Pharmaceutical Healthcare Facts and Figures 2010
2010 Pharmaceutical Healthcare Facts and Figures Franklin House 140 Pembroke Road Dublin 4 Ireland Tel: (353 1) 660 3350 Fax: (353 1) 668 6672 E-mail: info@ipha.ie
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All facts and figures were correct at time of going to print in April 2010.
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Pharmaceutical Healthcare Facts and Figures 2010
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 Reading through Pharmaceutical Healthcare Facts and Figures 2010 it is clear that the international research-based pharmaceutical industry’s footprint spans the entire island of Ireland. Everyday the industry plays a vital role in the lives of Irish patients and consumers. When they fall ill – whether it’s with a cold or something more serious like a heart attack – it is likely that they will take a medicine or treatment to help them get better. Our industry now has a further role to play in helping the Irish economy get better. The Government has spoken of its desire to create an “Innovation Island” and how this is central to our economic recovery. The international research-based pharmaceutical industry has been a key driver of the development of our economy over the last forty years. This sector sees, in Ireland, a country which is open for our business and responsive to our needs. That’s why today we employ more than 24,500 people directly and as many again indirectly. It also explains why we are the largest contributors to corporation tax and why pharmaceuticals, along with chemicals and medical products, account for 50% of Irish exports.
2
Pharmaceutical Healthcare Facts and Figures 2010
In order that the industry can play a full role in Ireland’s economic recovery it is crucial that Ireland maintains its reputation as a country that understands and values innovation and the contribution of the pharmaceutical industry. In this regard it is important that Irish patients continue to have timely access to innovative medicines. The “Innovation Island” and Ireland’s economic recovery depend on these types of actions.
Dr Gerald Farrell IPHA President
3
Contents Healthcare Today
6
Public Expenditure on Health 1999-2010 Health Expenditure as a % of GDP 2008 State Expenditure on Medicines 2000-2008 Pharmaceutical Expenditure as a % of Healthcare Expenditure in Selected Countries 2007 Pharmaceutical Expenditure per Capita in Western Europe 2008 Number of Day Cases Treated in Ireland 1998-2008 Self-perceived Health Status by Age Group 2007 Prevalence and Burden of Chronic Disease
Self-Care Today
16
Self Medication Market in Ireland 2008 OTC Medicines as a % of the Total Pharmaceutical Market 2008
Demographic Trends
20
Population projections 2011-2041 Impact of Ageing on Public Expenditure Main Causes of Death in Ireland 2008
Healthcare Tomorrow
26
Evolution of Innovative Medicines The Life Cycle of Innovative Medicines Cost of Developing an Innovative Medicine Number of New Molecular Entities (NMEs) First Launched Worldwide 1997 – 2007 Benefits of Innovative Medicines Need for Continued Medicines Innovation
4
Pharmaceutical Healthcare Facts and Figures 2010
The Medicines Industry
34
Leading Pharmaceutical and Biotechnology Companies by Sales Globally 2009 Distribution of Global Pharmaceutical Sales by Region 2008 European Trade in Pharmaceuticals Pharmaceutical Production in Europe, Japan and the US 9 of the World’s Top 15 Medicines are produced in Ireland Business Sector R&D in Ireland
Medicines in the Community
42
Community Medical Schemes Expenditure 2008 Most Commonly Prescribed Medicines 2008 GMS Scheme Expenditure and % Growth Rate 1998-2008 The Ageing of the GMS 1994-2008 Drugs Payment Scheme Expenditure 2000-2008 High Tech Scheme Expenditure 2002-2008 Long Term Illness Scheme Expenditure 2000-2008 Adverse Event Reporting by Source 2008 Making Headroom for Innovation
Medicines and Global Health
54
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
59
5
Healthcare
6
•
The last decade has seen an unprecedented increase in health expenditure following a period of cutbacks and stagnation in the early 1980s’s and the early 1990’s. Public expenditure on health has almost quadrupled in the period 1999 to 2009. However given the economic downturn and its impact on the public finances it will decline marginally in 2010.
•
Healthcare expenditure in Ireland, relative to other European States, is coming from a low base. Irish expenditure in 2008, as a percentage of GDP, is the second lowest after Luxembourg in the EU.
•
The Irish healthcare system remains a mix between public and private expenditure. Over 50% of the population continue to have some form of private health insurance.
•
The numbers employed in the health services increased by over 60% with 68,804 employed in 1997 compared to over 100,000 employed in 2008.
