In 2014, the total value of medtech merger deals hit $40 billion, which was more than twice as much as in 2013, according to a new EP Vantage report. The Medtronic and Covidien merger wasn’t even included in that figure since it closed at the beginning of 2015.

The top five deals in 2014 were between Thermo Fisher Scientific and Life Technologies, Carlyle Group and Johnson & Johnson’s ortho-clinical diagnostics business, Danaher and Noble Biocare, Essilor International and Transitions Optical, and Grifols and Novartis’s blood transfusion diagnostic business.

There was also an increase in companies going public — 34 device makers conducted initial public offerings (IPOs) on Western stock exchanges in 2014, which was over two times as many as in 2013. Additionally, the offerings were much larger — $2.2 billion was raised through IPOs in 2014 but only $742 million was raised the previous year.

The top ten medtech IPOs on the Western exchanges were Exova, Nevro, K2M, Horizon Discovery, Materialise Group, TriVascular Technologies, Lumenis, Sientra, Ocular Therapeutix and Inogen.

Seven out of 10 of the top deals involved over $1 billion transactions, which shows that the larger companies have a “large appetite for consolidation.” The surge in megamergers appears to be a positive thing, but that may be a bit deceiving.

The consolidation among larger companies is being fueled by the pressure to cut costs. In this new health care environment, their customers are demanding better prices and they must band together to make that happen.

Smaller acquisitions have taken the back seat to the larger megamergers, which is spurring fear that start-ups will not get the capital they need to fund their innovative products. The smaller acquisitions are needed to encourage venture backers to fund those smaller companies.

The European stock market didn’t perform as well in 2014 — it only had eight IPOs compared with the 29 in the U.S. All but one of the U.S. initial offerings were on the NASDAQ.

The U.S. also had 33 devices gain FDA approval in 2014, which was a 43 percent increase from the year before. However, it was still lower than the rates in 2011 and 2012.

The FDA is approving devices much faster now — last year it took an average of 17.6 months for a device to receive approval but the year before it took almost double that amount of time. Furthermore, the FDA has just starting to ease the regulatory burden and the report expects the approval time to speed up even more in the future.

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