2009 Healthcare Facts and Figures
All facts and figures were correct at time of going to print (February 2009)
2009 Healthcare Facts and Figures
IPHA The Irish Pharmaceutical Healthcare Association (IPHA) represents the international research-based pharmaceutical industry in Ireland. Its member companies include both manufacturers of prescription medicines and non-prescription or consumer health care medicines.
1
Introduction As outlined in this latest edition of Healthcare Facts and Figures the cost of developing a new medicine has increased from â‚Ź149 million in 1975 to â‚Ź1,059 million in 2006. It is also taking longer to bring a new medicine from the laboratory to a patient. As impressive as advances in pharmaceuticals have been, our work is far from over. Thousands upon thousands of people with serious diseases and conditions, and a healthcare system struggling with rising costs can benefit from new medicine discoveries. In this context it must be recognised that it is the medicines of today that inevitably pay for the medicines of tomorrow. We are on the verge of a new era of personalised and tailored medicine that holds great promise for patients and the healthcare system. That promise, however, is not a given and depends on sustained, substantial investment in R&D, a supportive public policy environment and an appropriate regulatory framework.
2
2009 Healthcare Facts and Figures
New medicines help patients to recover from ill health, faster and more fully. They make it possible to prevent or slow the development of many diseases, turning for example, previously fatal illnesses into manageable chronic conditions and helping avoid the discomfort of invasive surgery. They also offer cost savings and improve efficiency, delivering financial benefits to the whole healthcare system, through optimal management and reduction of treatment times, hospitalisation and time off work. These advances have immeasurably improved the lives of Irish patients, as well as their families and care givers. The encouragement of innovation in medicines, in how we deliver medicines and in how we deliver healthcare is central to the improvement of our healthcare system, of patient health and of our country’s economic development and needs to continue to be rewarded.
Dr Gerald Farrell IPHA President
3
Contents Healthcare Today
6
Public Expenditure on Health 1998-2009 Health Expenditure as a % of GDP 2007 State Expenditure on Medicines 2000-2007 Pharmaceutical Expenditure as a % of Healthcare Expenditure in Selected Countries Pharmaceutical Expenditure per Capita in Western Europe 2007 Number of Day Cases Treated in Ireland 1997-2007 Self-perceived Health Status by Age Group 2007 Prevalence and Burden of Chronic Disease
Self-Care Today
16
Self Medication Market in Ireland 2007 OTC Medicines as a % of the Total Pharmaceutical Market 2007
Demographic Trends
20
Population projections 2006-2036 Comparison of Age-Related Public Expenditure Main Causes of Death in Ireland 2007
Healthcare Tomorrow Evolution of Innovative Medicines Medicines Life Cycle Cost of Developing an Innovative Medicine Benefits of Innovative Medicines
4
26
2009 Healthcare Facts and Figures
Need for Continued Medicines Innovation Business Sector R&D in Ireland Changes in Location of Pharmaceutical Industry Research Sites in the Period 2001 – 2006
The Medicines Industry
36
Leading Pharmaceutical Companies by Sales in Ireland and Globally Distribution of Global Pharmaceutical Sales by Region 9 of the World’s Top 15 Medicines are Produced in Ireland World Trade in Pharmaceuticals 2006
Medicines in the Community
42
Community Medical Schemes Expenditure 2007 GMS Scheme Expenditure and % Growth Rate 1998-2007 Ageing of the GMS Scheme 1994-2007 Drugs Payment Scheme Expenditure 1999-2007 High Tech Scheme Expenditure 1999-2007 Long Term Illness Scheme Expenditure 1999-2007 Making Headroom for Innovation
Medicines and Global Health
52
Industry Supported Public-Private Partnerships in the Developing World Number of Positive Health Interventions made in the Developing World
Map of Pharmaceutical Locations in Ireland
56 5
Healthcare
6
•
The last decade has seen an unprecedented increase in health expenditure following a period of cutbacks and stagnation in the 1980’s and the early 1990’s. Public expenditure on health will have almost quadrupled in the period 1998 to 2009.
•
Healthcare expenditure in Ireland, relative to other European States, is coming from a low base. Irish expenditure in 2007, as a percentage of GDP, is the lowest alongside Luxembourg in the EU.
•
The Irish healthcare system remains a mix between public expenditure (75%) and private expenditure (25%). Over 50% of the population now have some form of private health insurance.
•
The numbers employed in the health services increased by over 60% between 1997 (68,084) and 2007 (111,505).