•
State expenditure on medicines has increased in tandem with the increase in public expenditure on healthcare. Medicines account for just 14% of total expenditure – a small but vital component.
Pharmaceutical Healthcare Facts and Figures 2010
Today •
The research-based pharmaceutical industry has recognised that the State continuously faces a challenge in funding healthcare and has over the years agreed robust, cost effective arrangements for the supply of medicines to the health services. In the period 2006 to 2010 the industry delivered savings in the region of €300 million to ensure the State had the monies needed to fund new therapies. In 2010, understanding the difficult state of the public finances as a result of the downturn in the economy and following a request from the Minister for Health and Children for immediate savings, the industry put in place arrangements which will yield savings to the State of approximately €94 million in a full year. This saving is in addition to the savings of over €105 million to be generated, from the 2006 arrangements, this year.
7
Public Health Expenditure 2000 – 2009
18 16 15,172
15,440
14,321
14 12,709 11,676
€ (Millions)
12 10,162
10 9,367 8,440
8 7,176
6
5,717
4
2
0 2000 Source:
8
2001
2002
2003
2004
2005
2006
2007
Department of Health and Children “Health in Ireland: Key Trends 2009”
2008
2009
Health Expenditure as a % of GDP 2008
Luxembourg
7.3
Ireland
7.6
Finland
8.2
UK
8.4
Spain
8.5
Italy
8.7
OECD
8.9
Sweden
9.1
Greece
9.6
Denmark
9.8
Portugal
9.9
Austria
10.1
Belgium
10.2
Germany
10.4
Switzerland
10.8
France
11
0
2
6
4
8
12
10
% Source:
OECD Health Data 2009
9
State Expenditure on Medicines 2000-2008
2000
30 1849
27
1800
1701
25
1600
1529
22
1400
1332 21
20 17 1022
1000
15
15 867
800
718
11
11
10
565
600
9
400 5
200 0
0
2001 2000 Euro (Millions)
2002
2003
2004
2005
2006
2007
% Growth Rate Source:
10
GMS/PCRS Annual Reports from 2000 – 2008. The GMS figure excludes VAT and the Hi-Tech Scheme figure excludes patient care fees.
2008
% Growth
€ (Millions)
1200
1202 18
Pharmaceutical Expenditure as a % of Healthcare Expenditure in Selected Countries 2007
Greece
24.8
Spain
21
Italy
19.3
OECD Average
17.6
France
16.3
Belgium
15.7
Germany
15.1
Finland
14.1
Ireland*
14
Sweden
13.4
Austria
13.3
Denmark
8.6
Norway
8.0
0
5
15
10
25
20
% Source:
OECD Health Data 2009 * IPHA estimate for Ireland based on HSE and Department of Health and Children Statistics
11
Pharmaceutical Expenditure per Capita in Western Europe 2008
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
400 300 US Dollars ($)
OECD Health Data 2008 * OECD Health at a Glance 2007
500
600
700
Number of Day Cases Treated in Ireland 1998-2008
800,000
770,000
700,000 662,000
600,000
500,000 425,978
400,000 353,000
300,000
273,000 243,000
200,000
100,000
0 1998 Source:
2000
2002
2004
2006
2008
Department of Health and Children Health Statistics 2005; HSE Annual Reports 2006 – 2008
13
Self-perceived Health Status by Age Group 2007
This is in a country where 29% of adults smoke, 39% are overweight, 23% are obese, 22% reported being physically inactive and 28% consume six or more standard drinks at least once a week*.
100 90 80 70 60 % 50 40 30 20 10 0 18-24
25-34
Bad/Very Bad 14
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 * HSE Annual Report 2008
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 •
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 reported1.
1
16
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
Pharmaceutical Healthcare Facts and Figures 2010
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 2008
Total Market: 333 m* Analgesics 23% Cough & Cold 17% Vitamins & Minerals 12% Digestives & Intestinal Remedies 10% Skin Treatment 10% Others 28% Source:
18
AESGP, Economic and Legal Framework for Non-Prescription Medicines 2009 * At consumer price level
2007 2008 Healthcare Facts and Figures
OTC Medicines as a % of the Total Pharmaceutical Market 2008
Spain
6.0
Portugal
6.6
Denmark
8.1
Sweden
9.3
Finland
9.9
Italy
11.4
Austria
11.9
*Netherlands
12.1
Germany
15.0
Belgium
15.1
Ireland
16.0
UK
17.3
France
18.2
0 Source:
2
4
6
8
10 %
12
14
16
18
20
AESGP Economic and Legal Framework for Non-Prescription Medicines 2009 *Based on 2007 figure
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 nearly 7 million by 2041.
