Pharmaceutical Healthcare Facts and Figures 2010

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2010Pharmaceutical Healthcare

Facts and FiguresPharm

aceutical Healthcare Facts

and Figu

res 2010

For a PowerPoint version of Pharmaceutical Healthcare Facts andFigures 2010 please visit www.ipha.ie.

All facts and figures were correct at time of going to print in April 2010.

Design and production: www.slickfish.ie

The Irish Pharmaceutical HealthcareAssociation (IPHA) represents theinternational research-basedpharmaceutical industry in Ireland. Itsmember companies include bothmanufacturers of prescriptionmedicines and non-prescription orconsumer health care medicines.

IPHA

Pharmaceutical Healthcare Facts and Figures 2010

1

2

IntroductionReading 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.


3

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

4

Healthcare Today 6

Public Expenditure on Health 1999-2010Health Expenditure as a % of GDP 2008State Expenditure on Medicines 2000-2008Pharmaceutical Expenditure as a % of Healthcare Expenditure inSelected Countries 2007Pharmaceutical Expenditure per Capita in Western Europe 2008Number of Day Cases Treated in Ireland 1998-2008Self-perceived Health Status by Age Group 2007Prevalence and Burden of Chronic Disease

Self-Care Today 16

Self Medication Market in Ireland 2008OTC Medicines as a % of the Total Pharmaceutical Market 2008

Demographic Trends 20

Population projections 2011-2041Impact of Ageing on Public ExpenditureMain Causes of Death in Ireland 2008

Healthcare Tomorrow 26

Evolution of Innovative MedicinesThe Life Cycle of Innovative MedicinesCost of Developing an Innovative MedicineNumber of New Molecular Entities (NMEs) First Launched Worldwide1997 – 2007Benefits of Innovative MedicinesNeed for Continued Medicines Innovation

Contents


5

The Medicines Industry 34

Leading Pharmaceutical and Biotechnology Companies by Sales Globally 2009Distribution of Global Pharmaceutical Sales by Region 2008European Trade in PharmaceuticalsPharmaceutical Production in Europe, Japan and the US9 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 2008Most Commonly Prescribed Medicines 2008 GMS Scheme Expenditure and % Growth Rate 1998-2008The Ageing of the GMS 1994-2008Drugs Payment Scheme Expenditure 2000-2008High Tech Scheme Expenditure 2002-2008Long Term Illness Scheme Expenditure 2000-2008Adverse Event Reporting by Source 2008Making Headroom for Innovation

Medicines and Global Health 54

Industry Supported Public-Private Partnerships in the Developing WorldNumber of Positive Health Interventions made in the Developing World

Map of Pharmaceutical Locations in Ireland 59

6

Healthcare• The last decade has seen an unprecedented increase in health

expenditure following a period of cutbacks and stagnation in theearly 1980s’s and the early 1990’s. Public expenditure on healthhas almost quadrupled in the period 1999 to 2009. However giventhe economic downturn and its impact on the public finances itwill decline marginally in 2010.

• Healthcare expenditure in Ireland, relative to other EuropeanStates, is coming from a low base. Irish expenditure in 2008, as apercentage of GDP, is the second lowest after Luxembourg in theEU.

• The Irish healthcare system remains a mix between public andprivate expenditure. Over 50% of the population continue tohave some form of private health insurance.

• The numbers employed in the health services increased by over60% with 68,804 employed in 1997 compared to over 100,000employed in 2008.

• State expenditure on medicines has increased in tandem with theincrease in public expenditure on healthcare. Medicines accountfor just 14% of total expenditure – a small but vital component.

Today


• The research-based pharmaceutical industry has recognised that the Statecontinuously faces a challenge in funding healthcare and has over theyears agreed robust, cost effective arrangements for the supply ofmedicines to the health services. In the period 2006 to 2010 the industrydelivered savings in the region of €300 million to ensure the State hadthe monies needed to fund new therapies. In 2010, understanding thedifficult state of the public finances as a result of the downturn in theeconomy and following a request from the Minister for Health andChildren for immediate savings, the industry put in place arrangementswhich will yield savings to the State of approximately €94 million in a fullyear. This saving is in addition to the savings of over €105 million to begenerated, from the 2006 arrangements, this year.