•
State expenditure on medicines has increased in tandem with the increase in public expenditure on healthcare. Medicines account for just 14.7 % of total healthcare expenditure – a small but vital component.
•
Irish consumption of medicines remains amongst the lowest in Western Europe. Growth in the Irish market has to be viewed against this background and against the ever-increasing sums being invested to improve public health.
2009 Healthcare Facts and Figures
Today •
The pharmaceutical industry has recognised that the State faces a challenge in funding healthcare going forward and has agreed robust, cost effective arrangements for the supply of medicines to the health services. The State has estimated that these arrangements will result in savings of â‚Ź300 million in the State medicines bill in the period through to September 2010, savings which will provide the State with the monies to fund new therapies which offer hope to patients of longer, healthier, more active lives.
7
Public Expenditure on Health 1998-2009
18 16.2
16
16.34
15.1
14 13.1 11.9
â‚Ź (Billions)
12 10.1
10 9.1 8.4
8 7.2
6
5.7 4.9 4.1
4
2
0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* Source:
8
Department of Health and Children Statistics * Budget provision for 2009
Health Expenditure as a % of GDP 2007
Ireland
7.5
Luxembourg
7.5
Finland
8.2
Spain
8.4
UK
8.4
OECD
8.9
Italy
9
Greece
9.1
Sweden
9.2
Denmark
9.5
Austria
10.1
Portugal
10.2
Belgium
10.4
Germany
10.6
France
11.1
Switzerland
11.3
0
2
6
4
8
12
10
% Source:
OECD Health Data 2007 (e) Estimate
9
State Expenditure on Medicines 2000-2007
1800
30 1701
27
1600
1529
25 22 1202
21
1200 € (Millions)
1332
1022
20
18
17
1000 867
15
15
800 718 11
600
11
10
565
400 5
200
0
0
2001 2000 Euro (Millions)
2002
2003
2004
2005
2006
% Growth Rate Source:
10
GMS/PCRS Annual Reports from 2000– 2007. The GMS figure excludes VAT and the Hi-Tech Scheme figure excludes patient care fees.
2007
% Growth
1400
Pharmaceutical Expenditure as a % of Healthcare Expenditure in Selected Countries 2006
Spain
21.7
Portugal
21.3
Italy
20
Greece
17.6
OECD
17.6
Belguim
16.9
France
16.4
Germany
14.8
Ireland*
14.7
Finland
14.6
Sweden
13.3
Austria
12.4
Denmark
8.5
0
5
15
10
20
25
% Source: OECD In Figures 2008 * IPHA calculation
11
Pharmaceutical Expenditure per Capita in Western Europe 2007
Denmark
276
Ireland
320
Sweden
351
UK
366
Finland
380
Netherlands
384
Norway
399
OECD
404
Austria
409
Switzerland
436
Portugal
441
Luxembourg
467
Germany
498
Italy
509
Spain
515
France
589
0 Source:
12
100
200
OECD Health Data 2008
400 300 US Dollars ($)
500
600
700
Number of Day Cases Treated in Ireland 1997-2007
600,000
590,000
512,000
500,000 449,000
400,000 358,000
297,000
300,000 249,000
200,000
100,000
0 1997 Source:
1999
2001
2003
2005
2007
Department of Health and Children Health Statistics 2005; HSE Annual Reports 2006 – 2007
13
Self-perceived Health Status by Age Group 2007
This is in a country where 1 in every 4 persons is obese and every 2nd person is overweight*. 100 90 80 70 60 % 50 40 30 20 10 0 18-24 14
25-34
Bad/Very Bad Source:
35-44 Fair
45-54
55-64 Good
65-69
70+ Very Good
Health Status and Health Service Utilisation Q3 2008, Central Statistics Office * SLAN 2007 Report (Survey of Lifestyle, Attitude & Nutrition)
All
2007 2008 Healthcare Facts and Figures
Prevalence and Burden of Chronic Disease
•
Chronic diseases such as diabetes, hypertension, heart disease and stroke are a large and growing burden on the health of Irish people and the Irish healthcare system. In the United States it is estimated that chronic diseases are responsible for about two-thirds of the rise in healthcare spending over the last 15 to 20 years.
•
The rising prevalence of chronic disease is partly the result of a population that is ageing and increasingly obese.
•
Today, approximately 25% of the Irish population have a chronic disease accounting for 78% of the country’s healthcare spending.
•
Approximately 80% of GP consultations and 60% of hospital days are related to chronic disease and their complications making those people the most frequent users of healthcare in Ireland.