•
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 21% of the population (1.43 million) in 2041 and the number of those aged 80 and over is set to quadruple from a 2001 level of 98,000 to 465,000 in 2041. 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. Life expectancy at birth for males increased from 57.4 years in 1926 to 76.7 years in 2005, representing a gain of 19.3 years over the seventy-nine year period. The corresponding female rates were 57.9 and 81.5 years, respectively, which represents a gain of 23.6 years.
Pharmaceutical Healthcare Facts and Figures 2010
hic Trends •
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.
21
Population Projections 2011 – 2041
8
7
6,759,000 6,496,900 6,219,600 5,920,200
6 5,590,100 5,187,900
Millions
5
4,728,500
4
3
2 1,434,300
1
774,800
648,600
536,700
918,200
1,075,700
1,243,000
0 2011
2016
2021
2026
Year Total population Source:
22
Population over 65
Central Statistics Office
2031
2036
2041
Impact of Ageing on 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 2008
Heart Disease Circulatory Diseases
35%
Stroke
8%
Cancer
30%
Other Circulatory Diseases
9%
Respiratory Diseases 12% Injury and Poisoning Other causes
24
18%
Source:
6% 17%
Central Statistics Office
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 860 medicines in development to combat cancer, 312 for two of the leading causes of death in Ireland - heart disease and stroke and 183 for diabetes and related conditions.
•
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 of 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 117,000 people in R&D in 2008 and spent a total of €27.2 billion on such work.
Pharmaceutical Healthcare Facts and Figures 2010
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
The Life Cycle of an Innovative Medicine
From concept to product: steps in the genesis of a medicine
10,000 molecules screened
100 molecules tested
10 candidate molecules 1 medicine
Research phase
Test 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
Number of New Molecular Entities (NME) first Launched Worldwide 1990 – 2007
The number of new chemical entities (i.e. medicines that have never before been approved for any use) is declining as a result of the increased complexity of developing new medicines and more stringent regulatory requirements.
60
51
50 46 43
41 40
40 36
41
40 36
37 32
30
31 28
28 26 24
25 21
20
10
0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Source:
EFPIA and CMR International
31
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:
32
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).
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) No medicines (R&D to bridge the gap) Source:
IFPMA, The Value of Innovation (2008)
33
The Medic
34
•
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. Thirteen of the world’s top 15 pharmaceutical companies have substantial operations here. 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 generates over 50% of the country’s exports and 11% of its Gross Domestic Product which contribute to making Ireland the second largest net exporter of medicines in the world.
•
Over €7 billion has been invested by the pharmaceutical sector over the last 10 years. According to IDA Ireland the replacement value of the investment by the pharmaceutical sector in the Irish economy is over €40 billion.
Pharmaceutical Healthcare Facts and Figures 2010
ines Industry •
The market for pharmaceuticals in Ireland continues to grow as outlined in the next section on Medicine in the Community and there are opportunities for the industry to develop its operations in Ireland still further in the area of clinical research.
35
Leading Pharmaceutical and Biotechnology Companies by Sales Globally Global Top 10 Pharmaceutical Companies1
Source:
36
Global Top 10 Biotechnology Companies2
By Rank
By Rank
1. Pfizer
1.
Amgen
2. Merck & Co
2.
Genetech
3. Novartis
3.
Genzyme
4. sanofi-aventis
4.
CSL
5. GlaxoSmithKline
5.
Biogen Idec
65. AstraZeneca
6.
Daewoong Pharmaceuticals
7. Roche
7.
Biotest
8. Johnson & Johnson
8.
Crucell
9. Eli Lilly
9.