7

8

Public Health Expenditure2000 – 2009

0

2

4

6

8

10

€ (M

illio

ns)

12

14

16

18

Source: Department of Health and Children “Health in Ireland: Key Trends 2009”

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

5,717

7,176

8,440

9,367

10,162

11,676

12,709

14,321

15,17215,440

9

Health Expenditure as a % of GDP 2008

0 2 4 6%

8 10 12

Source: OECD Health Data 2009

7.3

7.6

8.2

8.4

8.5

8.7

8.9

9.1

9.6

9.8

9.9

10.1

10.2

10.4

10.8

11

Luxembourg

Ireland

Finland

UK

Spain

Italy

OECD

Sweden

Greece

Denmark

Portugal

Austria

Belgium

Germany

Switzerland

France

10

State Expenditure on Medicines 2000-2008

% G

row

th

5

10

15

20

25

30

0

200

400

600

800

1000

€ (

Mill

ions

)

1200

1400

1600

1800

2000

2000

Source: GMS/PCRS Annual Reports from 2000 – 2008. The GMS figure excludes VAT and the Hi-Tech Scheme figure excludes patient care fees.

2001 2002 2003 2004 2005 2006

565

718

867

1202

21

27

22

17 18

11

15

11

9

1332

1529

20070

1701

2008

1849

1022

Euro (Millions)

% Growth Rate

11

Pharmaceutical Expenditure as a % ofHealthcare Expenditure in Selected Countries 2007

0 5 15%

252010

Source: OECD Health Data 2009 * IPHA estimate for Ireland based on HSE and Department of Health and Children Statistics

13.4

24.8

21

19.3

17.6

16.3

15.7

15.1

14.1

14

13.3

8.6

8.0

Greece

Spain

Italy

OECD Average

France

Belgium

Germany

Finland

Ireland*

Sweden

Austria

Denmark

Norway

12

Pharmaceutical Expenditure per Capita in Western Europe2008

0 100 300US Dollars ($)

500400 600 700200

Source: OECD Health Data 2008 * OECD Health at a Glance 2007

276

320

351

366

380

384

399

404

409

436

441

467

498

509

515

589

Denmark

*Ireland

Sweden

UK

Finland

Netherlands

Norway

OECD

Austria

Switzerland

Portugal

Luxembourg

Germany

Italy

Spain

France

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

Source: Department of Health and Children Health Statistics 2005; HSE Annual Reports 2006 – 2008

1998 2000 2002 2004 2006 2008

243,000273,000

353,000

425,978

662,000

770,000

13

Number of Day Cases Treated in Ireland 1998-2008

Self-perceived Health Status byAge Group 2007

0

10

20

30

40

50%

60

70

80

90

100

Source: Health Status and Health Service Utilisation Q3 2008, Central Statistics Office * HSE Annual Report 2008

18-24 25-34 35-44 45-54 55-64 65-69 70+ All

Bad/Very Bad Fair Good Very Good

Source: Health Status and Health Service Utilisation Q3 2008, Central Statistics Office * HSE Annual Report 2008

Bad/Very Bad Fair Good Very Good

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*.

14

• Chronic diseases such as diabetes, hypertension, heart disease andstroke are a large and growing burden on the health of Irish peopleand the Irish healthcare system. In the United States it is estimatedthat chronic diseases are responsible for about two-thirds of the risein healthcare spending over the last 15 to 20 years.

• The rising prevalence of chronic disease is partly the result of apopulation that is ageing and increasingly obese.

• Today, approximately 25% of the Irish population have a chronicdisease accounting for 78% of the country’s healthcare spending.

• Approximately 80% of GP consultations and 60% of hospital daysare related to chronic disease and their complications making thosepeople the most frequent users of healthcare in Ireland.

• 2 out of 3 patients admitted as medical emergencies haveexacerbations of chronic disease and 60% of deaths are as a resultof a chronic disease.

• Chronic diseases can be disabling and reduce a person’s quality oflife, especially if left undiagnosed or untreated. For example, every30 seconds, somewhere in the world a lower limb is amputated as aconsequence of diabetes.

• There is a significant increase predicted in chronic disease due to theestimated doubling of the elderly population over the next 30 years.This has implications for the healthcare system, if the current trendscontinue, bed requirements in hospitals will increase by 50-60%over the next 15 years.

Many of the consequences and costs of chronic disease are avoidablethrough screening, early intervention, behaviour change and theelimination of key risk factors such as poor diet, inactivity and smoking.

2007 2008 Healthcare Facts and Figures

15

Prevalence and Burden of Chronic Disease

Self-Care• Consumers want to actively manage their own health and are

taking greater individual responsibility for their healthcare andhealth choices.

• The health, social and economic benefits of responsible self-medication are well known and have been extensively reported1.

