Changing medicine trends and its likely impact on

the SA healthcare industry

committed to excellencecommitted to excellence

• Top therapeutic groups by expenditure

• Top therapeutic groups by prevalence

• Top 50 medicines • Chronic conditions and medicine

adherence/compliance• Compliance and persistence • Compliance - the Mediscor experience

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Content

Presented by: Dr. Elsabé Hammann

(Medical Affairs: Mediscor PBM)

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Top therapeutic groups by expenditure

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Therapeutic group % Expenditure

% Prevalence

Anti-hypertensives 11.4 18.7

Hipolipidaemic agents

5.9 9.5

Anti-depressants 5.1 13.6

Acid reducers 4.4 20.7

Cytostatics 3.9 0.7

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Top therapeutic groups by prevalenceTherapeutic group %

Prevalence%

Expenditure

Combination analgesics

51 3.1

Cough & cold preparations

49 2.7

Beta-lactam antibiotics

45 3.4

NSAIDs 32 3.4

Anti-histamines 23 1.6

Top 50 medicines

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Top 50 medicines by value - 2007

23% of total expenditure 14% of total volume

• 4 NCE on top 50 list

• 12 generics on top 50 list

• 9 new additions to list, including a biological

NCE = New chemical entity, products registered after 2003

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Top 50 medicines - top 5 cost drivers

4.5% of total expenditure 2.4% of total volume

1. Cipralex (1.1%)

2. Lipitor 10mg (1%)

3. Nexiam 40mg (0.8%)

4. Prexum 4mg (0.8%)

5. Celebrex 200mg (0.8%)7

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Top 50 medicines - New chemical entities

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Cipralex Cymbalta

Crestor

Prexige

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New chemical entities - 1st story

Cipralex • Newer generation anti-depressant• Prevalence of 1.9% and 1.1% of total spent• Launched during 2004• Moved from position 7 in 2005 to 3 in 2006• Number 1 product in 2007• Lesson - power of marketing - perception that newer is better

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New chemical entities – 2nd story

Prexige • COXIB• Prevalence of 2.2% and 0.4% of total spent in 2007• Launched during 2006• Moved from position 330 in 2006 to 25 in 2007• Cases reported with liver related adverse effects• Various countries withdrew product• 18 January 2008 – withdrawn from the SA market• Lesson: - clinical trials do not represent real world - neither safety in general population, nor long-term

safety has been established before launch of product.

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Top 50 medicines - generics

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• Prexum• Prexum Plus• Adco-Simvastatin• Aspen Lamzid• Adco-Zolpidem• Coxflam• Amloc• Cilift• Lansoloc• Altosec• Flomist

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Top 50 medicines – new listings

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• Crestor - position 24• Prexige - position 25• Amloc - position 33• Arimidex - position 40• Altosec - position 41• Singulair - position 42• Lantus - position 44• Lentogesic - position 47• Enbrel - position 50

Chronic conditions and medicine adherence/compliance

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Chronic conditions and medicine adherence

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Compliance = the extent to which a patient acts in accordance with the prescribed interval and dose of a medicine dosing regimen

Persistence = the duration of time from initiation to discontinuation of therapy

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Non-compliance - causes

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Poor compliance can be caused by:

• Forgetfulness• Lack of knowledge by patient• A perceived lack of effect• Real or perceived side-effects• Unclear instructions for administration• Physical difficulty in complying with instructions• Unattractive formulation• Complicated regimen• Cost of medicines

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Compliance - importance

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Good adherence to medicine therapy is associatedwith positive health outcomes.

Improved compliance may have the following outcomes:

• Economic: increased medicine expenditure, withassociated decrease in overall healthcare costs.

• Clinical: better control of the disease.• Humanistic: improved patient and physician

satisfaction.

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Compliance – measuring

Compliance can be measured as follows:

• Patient self reports• Clinical assessment and – estimation• Pill counts• Pharmacy refill data• Biological and chemical markers• Electronic event monitoring systems

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Compliance – the Mediscor experience

Criteria:• Patient population - all registered CDL

PMB patients for 2007 • Measured the number of months in

which medicine for CDL was claimed • Compliance defined as 10 or more

months of treatment in 12 months

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Compliance - the Mediscor experience

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Compliance - the Mediscor experience

20HIV

Parkinson's

Schizophr

Cardiom

Addison's

MS

HypothyroidCAD

HTChr renal

Hiperlipid

CHFBMD

DM type 2

Epilepsy

Dysrhythmia

Diab Insip

RACOPD

DM type 1

Crohn's

GlaucomaUlcer colitis

SLE

Bronchiec

Asthma

Haemophilia

0.0 20.0 40.0 60.0 80.0 100.0

% Compliant patients

2121

In summary

• Five therapeutic groups are responsible for 31% of total medicine expenditure in 2007

• Top 50 products are responsible for 23% of expenditure Four NCEs on the top 50 list Cipralex, a NCE, is the number one product 12 generics on the top 50 list 9 “new” products

• 50% of patients claimed at least once for a combination analgesic and a cough & cold preparation

• 64% patients with a registered CDL PMB condition is compliant with their treatment

• Compliance Measures to enhance compliance should be implemented Increased compliance will increase medicine expenditure, but Overall healthcare costs will decrease.

www.mediscor.net

For more information please contact Elsabé Hammann on +27 12 674-8113