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Plain betablockers Teno5min ; as a competitive alternative to Astra's largest selling betablocker in those countries. 59. Moreover, the data submitted by the parties indicates that Astra's prices for plain betablockers in Sweden and Norway are higher than their prices in the other Member States although some variation exists with different pack-sizes and strengths ; . Zeneca, on the other hand, has had its lowest European prices in Sweden and Norway. Prices in Belgium and the Netherlands are on the European average for both companies. Moreover, the parties have submitted evidence indicating that prices for Astra's best selling plain betablocker has decreased in Belgium and, in particular, in the Netherlands since the launch of the product. For Sweden and Norway, the price for the same product has increased over the period. 60. In conclusion, as shown above, Astra and Zeneca has a combined market share at the EEA level of [ 40%]. Although none of their competitors have a share exceeding 10% at this level, it is clear that there are a number of large pharmaceutical companies that are active on a significant scale in various parts of the EEA. Thus, the horizontal overlaps of significance are confined to the Swedish, Norwegian, Belgian and Dutch markets. 61. In Belgium, the merged entity will remain subject to competition from three multinational pharmaceutical producers AHP, Merck and SKB ; , each with at least 10% of the market. In addition, the parties' market shares are below 40% measured in volume, which together with the available price data indicates that the concentration will not create or strengthen a dominant position in that country. 62. In the Netherlands, the overlap between the parties is relatively small, as Zeneca only has a market share of [ 10%]. Furthermore, although none of the multi-national pharmaceutical producers has a market share exceeding 10%, the available price data indicates that these competitors and generic competition have resulted in a significant price decrease since the launch of the product. Thus, the concentration will not create or strengthen a dominant position for plain betablockers in the Netherlands. 63. However, for Sweden and Norway the parties would attain value based market shares of [ 80%] and [ 70%] respectively. Moreover, the market shares would be almost at the same level if measured in volume terms, which, together with the fact that Astra has been able to charge significantly higher prices than in other Member States, provides an indication that competition from other producers including generic products ; and or imports have not significantly restricted the company's market behaviour. Nor have the parties demonstrated that their future behaviour would be significantly restricted in the future. Furthermore, there are clear indications that Zeneca, in these countries, until now has been Astra's main competitor in plain betablockers. For all of these reasons, insofar as the Swedish and Norwegian markets for plain betablockers are concerned, the proposed concentration raises serious doubts as to the compatibility with the common market and the functioning of the EEA agreement. 2. Combined betablockers C7B 64. In 1997 the total sales of combined betablockers in the EEA reached a value of EUR [.]. At this aggregated level, Astra and Zeneca achieved sales of EUR [.] and EUR [.] respectively. Thus, their combined sales were EUR [.], representing [ 60%] of. 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Patients attending gastroenterology clinics are diagnosed with IBS, so it is essential that nurses have a good understanding of symptoms and treatments of this condition Gunn et al 2003 ; . Incidence and prevalence Between 20 and 25 per cent of the population present with IBS Barnes 1996, Gunn et al 2003 ; , and although it may affect either sex at any age, it is more prevalent in females. It often presents in late adolescence Barnes 1996 ; and incidence reduces with age. However, a recent study in the UK suggests that the influence of ageing is minimal Heaton et al 1992 ; . It is disease of relapse and remission, and accounts for 36 to 50 per cent of all gastrointestinal consultations, although many patients do not seek help and often attempt to self-treat Gunn et al 2003, Parker 2004 ; . IBS has a considerable impact on healthcare resources at both primary and secondary care levels, and is second only to back pain as a cause of lost working hours Silk 2001, Trickett 1990 ; . In a more recent study conducted in the US, 34 per cent of people with IBS averaged 30 sick days per year and more than 20 per cent stated that it limited their daily activities Heitkemper and Jarrett 2001 ; . Although IBS is neither life threatening, nor associated with the development of other gastrointestinal disorders such as cancer, it is often a debilitating condition and has a significant impact on the quality of life of many patients Heitkemper and Jarrett 2001 ; . Activities of daily living may be affected Heitkemper and Jarrett 2001 ; and patients often experience problems associated with lack of energy and fatigue, and role limitations caused by physical health Jones et al 2000 ; . Box 1. Rome II criteria for the diagnosis of irritable bowel syndrome IBS ; Abdominal discomfort or pain for at least 12 weeks need not be consecutive ; within 12 months that has at least two out of the following three features: I Relief with defecation I Onset associated with a change in form appearance ; of stool I Onset associated with a change in the frequency of stool The second group of Rome I symptoms cumulatively support the diagnosis of IBS: I Fewer than three bowel movements a week I More than three bowel movements a day I Hard or lumpy stools I Loose or watery stools I Straining during a bowel movement I Urgency I Feeling of incomplete evacuation I Passing mucus during a bowel movement I Abdominal fullness, bloating or swelling and zovirax.

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