– Patients and consumers benefit due to wellness, enhancedproductivity and improved health in terms of prevention andincreased patient satisfaction as a result of being able toobtain the correct medication directly.

– Employers gain by having employees attend work when theymight otherwise have stayed at home.

– General Practitioners save time which enables them to betteruse that time for those patients with complicated or seriousillnesses. A recent report estimated that 51.4 million GPconsultations in the UK were solely for minor ailments. Itestimated that this represented 18% of a GP’s workload.Furthermore it estimated that the total cost to the NHS ofthese consultations was €2.5 billion and 80% of this cost(€2.15 billion) related to the cost of the GP’s time.2 It alsopresents more of an opportunity for doctors to educatepatients about common ailments and diminishes patientexpectations of a prescription for every visit.

– Pharmacists play a more active advisory role using their skilledknowledge of medicines and expertise in advising onsymptoms.

– Consumers pay less visits to accident and emergencydepartments and doctor surgeries. This in turn reduces thenumber of prescriptions, most of which are paid for, directly orindirectly, by the State.

161 E.g. Guiding Principles in Self-Medication: WSMI: http://www.wsmi.org/publications.htm 2 Minor ailments cost the NHS £2 billion/year. Pharm J 2008; 280:1090


Today• The Association of the European Self-Medication Industry (AESGP)

has estimated that savings of over €75 million annually could beachieved in Ireland if self-medication was practised more widely.The savings could then be put to better use elsewhere in thehealthcare system.

• Self-medication is an important element of the total Irish marketfor pharmaceutical products. The leading areas of the marketinclude analgesics (23%), cough and cold treatments (17%) andvitamins and minerals (12%).

17

18

Self Medication Market in Ireland 2008

Source: AESGP, Economic and Legal Framework for Non-Prescription Medicines 2009 * At consumer price level

Analgesics 23%

Cough & Cold 17%

Vitamins & Minerals 12%

Digestives & Intestinal Remedies 10%

Skin Treatment 10%

Others 28%

Total Market: 333 m*


19

0 2 6%108 12 14 16 18 204

Source: AESGP Economic and Legal Framework for Non-Prescription Medicines 2009 *Based on 2007 figure

6.6

6.0

8.1

9.3

9.9

11.4

11.9

12.1

15.0

15.1

16.0

17.3

18.2

Spain

Portugal

Denmark

Sweden

Finland

Italy

Austria

*Netherlands

Germany

Belgium

Ireland

UK

France

OTC Medicines as a % of the TotalPharmaceutical Market 2008

Demograp• The population of the Republic of Ireland increased by nearly

325,000 in the four year period April 2002 to April 2006. Havingonly recently passed 4 million, the population is set to exceed 5million within the next 15 years and projected to rise to nearly 7million by 2041.

• With an average age of 35.6 years Ireland has a relatively youthfulage structure; however this is set to change. Those aged 65 andover will account for 21% of the population (1.43 million) in 2041and the number of those aged 80 and over is set to quadruplefrom a 2001 level of 98,000 to 465,000 in 2041. These changes willhave significant implications for public spending and in particularhealthcare expenditure as the elderly typically require 2 - 5 timesas many resources as those under 65.

• The life expectancy of those over the age of 65 has improvedsignificantly in recent years but remains low by comparison to ourWestern European neighbours. Life expectancy at birth for malesincreased from 57.4 years in 1926 to 76.7 years in 2005,representing a gain of 19.3 years over the seventy-nine yearperiod. The corresponding female rates were 57.9 and 81.5 years,respectively, which represents a gain of 23.6 years.

20


21

hic Trends• Circulatory diseases continue to be the principal cause of death in

Ireland and along with cancer account for nearly two thirds of alldeaths.

• Approximately one in five deaths in Ireland is of a person agedless than 65 years old.

22

Population Projections 2011 – 2041

0

1

2

3

4

5

6

7

8

Mill

ions

Year

Source: Central Statistics Office

Total population Population over 65

4,728,500

5,187,900

5,590,100

5,920,2006,219,600

6,496,9006,759,000

536,700 648,600774,800 918,200

1,075,7001,243,000

1,434,300

2011 2016 2021 2026 2031 2036 2041

23

Impact of Ageing on Public Expenditure

Years

Source: 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

Ireland

Female

Male

0

2000

4000

6000

7000

60-64 yrs

25181939

70-74 yrs

3854

2914

80-84 yrs

5392

4052

90-94 yrs

6110

4604

0

2000

4000

6000

7000

1000

3000

5000

1000

3000

5000

euro

euro

60-64 yrs

28002117

70-74 yrs

4514

3365

80-84 yrs

6034

4472

90-94 yrs

6567

4964

EU 15

24

Main Causes of Death in Ireland2008

Source: Central Statistics Office

Cancer 30%

Respiratory Diseases 12%

Injury and Poisoning 6%

Other causes 17%

Circulatory Diseases 35%

Other Circulatory Diseases 9%

Stroke 8%

Heart Disease 18%

• Research and development of new medicines offers hope to anageing population of a longer healthy life, well beyond that ofprevious generations. For example, there are currently over 860medicines in development to combat cancer, 312 for two of theleading causes of death in Ireland - heart disease and stroke and 183for diabetes and related conditions.