•
2 out of 3 patients admitted as medical emergencies have exacerbations of chronic disease and 60% of deaths are as a result of a chronic disease.
•
Chronic diseases can be disabling and reduce a person’s quality of life, especially if left undiagnosed or untreated. For example, every 30 seconds, somewhere in the world a lower limb is amputated as a consequence of diabetes.
•
There is a significant increase predicted in chronic disease due to the estimated doubling of the elderly population over the next 30 years. This has implications for the healthcare system, if the current trends continue, bed requirements in hospitals will increase by 50-60% over the next 15 years.
•
Many of the consequences and costs of chronic disease are avoidable through screening, early intervention, behaviour change and the elimination of key risk factors such as poor diet, inactivity and smoking.
15
Self-Care
16
•
Consumers want to actively manage their own health and are taking greater individual responsibility for their healthcare and health choices.
•
The health, social and economic benefits of responsible selfmedication are well known and have been extensively reported.1
1 2
–
Patients and consumers benefit due to wellness, enhanced productivity and improved health in terms of prevention and increased patient satisfaction as a result of being able to obtain the correct medication directly.
–
Employers gain by having employees attend work when they might otherwise have stayed at home.
–
General Practitioners save time which enables them to better use that time for those patients with complicated or serious illnesses. A recent report estimated that 51.4 million GP consultations in the UK were solely for minor ailments. It estimated that this represented 18% of a GP’s workload. Furthermore it estimated that the total cost to the NHS of these consultations was €2.5 billion and 80% of this cost (€2.15 billion) related to the cost of the GP’s time.2 It also presents more of an opportunity for doctors to educate patients about common ailments and diminishes patient expectations of a prescription for every visit.
–
Pharmacists play a more active advisory role using their skilled knowledge of medicines and expertise in advising on symptoms.
–
Consumers pay less visits to accident and emergency departments and doctor surgeries. This in turn reduces the number of prescriptions, most of which are paid for, directly or indirectly, by the State.
E.g. Guiding Principles in Self-Medication: WSMI: http://www.wsmi.org/publications.htm Minor ailments cost the NHS £2 billion/year. Pharm J 2008; 280:1090
2009 Healthcare Facts and Figures
Today •
The Association of the European Self-Medication Industry (AESGP) has estimated that savings of over €75 million annually could be achieved in Ireland if self-medication was practised more widely. The savings could then be put to better use elsewhere in the healthcare system.
•
Self-medication is an important element of the total Irish market for pharmaceutical products. The leading areas of the market include analgesics (23%), cough and cold treatments (17%) and vitamins and minerals (12%).
17
Self Medication Market in Ireland 2007
Total Market: â‚Ź315 m* Analgesics 23% Cough & Cold 17% Vitamins & Minerals 12% Digestives & Intestinal Remedies 10% Skin Treatment 10% Smoking Cessation 7% Others 22% 18
Source:
IMS Health, 2008 * At consumer price level
2007 2008 Healthcare Facts and Figures
OTC Medicines as a % of the Total Pharmaceutical Market 2007
Portugal
7.5
Spain
8.2
Denmark
8.9
Sweden
9.3
Finland
10.9
Italy
11.2
Austria
12.1
Netherlands
12.3
Belgium
15.1
Ireland
16.0
Germany
16.0
UK
17.3
France
19.1
0 Source:
2
4
6
8
10 %
12
14
16
18
20
AESGP Economic and Legal Framework for Non-Prescription Medicines 2008
19
Demograp
20
•
The population of the Republic of Ireland increased by nearly 325,000 in the four year period April 2002 to April 2006. Having only recently passed 4 million, the population is set to exceed 5 million within the next 15 years and projected to rise to 5.8m by 2036.
•
With an average age of 35.6 years Ireland has a relatively youthful age structure; however this is set to change. Those aged 65 and over will account for 20% of the population (1.14 million) by 2036 as against just 11% of the population (430,000) in 2001 and the number of those aged 80 and over is set to treble from a 2001 level of 98,000 to 320,000 in 2036. These changes will have significant implications for public spending and in particular healthcare expenditure as the elderly typically require 2–5 times as many resources as those under 65.
•
The life expectancy of those over the age of 65 has improved significantly in recent years but remains low by comparison to our Western European neighbours.
•
Circulatory diseases continue to be the principal cause of death in Ireland and along with cancer account for nearly two thirds of all deaths.
•
Approximately one in five deaths in Ireland is of a person aged less than 65 years old.