Orchid Pharmaceuticals
10. Abbott
10. Alexion Pharmaceuticals
(1) IMS Health Midas, December 2009 (2) Scrip Pharmaceutical Company League Tables 2009
Distribution of Global Pharmaceutical Sales by Region 2009
North America
40%
Europe
31%
Asia (excl. Japan), Africa and Australia
12%
Japan
11%
Latin America Source:
2009 Global Sales $808 billion
6%
IMS Health Market Prognosis, March 2010
37
European Trade in Pharmaceuticals 2008
Exports €
Imports €
Balance €
Switzerland
35,000
15,000
20,000
Ireland
17,000
3,000
14,000
Germany
47,000
32,000
14,000
UK
14,000
21,500
7,500
Belgium
33,500
30,000
3,500
France
22,500
17,500
5,000
Sweden
6,000
3,000
3,000
Denmark
5,500
2,500
3,000
Netherlands
8,500
9,500
-1,000
Italy
11,000
13,500
-2,500
Spain
7,500
10,000
-2,500
65
300
-235
Country
Luxembourg
Source:
38
Eurostat
2007 2008 Healthcare Facts and Figures
Pharmaceutical Production in Europe, Japan and the US
1990: €136 Billion USA 32% Japan 23% Germany 9% France 9% Italy 8% UK 7% Switzerland 4% Other 8%
2007: €352 Billion
USA 33% Japan 13% France 10% Germany 8% UK 7% Italy 6% Switzerland 6% Ireland 4% Other 13%
39
5 of the world’s top 12 medicines are produced in Ireland
Source:
Rank
Medicine
Company
1.
Lipitor
Pfizer
6.
Enbrel
Pfizer
7.
Remicade
Centocor (J&J)
9.
Zyprexa
Eli Lilly
12.
Singulair
Merck Sharp & Dohme
IPHA Analysis. Rankings based on IMS Health Midas, December 2009
Product names shown are IMS International Product names. Products marketed around the world with different names or marketing companies are grouped together. The names generally reflect the name in the country where the product was launched first. A match on two of three criteria (local brand name, marketing corporation and active ingredient) will be grouped together.
40
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 2009 – At a Glance
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 2008 was 49,000 a six 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 nearly 12 million in 2008 (an increase of 233%).
•
Epidemiological evolution: the increased incidence of chronic and non-communicable diseases is generally quite costly to treat. Ireland has the fourth 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 (DPS) resulted in substantial growth in the State bill for medicines. 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 number claimants under the DPS increased by 40% between 2000 and 2002.
Pharmaceutical Healthcare Facts and Figures 2010
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. 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 increases in Irish health spending that occurred in the boom years.
43
Community Medical Schemes Expenditure 2008
1200 1122
1125 1050 975 900 825 750
â‚Ź (Millions)
675 600 525 450 375 312 275
300 225 138
150 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 2008 The GMS Scheme figures exclude VAT and the High Tech Scheme figures exclude patient care fees.
Most Commonly Prescribed Medicines 2008
General Medical Services (GMS) Scheme
Drug Payment Scheme
1
Acetylsalicylic Acid-Aspirin (Antithrombotic)
1
Acetylsalicylic Acid-Aspirin (Antithrombotic)
2
Atorvastatin
2
Atorvastatin
3
Levothyroxine Sodium
3
Levothyroxine sodium
4
Bisoprolol
4
Salbutamol (Inhaled)
5
Calcium, Combinations
5
Esomeprazole
6
Paracetamol
6
Diclofenac (Systemic)
7
Amlodipine
7
Amoxicillin and Enzyme Inhibitor
8
Salbutamol (Inhaled)
8
Bisoprolol
9
Amoxicillin and Enzyme Inhibitor
9
Calcium, Combinations
10
Ramipril
10
Rosuvastatin
11
Warfarin
11
Amlodipine
12
Lansoprazole
12
Omeprazole
13
Esomeprazole
13
Salmeterol and other drugs for obstructive
14
Furosemide
15
Omeprazole
14
Lansoprazole
16
Diclofenac (Systemic)
15
Ramipril
17
Pravastatin
16
Perindopril
18
Perindopril
17
Prednisolone (Systemic)
19
Atenolol
18
Atenolol
20
Diazepam
19
Pravastatin
20
Clarithromycin
Source:
airway diseases
HSE Primary Care Reimbursement Service Annual Report 2008
45
Most Commonly Prescribed Medicines 2008
High Tech Scheme
Long Term Illness Scheme
1
Etanercept
1
Acetylsalicylic Acid-Aspirin (Antithrombotic)
2
Adalimumab
2
Metformin
3
Bicalutamide
3
Atorvastatin
4
Tacrolimus
4
Needles/Syringes/Lancets
5
Mycophenolic Acid
5
Gliclazide
6
Ciclosporin
6
Insulin Aspart, Fast Acting
7
Erythropoietin
7
Ramipril
8
Darbepoetin alfa
8
Perindopril
9
Interferon beta-1a
9
Valproic Acid
10
Triptorelin
10
Amlodipine
11
Leuprorelin
11
Insulin Glargine, Long Acting
12
Pegfilgrastim
12
Lamotrigine
13
Teriparatide
13
Carbamazepine
14
Interferon beta-1b
14
Rosuvastatin
15
Somatropin
15
Insulin Detemir, Long Acting
16
Goserelin
16
Bisoprolol
17
Capecitabine
17
Pravastatin
18
Cinacalcet
18
Doxazosin
19
Dornase alfa
19
Atenolol
20
Filgrastim
20
Lisinopril
Source:
46
HSE Primary Care Reimbursement Service Annual Report 2008
2007 2008 Healthcare Facts and Figures
GMS Scheme Expenditure and % Growth Rate 1998-2008 The Scheme provides free medical services to persons who would not otherwise be able, without undue hardship, to afford such services.