• Research based pharmaceutical companies are the engines ofmedicines innovation. They have discovered and developed over90% of all new medicines made available to patients worldwideover the last twenty years.

• The discovery, development, testing and gaining of regulatoryapproval for new medicines has become an even more highlycomplex, lengthy, risky and expensive process. Each success is builton many, many prior failures. On average only one or two of every10,000 promising molecules will successfully pass extensive tests andstringent regulatory requirements and go on to be approved asmedicines, which are suitable for use in patients. As such the cost ofdeveloping 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 medicinefrom the time it is discovered to when it passes the regulatorystandards of safety, quality and efficacy and is available to patients.Once on the market the average medicine has only 8 to 10 years ofeffective patent protection left before facing generic competition.Only three out of ten marketed medicines produce revenues thatmatch or exceed their R&D costs before they lose patent protection.

• The European pharmaceutical industry employed over 117,000people in R&D in 2008 and spent a total of €27.2 billion on suchwork.

Healthcare

26


Tomorrow

27

• Innovation is central to the creation of the knowledge basedeconomy of the 21st century. In Ireland pharmaceutical industryR&D is responsible for 20% of all business R&D. If innovation is toflourish then it must be rewarded. Whilst Ireland retains a pro-innovation outlook this is increasingly not the case in Europegenerally with patient access to new medicines via Statereimbursement systems being delayed or even denied entirely.As a result of this less favourable climate for innovation more andmore pharmaceutical companies, including European ones,are deciding to locate new R&D facilities outsideEurope.

28

Evolution of Innovative Medicines Co

mpl

exity

1890 1900 1910 1920 1930 1940 1950Accumulated Knowledge of Human, Cell and Molecular Biology

1960 1970 1980 1990 2000 2010

Source: Boston Consulting Group

SerendipitousObservation

Aspirin

Sulfonamides

Antibiotics

Antihypertensives

Tranquilizers

Anti-arthritis

Beta-blockers

Cancer therapies

CNS drugs

Treatment forautoimmune disease

Focus onTissue Biochemistry

Focus onCell Biochemistry

Focus onMolecular Structure

29

The Life Cycle of an Innovative Medicine

Researchphase

10,000 molecules screened

From concept to product:steps in the genesis of a medicine

100 molecules tested

10 candidate molecules1 medicine

Testphase

5 years0 15 years 20 years

Patent filing Patent expiry

10 years R&D 2 to 3 years

Developmentphase

AdministrativeProcedures Commercialisation phase

10 years

Source: LEEM

30

Cost of Developing an InnovativeMedicine

0

200

400

800

600

1000

1200

€ (M

illio

ns)

1975

Source: 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

1987 2001

149

344

868

2006

1,059

31

Number of New Molecular Entities (NME)first Launched Worldwide1990 – 2007

0

10

20

30

40

50

60

Source: EFPIA and CMR International

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

36

51

43

40 4041

36

46

37

41

3231

2826

24

28

25

21

The number of new chemical entities (i.e. medicines that have never beforebeen approved for any use) is declining as a result of the increased complexityof developing new medicines and more stringent regulatory requirements.

32

Benefits of Innovative Medicines

Beta Blockers

Source: 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).

23% reduction in long term risk of death

Improved bypass operation survival rates

22% reduction in risk of death from heart attack and stroke

30% reduction in stroke events

29% reduction in coronary heart disease events

CalciumAntagonists

39% reduction in stroke events

28% reduction in major cardiovascular events

CombinationTherapy

72-80% reduction in risk of death when using acombination of anti-platelets, beta blockers, ACE inhibitorsand statins

AceInhibitors

60% reduction in risk of heart attack

30% reduction in risk of death

17-30% reduction in stroke events

Statins

33

Need for Continued MedicinesInnovation

HIV/AIDSPrevention

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)

Treatment Cure

Tuberculosis

Malaria

Childhood Diseases

Respiratory Infections

Cancers

Neuropsychiatric Disorders

Cardiovascular Diseases

Diabetes

Respiratory Diseases

Source: IFPMA, The Value of Innovation (2008)

The Medic• The international research-based pharmaceutical industry is

critical to the health of the nation as it plays a vital role in theIrish economy.

