42 million is nothing in the drug world. One reason it is so expensive is that the expectation of sales is low. The smaller the pool of potential patients the higher the price. While patches are costly to make, they are not that costly, and there is no expensive drug in it.
The cost is to cover the smaller user base and the control of dispensing etc.

I used to sell these products, so I know how many left the shelves each week. And each week is a huge exaggeration...they actually sat around until they expired for the most part and we'd have to send them back. When people got the cream on RX they never came back for refills.

Since this thread is so complex with alot of information on it, I'm going to request it be moved to the subforum above, where the informational posts are.

So look for it there in the near future.

Zostrix was put out there specifically for neuropathy caused by Shingles. Even tho it is OTC we used to keep it behind the counter at first, and use it only on RX --because it was only detailed to doctors. But it soon was moved to the BenGay section when advertisments started appearing in magazines for the general public. It was pretty expensive at first.. back then over $25 a tube. Now it is less. This link to Amazon for Zostrix HP ($15) has a very negative but typical review/response:
http://www.amazon.com/Zostrix-Potenc.../dp/B000F5IEK8

I had a tube by another company, here, my son used for hand pain from his overusing his video gaming controller... he liked it and it didn't burn for him. But he didn't use it for very long either. I just couldn't stand it. It was the weaker strength.
In all the years (over 10+) I have been on this board and its predecessor only a handful have ever reported success with it.
That is just the way it is.

There have over the years been other drugs in various pipelines to block Substance P. Merck had one it was going to sell as an antidepressant. But studies didn't pan out for it. It then went RX for nausea from chemo. Emend.
I recall some others now in the pipeline for pain, and only time will tell if they withstand the 3 tiers of clinical trials. It would be nice to have something really effective, so I am ever hopeful. But it might be a long time in coming.

Typically the press releases you can find on the net are very glowing.
They imply great success always, so that perhaps people will invest.

This location is actually the nitty gritty of the Pharm industry, and this is the link to Astellas:
http://www.cafepharma.com/boards/forumdisplay.php?f=68
So far there is only one brief mention of the "pain patch" coming out in Europe in Dec '10. But when Qutenza comes out, the reps will have alot to say about it. (from their perspective). Cafepharma is usually unpleasant IMO, but sometimes interesting data can be had from it.