Healthcare Facts and Figures 2009

Healthcare Facts and Figures

2009

All facts and figures were correct at time of going to print (February 2009)

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

IPHA

2009 Healthcare Facts and Figures

1

2

IntroductionAs outlined in this latest edition of Healthcare Facts and Figures the

cost of developing a new medicine has increased from €149 million in

1975 to €1,059 million in 2006. It is also taking longer to bring a new

medicine from the laboratory to a patient.

As impressive as advances in pharmaceuticals have been, our work is

far from over. Thousands upon thousands of people with serious

diseases and conditions, and a healthcare system struggling with

rising costs can benefit from new medicine discoveries.

In this context it must be recognised that it is the medicines of today

that inevitably pay for the medicines of tomorrow.

We are on the verge of a new era of personalised and tailored

medicine that holds great promise for patients and the healthcare

system. That promise, however, is not a given and depends on

sustained, substantial investment in R&D, a supportive public policy

environment and an appropriate regulatory framework.


3

New medicines help patients to recover from ill health, faster and

more fully. They make it possible to prevent or slow the development

of many diseases, turning for example, previously fatal illnesses into

manageable chronic conditions and helping avoid the discomfort of

invasive surgery. They also offer cost savings and improve efficiency,

delivering financial benefits to the whole healthcare system, through

optimal management and reduction of treatment times,

hospitalisation and time off work. These advances have immeasurably

improved the lives of Irish patients, as well as their families and care

givers.

The encouragement of innovation in medicines, in how we deliver

medicines and in how we deliver healthcare is central to the

improvement of our healthcare system, of patient health and of our

country’s economic development and needs to continue to be

rewarded.

Dr Gerald Farrell

IPHA President

4

Healthcare Today 6Public Expenditure on Health 1998-2009

Health Expenditure as a % of GDP 2007

State Expenditure on Medicines 2000-2007

Pharmaceutical Expenditure as a % of Healthcare Expenditure inSelected Countries

Pharmaceutical Expenditure per Capita in Western Europe 2007

Number of Day Cases Treated in Ireland 1997-2007

Self-perceived Health Status by Age Group 2007

Prevalence and Burden of Chronic Disease

Self-Care Today 16Self Medication Market in Ireland 2007

OTC Medicines as a % of the Total Pharmaceutical Market 2007

Demographic Trends 20Population projections 2006-2036

Comparison of Age-Related Public Expenditure

Main Causes of Death in Ireland 2007

Healthcare Tomorrow 26Evolution of Innovative Medicines

Medicines Life Cycle

Cost of Developing an Innovative Medicine

Benefits of Innovative Medicines

Contents


5

Need for Continued Medicines Innovation

Business Sector R&D in Ireland

Changes in Location of Pharmaceutical Industry Research Sites in thePeriod 2001 – 2006

The Medicines Industry 36Leading Pharmaceutical Companies by Sales in Ireland and Globally

Distribution of Global Pharmaceutical Sales by Region

9 of the World’s Top 15 Medicines are Produced in Ireland

World Trade in Pharmaceuticals 2006

Medicines in the Community 42Community Medical Schemes Expenditure 2007

GMS Scheme Expenditure and % Growth Rate 1998-2007

Ageing of the GMS Scheme 1994-2007

Drugs Payment Scheme Expenditure 1999-2007

High Tech Scheme Expenditure 1999-2007

Long Term Illness Scheme Expenditure 1999-2007

Making Headroom for Innovation

Medicines and Global Health 52Industry Supported Public-Private Partnerships in the Developing World

Number of Positive Health Interventions made in the Developing World

Map of Pharmaceutical Locations in Ireland 56

6

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

expenditure following a period of cutbacks and stagnation in the1980’s and the early 1990’s. Public expenditure on health will havealmost quadrupled in the period 1998 to 2009.

• Healthcare expenditure in Ireland, relative to other EuropeanStates, is coming from a low base. Irish expenditure in 2007, as apercentage of GDP, is the lowest alongside Luxembourg in the EU.

• The Irish healthcare system remains a mix between publicexpenditure (75%) and private expenditure (25%). Over 50% ofthe population now have some form of private health insurance.

• The numbers employed in the health services increased by over60% between 1997 (68,084) and 2007 (111,505).

