The spine is a column of bone and cartilage that extends from the base of the skull to the pelvis and acts as the core of the human skeleton, supporting both the head and body. Given the complexity of the spine structure, it is susceptible to various ailments that can lead to instability and significant pain in people. Back pain is a leading cause of healthcare expenditures globally. It affects around 31 million people in the US. Spine disorders/ailments are primarily caused by degenerative disease, trauma, deformity, and tumors.

As per the scope of the report, the veterinary healthcare market is a growing industry, comprising therapeutic products and solutions for companion and farm animals. Companion animals can be tamed or adopted for companionship or as house/office guard, and farm animals are raised for meat- and milk-related products. Companion animals include canine, feline, and equine. Farm animals are bovine, poultry, and porcine. The UK veterinary healthcare market is segmented based on product types (therapeutics and diagnostics) and animal types (farm animals and companion animals). The segment therapeutics consists of vaccines, medical feed additives, parasiticides, anti-infective agents, and other pharmaceuticals.

Taiwan's disease profile will remain favourable for prescription drugs as the prevalence of chronic diseases continues to grow and authorities work to improve the drug approval process. This will cause a corresponding rise in demand for treatments in therapeutic areas such as cardiovascular diseases, oncology and dementia. A key risk facing multinational drugmakers seeking to commercialise products that target these disease groups will stem from the cost containment measures employed by the National Health Insurance Administration (NHIA). The Taiwanese pharmaceutical market amounted to TWD195bn (USD6.5bn) in 2018, accounting for 16.7% of total healthcare spending. It has one of the largest medicine market in the Asia Pacific, with a high per- capita pharmaceutical spending of around USD273 in the same year. As with most developed countries, prescription drugs are dominant in the market, accounting for 93% of total sales in 2018 - the bulk of which (around 70%) came from patented drugs with a value of TWN126bn (USD4.2bn).

仿制药降价扩大省份，创新研发成为行业新常态和新动力。本月带量采购扩大省份正式落地，9 月25 日上海阳光医药采购网发布联盟地区药品集中采购拟中选结果，“4+7”试点带量采购推广至全国25 个联盟。此次联盟采购产生拟中选企业45 家及拟中选产品60 个，品种不变、参与企业和省份大幅增加。从结果来看，降价极为成功，试点扩围是预料之内、降幅也在情理之中。

2019 年9 月上证综指同比上涨0.66%，报2,905.19 点，中小板指上涨1.95%，报5,997.80 点，创业板指上涨1.03%，报1,627.55 点。医药生物指数下跌0.13%，报7,540.34 点，表现弱于上证0.78 个pp，弱于中小板2.08 个pp，弱于创业板1.16 个pp。截至9 月30 日，全部A 股估值为12.82 倍，医药生物估值为34.71 倍，相对A 股溢价率升至171%。

集采招标全国推广方案降价幅度较大，避险情绪浓厚：在刚刚结束的集采全国推广招标中，相关产品降价幅度超出市场预期。对于明年进行的第二轮集采招标，就目前一致性评价的进度来看，我们认为入围品种数量可能较第一轮有较大幅度提升。招标核心还是看产品竞争格局，三家以上竞标的产品降价幅度可能较大，三家以内品种会相对缓和。整体而言，市场对于医药板块的配置还是继续聚焦政策免疫品种，避险情绪浓厚。

医药生物9 月行情回顾：2019 年以来，医药生物上涨29.10%，本月医药生物下跌0.19%，沪深300 指数上涨0.39%，医药生物跑输沪深300 指数0.52 个百分点，其中医疗服务表现相对较好，上涨2.56%。医药生物整体估值32.40 倍，全部A 股估值14.49倍，医药生物相对于A 股溢价率123.60%。

①医保局：市场最为关注的集采扩面落地，配套政策出台，结果符合预期，对市场冲击明显弱于去年；②药监局发布注册、生产及经营监督管理办法（修订）征求意见稿，鼓励创新，加强监管。ASCO及ESMO大会分别于9月和10月圆满闭幕。ESMO大会上，中国原创新药百花齐放，多个中国原创新分子实体药物发布临床数据。和黄医药的索凡替尼，正大天晴的安罗替尼，恒瑞医药的氟唑帕利、阿帕替尼，百济神州的Pamiparib、替雷利珠单抗，艾力斯的艾氟替尼均在ESMO发布数据。

根据中检院及各地药检所披露，2019 年前三季度，国内人血白蛋白批签发总量（折合10g/瓶）为3307.89 万瓶，同比下降5.2%，其中国产人血白蛋白批签发量为1405.88 万瓶（+1.3%）、进口人血白蛋1902.01 万瓶（-9.5%），进口占比较18 年末下降2pp 至57.5%。受年初上海新兴事件以及部分外资企业GMP 到期重新认证等因素影响，19 年第一季度国内人血白蛋白批签发量下滑明显，但自第二季度迅速得到恢复，进口占比下降。

智飞生物：2019年1-9月批签发总量为1546.5万支，同比增长28%，增速较1-8月小幅放缓，代理品种保持高增长。4价HPV批签发396.8万支，同比增长4%；9价HPV批签发187.6万支，实现大幅增长；5价重配轮状病毒疫苗299.3万支，9月无批签发。展望未来：1）三联苗冻干剂型申报在即，水针剂型库存充足，19年销售无影响，预计20年影响销售两个季度左右；2）EC诊断试剂盒及微卡苗有望于年内获批；3）加强5价轮状病毒及4价流脑结合疫苗销售；4）公司第2期员工持股计划覆盖面广，并已完成大部分股票购买，核心骨干与公司利益深度绑定。

行业创新：多部委联合制定促进健康产业高质量发展行动纲要，海外奥希替尼一线治疗NSCLC的III期总生存期数据公布。本周行业政策上国家发改委、国家医保局、财政部、卫健委等21部委共同制定的《促进健康产业高质量发展行动纲要（2019-2022年）》发布，主要是推进药品和医疗器械提质创新；对临床急需的新药和罕见病用药予以优先审评审批；持续推进仿制药质量和疗效一致性评价。海外创新方面，奥西替尼ESMO年会正式公布FLAURA研究的OS数据，结果显示奥希替尼对EGFR突变NSCLC患者实现了EGFR-TKI单药一线治疗最长的OS，比一代EGFR-TKI标准治疗延长了近7个月（38.6 vs 31.8个月）。