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Medicin der virker
Martin S. KnudsenSenior Consultant
IMS Health Economics and Outcomes Research
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Emner
Hvordan er lgemiddel markedet i Danmark set i forhold tilEuropa og det globale marked
Er udgifterne hje, hvorfor stiger de
Hvad betyder lgemidler for national konomien Afspejler priserne behandlingseffekten, er der muligheder I
value based pricing
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2011 sales and growth
Japan
Size: U.S.$95-100bn
Growth: 5-7 %
US
Size: U.S.$320-330bn
Growth: 3-5 %
Top 5 Europe
Size: U.S.$135-145bn
Growth: 1-3 %
Pharmerging Markets
Size: U.S.$170-180bn
Growth: 15-17 %
Rest of World
Size: U.S.$145-155bn
Growth: 3-5 %
Global Market
Size: $880-890bn
Growth: 5-7 %
2011 Sales and growthSource: IMS Health, Market Prognosis, Sep 2010
China Venezuela Egypt
Brazi l Poland Thai land
Russia Argentina Romania
India Indonesia Pakistan
Mexico S. Africa Vietnam
Turkey Ukraine
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Global Pharma growth to remain in single digitsA trillion dollar market by 2014 energised by emerging markets
0
200
400
600
800
1000
1200
2010 (
) 2011 (
) 2012 (
) 201 (
) 2014(
)
ALUE
ALESUS$
N
0%
5%
10%
15%
20%
25%
0%
ALUEG
W
%(
onst
US$)
Global USAEU5 Ja an
ier 1 Pharmerging
ier 2 Pharmerging
ier Pharmerging
Source: IMS Health Market Prognosis September 2010; Tier 1 = China; Tier 2 = Brazil, Russia, India; Tier 3 = Venezuela, Poland, Argentina,Turkey, Mexico, Vietnam, S. Africa, Thailand, Indonesia, Romania, Egypt, Pakistan, Ukraine
Global Sales and Market Growth Pharmaco challenges
Global Pharma Market Dynamics & Current Economic Environment
US/EU / apan no longer dominateglobal growth
ower GDP growth and tax revenues
will impact healthcarebudgets/promote more aggressivecost containment
New product launches are notreplacing revenues lost to genericcompetition, especially in primarycare
Emerging markets present the mostattractive areas for growth
Increased pricing & reimbursementpressures
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2001 Rank 2006 Rank 2011 Rank
1 United States 1 United States 1 United States2 apan 2 apan 2 apan3 France 3 France 3 China4 Germany 4 Germany 4 Germany
Italy Italy France United Kingdom Canada Italy7 Canada 7 Spain 7 Brazil
Spain United Kingdom Canada9 China 9 China 9 Spain10 Brazil 10 Brazil 10 United Kingdom11 Mexico 11 Mexico 11 Russia12 Australia 12 Australia 12 India13 South Korea 13 South Korea 13 South Korea14 India 14 Russia 14 Australia
1
Netherlands 1
India 1
Mexico1 Russia 1 Turkey 1 Turkey17 Poland 17 Netherlands 17 Venezuela1 Belgium 1 Poland 1 Poland19 Portugal 19 Belgium 19 Greece20 Switzerland 20 Greece 20 Belgium
Leading pharmerging markets projected to climb inthe 2011 global market ranking
Source: IMS Health Market Prognosis, Sep 2010. Market size ranking in constant US
Chinaexpected toenter 2011
as #3 market
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Den samlede udgift til lgemidler i DK stiger, isr isygehussektoren
Samlet omstning af lgemidler i DK, rets priser
0
2.000
4.000
6.000
8.000
10.000
12.000
14.000
16.000
2005 2006 2007 2008 2009
Mio.kr
Sygehus sektor Primr sektor
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men gennemsnits prisen falderLgemiddelpriser DK 2005-2010, indeks 2005-12=100
50
60
70
80
90
100
110
2005
-12
2006
-03
2006
-06
2006
-09
2006
-12
2007
-03
2007
-06
2007
-09
2007
-12
2008
-03
2008
-06
2008
-09
2008
-12
2009
-03
2009
-06
2009
-09
2009
-12
2010
-03
2010
-06
2010
-09
2010
-12
Indeks,2
005-12=100
DDD-baseret indeks Receptpligt. lgemidler m. tilskudsstatus AIP
DDD-baseret indeks Alle lgemidler undt. lib. sortiment AIP
Alle lgemidler
Recept
Kilde; Lgemiddelstyrelsen
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Netto eksport af lgemidler Schweiz er strst,Danmark er nummer i Europa
" # # $ " # # % " # # & ' ( ( ( ' ( ( ' ' ( ( $ ' ( ( % ' ( ( &
- $
&
$
' (
" %
" '
(
IRELAND
S) ITZER-LAND
UNITEDKINGDOM
S)
EDEN
GERMANY
FRANCE
DENMARK
BELGIUM
AUSTRIA
Trade balance (2010)(Billion
Source: EuroStat. *Trade balance calculations are made by subtracting revenues spent on importing from revenues made from exporting.EFPIA, The Pharmaceutical industry in figures, 2010 edition
Trade balance*(Billion , MAT
Trade of Medical and Pharmaceutical Products
100
SLOVENIA
DENMARK
S 0 EDEN
BELGIUM
FRANCE
UK
IRELAND
GERMANY
S 0 ITZERLAND
1 1 1 20
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99