• State expenditure on medicines has increased in tandem with theincrease in public expenditure on healthcare. Medicines accountfor just 14.7 % of total healthcare expenditure – a small but vitalcomponent.

• Irish consumption of medicines remains amongst the lowest inWestern Europe. Growth in the Irish market has to be viewedagainst this background and against the ever-increasing sumsbeing invested to improve public health.

Today


7

• The pharmaceutical industry has recognised that the State faces achallenge in funding healthcare going forward and has agreedrobust, cost effective arrangements for the supply of medicines tothe health services. The State has estimated that thesearrangements will result in savings of €300 million in the Statemedicines bill in the period through to September 2010, savingswhich will provide the State with the monies to fund newtherapies which offer hope to patients of longer, healthier, moreactive lives.

8

Public Expenditure on Health 1998-2009

0

2

4

6

8

10

€ (B

illio

ns)

12

14

16

18

1998

Source: Department of Health and Children Statistics * Budget provision for 2009

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009*

4.1

4.9

5.7

7.2

8.4

9.1

10.1

11.9

13.1

15.1

16.216.34

9

Health Expenditure as a % of GDP 2007

0 2 4 6%

8 10 12

Source: OECD Health Data 2007 (e) Estimate

7.5

7.5

8.2

8.4

8.4

8.9

9

9.1

9.2

9.5

10.1

10.2

10.4

10.6

11.1

11.3

Ireland

Luxembourg

Finland

Spain

UK

OECD

Italy

Greece

Sweden

Denmark

Austria

Portugal

Belgium

Germany

France

Switzerland

10

State Expenditure on Medicines 2000-2007

0

200

400

600

800

1000

€ (

Mill

ions

)

% G

row

th

1200

1400

1600

1800

2000

Source: GMS/PCRS Annual Reports from 2000– 2007. The GMS figure excludes VAT and the Hi-Tech Scheme figure excludes patient care fees.

2001 2002 2003 2004 2005 2006

565

718

867

120221

27

22

17

18

11

15

11

1332

1529

20070

5

10

15

20

25

301701

1022

Euro (Millions)

% Growth Rate

11

Pharmaceutical Expenditure as a % ofHealthcare Expenditure in Selected Countries2006

0 5 15%

252010

Source: OECD In Figures 2008* IPHA calculation

14.6

21.7

21.3

20

17.6

17.6

16.9

16.4

14.8

14.7

13.3

12.4

8.5

Spain

Portugal

Italy

Greece

OECD

Belguim

France

Germany

Ireland*

Finland

Sweden

Austria

Denmark

12

Pharmaceutical Expenditure per Capita in Western Europe2007

0 100 300US Dollars ($)

500400 600 700200

Source: OECD Health Data 2008

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

Source: Department of Health and Children Health Statistics 2005; HSE Annual Reports 2006 – 2007

1997 1999 2001 2003 2005 2007

249,000

297,000

358,000

449,000

512,000

590,000

13

Number of Day Cases Treated in Ireland 1997-2007

14

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 * SLAN 2007 Report (Survey of Lifestyle, Attitude & Nutrition)

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

Bad/Very Bad Fair Good Very Good

This is in a country where 1 in every 4 persons is obese andevery 2nd person is overweight*.

• 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 areavoidable through screening, early intervention, behaviour changeand the elimination of key risk factors such as poor diet, inactivityand 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 reported.1

– 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%) and vitamins and minerals (12%).

17

18

Self Medication Market in Ireland 2007

Source: IMS Health, 2008 * At consumer price level

Analgesics 23%

Cough & Cold 17%

Vitamins & Minerals 12%

Digestives & Intestinal Remedies 10%

Skin Treatment 10%

Smoking Cessation 7%

Others 22%

Total Market: €315 m*


19

0 2 6%108 12 14 16 18 204

Source: AESGP Economic and Legal Framework for Non-Prescription Medicines 2008

7.5

8.2

8.9

9.3

10.9

11.2

12.1

12.3

15.1

16.0

16.0

17.3

19.1

Portugal

Spain

Denmark

Sweden

Finland

Italy

Austria

Netherlands

Belgium

Ireland

Germany

UK

France

OTC Medicines as a % of the TotalPharmaceutical Market 2007

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 5.8m by2036.