• More than 120 pharmaceutical companies have a presence inIreland. Thirteen of the world’s top 15 pharmaceutical companieshave substantial operations here. The industry directly employsover 24,500 people, half of whom are third level graduates, withas many again employed in the provision of services to the sector.The industry contributes approximately €3 billion annually intaxes to the State.

• Pharmaceutical production in Ireland generates over 50% of thecountry’s exports and 11% of its Gross Domestic Product whichcontribute to making Ireland the second largest net exporter ofmedicines in the world.

• Over €7 billion has been invested by the pharmaceutical sectorover the last 10 years. According to IDA Ireland the replacementvalue of the investment by the pharmaceutical sector in the Irisheconomy is over €40 billion.

34


35

ines Industry• The market for pharmaceuticals in Ireland continues to grow as

outlined in the next section on Medicine in the Community andthere are opportunities for the industry to develop its operationsin Ireland still further in the area of clinical research.

Source: (1) IMS Health Midas, December 2009 (2) Scrip Pharmaceutical Company League Tables 2009

By Rank

1. Pfizer

2. Merck & Co

3. Novartis

4. sanofi-aventis

5. GlaxoSmithKline

65. AstraZeneca

7. Roche

8. Johnson & Johnson

9. Eli Lilly

10. Abbott

By Rank

1. Amgen

2. Genetech

3. Genzyme

4. CSL

5. Biogen Idec

6. Daewoong Pharmaceuticals

7. Biotest

8. Crucell

9. Orchid Pharmaceuticals

10. Alexion Pharmaceuticals

Global Top 10Pharmaceutical Companies1

Global Top 10Biotechnology Companies2

36

Leading Pharmaceutical andBiotechnology Companies by Sales Globally

37

Distribution of Global Pharmaceutical Salesby Region 2009

Source: IMS Health Market Prognosis, March 2010

Europe 31%

Asia (excl. Japan), Africa and Australia 12%

Japan 11%

North America 40%

Latin America 6%

2009 Global Sales $808 billion

38

European Trade in Pharmaceuticals 2008

Source: Eurostat

Country 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

Luxembourg 65 300 -235

USA 32%

Japan 23%

Germany 9%

France 9%

Italy 8%

UK 7%

Switzerland 4%

Other 8%

1990: €136 Billion

USA 33%

Japan 13%

France 10%

Germany 8%

UK 7%

Italy 6%

Switzerland 6%

Ireland 4%

Other 13%

2007: €352 Billion


39

Pharmaceutical Production in Europe,Japan and the US

40

5 of the world’s top 12 medicines areproduced in Ireland

Source: 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 begrouped together.

Rank Medicine Company

1. Lipitor Pfizer

6. Enbrel Pfizer

7. Remicade Centocor (J&J)

9. Zyprexa Eli Lilly

12. Singulair Merck Sharp & Dohme

41

Business Sector R&D in Ireland

Source: Forfás Research and Development Statistics in Ireland 2009 – At a Glance

Electrical/Electronic equipment 21%

Pharmaceuticals 20%

Instruments 9%

Food, Drink & Tobacco 5%

Software/Computer related 30%

Other services 4%

Chemicals 3%

Other sectors 8%

Medicines in

42

Expenditure on the community medicines schemes has risen steadilyin recent years. The factors behind that growth include:

• Ireland’s rapidly increasing and ageing population as outlined inthe section on Demographic Trends.

• The development of new treatments becoming available and morepatients availing of them: for example in the areas of preventativemedicine and the long-term treatment of chronic illness. Thenumber of patients registered under the High Tech Scheme in 2008was 49,000 a six fold increase on the figure in 1997 (8,250).

• The introduction of Government initiatives to improve publichealth: the cardiovascular and the cancer strategies were launchedwith a view to improving poor health outcomes in these diseaseareas. They have resulted in more people being treated andnaturally an increase in the utilisation of medicines. For examplethe prescribing frequency of cardiovascular system medicationunder the GMS Scheme increased from 3.6 million in 1996 to nearly12 million in 2008 (an increase of 233%).

• Epidemiological evolution: the increased incidence of chronic andnon-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 andobesity.

