her presentation. So with MIDAS disease, we're actually now covering 600 diseases, which includes 35 oncology tumors across the whole MIDAS ecosystem of 93 countries and about 1.6 million products. Now what this means is if we look at the next slide, that essentially whilst MIDAS traditionally and MIDAS today allows you to look at the sales of a drug in a particular country, as you see on the left-hand side, with this example of pembrolizumab in Germany. Now MIDAS disease gives you that extra disease dimension. So on the right-hand side, you've seen that same view of pembrolizumab in Germany, but now split by tumor type. And we see non-small cell lung cancer with the largest share of pembrolizumab sales in Germany, but actually some of that growth being driven by other tumor types. You see, for example, kidney cancer in the gray blue color, driving some of that growth in latter quarters. So we're going to do a short demo for immunology looking at adalimumab and then nivolumab for oncology. So essentially here, we have a view today of MIDAS sales for adalimumab by country, no surprises that those sales are being driven by the U.S. market quarter-on-quarter. And this snapshot view that you see here on screen is taken from our business intelligence tool called SMART, which some of you may be familiar with, if you use MIDAS data on a regular basis. The table at the top looks at sales value in U.S. dollars and volume in standard units. And the chart at the bottom reflects the same but in U.S. dollar value terms only. So what you can do with MIDAS data is you can analyze country by country, and you can drill down to one specific country. So in this case, what we're looking at is adalimubab sales now in the U.S. sales evolution back to 2017 quarter-on-quarter. Now what we have with MIDAS disease is actually a brand-new set of attributes for disease segmentation, and you see these highlighted in the green box on the slide. And you could use these attributes at quite a top line level, so you could look at particular disease areas such as immunology, such as oncology, such as CNS. Or you can actually drill down into the data to focus on a more granular segmentation by disease. And actually, it's worth noting that the disease taxonomy that we use to build MIDAS disease is based with the exception of oncology on the WHO ICD-10 codes, which some of you may be familiar. So we're leveraging that WHO ICD-10 disease taxonomy. And actually, within the data itself, you can drill down to that diagnosis [ core ] level to see the direct correlation with those ICD-10 codes. We also have the ability for oncology to analyze data by regimen, so really focusing in on when drugs are used concomitantly with other drugs, it's the treatment pathway or as a monotherapy in themselves. And lastly, the other feature that we've built into the data itself is the ability to see from which source available at IQVIA, we are using to determine the disease split ratios that feed into minus disease. And just to note on sourcing, it depends on the country and the drug that you're looking at as to which sources we're using to determine those disease splits. So for example, for oncology and immunology, we have very specialist data sources that we're leveraging, which include hospital inputs. And for other disease areas, we may be leveraging EMR, so electronic medical records as in the case of some of the European countries, or primary market research or even claims-based asset. And claims data is something that we use across the board to leverage the disease splits for the U.S. within MIDAS disease. So essentially, now what we have is that additional view for adalimumab in the U.S., but this time with the disease segmentation. So you can see here in this particular slide, rheumatoid arthritis, driving the sales for adalimumab in the U.S. But you can see other diseases coming in. So in the dark blue, you see that gradual uptake of Crohn's disease, for example, quarter-on-quarter. So you can really see those disease dynamics coming into play. If we switch that view over to adalimumab in Germany, and this time, we're looking at a different level of granularity. So here, we've actually segmented the data by strength, and we have a view here of MIDAS today, and you can do this in MIDAS disease, and you can do this in MIDAS today. We have a view of adalimumab 40-milligram strength in Germany. If you add in the new disease segmentation, what we now have is a view of that 40-milligram strength of the product in Germany but split by disease. And you can see rheumatoid arthritis here being the dominant disease, and we expect this because the 40-milligram strength of the drug is actually the main strength used in the treatment of rheumatoid arthritis. But you switch that over and look at the picture for the 80-milligram strength and what you see are different disease dynamics. So actually, the sales here are lower than with the 40-milligram strength that we saw previously, but the dynamics you see are quite different. So you see here actually driving the sales is ulcerative colitis for the 80-milligram strength followed by Crohn's disease. And we know that the 80-milligram strength of adalimumab is actually the induction dose strength of the drugs used in the treatment of UC and that Crohn's disease also uses -- often uses a higher dosing. So you can really see kind of how the data can interact even at strength level and give you those different disease dynamics. You can also flip the view slightly. So you could also use MIDAS disease to focus on disease sizing within a market. So in this example, we're looking at disease sizing within Germany. It's rather a crowded chart at the bottom. But obviously, what you can see at the top is that diabetes is the leading value market in USD, looking at this quarter-on-quarter view. But you can go further and focus in and hone in on one particular disease area. So in this example, we're focusing in on ulcerative colitis, again, in Germany. And here, you can see the drugs driving sales for UC. What's interesting here actually is the uptake of ustekinumab that you see in the light blue in recent years. And a similar analysis can be done for other disease areas, and we are covering those 600 diseases within MIDAS disease. So let's have a brief look at oncology. So here in the next slide, we have a view of nivolumab sales in the U.S. by tumor type. So we see kidney cancer in the blue purple color, increasing its cell share followed by malignant melanoma that you see in the light green, and the light blue you see here is non-small cell lung cancer. But actually, for oncology, you can get an even further granularity in terms of insights. So I mentioned earlier, it's possible within MIDAS disease to analyze sales and volume across regimen for oncology. So really focusing in on that share of concomitant treatment versus a monotherapy. And in this example, we have nivolumab in Germany. And you can see here that it's the cabozantinib -- nivolumab treatment that has higher sales than, for example, nivolumab as the monotherapy or the 2 other concomitant pathways that you see here. Like we saw with immunology, you can really focus in on a particular disease or in this case, a particular tumor type. So here again, we're looking at kidney cancer, and we're looking in Germany. Of particular note here, you can see the uptake of pembrolizumab that you see in the dark green color, especially since 2021, really driving some of that growth within the kidney cancer space. And then finally, again, we can look right down to strength level to analyze the data at a more granular level within MIDAS disease. And actually, MIDAS disease can interact with all the standard measures and attributes that we have on MIDAS today, whether that be a therapy class level, a pack level, at strength level, at all level, in U.S. dollars, in volume, MIDAS disease interacts with all of that. So we're really getting that cross-country, that granular level view with this added disease segmentation. And as I said, we launched this offering at the beginning of July this year. So hopefully, that gave you a flavor as to how MIDAS disease works and how it can really help segment the market by disease at different levels of granularity. And with that, I think we've got quite ample time for some questions.