2009 Healthcare Facts and Figures
hic Trends
21
Population Projections 2006-2036
5,800,00
6
5,600,000 5,400,000 5,100,000 4,900,000
5 4,500,000 4,200,000
Millions
4
3
2
1,002,000
1 466,000
531,000
631,000
741,000
1,140,000
866,000
0 2006 All Source:
22
2011 Over 65’s
Central Statistics Office
2026
2016
Year
2031
2036
Comparison of Age-Related Public Expenditure
Male
7000
6567 6034
6000
euro
5000
4964
4514
4000
4472 3365
3000
2800 2117
2000 1000 0
60-64 yrs
80-84 yrs
70-74 yrs
90-94 yrs
Female
7000
6110
6000
5392
euro
5000
4604 4052
3854
4000 3000
2914
2518 1939
2000 1000 0
60-64 yrs Ireland EU 15 Source:
80-84 yrs
70-74 yrs
90-94 yrs
Years
The impact of ageing on public expenditure: projections for the EU25 Member States on pensions, health care, long term care, education and unemployment transfers (2004-2050), European Commission 2006
23
Main Causes of Death in Ireland 2007
Heart Disease Circulatory Diseases
35%
Stroke
Cancer
29%
Other Circulatory Diseases 10%
Respiratory Diseases 14% Injury and Poisoning Other causes 24
18%
Source:
5% 17%
Central Statistics Office
7%
25
Healthcare
26
•
Research and development of new medicines offers hope to an ageing population of a longer healthy life, well beyond that of previous generations. For example, there are currently over 750 medicines in development to combat cancer, 547 for neurological conditions and 303 for rare diseases.
•
Research based pharmaceutical companies are the engines of medicines innovation. They have discovered and developed over 90% of all new medicines made available to patients worldwide over the last twenty years.
•
The discovery, development, testing and gaining of regulatory approval for new medicines has become an even more highly complex, lengthy, risky and expensive process. Each success is built on many, many prior failures. On average only one or two of every 10,000 promising molecules will successfully pass extensive tests and stringent regulatory requirements and go on to be approved as medicines, which are suitable for use in patients. As such the cost of developing a medicine has gone from €149 million in 1975 to €1,059 million in 2006.
•
It takes an average 10 to 12 years to develop a new medicine from the time it is discovered to when it passes the regulatory standards of safety, quality and efficacy and is available to patients. Once on the market the average medicine has only 8 to 10 years of effective patent protection left before facing generic competition. Only three out of ten marketed medicines produce revenues that match or exceed their R&D costs before they lose patent protection.
•
The European pharmaceutical industry employed over 107,000 people in R&D in 2007 and spent a total of €24.8 billion on such work.
2009 Healthcare Facts and Figures
Tomorrow •
Innovation is central to the creation of the knowledge based economy of the 21st century. In Ireland pharmaceutical industry R&D is responsible for 20% of all business R&D. If innovation is to flourish then it must be rewarded. Whilst Ireland retains a proinnovation outlook this is increasingly not the case in Europe generally with patient access to new medicines via State reimbursement systems being delayed or even denied entirely. As a result of this less favourable climate for innovation more and more pharmaceutical companies, including European ones, are deciding to locate new R&D facilities outside Europe.
27
Evolution of Innovative Medicines
Treatment for autoimmune disease
CNS drugs
Cancer therapies
Focus on Molecular Structure
Complexity
Beta-blockers Anti-arthritis Tranquilizers
Focus on Cell Biochemistry
Antihypertensives
Serendipitous Observation
Antibiotics
Sulfonamides
Focus on Tissue Biochemistry Aspirin
1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 Accumulated Knowledge of Human, Cell and Molecular Biology Source:
28
Boston Consulting Group
Medicines Life Cycle
From concept to product: steps in the genesis of a medicine
10,000 molecules screened
100 molecules tested
10 candidate molecules 1 medicine
Test phase
Research phase 0
5 years 10 years R&D
Patent filing
Source:
Development phase 10 years
Administrative Procedures 15 years
Commercialisation phase 20 years
2 to 3 years
Patent expiry
LEEM
29
Cost of Developing an Innovative Medicine
1200
1,059
1000 868
€ (Millions)
800
600
400 344
200
149
0 1975 Source:
30
1987
2001
2006
J.A DiMasi and H.G. Grabowski, ‘The Cost of Biopharmaceutical R&D: Is Biotech Different?, Price of Innovation: New Estimates of Drug Development Costs’, Managerial and Decision Economics 28 (2007) : 469- 479
Benefits of Innovative Medicines
Beta Blockers
23% reduction in long term risk of death Improved bypass operation survival rates
22% reduction in risk of death from heart attack and stroke
Ace Inhibitors
Calcium Antagonists
30% reduction in stroke events 29% reduction in coronary heart disease events
39% reduction in stroke events 28% reduction in major cardiovascular events
60% reduction in risk of heart attack
Statins
30% reduction in risk of death 17-30% reduction in stroke events
Combination Therapy
Source:
72-80% reduction in risk of death when using a combination of anti-platelets, beta blockers, ACE inhibitors and statins
Adapted from an ABPI Report (2004) The Human and Economic Value of Pharmaceutical Innovation and Opportunities for the NHS: Blood Pressure Lowering Treatment Trialists’ Collaboration (2000) The Lancet. See also IFPMA: The Value of Innovation (2008).