• State decisions on eligibility and administration of the communitydrug schemes: The granting of medical cards to everyone over 70and the introduction of the Drug Payment Scheme (DPS) resulted insubstantial growth in the State bill for medicines. For example theDeloitte review of the Governance and Accountability Mechanismsin the Community Drug Schemes (2003) noted that the provision ofmedical cards to the over 70s cost an additional €126m in the firstfull year of the arrangement in 2002. It also noted that numberclaimants under the DPS increased by 40% between 2000 and 2002.


the CommunityThe growth in medicine expenditure also has to be seen in the context of the factthat Ireland historically has one of the lowest levels of consumption of medicinesper head of population. It is only to be expected that spending on medicines willincrease as the healthcare system endeavours to improve life expectancy andquality of life. It also has to be seen in the context of the large scale increases inIrish health spending that occurred in the boom years.

43

44

Community Medical Schemes Expenditure2008

0

150

75

300

225

450

600

375

525

750

900

975

1125

1200

1050

675

825

€ (M

illio

ns)

Long TermIllness Scheme

Source: HSE Primary Care Reimbursement Service Annual Report 2008 The GMS Scheme figures exclude VAT and the High Tech Scheme figures exclude patient care fees.

138

High TechScheme

275

Drug PaymentScheme

312

General MedicalServices (GMS) Scheme

1122

45

Most Commonly Prescribed Medicines 2008

General Medical Services (GMS) Scheme

1 Acetylsalicylic Acid-Aspirin (Antithrombotic)

2 Atorvastatin

3 Levothyroxine Sodium

4 Bisoprolol

5 Calcium, Combinations

6 Paracetamol

7 Amlodipine

8 Salbutamol (Inhaled)

9 Amoxicillin and Enzyme Inhibitor

10 Ramipril

11 Warfarin

12 Lansoprazole

13 Esomeprazole

14 Furosemide

15 Omeprazole

16 Diclofenac (Systemic)

17 Pravastatin

18 Perindopril

19 Atenolol

20 Diazepam

Drug Payment Scheme


2 Atorvastatin

3 Levothyroxine sodium

4 Salbutamol (Inhaled)

5 Esomeprazole

6 Diclofenac (Systemic)

7 Amoxicillin and Enzyme Inhibitor

8 Bisoprolol

9 Calcium, Combinations

10 Rosuvastatin

11 Amlodipine

12 Omeprazole

13 Salmeterol and other drugs for obstructive

airway diseases

14 Lansoprazole

15 Ramipril

16 Perindopril

17 Prednisolone (Systemic)

18 Atenolol

19 Pravastatin

20 Clarithromycin

Source: HSE Primary Care Reimbursement Service Annual Report 2008

46

Most Commonly Prescribed Medicines2008

High Tech Scheme

1 Etanercept

2 Adalimumab

3 Bicalutamide

4 Tacrolimus

5 Mycophenolic Acid

6 Ciclosporin

7 Erythropoietin

8 Darbepoetin alfa

9 Interferon beta-1a

10 Triptorelin

11 Leuprorelin

12 Pegfilgrastim

13 Teriparatide

14 Interferon beta-1b

15 Somatropin

16 Goserelin

17 Capecitabine

18 Cinacalcet

19 Dornase alfa

20 Filgrastim

Long Term Illness Scheme


2 Metformin

3 Atorvastatin

4 Needles/Syringes/Lancets

5 Gliclazide

6 Insulin Aspart, Fast Acting

7 Ramipril

8 Perindopril

9 Valproic Acid

10 Amlodipine

11 Insulin Glargine, Long Acting

12 Lamotrigine

13 Carbamazepine

14 Rosuvastatin

15 Insulin Detemir, Long Acting

16 Bisoprolol

17 Pravastatin

18 Doxazosin

19 Atenolol

20 Lisinopril

Source: HSE Primary Care Reimbursement Service Annual Report 2008


47

GMS Scheme Expenditure and % Growth Rate1998-2008

Source: GMS (Payments) Board Annual Reports 1998 – 2005 HSE Primary Care Reimbursement Service Annual Reports 2006 - 2008 Figures excluding VAT.

00

100

200

300

400

500

600

700

800

900

1000

1100

1200

5

10

20

15

30

25

€ (M

illio

ns)

1998 1999 2000 2001 2002 2003 2004 2005 2006

252

11 12

17

28

27

18

17

8

14.8

283

332

426

540

639

749

816

922

2007

1029

2008

1122

Euro (Millions)

% Growth Rate

11.6

9%

Gro

wth

The Scheme provides free medical services to persons who would nototherwise be able, without undue hardship, to afford such services.