• 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 20% of the population (1.14 million) by 2036as against just 11% of the population (430,000) in 2001 and thenumber of those aged 80 and over is set to treble from a 2001level of 98,000 to 320,000 in 2036. These changes will havesignificant 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.

• Circulatory diseases continue to be the principal cause of death inIreland 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.

20


21

hic Trends

22

Population Projections 2006-2036

0

1

2

3

4

5

6

Mill

ions

Year

2006

Source: Central Statistics Office

2011 2016

All

2026 2031 2036

4,200,0004,500,000

4,900,000

5,100,000

5,400,000

5,600,0005,800,00

466,000 531,000 631,000 741,000 866,000

1,002,0001,140,000

Over 65’s

23

Comparison of Age-Related PublicExpenditure

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 Ireland2007

Source: Central Statistics Office

Cancer 29%

Respiratory Diseases 14%

Injury and Poisoning 5%

Other causes 17%

Circulatory Diseases 35%

Other Circulatory Diseases 10%

Stroke 7%

Heart Disease 18%

25

• 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 750medicines in development to combat cancer, 547 for neurologicalconditions and 303 for rare diseases.

• 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 10 to 12 years to develop a new medicine fromthe time it is discovered to when it passes the regulatory standardsof safety, quality and efficacy and is available to patients. Once onthe market the average medicine has only 8 to 10 years of effectivepatent protection left before facing generic competition. Only threeout of ten marketed medicines produce revenues that match orexceed their R&D costs before they lose patent protection.

• The European pharmaceutical industry employed over 107,000people in R&D in 2007 and spent a total of €24.8 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 outside Europe.

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

Medicines Life Cycle

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

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

32

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)

33

Business Sector R&D in Ireland

Source: Forfás Research and Development Statistics in Ireland, 2006 – 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%

34

Changes in Location ofPharmaceutical Industry ResearchSites in the Period2001-2006

0

2

4

6

10

14

8

12

16

18

Europe

Note: Data collected from 22 global pharmaceutical companiesSource: IMI, EFPIA Research Directors Group, IFPMA

USA

New Research Sites

Num

ber P

harm

aceu

tical

Indu

stry

Res

earc

h Si

tes

Asia

Closed Research Sites

35

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, of which 13 of the world’s top 15 pharmaceuticalcompanies have substantial operations. The industry directlyemploys over 24,500 people, half of whom are third levelgraduates, with as many again employed in the provision ofservices to the sector. The industry contributes approximately €3billion annually in taxes to the State.

• Pharmaceutical production in Ireland currently generates nearly50% of the country’s exports and 11% of its Gross DomesticProduct which contribute to making Ireland the largest netexporter of medicines in the world.

• Nearly €7 billion has been invested by the pharmaceutical sectorover the last nine years in a period when job growth in the sectorhas averaged 1,000 annually. According to IDA Ireland thereplacement value of the investment by the pharmaceuticalsector in the Irish economy is over €40 billion.

36


37

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

the next section on Medicines in the Community and there areopportunities for the industry to develop its operations in Irelandstill further.

Source: 1 IMS Health Data Dec 2008 2 IMS Health Data Dec 2008 Note: “Merck & Co., Inc.” has its headquarters in Whitehouse Station, NJ, USA and operates in most countries outside the U.S., including Ireland, as Merck Sharp & Dohme.

By Rank

1. Pfizer

2. AstraZeneca

3. GlaxoSmithKline

4. sanofi-aventis

5. Wyeth

6. Roche

7. Novartis

8. Merck Sharp & Dohme

9. Abbott

10. Lilly

By Rank

1. Pfizer

2. GlaxoSmithKline

3. Novartis

4. sanofi-aventis

5. AstraZeneca

6. Johnson & Johnson

7. Roche

8. Merck & Co.

9. Abbott

10. Lilly

Ireland Top 101 Global Top 102

38

Leading Pharmaceutical Companiesby Sales in Ireland and Globally

39

Distribution of Global Pharmaceutical Salesby Region

Source: IMS Midas, Dec 2007

Europe 31%

Asia (excl. Japan), Africa and Australia 9%

Japan 9%

North America 46%

Latin America 5%

2007 Global Sales€663.50 billion

40

9 of the world’s top 15 medicines areproduced in Ireland

Source: IPHA Analysis. Rankings based on IMS Health Data, Dec 2008

Rank Medicine Company

1. Lipitor Pfizer

5. Enbrel Wyeth

7. Zyprexa Eli Lilly

8. Remicade Centocor

9. Singulair Merck Sharp & Dohme

10. Risperdal Janssen Pharmaceuticals

12. Takepron Takeda

13. Effexor XR Wyeth

15. Actos Takeda

41

World Trade in Pharmaceuticals2006

Source: International Trade Centre, a joint agency of the World Trade Organisation and the United Nations (http://www.intracen.org/dbms/country/CA_CtryIndex.Asp?CT=372)