31
Need for Continued Medicines Innovation Prevention
Treatment
Cure
HIV/AIDS Tuberculosis Malaria Childhood Diseases Respiratory Infections Cancers Neuropsychiatric Disorders Cardiovascular Diseases Diabetes Respiratory Diseases Medicines exist (R&D to improve their utility for patients) Medicines exist (R&D to overcome emerging challenges e.g. drug resistance)
32
No medicines (R&D to bridge the gap) Source:
IFPMA, The Value of Innovation (2008)
Business Sector R&D in Ireland
Software/Computer related
30%
Electrical/Electronic equipment
21%
Pharmaceuticals
20%
Instruments
9%
Food, Drink & Tobacco
5%
Other services
4%
Chemicals
3%
Other sectors
8%
Source:
Forfås Research and Development Statistics in Ireland, 2006 – at a glance
33
Changes in Location of Pharmaceutical Industry Research Sites in the Period 2001-2006
18 16
Number Pharmaceutical Industry Research Sites
14
12
10
8
6
4
2 0 Europe
USA
New Research Sites Closed Research Sites 34
Note: Source:
Data collected from 22 global pharmaceutical companies IMI, EFPIA Research Directors Group, IFPMA
Asia
35
The Medic
36
•
The international research-based pharmaceutical industry is critical to the health of the nation as it plays a vital role in the Irish economy.
•
More than 120 pharmaceutical companies have a presence in Ireland, of which 13 of the world’s top 15 pharmaceutical companies have substantial operations. The industry directly employs over 24,500 people, half of whom are third level graduates, with as many again employed in the provision of services to the sector. The industry contributes approximately €3 billion annually in taxes to the State.
•
Pharmaceutical production in Ireland currently generates nearly 50% of the country’s exports and 11% of its Gross Domestic Product which contribute to making Ireland the largest net exporter of medicines in the world.
•
Nearly €7 billion has been invested by the pharmaceutical sector over the last nine years in a period when job growth in the sector has averaged 1,000 annually. According to IDA Ireland the replacement value of the investment by the pharmaceutical sector in the Irish economy is over €40 billion.
2009 Healthcare Facts and Figures
ines Industry •
The market for pharmaceuticals continues to grow as outlined in the next section on Medicines in the Community and there are opportunities for the industry to develop its operations in Ireland still further.
37
Leading Pharmaceutical Companies by Sales in Ireland and Globally
Ireland Top 101
Source:
By Rank
By Rank
1. Pfizer
1.
Pfizer
2. AstraZeneca
2.
GlaxoSmithKline
3. GlaxoSmithKline
3.
Novartis
4. sanofi-aventis
4.
sanofi-aventis
5. Wyeth
5.
AstraZeneca
6. Roche
6.
Johnson & Johnson
7. Novartis
7.
Roche
8. Merck Sharp & Dohme
8.
Merck & Co.
9. Abbott
9.
Abbott
10. Lilly
10. Lilly
1
IMS Health Data Dec 2008 IMS Health Data Dec 2008 Note: “Merck & Co., Inc.” has its headquarters in Whitehouse Station, NJ, USA and operates in most countries outside the U.S., including Ireland, as Merck Sharp & Dohme.
2
38
Global Top 102
Distribution of Global Pharmaceutical Sales by Region
North America
46%
Europe
31%
Asia (excl. Japan), Africa and Australia
9%
Japan
9%
Latin America
5%
2007 Global Sales â‚Ź663.50 billion
Source: IMS Midas, Dec 2007
39
9 of the world’s top 15 medicines are produced in Ireland
Source:
40
Rank
Medicine
Company
1.
Lipitor
Pfizer
5.
Enbrel
Wyeth
7.