48

Ageing of the GMS Scheme1994 - 2008

Source: GMS (Payment) Board Annual Reports 1994-2005 HSE Primary Care Reimbursement Service Annual Reports 2006 - 2008

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%

Total No. of Eligible Persons

Year As a % of the Population

Total No. Aged 65 years+

65+ as a % of Eligible Persons

While the overall numbers eligible for medical cards has fallen since1994, the number of cardholders aged 65 and over has increased bynearly 36% (a trend significantly accentuated by the granting ofmedical cards to everyone over 70 years old in 2001).

49

Drugs Payment Scheme Expenditure2000-2008

0

25

50

75

100

125

150

175

200

225

250

275

300

325

€ (M

illio

ns)


2000

141

2001

178

2002

192

2003

204

2004

224

2005

247

2006

283

2007

307

2008

312

50

High Tech Scheme Expenditure2002-2008

0

50

100

150

200

250

300

0

10000

20000

30000

40000

50000

60000

€ (M

illio

ns)

Num

ber o

f par

ticip

ants

2002

Source: GMS (Payments) Board Annual Reports 1998 – 2005 HSE Primary Care Reimbursement Service Annual Reports 2006 - 2008 Figures excluding VAT.

89

2003

104

2004

141

2005

169

2006

207

2007

239

2008

275

Euro (Millions)Number of Patients on Scheme

49,000

41,500

36,500

31,550

28,385

22,353

18,353

Developments in biotechnology and therapeutics have given rise tothe introduction of medicines for the treatment of medicalconditions, many of which previously had either no effectivetreatment or required extended in-patient hospital care. Under theScheme these medicines are dispensed by the community pharmacist.

51

Long Term Illness Scheme Expenditure2000-2008

0

20

40

60

80

100

120

140

€ (M

illio

ns)


2000

42

2001

52

2002

62

2003

73

2004

86

2005

101

2006

115

2007

126

2008

138

The Long Term Illness Scheme is for persons who suffer from one or moredefined long term illnesses. It gives such persons the right to obtain,irrespective of income, relevant medication free of charge.

52

Adverse Event Reporting by Source2008

Source Number of Adverse Event Reports

MA Holders (Pharmaceutical Company) 1,867

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 7

Total 2,742

An adverse reaction is defined as ‘a reaction which is noxious andunintended and which occurs at doses normally used in man for theprophylaxis, diagnosis or therapy of disease or for the correction ormodification of physiological function.’*

Source: Irish Medicines Board Annual Report 2008*Irish Medicines Board Definition

Per Item Cost on the GMS, DPS and LTI schemes is reducing

0

15

20

25

30

35

40

45

50

55

2000 2001 2002 2003 2004 2005 2007 20082006

42.3

27.3

11.5

45

29.2

12.9

48.1

31.7

14.4

50.1

34

15.6

51.1

35.4

16.7

52.1

36.7

17.5

53.2

37.3

18.3

52.7 52.2

36.6 36.4

18.6 18.3

Long Term Illness SchemeDrugs Payment SchemeGeneral Medical Services

Source: GMS (Payment) Board Annual Reports 1999-2005 HSE Primary Care Reimbursement Service Annual Reports 2006-2008

€

53

Making Headroom for Innovation

Medicinesand

54

• Of the 340 medicines on the World Health Organisation (WHO)essential drugs lists, 95% of them have no patents. This meansthat there is no patent obstacle preventing cheap generic copiesof the vast majority of essential medicines being produced locallyfor poor people in developing countries. But those people are notgetting them.

• Patents do not prevent access to medicines. The real barrierhindering access to treatments is in fact a lack of the basichealthcare infrastructure required to get existing medicines topeople. 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 likecondoms and mosquito nets, unfortunately mean that poorhealth is endemic for the world's poorest people.

• Pharmaceutical companies globally are currently involved in morethan 175 health partnerships and programmes in the developingworld which are designed primarily to improve access tomedicines and other aspects of healthcare. One hundred and fortyone of these involve capacity building activities. These include theprovision of basic health education, encouraging behaviouralchange, training health personnel, mounting preventioncampaigns, as well as providing infrastructure for deliveringhealthcare services.

• In the period 2000 to 2008, the industry provided enough healthinterventions – medicines, vaccines, equipment, health educationand training – to help nearly 1.75 billion people in developingcountries.


Global Health• The industry has made available medicines, vaccines, equipment,

training and health education worth $9.2 billion, of which $2.7 billionwas in 2007 alone, to the developing world since the United Nationsannounced the Millennium Development Goals.