Country Exports $ Imports $ Balance $

Ireland 12,734 1,753 10,981

Switzerland 20,663 10,292 10,371

Germany 32,243 24,622 7,621

UK 18,508 12,679 5,829

France 18,023 12,231 5,792

Sweden 6,350 2,362 3,988

Belgium 28,410 25,679 2,731

Austria 3,861 2,781 1,080

Netherlands 9,046 8,937 109

Italy 9,727 9,949 -222

Spain 5,338 6,951 -1,613

Japan 1,878 5,753 -3,875

USA 19,129 32,318 -13,189

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 2007was 41,500, a five 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 11.1million in 2007 (an increase of 208%).

• Epidemiological evolution: the increased incidence of chronic andnon-communicable diseases is generally quite costly to treat.Ireland has one of the 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 resulted insubstantial growth in the State bill. For example the Deloittereview of the Governance and Accountability Mechanisms in theCommunity 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 the numberof claimants under the DPS increased by 40% between 2000 and2002.


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, so 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 and ongoingincreases in Irish health spending.

43

44

Community Medical Schemes Expenditure2007

0

150

75

300

225

450

600

375

525

750

900

975

1050

675

825

€ (M

illio

ns)

Long TermIllness Scheme

Source: HSE Primary Care Reimbursement Service Annual Report 2007 The GMS Scheme figures exclude VAT and the High Tech Scheme figures exclude patient care fees.

124

High TechScheme

239

Drug PaymentScheme

307

General MedicalServices (GMS) Scheme

1029

45

GMS Scheme Expenditure and % Growth Rate1998-2007

00

100

200

300

400

500

600

700

800

900

1000

1100

5

10

20

15

30

25

€ (M

illio

ns)

1998

Source: GMS (Payments) Board Annual Reports 1998 – 2005 HSE Primary Care Reimbursement Service Annual Reports 2006 & 2007 Figures excluding VAT.

1999 2000 2001 2002 2003 2004 2005 2006

252

11 12

17

28

27

1817

8

14.8

283

332

426

540

639

749

816

922

2007

1029

Euro (Millions)

% Growth Rate

11.6%

Gro

wth

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

46

Ageing of the GMS Scheme1994-2007

Source: GMS (Payment) Board Annual Reports 1994-2005 HSE Primary Care Reimbursement Service Annual Reports 2006 & 2007

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%

2007 1,276,000 30.1% 416,000 32.6%

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).

47

Drugs Payment Scheme Expenditure1999-2007

0

25

50

75

100

125

150

175

200

225

250

275

300

325

€ (M

illio

ns)

1999


105

2000

141

2001

178

2002

192

2003

204

2004

224

2005

247

2006

283

2007

307

48

High Tech Scheme Expenditure1999-2007

0

50

100

150

200

250

€ (M

illio

ns)

1999Source: GMS (Payment) Board Annual Reports 1999-2005 HSE Primary Care Reimbursement Service Annual Reports 2006 & 2007 Figures exclude patient care fees. The number of patients registered under the Scheme has increased from just over 8,000 in 1998 to nearly 41,500 in 2007.

40

2000

49

2001

61

2002

80

2003

104

2004

141

2005

169

2006

207

2007

239

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.

49

Long Term Illness Scheme Expenditure1999-2007

0

20

40

60

80

100

120

140

€ (M

illio

ns)

1999


34

2000

42

2001

52

2002

62

2003

73

2004

86

2005

101

2006

115

2007

124

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.