Zyprexa
Eli Lilly
8.
Remicade
Centocor
9.
Singulair
Merck Sharp & Dohme
10.
Risperdal
Janssen Pharmaceuticals
12.
Takepron
Takeda
13.
Effexor XR
Wyeth
15.
Actos
Takeda
IPHA Analysis. Rankings based on IMS Health Data, Dec 2008
World Trade in Pharmaceuticals 2006
Country
Exports $
Imports $
Balance $
Ireland
12,734
1,753
10,981
Switzerland
20,663
10,292
10,371
Germany
32,243
24,622
7,621
UK
18,508
12,679
5,829
France
18,023
12,231
5,792
Sweden
6,350
2,362
3,988
Belgium
28,410
25,679
2,731
Austria
3,861
2,781
1,080
Netherlands
9,046
8,937
109
Italy
9,727
9,949
-222
Spain
5,338
6,951
-1,613
Japan
1,878
5,753
-3,875
19,129
32,318
-13,189
USA
Source:
International Trade Centre, a joint agency of the World Trade Organisation and the United Nations (http://www.intracen.org/dbms/country/CA_CtryIndex.Asp?CT=372)
41
Medicines in Expenditure on the community medicines schemes has risen steadily in recent years. The factors behind that growth include:
42
•
Ireland’s rapidly increasing and ageing population as outlined in the section on Demographic Trends.
•
The development of new treatments becoming available and more patients availing of them: for example in the areas of preventative medicine and the long-term treatment of chronic illness. The number of patients registered under the High Tech Scheme in 2007 was 41,500, a five fold increase on the figure in 1997 (8,250).
•
The introduction of Government initiatives to improve public health: the cardiovascular and the cancer strategies were launched with a view to improving poor health outcomes in these disease areas. They have resulted in more people being treated and naturally an increase in the utilisation of medicines. For example the prescribing frequency of cardiovascular system medication under the GMS Scheme increased from 3.6 million in 1996 to 11.1 million in 2007 (an increase of 208%).
•
Epidemiological evolution: the increased incidence of chronic and non-communicable diseases is generally quite costly to treat. Ireland has one of the highest incidences of asthma in the world, currently 12%, and increasing levels of diseases like diabetes and obesity.
•
State decisions on eligibility and administration of the community drug schemes: The granting of medical cards to everyone over 70 and the introduction of the Drug Payment Scheme resulted in substantial growth in the State bill. For example the Deloitte review of the Governance and Accountability Mechanisms in the Community Drug Schemes (2003) noted that the provision of medical cards to the over 70s cost an additional €126m in the first full year of the arrangement in 2002. It also noted that the number of claimants under the DPS increased by 40% between 2000 and 2002.
2009 Healthcare Facts and Figures
the Community The growth in medicine expenditure also has to be seen in the context of the fact that Ireland historically has one of the lowest levels of consumption of medicines per head of population, so it is only to be expected that spending on medicines will increase as the healthcare system endeavours to improve life expectancy and quality of life. It also has to be seen in the context of the large scale and ongoing increases in Irish health spending.
43
Community Medical Schemes Expenditure 2007
1050
1029
975 900 825 750 675 â‚Ź (Millions)
600 525 450 375 307
300 239
225 150
124
75 0 Long Term Illness Scheme Source:
44
High Tech Scheme
Drug Payment Scheme
General Medical Services (GMS) Scheme
HSE Primary Care Reimbursement Service Annual Report 2007 The GMS Scheme figures exclude VAT and the High Tech Scheme figures exclude patient care fees.
GMS Scheme Expenditure and % Growth Rate 1998-2007 The Scheme provides free medical services to persons who would not otherwise be able, without undue hardship, to afford such services.
30
1100 1029
28 27
1000
922
25
900 816
800
749
20 700
18
â‚Ź (Millions)
639
600
17
540
15
14.8
500 11
426
12
11.6
400
10
332
300
252
283
8
200
5
100
0
0 1998 1999 Euro (Millions)
2000
2001
2002
2003
2004
2005
2006
2007
% Growth Rate Source:
GMS (Payments) Board Annual Reports 1998 – 2005 HSE Primary Care Reimbursement Service Annual Reports 2006 & 2007 Figures excluding VAT.
45
% Growth
17
Ageing of the GMS Scheme 1994-2007
While the overall numbers eligible for medical cards has fallen since 1994, the number of cardholders aged 65 and over has increased by nearly 36% (a trend significantly accentuated by the granting of medical cards to everyone over 70 years old in 2001).