That's perfect. Thank you so much, Sarah. So I will be handling the Q&A today. My name is Tom Woods. I'm a consultant in the Europe, Middle East and Africa Thought Leadership team. And it's great to see there's been so many questions already come through on that, please do continue to pass them our way, and we'll try and get to as many as we can in the remaining time. So I'd like to start with the first one. And I should also say that we're joined by Kapil actually, who's a director in our MIDAS Thought team as well. So we've got a few of us, you can ask questions to on the call at the moment. So -- but I'll start with you, Helena, and thank you for your presentation, too. It was really good oversight. And so within MIDAS disease, can we filter by the formulation or presentation of different drug time for a particular disease? For example, could we see the proportion of injectables in the immunology market?

Thanks, Tom. That's a good question. And the answer is yes, absolutely. So in MIDAS disease, you can split the data by NFC codes which I tell you in the presentation. And we are looking at immunology area. And at the moment, 79% of immunology drugs are parental globally in terms of value. So parental means that it includes drugs that are administered by injection or infusion. And it's possible to break this down even further on MIDAS disease. We've got the next 2 levels of NFC codes as well. And we can also look at the presentation for a particular disease. So for example, for psoriasis, 87% of therapies are parental [indiscernible].

Fantastic. So actually, going back to yourself, Sarah and Kapil. So in the metabolic market, given there's a close correlation between diabetes and obesity prescribing by physicians, how precisely can we segment that growth of individual diabetes or obesity markets?

Yes. Thanks, Tom. So in MIDAS disease, we use real-world evidence diagnostics information. And basically, we built a solution on the primary diagnosis that a physician has reported. So there could be several reasons why a physician may not report a primary diagnosis like [indiscernible] or any other conditions. And we do not capture any qualitative information. But we consider only the quantitative information. What the physician has reported, that's a primary indication.

Thank you, Kapil. Another one probably for you, Helena, I think. So we've seen it is possible to obtain oncology insights to a number of different metals, and we've seen that in quite a lot of depth. But are there any ways in which we can get an even more detailed view of various indications within the oncology space?

Thanks, Tom. So it's another good question. And yes, yes, there are. So as Sarah mentioned, we can look at the regimen, which means that we focus on a particular drug for a particular indication and see what proportion of that drug is given as a monotherapy, which means that the patient is seeking just that drug to treat that illness and what proportion of the drug is given alongside other drugs. And MIDAS disease gives you the full breakdown of these exact combinations. And for example, for breast cancer, we saw that Ibrance or Palbociclib is the market leader. And at the moment, [indiscernible] 60% of the time, Ibrance is used as a monotherapy for breast cancer. But a quarter of the time it's taken with [indiscernible], so you can really start to understand the combinations.

Fantastic. Okay. I'm going to add a couple of different questions here. I think it's coming from different angles, and everyone is very excited about the MIDAS disease [ offering ] teams that are on the call. So is this level of information MIDAS disease available at a company or country level. And the country splits are causing a lot of discussion in the chat. So either yourself, Sarah or Kapil could provide some light on the company and also country level split within MIDAS disease.

Sure. So you're probably aware that within MIDAS itself, we've got a corporation and manufacturer attributes that allow you to look by company. And yes, that data can interact with MIDAS disease. So of course, you can look at disease segmentation by corporation and see which corporation are driving some of those disease sales. With regards to countries, as I said, we're covering 93 countries. So all of the countries that are available on MIDAS today, we are covering for MIDAS disease as well. We can obviously provide a list of the 93 countries that we cover, but we cover all the major markets. There's probably -- why we've got the biggest gap is probably for obvious reasons in some of the African countries, right? But as I said, we are covering in value terms, 95% of the global pharmaceutical market.