Ruud Dobber: Try to answer all the questions in a concise way. First of all, the field force, I’m not going to let’s say, give you complete numbers, but it’s a very substantial field for us. It’s substantial for 2 reasons. We’re detailing on the allergy as well as pulmonologist as well as we are detailing on a very large number of primary care physicians. Now the good news is that field force is a shared field force with Breast03. So we try to be very economically savvy in order to make sure that we’re not going over the top. The awareness, we have used 2023 to create a very substantial amount of awareness, the awareness over 80% at the level of both the allergists and pulmonologists and especially allergists are the first prescribers.
We started in a soft way in the last quarter. And the last quarter, we had already 5,000 trialists, especially at the specialist level for Airsupra. Once again, the biggest change and that’s the last question you were asking, what is not the headwind, but what is the biggest challenge? The biggest challenge is we are very happy the 3 large commercial PBMs have now listed as Airsupra but there are multiple downstream PBMs, and we still need to gain access there. There’s nothing specific to Airsupra. It’s just a fact of life of the U.S. environment. So we are working very diligently with our market access teams to — or in order to create that access. And equally, we’re going to bid for Part D in the course of this year as well.
David Fredrickson : Yes. So on Tagrisso within China, fourth quarter hospital ordering dynamics we’ve seen for the last several years, and it just really has to do with hospitals managing their budgets as they come to the end of the calendar year, which is also the fiscal year. So it doesn’t, for me, carry any weight into outlook for 2024. In fact, as I think about how we enter into 2024. Certainly, we continue to face competition, but where we don’t face nearly as much competition is in the adjuvant setting. I think it’s important to remind that there’s a sizable EGFR population within China. 30% to 40%. Also thoracic surgeons do have the ability to prescribe systemic therapies. So therefore, there’s a relatively high adjuvant treatment rate, and we had ADAURA added into the NRDL with no discount.
So I think that we come into the year with an opportunity to see growth in these really real demand side of things. And there are many fewer competitors that are playing within that adjuvant space. And our data, I think, stands out as being the most impressive there. The Australia rebate reclassification is almost a direct offset between what you see on the Zoladex established rest of world Beat and the Tagrisso Rest of World Beat’s, mostly a onetime event. And I’d say mostly just because there’s some carry on through the year, but I don’t anticipate talking about it ever again.
Pascal Soriot : Thank you, Dave. So thank you so much for your interest and your great questions. Maybe a few messages to close this meeting. The first 1 is just kind of taking into account all the questions last today. First 1 is product sales in 2024. We will still have very strong product sales and the product sets will grow. I mean the growth of product sales in is coherent with the guidance we gave for top line revenue. So the clear message is we are not dependent on collaboration revenue to grow in 2024. Our portfolio is doing very well, and all our geographies are doing very, very well. The second message is we are committed to this midterm operating margin, and it is, of course, challenging because as you’ve said, we have a very big portfolio.
We have to invest in this growth, but we will get there. We are committed to this, and we are working towards this, making good progress. You saw the margin expansion in 1 of the slides, and we’ll continue in that direction. The third message maybe is we believe we can manage through the Part D reform, and I mentioned it because I know some people have speculated this is going to be a big problem. It is a small headwind. I mean, headwinds, we have headwinds constantly in 1 market or another, 1 product or another. The beauty of our pipeline and our footprint geographically is when 1 product face a headwind and other product picks up, remember, we have 13 products that are blockbuster status today. And 1 geography is struggling a bit another 1 is doing better, and that’s really the model as we have it.
But overall, partly and we spent a lot of time, our teams have spent a lot of time working on modeling this. The incremental rebates that we will have to deal with is, first of all, in part compensated by the reduction of free goods, which is substantial for some of our oncology medicines. And overall, the net effect is certainly a negative, but it really totally manageable in the context of our total global sales and the growth rate we are experiencing. And finally, but importantly, we are absolutely confident we can deliver a very strong long-term growth. And that’s really what we want to show you and hopefully convince you at this R&D day, and I hope many of you will join us in the beautiful disk, where we have tremendously talented teams that are doing a great job.
We have today a huge number of collaborations in the Cambridge area, and this is really leading to very good productivity from our R&D efforts. With this, thank you very much. And again, thanks for your great questions.