Year
As a % of the Population
Total No. Aged 65 years+
65+ as a % of Eligible Persons
1994
1,287,000
36.0%
297,000
23.1%
2000
1,148,000
30.3%
323,000
28.1%
2004
1,149,000
29.3%
383,000
33.3%
2007
1,276,000
30.1%
416,000
32.6%
Source:
46
Total No. of Eligible Persons
GMS (Payment) Board Annual Reports 1994-2005 HSE Primary Care Reimbursement Service Annual Reports 2006 & 2007
Drugs Payment Scheme Expenditure 1999-2007
325 307
300 283
275 247
250 224
225 204
200
192 178
â‚Ź (Millions)
175 150
141
125 105
100 75 50 25 0 1999
Source:
2000
2001
2002
2003
2004
2005
GMS (Payment) Board Annual Reports 1999-2005 HSE Primary Care Reimbursement Service Annual Reports 2006 & 2007
2006
2007 47
High Tech Scheme Expenditure 1999-2007
Developments in biotechnology and therapeutics have given rise to the introduction of medicines for the treatment of medical conditions, many of which previously had either no effective treatment or required extended in-patient hospital care. Under the Scheme these medicines are dispensed by the community pharmacist.
250 239
207
200
â‚Ź (Millions)
169
150
141
104
100 80 61
50
49 40
0 1999 Source:
48
2000
2001
2002
2003
2004
2005
2006
2007
GMS (Payment) Board Annual Reports 1999-2005 HSE Primary Care Reimbursement Service Annual Reports 2006 & 2007 Figures exclude patient care fees. The number of patients registered under the Scheme has increased from just over 8,000 in 1998 to nearly 41,500 in 2007.
Long Term Illness Scheme Expenditure 1999-2007
The Long Term Illness Scheme is for persons who suffer from one or more defined long term illnesses. It gives such persons the right to obtain, irrespective of income, relevant medication free of charge.
140 124
120
115
101
100
â‚Ź (Millions)
86
80 73 62
60 52 42
40
34
20
0 1999 Source:
2000
2001
2002
2003
2004
2005
GMS (Payment) Board Annual Reports 1999-2005 HSE Primary Care Reimbursement Service Annual Reports 2006 & 2007
2006
2007 49
Creating Headroom for Innovative Medicines Per Item Cost on GMS Scheme is stabilising while the DPS and LTI Scheme is reducing
55 53.5
50 50
51
52
53
48
45 45 42.1
40
35 â‚Ź
35.75
36.25
37.1
36.25
34 31.9
30 29 27
25 20
15
15.8 11.5
16.9
17.2
2004
2005
18.1
18.5
2006
2007
14.2 13
0 2000
2001
2002
2003
Long Term Illness Scheme Drugs Payment Scheme GMS Scheme
50
Source:
HSE Corporate Pharmaceutical Unit, 2008
51
Medicinesand
52
•
Of the 340 medicines on the World Health Organisation (WHO) essential drugs lists, 95% of them have no patents. This means that there is no patent obstacle preventing cheap generic copies of the vast majority of essential medicines being produced locally for poor people in developing countries. But those people are not getting them.
•
Patents do not prevent access to medicines. The real barrier hindering access to treatments is in fact a lack of the basic healthcare infrastructure required to get existing medicines to people. Other factors such as a lack of access to basics like food, decent housing and clean water, armed conflict, corruption, bureaucracy and the lack of simple prevention measures like condoms and mosquito nets, unfortunately mean that poor health is endemic for the world's poorest people.
•
Pharmaceutical companies globally are currently involved in more than 150 health partnerships and programmes in the developing world which are designed primarily to improve access to medicines and other aspects of healthcare. Seventy-eight of these involve capacity building activities. These include the provision of basic health education, encouraging behavioural change, training health personnel, mounting prevention campaigns, as well as providing infrastructure for delivering healthcare services.
•
In the period 2000 to 2008, the industry provided enough health interventions – medicines, vaccines, equipment, health education and training – to help nearly 1.75 billion people in developing countries.
2009 Healthcare Facts and Figures
Global Health •
The industry has made available medicines, vaccines, equipment, training and health education worth $9.2 billion, of which $2.7 billion was in 2007 alone, to the developing world since the United Nations announced the Millennium Development Goals.
•
Pharmaceutical companies are involved in 67 R&D programmes, up from 58 in 2007, for neglected tropical diseases and other diseases of the developing world such as malaria, sleeping sickness, dengue fever and chagas disease.