50

Creating Headroom for Innovative Medicines

Per Item Cost on GMS Scheme is stabilising while the DPS and LTIScheme is reducing

0

15

20

25

30

35

40

45

50

55

2000 2001 2002 2003 2004 2005 20072006

42.1

27

11.5

45

29

13

48

31.9

14.2

50

34

15.8

51

35.75

16.9

52

36.25

17.2

53.5

37.1

18.1

53

36.25

18.5

Long Term Illness SchemeDrugs Payment SchemeGMS Scheme

Source: HSE Corporate Pharmaceutical Unit, 2008

€

51

• 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 150 health partnerships and programmes in the developingworld which are designed primarily to improve access tomedicines and other aspects of healthcare. Seventy-eight of theseinvolve capacity building activities. These include the provision ofbasic health education, encouraging behavioural change, traininghealth personnel, mounting prevention campaigns, as well asproviding infrastructure for delivering healthcare 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.

Medicinesand

52


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 are involved in 67 R&D programmes, upfrom 58 in 2007, for neglected tropical diseases and other diseases ofthe developing world such as malaria, sleeping sickness, dengue feverand chagas disease.

53

© BMS – www.securethefuture.com

54

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 2007 www.ifpma.org/healthpartnerships

ChronicDiseases

Child &Maternal

VaccinePreventable

TropicalDisease

Tuberculosis

Malaria

HIV/Aids

11

17

10

19

13

13

52


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

Open...to see the foot-print of Ireland’s phar-maceutical industry.

DublinAbbott Laboratories A Menarini Pharmaceuticals Alliance PharmaceuticalsAmgenArchAstellas PharmaAstraZeneca PharmaceuticalsBayer Consumer CareBayer Schering PharmaBiogen IdecBoehringer IngelheimBOCBristol Myers SquibbPharmaceuticalsCelgeneCephalon PharmaCovidienEisaiEli Lilly & CompanyForest LaboratoriesGlaxoSmithKlineGlaxoSmithKline ConsumerHealthcareGrunenthal PharmaHelsinn Birex TherapeuticsIpsen PharmaceuticalsJanssen-CilagLabopharm EuropeLEO PharmaHenkel LoctiteLundbeck MEDAMcNeil HealthcareMerck SeronoMSDMundipharmaNovartisNovartis Consumer HealthNovo NordiskNycomedOrganon LaboratoriesPfizer HealthcarePierre FabreProctor & GambleReckitt BenckiserRehelsRoche ProductsRottapharmsanofi-aventisSanofi Pasteur MSDSchering Plough PharmaceuticalsServier LaboratoriesShire Pharmaceuticals Solvay HealthcareSSL HealthcareStiefel LaboratoriesTakedaTillotts PharmaUCB PharmaWyeth Consumer HealthcareWyeth Pharmaceuticals

Cork Cara PartnersCentocorCognis (Henkel)CordenDynoEli Lilly & CompanyFMCGE HealthcareGilead SciencesGlaxoSmithKlineJanssen (J&J)NovartisPfizerRecordatiSchering PloughQuest (ICI)Wexport (Leo)

Newbridge Wyeth Medica (AHP)

RathdrumSchering Plough

Arklow Servier

WaterfordArkopharmaGenzymeLawter InternationalNovartis AgribusinessTEVA

DungarvanGlaxoSmithKline

Cashel Ranbaxy

ClonmelClonmel Healthcare (Stada)MSD

KillorglinAstellas PharmaTemmler

Limerick Aughinish Alumnia (Glencore AG)HeraeusInfo Lab (Huber Group)Schwarz PharmaWyeth Nutritional (AHP)

Ennis OlympusRoche

Athlone Athlone PharmaceuticalsElan

Westport Allergan

Sligo Abbott Diagnostics Fort Dodge (AHP)Stiefel Laboratories

Monaghan Norbrook Labs

Bray Takeda

KILLORGLIN

ENNIS

ATHLONE

MONAGHAN16

13 3

4 17

SLIGO

WESTPORT

DUNGARVAN

WATERFORD

CASHEL

ARKLOW

BRAYRATHDRUM

DUBLIN

NEWBRIDGE

5

1 2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

6

710

2

1

11

12

14

15

8

9CLONMEL

CORK

LIMERICK

Design and production: www.slickfish.ieTPG0209

Franklin House140 Pembroke RoadDublin 4Ireland Tel: (353 1) 660 3350 Fax: (353 1) 668 6672 E-mail: [email protected]

www.ipha.iewww.medicines.iewww.feelbetter.ie

Documents

Healthcare Facts and Figures 2009