Despite a strong 2022 for both med-tech deals and M&As, the industry lost ground with both types of transactions in the first quarter of 2023, with deal values falling 32% and M&A values dropping 83%, in comparison with the first quarter of last year.

Quest Diagnostics Inc. evidently found what it was looking for, as it agreed to acquire Haystack Oncology Inc. in an all-cash deal valued at up to $450 million with $300 million at closing and $150 million contingent on meeting specific milestones. Haystack focuses on minimal residual disease (MRD) testing, which can detect residual or recurring cancer in its early stages and help guide therapy decisions using blood samples rather than biopsied tissue. The companies expect the transaction to close before the end of June.

Eli Lilly and Co. is selling worldwide rights to its hypoglycemia nasal treatment Baqsimi to Amphastar Pharmaceuticals Inc. in a deal potentially worth over $1 billion. Under the agreement, Amphastar, of Rancho Cucamonga, Calif., will foot a $500 million cash payment on closing, and will pay Indianapolis-based Lilly an additional $125 million on the one year anniversary of closing. Lilly is also eligible to receive milestone payments of up to $450 million, based on annual sales of $175 million and $200 million, and on total net sales over five years of $950 million.

Alphatec Holdings Inc. (ATEC) acquired the robotic-enabled minimally invasive (REMI) system from Fusion Robotics LLC, a division of Integrity Implants Inc. (dba Accelus Inc.), for $55 million in cash. The deal brings a sophisticated navigation system for spine procedures into the Alphatec fold, something management previously identified as a target for expansion. Alphatec focuses on spinal surgery solutions. REMI integrates navigation and robotics into a range of spinal procedures and allows use of either a 3D imaging scan or 2D fluoroscopic images to precisely guide instruments and implants to the desired location during surgery.

Tubulis GmbH is banking $22.75 million up front and could earn more than $1 billion in development, regulatory and commercial milestones from an alliance with Bristol Myers Squibb Co. focused on the design and development of antibody-drug conjugates for solid tumor applications. It would also receive tiered royalties on the sales of any products that emerge from the pact.

Despite strong deal activity throughout each of the last two years, the volume and value of partnerships began sliding in the first quarter (Q1) of 2023, while M&As continue to trail several other years.