• Pharmaceutical companies were involved in 67 R&D programmes in2008, up from 58 in 2007, for neglected tropical diseases and otherdiseases of the developing world such as malaria, sleeping sickness,dengue fever and chagas disease.

55

56

Industry Supported Public-PrivatePartnerships in the Developing World

0 10 30Number of public-private partnerships

5040 6020

Source: 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

54

29

24

21

17

16

15VaccinePreventable

Tuberculosis

Malaria

TropicalDisease

ChronicDisease

Child andMaternal

HIV /AIDS

The pharmaceutical industry has also made substantial donations tomany disaster and emergency relief efforts including the Asiantsunami, Cyclone Sidr (Bangladesh), Hurricane Katrina (New Orleans),the earthquake in Haiti and many others.


Number of Positive Health Interventionsmade in the Developing World

0

50

100

150

200

250

300

Mill

ions

of p

eopl

e po

tent

ailly

reac

hed

350

400

2000 2001 2002 2003 2004 2005 2006 2007

Other health interventions + education + trainingMedicines, Vaccines & Diagnostics - no profitMedicines, 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

1

11

49

2

1

5

3

2

2

20

4

5

11

2

1

1

1

1

DUBLIN

MEATH

KILDARE

WESTMEATH

WICKLOW

CARLOW

WATERFORD

TIPPERARY

MAYO

CLARE

CORK

KERRY

SLIGO

DONEGAL

LIMERICK

CAVAN

LONGFORD

58

DublinShared Services SitesAbbott Laboratories A Menarini Pharmaceuticals Alliance PharmaceuticalsAmgenAstellas PharmaAstraZenecaPharmaceuticalsBayer Consumer CareBayer Schering PharmaBiogen IdecBoehringer IngelheimBristol Myers SquibbCelgeneCephalonDaiichi Sankyo IrelandEisaiEli Lilly & CompanyGlaxoSmithKlineGlaxoSmithKline ConsumerHealthcareGrunenthal PharmaIpsen PharmaceuticalsJanssen-Cilag (J&J)Labopharm EuropeLEO PharmaLundbeck McNeil Healthcare (J&J)Merck SeronoMSDMundipharmaNovartisNovartis Consumer HealthNovo NordiskNycomedOrganon LaboratoriesPfizer (2 sites)Pierre FabreProcter and GambleReckitt BenckiserRoche Productssanofi-aventisSanofi Pasteur MSDSchering Plough (MSD)Servier LaboratoriesShire Pharmaceuticals Solvay HealthcareSSL HealthcareStiefel LaboratoriesTillotts PharmaUCB Pharma

Manufacturing SitesBristol Myers SquibbCovidienHelsinn BirexIpsen

Merrion PharmaceuticalsPfizer (3 Sites)RottapharmSchering Plough (MSD)Swords Laboratories (BMS)

MeathShared Services SitesMEDA

Manufacturing SitesBASF Ireland

WestmeathManufacturing SitesElan

KildareManufacturing SitesPfizer

WicklowManufacturing SitesSchering PloughPharmaceuticals (MSD) (2Sites)Sigma Aldrich Ireland LtdServier LaboratoriesTakeda

CarlowManufacturing SitesMSD

WaterfordManufacturing SitesGenzymeGlaxoSmithKlineTEVA

TipperaryManufacturing SitesAbbott Alza Ireland (J&J)Clonmel HealthcareMSD

Mayo Manufacturing SitesAllerganCharles River LaboratoriesServices

SligoManufacturing SitesStiefel LaboratoriesAbbott Laboratories (3 Sites)Pfizer

ClareManufacturing SitesRoche Schwarz Pharma Ltd

CorkShared Services SitesGlaxoSmithKlinePfizer

Manufacturing SitesCara PartnersCentocor BiologicsEli Lilly & CompanyFMC InternationalFournier PharmaGE HealthcareGilead ServicesGlaxoSmithKlineHovioneIpsenJanssen-Pharmaceuticals (J&J)NovartisRecordati Ireland LtdPfizer (5 Sites)Schering Plough (MSD)Leo Pharma Wexport

Kerry Manufacturing SitesAstellas IrelandTemmler

LimerickManufacturing SitesPfizer

CavanManufacturing SitesAbbott

LongfordManufacturing SitesAbbott

DonegalManufacturing SitesAbbott

49

11

1

1

1

1

3

5

20

2

2

1

1

1

1

2

4

5

12

59

For a PowerPoint version of Pharmaceutical Healthcare Facts andFigures 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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