53 © BMS – www.securethefuture.com
Industry Supported Public-Private Partnerships in the Developing World
Chronic Diseases
11
Child & Maternal
17
Vaccine Preventable
10
Tropical Disease
19
Tuberculosis
13
Malaria
13
HIV/Aids
52
0
Source:
54
10
40 30 20 Number of public-private partnerships
50
IFPMA Partnerships to Help Build Healthier Societies in the Developing World 2007 www.ifpma.org/healthpartnerships
60
2007 2008 Healthcare Facts and Figures
Number of Positive Health Interventions made in the Developing World
400
Millions of people potentailly reached
350
300
250
200
150
100
50
0 2000
2001
2002
2003
2004
2005
2006
2007
Other health interventions + education + training Medicines, Vaccines & Diagnostics - no profit Medicines, Vaccines & Diagnostics - donated A positive health intervention is: (a) the delivery of sufficient medicine to cure one person of one disease, (b) the provision of a course of therapy sufficient to manage one disorder in one person for one year, (c) provision of sufficient vaccine to immunise one person against one disease for at least one year, or (d) delivery of a proven program of health education or training to one person. These metrics were used because, while companies know the number of doses they make available, they have a less precise view of the number of patients actually treated. Source: IFPMA www.ifpma.org/healthpartnerships
Open...to see the footprint of Ireland’s pharmaceutical industry.
1
16
MONAGHAN 15
SLIGO 14
WESTPORT DUBLIN 13
NEWBRIDGE
ATHLONE
RATHDRUM
ENNIS
1
3 4
ARKLOW
12
17
BRAY
5
CASHEL 8
11
CLONMEL
LIMERICK
9
WATERFORD 10
CORK
TPG0209
DUNGARVAN
KILLORGLIN
6
7
2
Design and production: www.slickfish.ie
Dublin Abbott Laboratories A Menarini Pharmaceuticals Alliance Pharmaceuticals Amgen Arch Astellas Pharma AstraZeneca Pharmaceuticals Bayer Consumer Care Bayer Schering Pharma Biogen Idec Boehringer Ingelheim BOC Bristol Myers Squibb Pharmaceuticals Celgene Cephalon Pharma Covidien Eisai Eli Lilly & Company Forest Laboratories GlaxoSmithKline GlaxoSmithKline Consumer Healthcare Grunenthal Pharma Helsinn Birex Therapeutics Ipsen Pharmaceuticals Janssen-Cilag Labopharm Europe LEO Pharma Henkel Loctite Lundbeck MEDA McNeil Healthcare Merck Serono MSD Mundipharma Novartis Novartis Consumer Health Novo Nordisk Nycomed Organon Laboratories Pfizer Healthcare Pierre Fabre Proctor & Gamble Reckitt Benckiser Rehels Roche Products Rottapharm sanofi-aventis Sanofi Pasteur MSD Schering Plough Pharmaceuticals Servier Laboratories Shire Pharmaceuticals Solvay Healthcare SSL Healthcare Stiefel Laboratories Takeda Tillotts Pharma UCB Pharma Wyeth Consumer Healthcare Wyeth Pharmaceuticals
2
Cork Cara Partners Centocor Cognis (Henkel) Corden Dyno Eli Lilly & Company FMC GE Healthcare Gilead Sciences GlaxoSmithKline Janssen (J&J) Novartis Pfizer Recordati Schering Plough Quest (ICI) Wexport (Leo)
3
Newbridge
12
Olympus Roche 13
Athlone Athlone Pharmaceuticals Elan
14
Westport Allergan
15
Sligo Abbott Diagnostics Fort Dodge (AHP) Stiefel Laboratories
16
Monaghan Norbrook Labs
17
Wyeth Medica (AHP) 4
Ennis
Bray Takeda
Rathdrum Schering Plough
5
Arklow Servier
6
Waterford Arkopharma Genzyme Lawter International Novartis Agribusiness TEVA
7
Dungarvan
8
Cashel
GlaxoSmithKline Ranbaxy
9
Clonmel Clonmel Healthcare (Stada) MSD
10
Killorglin Astellas Pharma Temmler
Limerick
11 Aughinish Alumnia (Glencore AG) Heraeus Info Lab (Huber Group) Schwarz Pharma Wyeth Nutritional (AHP)
Franklin House 140 Pembroke Road Dublin 4 Ireland Tel: (353 1) 660 3350 Fax: (353 1) 668 6672 E-mail: info@ipha.ie
www.ipha.ie www.medicines.ie www.feelbetter.ie