Drug Spending % of Healthcare Spending DRUG SPENDING % OF HEALTHCARE - - PowerPoint PPT Presentation

54

0% 5% 10% 15% 20% 1995 2000 2005 2010 2015

DRUG SPENDING % OF HEALTHCARE SPENDING

France Germany Japan United Kingdom United States Net

Drug Spending % of Healthcare Spending

Understanding the Dynamics of Drug Expenditure. Report by the QuintilesIMS Institute.

Source: QuintilesIMS Institute Sep 2016; WHO Global Health Expenditure Database Dec 2016 Chart Notes: Drug Spending from QuintilesIMS Audits of medicine spending and inclusive of all types of products and all channels of distribution, but not reflecting off-invoice discounts and rebates except where referred to as “net”. Japan, 15.0% France, 9.8% US Net, 9.8% UK, 9.7% Germany, 9.0%

55 France, 492 Germany, 508 Japan, 576 UK, 395 US est net, 974

200 400 600 800 1000 1200 1995 2000 2005 2010 2015

REAL PER CAPITA SPENDING 2015 CONSTANT US$

France Germany Japan UK US est net

Real Per Capita Drug Spending 1995-2015

Understanding the Dynamics of Drug Expenditure. Report by the QuintilesIMS Institute.

Source: QuintilesIMS MIDAS; QuintilesIMS Institute Sep 2016; Economist Intelligence Unit Sept 2016

56

5 10 15 20 25 30 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Annual Growth from New Protected Brands 1996-2015

Absolute Growth in 5 Countries of Products <24 mths since Launch, Real 2015 Const US$Bn

Source: QuintilesIMS MIDAS; QuintilesIMS Institute Sep 2016

Understanding the Dynamics of Drug Expenditure. Report by the QuintilesIMS Institute.

57

Understanding the Dynamics of Drug Expenditure. Report by the QuintilesIMS Institute.

Oncology Pain Hypertension Autoimmune Anticoagulants Antibacterials Antidiabetics Respiratory HIV Antivirals Mental Health Cholesterol Viral Hepatitis GI Products Antiulcerants

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1995 2000 2005 2010 2015

Total Others Blood Coagulation Other Cardiovasculars Antiulcerants Multiple Sclerosis Nervous System Disorders Dermatologics GI Products Viral Hepatitis Cholesterol Mental Health Hospital Solutions HIV Antivirals Respiratory Antidiabetics Antibacterials Anticoagulants Autoimmune Hypertension Pain Oncology

France Composition of Protected and New Brands Expenditure by Drug Class 1995-2015

Protected & New Brands France Top 20 Classes & Others

Source: QuintilesIMS MIDAS; QuintilesIMS Institute Sep 2016 Note: The group of therapies termed “Other Cardiovasculars” includes a variety of drugs for heart failure, heart surgery, and pulmonary arterial

• hypertension. In this report, cholesterol and hypertension treatments have been reported separately.

58

Understanding the Dynamics of Drug Expenditure. Report by the QuintilesIMS Institute.

Oncology Antidiabetics Autoimmune Pain Anticoagulants Multiple Sclerosis Hypertension Respiratory Viral Hepatitis Mental Health Vaccines Nervous System Disorders Antibacterials

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1995 2000 2005 2010 2015

Total Others Hospital Solutions Immunosuppressants Antibacterials Cough Cold, Incl Flu Antivirals Other Cardiovasculars GI Products HIV Antivirals Dermatologics Nervous System Disorders Vaccines Mental Health Viral Hepatitis Respiratory Hypertension Multiple Sclerosis Anticoagulants Pain Autoimmune Antidiabetics Oncology

Germany Composition of Protected and New Brands Expenditure by Drug Class 1995-2015

Protected & New Brands Germany Top 20 Classes & Others

Source: QuintilesIMS MIDAS; QuintilesIMS Institute Sep 2016 Note: The group of therapies termed “Other Cardiovasculars” includes a variety of drugs for heart failure, heart surgery, and pulmonary arterial

• hypertension. In this report, cholesterol and hypertension treatments have been reported separately.

59

100 200 300 400 500 600 700 800 900 1,000

1995 2000 2005 2010 2015

Cholesterol Real Drug Expenditures (Euro Mn)

Existing Protected Brands New Protected Brands Brands No Longer Protected Generics

0.00 € 0.10 € 0.20 € 0.30 € 0.40 € 0.50 € 0.60 € 0.70 € 0.80 € 0.90 € 500 1,000 1,500 2,000 2,500

1995 2000 2005 2010 2015

Cholesterol Volumes (Standard Units Mn) and Average Price Real Euros

Standard Units Mn Average Real Expenditure per SU

Germany Cholesterol Volumes Average Prices and Expenditures by Product Type 1995-2015

Understanding the Dynamics of Drug Expenditure. Report by the QuintilesIMS Institute.

Source: QuintilesIMS MIDAS; QuintilesIMS Institute Sep 2016

What payers want …

63

The four evidence categories required by G-BA are:

1. Mortality (OS) 2. Morbidity (symptomatic progress such as pain & SRE, opiate use: documented medication is expected, fatigue, etc.) 3. Patient reported QoL (e.g., FACT measures, SF- 36, and EORTC) 4. Adverse Events

Head of G-BA : “Proven added benefit for PRO is a must-have for the success of future submissions!” -

August 2013

… but does that work for disruptive innovation ?

What insurers need to think of :

• Innovation needs vision and incentives, it is not stimulated

by HTA, price control and fixed budget thinking.

• Budget therefore needs to be released outside government

systems. AND

• The future is about Disease Interception

– Genomic profiling èData è prediction of risk è Personalised prevention of disease – Examples : Pre-prodromal Alzheimers, pre-diabetes, circulating tumor cells.

• Therefore new insurance models are needed in both

developing and developed countries.

Five predictions about RWE

• 1. All data in the world will become available to

anyone who desires to analyse them.

• 2. All databases will become richer, better and

linked.

• 3. RWE will become an essential part of Price &

Reimbursement negotations.

• 4. Randomisation within databases will replace

RCT’s and registries.

• 5. Colourful coalitions of patients, payers,

academics and activists will take clinical trials

• ut of the industry’s hands.

Dynamic Efficiency And The fallacy of fixed budget thinking