30
1200 1122
28
1100
27
1029
25
1000 922
900 816
20
800
749
18 17
17 639
600 500
11.6
12
11
15
14.8
540
426
9
400
10
332
8
283
300
252
200
5
100
0
0 1998 1999 Euro (Millions)
2000
2001
2002
2003
2004
2005
2006
2007
2008
% Growth Rate Source:
GMS (Payments) Board Annual Reports 1998 – 2005 HSE Primary Care Reimbursement Service Annual Reports 2006 - 2008 Figures excluding VAT.
47
% Growth
â‚Ź (Millions)
700
Ageing of the GMS Scheme 1994 - 2008
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%
2008
1,352,000
31.9%
423,000
31.3%
Source:
48
Total No. of Eligible Persons
GMS (Payment) Board Annual Reports 1994-2005 HSE Primary Care Reimbursement Service Annual Reports 2006 - 2008
Drugs Payment Scheme Expenditure 2000-2008
325
312 307
300 283
275 247
250 224
225 204
200
192 178
â‚Ź (Millions)
175 150
141
125 100 75 50 25 0 2000
Source:
2001
2002
2003
2004
2005
2006
GMS (Payment) Board Annual Reports 1999-2005 HSE Primary Care Reimbursement Service Annual Reports 2006 - 2008
2007
2008
49
High Tech Scheme Expenditure 2002-2008
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.
300
60000 275
250
239
49,000
50000
207 41,500 36,500
169 31,550
141
150
40000
30000
28,385 104
100
22,353
89
20000
18,353
50
0
10000
2002
2003
2004
Euro (Millions) Number of Patients on Scheme
50
2005 Source:
2006
2007
2008
0
GMS (Payments) Board Annual Reports 1998 – 2005 HSE Primary Care Reimbursement Service Annual Reports 2006 - 2008 Figures excluding VAT.
Number of participants
â‚Ź (Millions)
200
Long Term Illness Scheme Expenditure 2000-2008
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
138 126
120
115
101
100
â‚Ź (Millions)
86
80 73 62
60 52 42
40
20
0 2000 Source:
2001
2002
2003
2004
2005
2006
GMS (Payment) Board Annual Reports 1999-2005 HSE Primary Care Reimbursement Service Annual Reports 2006 - 2008
2007
2008
51
Adverse Event Reporting by Source 2008
An adverse reaction is defined as ‘a reaction which is noxious and unintended and which occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease or for the correction or modification of physiological function.’*
Source
Number of Adverse Event Reports
MA Holders (Pharmaceutical Company) General Practitioners
253
Hospital Doctors
152
Hospital Pharmacists
132
Community Care Doctors
82
Community Pharmacists
71
Hospital Nurses
48
Patients/Consumers
48
Clinical trials
44
Haemovigilance Officers
5
Dentists
1
Other Healthcare Professionals Total
Source: Irish Medicines Board Annual Report 2008 *Irish Medicines Board Definition
52
1,867
7 2,742
Making Headroom for Innovation
Per Item Cost on the GMS, DPS and LTI schemes is reducing
55 53.2
50 50.1
51.1
52.7
52.2
36.6
36.4
18.3
18.6
18.3
2006
2007
2008
52.1
48.1
45 45
40
42.3
35 â‚Ź
35.4
36.7
37.3
34 31.7
30 29.2
25
27.3
20
15
15.6 11.5
16.7
17.5
2004
2005
14.4 12.9
0 2000
2001
2002
2003
Long Term Illness Scheme Drugs Payment Scheme General Medical Services Source:
GMS (Payment) Board Annual Reports 1999-2005 HSE Primary Care Reimbursement Service Annual Reports 2006-2008
53
Medicinesand
54
•
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 175 health partnerships and programmes in the developing world which are designed primarily to improve access to medicines and other aspects of healthcare. One hundred and forty one 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.
