The purchase of Zymenex by Italy’s Chiesi has allowed VC firm Sunstone Capital to reap a second return on its investment in the Danish developer of enzyme replacement therapies.

Biopharma alliance volume has dropped over the past five years, but in 2012, privately held out-licensers averaged better up-fronts than their publicly traded counterparts, according to Elsevier’s Strategic Transactions.

In one of several large up-front deals it’s done in the past few years, Abbott paid $110 million for Action’s kidney injury candidate. Agilent bought cancer diagnostics firm Dako for $2.2 billion. And both biopharma and medical device financing went up in May compared with April.

Medicare’s bundling policy for drugs and services in dialysis has turned on the pricing pressure in kidney disease. The cost containment policies have negatively impacted sales of some drugs and put a spotlight on growing costs in chronic kidney disease and end-stage renal disease. Nonetheless, there is plenty of opportunity for new drugs that can address the area’s unmet medical need, especially if they can help to reduce broader health care spending. That will require demonstrating value to payors and providers, however, particularly for drugs that treat secondary conditions associated with kidney disease.