Outside the UK/US which are first and fast there is a range ofuptake times across market but on average Denmarks marketis opened quickly
2
3 2 2
4 2 2
5 2 2
6 2 2
7 2 2 2
7 3 2 2
7 4 2 2
elgium
Slov
akia
Austria ta
lyrance
unga
rySp
ain
echrepu
blic
Slov
eniareece
ston
iaolan
d
ortugal
Swit
erland
ethe
rlands
Swed
en
inland
orway
reland
Den
mark
ermany UK US
Delay
8
day
s9
@ aA imum/ @ inimum Average
Range of timedelays betweenmarketing
authorisation andmarket accesshospital and
retail combined
All new medicineswith marketingauthorisation from
anuary 3 to3 December
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Protected NLP GenericsTotal
Share% / Dose Share% / Dose Share% / Dose
POL 0% 0.91 9% 0.26 91% 0.16 0.17
DNK 14% 1.10 2% 0.31 84% 0.03 0.18
FIN 9% 0.92 21% 0.23 70% 0.08 0.18
SWE 15% 1.14 2% 0.23 83% 0.03 0.20
DEU 7% 1.12 27% 0.17 66% 0.13 0.21
NOR 3% 1.10 24% 0.48 74% 0.10 0.22
CZE 3% 0.91 28% 0.25 69% 0.20 0.24
GBR 29% 0.80 1% 0.45 69% 0.05 0.28
AUT 18% 0.93 13% 0.36 69% 0.24 0.38
HUN 11% 0.58 15% 0.38 74% 0.36 0.39
NLD 39% 0.93 4% 0.24 57% 0.04 0.40
PRT 24% 0.68 9% 0.44 67% 0.33 0.43
FRA 44% 0.69 19% 0.25 37% 0.26 0.44
ESP 5% 1.09 43% 0.78 52% 0.18 0.48
ITA 51% 0.75 26% 0.29 23% 0.21 0.51
BEL 38% 1.06 22% 0.26 40% 0.16 0.52
CHE 46% 1.12 10% 0.64 44% 0.44 0.78
GRC 44% 1.00 8% 0.77 47% 0.84 0.91
IRL 76% 1.13 14% 0.77 11% 0.70 1.04
Source: IMS Health Monthly MIDAS, Q3/10. Market share in volume (SUB and price in Euros at MNF level.
Original Brands Statiner
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Health Technology Assessment (HTA) anvendt plgemidler
"Health Technology Assessment" svarer nogenlunde til detdanske koncept for Medicinsk Teknologi Vurdering (MTV)
Anvendes som betegnelse for en systematisk evaluering aflgemidler som bde omfatter kliniske data og konomi
Er i varierende grad et krav til godkendelse af markedsadgang og/eller tilskudsstatus i en del lande
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Influences price & access
Influences access only
Limited influence on price/ access
FR
IT
AU
DN HUIR
CH
SWPL PO
UK DE
Part ofP&R
process
HTA isseparateprocess
Part ofP&R
process
Organizationally, HTAs have beenset up with a wide range of levelsof influence and incorporationinto the P&MA process
HTA bodies can be part of the
P&R process or separate These HTA bodies can
influence two factors
- Price and Access
- Access only
The range of influence varies
widely by countries- In countries, HTA bodies
exist but have limitedinfluence
CZ GR
EST
LI
LV
BEL
SK
TUSL RO
NO
BUL
NE
FI
SP
Most EU27 countries report that a formal HTAprocess exists in their market at the national level
Source: IMS Consulting research among a number of P&R authority officials and industry affiliates in 200 C
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Value based pricing en international tendens?
Udfordring
Priser for patentbeskyttede produkter afspejler ikke behandlingens vrdi
forskel paa priser for produkter med ensartet effekt Usikkerhed om langsigtede konsekvenser begrnser adgang til nye produkter Behov for fleksible priser naar produkter anvendes til forskellige indikationer Priskontrol/reduktion hmmer investerings lysten (UK)
Lsning (?)= Value based pricing
Maximal pris betinget af behandlings effekt
Risk sharing hvis behandlingen ikke virker betales der tilbage
Status
Anvendes bl.a i Sverige og flere europiske lande
I UK planlgger man at erstatte det nuvende PPRS system med et system baseretpaa value based pricing i 2013
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Value based pricing - eksempler
Sverige
Duodopa blev tilskudsberettiget i 2003 med tidsbegrnsningunder forudstning af at yderligere dokumentation kunne pviseen omkostnings effektivitet p et rimeligt niveau. Frst I 200 fikDuodopa en endelig accept.
UK
Det overvejes at graduere standarden for, hvad der er omkost-ningseffektivt, s man belnner ny medicin paa srlige omrder
stort behandlingsbehov (unmet need)
Innovativ medicin, signifikant bedre effect
Bredere samfundsmssige gevinster
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Sammenfatning
Danske medicinudgifter er i international sammenhng ikkemarkant hje.
Danmark har forholdvis hj beskftigelse i en medicinalindustri, som bidrager positivt til betalingsbalancen.
Ny medicin lanceres relativt hurtigt og Danmark har et hjtoptag af ny medicin.
Bortfaldet af patenter har medvirket til faldende priser.
Udgifterne er de seneste r drevet op af ny sygehusmedicin.
Value based pricing kan mske levere en ramme forintroduktion af ny medicin.
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Tak for opmrksomheden!