Pharmaceutical Healthcare Facts and Figures 2010
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 were involved in 67 R&D programmes in 2008, 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.
55
Industry Supported Public-Private Partnerships in the Developing World
The pharmaceutical industry has also made substantial donations to many disaster and emergency relief efforts including the Asian tsunami, Cyclone Sidr (Bangladesh), Hurricane Katrina (New Orleans), the earthquake in Haiti and many others.
HIV /AIDS
54
Child and Maternal
29
Chronic Disease
24
Tropical Disease
21
Malaria
17
Tuberculosis
16
Vaccine Preventable
15
0
Source:
56
10
40 30 20 Number of public-private partnerships
50
60
IFPMA Partnerships to Help Build Healthier Societies in the Developing World 2009 For more information please visit www.ifpma.org/healthpartnerships and www.globalhealthprogress.org
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
1
DONEGAL
5
1
SLIGO
2
CAVAN
MAYO
1 1
1
LONGFORD
MEATH 1 49
WESTMEATH
DUBLIN
1
KILDARE
5
2
WICKLOW
CLARE 1
4 1
CARLOW
TIPPERARY
LIMERICK 3
2
KERRY
WATERFORD 2
20
CORK
58
11
Dublin 49
Shared Services Sites Abbott Laboratories A Menarini Pharmaceuticals Alliance Pharmaceuticals Amgen Astellas Pharma 1 AstraZeneca Pharmaceuticals Bayer Consumer Care 1 Bayer Schering Pharma Biogen Idec Boehringer Ingelheim Bristol Myers Squibb 1 Celgene Cephalon Daiichi Sankyo Ireland Eisai 1 Eli Lilly & Company GlaxoSmithKline GlaxoSmithKline Consumer Healthcare 5 Grunenthal Pharma Ipsen Pharmaceuticals Janssen-Cilag (J&J) Labopharm Europe LEO Pharma Lundbeck McNeil Healthcare (J&J) Merck Serono MSD 1 Mundipharma Novartis Novartis Consumer Health Novo Nordisk Nycomed 3 Organon Laboratories Pfizer (2 sites) Pierre Fabre Procter and Gamble Reckitt Benckiser 4 Roche Products sanofi-aventis Sanofi Pasteur MSD Schering Plough (MSD) Servier Laboratories Shire Pharmaceuticals Solvay Healthcare SSL Healthcare 2 Stiefel Laboratories Tillotts Pharma UCB Pharma
11 Manufacturing Sites Bristol Myers Squibb Covidien Helsinn Birex Ipsen
Merrion Pharmaceuticals Pfizer (3 Sites) Rottapharm Schering Plough (MSD) Swords Laboratories (BMS)
Meath Shared Services Sites MEDA Manufacturing Sites BASF Ireland
Westmeath Manufacturing Sites Elan
Kildare Manufacturing Sites Pfizer
Wicklow Manufacturing Sites Schering Plough Pharmaceuticals (MSD) (2 Sites) Sigma Aldrich Ireland Ltd Servier Laboratories Takeda
Carlow Manufacturing Sites MSD
Waterford Manufacturing Sites Genzyme GlaxoSmithKline TEVA
Tipperary
Clare
2 Manufacturing Sites Roche Schwarz Pharma Ltd
Cork
2 Shared Services Sites GlaxoSmithKline Pfizer 20 Manufacturing Sites Cara Partners Centocor Biologics Eli Lilly & Company FMC International Fournier Pharma GE Healthcare Gilead Services GlaxoSmithKline Hovione Ipsen Janssen-Pharmaceuticals (J&J) Novartis Recordati Ireland Ltd Pfizer (5 Sites) Schering Plough (MSD) Leo Pharma Wexport
Kerry 2 Manufacturing Sites Astellas Ireland Temmler
Limerick 1 Manufacturing Sites Pfizer
Cavan 1 Manufacturing Sites Abbott
Manufacturing Sites Abbott Alza Ireland (J&J) Clonmel Healthcare MSD
1 Manufacturing Sites Abbott
Mayo
1 Manufacturing Sites Abbott
Manufacturing Sites Allergan Charles River Laboratories Services
Longford
Donegal
Sligo 5
Manufacturing Sites Stiefel Laboratories Abbott Laboratories (3 Sites) Pfizer
59
For a PowerPoint version of Pharmaceutical Healthcare Facts and Figures 2010 please visit www.ipha.ie.
All facts and figures were correct at time of going to print in April 2010.
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Pharmaceutical Healthcare Facts and Figures 2010
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