Richard Laing MIE/EMP &
Iris Buysse (University of Utrecht) with materials provided by Peter Stephens from IMS Health
Utrecht
7 th January 2010
1

1.4
Real GDP (LCU)
(Q2 ’97=1)
Drug Consumption (SU)
(Q2 ’97=1)
1.4
1.3
1.3
Korea
1.2
1.2
1.1
1.0
0.9
0.0
-4 -2 0 2 4 6 8 10 12 14 16 18 20 22 24
# of Quarters
Q
0
= Q2 ’97
Source: ????
Thailand
Indonesia
1.1
1.0
Thailand
Indonesia
0.9
0.8
0.0
-4 -2 0 2 4 6 8 10 12 14 16 18 20 22 24
# of Quarters
Q
0
= Q2 ’97
Source: IMS Midas
Korea
2

1.4
1.3
1.2
1.1
1.0
0.9
Chronic disease consumption recovered quicker than overall consumption.
Real GDP (LCU)
(Q2 ’97=1)
Chronic Disease Consumption (SU)
(Q2 ’97=1)
1.4
1.3
Korea
1.2
1.1
Thailand
Indonesia
1.0
Thailand
Korea
Indonesia
0.9
0.8
0.0
-4 -2 0 2 4 6 8 10 12 14 16 18 20 22 24
# of Quarters
Q
0
= Q2 ’97
Source: WHO
0.0
-4 -2 0 2 4 6 8 10 12 14 16 18 20 22 24
# of Quarters
Q
0
= Q2 ’97
Source: IMS Midas
3

1.4
Real GDP (LCU)
(Q2 ’97=1)
Acute Disease Consumption (SU)
(Q2 ’97=1)
1.4
1.3
1.3
1.2
1.1
1.0
0.9
0.0
-4 -2 0 2 4 6 8 10 12 14 16 18 20 22 24
# of Quarters
Q
0
= Q2 ’97
Source: WHO
Korea 1.2
1.1
Thailand
Indonesia
1.0
0.9
Indonesia
Thailand
0.8
0.7
0.0
-4 -2 0 2 4 6 8 10 12 14 16 18 20 22 24
# of Quarters
Q
0
= Q2 ’97
Source: IMS Midas
Korea
4

The WHO, in collaboration with IMS, has established a programme to monitor the impact of the 08/09/?? recession
• 83 countries, approximately 81% of global population, quarterly reports (Small, poor and
African countries missing)
• Impact on consumption (Lagging indicator)
– Total volume
– Volume of acute and chronic medicines
– Movement to or from original and licensed branded medicines
Impact on expenditure (Leading indicators)
– Total expenditure
– Average price per unit of volume (SU)
5

• IMS collects data on consumption and prices at one point in the distribution channel.
• Data generally collected from private sector but in many countries the private sector supplies the public sector.
Generally do not capture tender data
• In some countries only captures hospital data (e.g.
China)
• Uses the same point and methods in each country, so good for detecting changes less so for cross country comparisons
• Volume data is more reliable than pricing data
6

GDP
(Percentage change on Q1 08)
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
-5.00%
-8.18%
-10.00%
-15.00%
-20.00%
-17.33%
Q1 07 Q2 07
Estonia
Q3 07
Latvia
Q4 07 Q1 08
Lithuania
Q2 08
9.60%
-1.54%
-10.08%
Q3 08 Q4 08
Mexico (priv.)
Q1 09 Q2 09
Poland
7

Pharmaceutical consumption
Global and WHO regions
(Evolution on Q1 08)
1,25
1,20
1,23
1,18
1,15
1,10
1,11
1,10
1,07
1,05
1,00
0,99
0,95 0,95
0,93
0,90
0,94
Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09
GLOBAL AFRO AMRO EMRO EURO SEARO WPRO
8

Pharmaceutical consumption
Global, EURO and Baltics
(Evolution on Q1 08)
1,15
1,10
1,05
1,00
0,99
0,95
0,97
0,95
0,90
1,03
1,10
0,94
0,85
0,83
0,80
0,75
0,70
0,76
0,72
Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09
GLOBAL EURO Estonia Latvia Lithuania
9

Consumption
Global, WPRO, China and Malaysia
(Evolution on Q1 08)
1,40
1,30
1,40
1,20
1,18
1,10
1,10
1,00
0,97
0,95
0,90
0,90
0,97
0,80
10
Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09
GLOBAL WPRO CHINA MALAYSIA

1,30
1,25
1,20
1,15
1,10
1,05
1,00
0,95
0,90
0,92
0,90
0,85
0,84
0,80
Average pharmaceutical expenditure index
Global and WHO regions
(Evolution on Q1 08)
GLOBAL AFRO AMRO EMRO EURO SEARO
1,28
1,24
1,20
1,10
1,00
WPRO

Average pharmaceutical expenditure
Global, EURO and Baltics
(Evolution on Q1 08)
1,20
1,15
1,10
1,05
1,17
1,00
0,95
0,95
0,92
0,90 0,90
0,88
0,85
1,00
0,87
0,83
0,80
0,75
0,77
Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09
12
GLOBAL EURO Estonia Latvia Lithuania

Pharmaceutical expenditure
Global, WPRO, China and Malaysia
(Evolution on Q1 08)
1,50
1,40
1,30
1,20
1,10
1,00
0,90
0,80
0,70
0,91
0,91
0,79
1,54
1,20
1,17
1,14
Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09
GLOBAL WPRO CHINA MALAYSIA
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Price per IMS Standard Unit
Global and WHO regions
(Evolution on Q1 08)
1,15
1,10
1,11
1,05
1,00
0,97
0,95 0,94
0,93
0,90
0,85
0,88
Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09
GLOBAL AFRO AMRO EMRO EURO SEARO WPRO
14

Price per IMS Standard Unit
Global, EURO, Baltics
(Evolution on Q1 08)
1,25
1,20
1,15
1,10
1,05
1,00
1,21
1,08
1,02
1,01
0,95
0,90
0,93
0,92
0,85
0,85
Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09
GLOBAL EURO Estonia Latvia Lithuania
15

Price per IMS Standard Unit
WPRO, China and Malaysia
(Evolution on Q1 08)
1,20
1,15
1,17
1,10
1,05
1,00
0,96
0,95
1,10
1,08
0,90
0,87
0,85
Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09
GLOBAL WPRO CHINA MALAYSIA
16

• Pareto analysis on ATC2 and ATC3-level on consumption distribution for 6 most affected countries
• ATC-2 & 3 level analysis to identify top and bottom 10 of most decline
• Investigate whether Individual product level data can identify marker medicines within ATC4 categories
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Example of distribution of ATC3 categories of total consumption in IMS supply units
Annual consumption distribution Estonia 2008
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
0.0%
20.2 % of all ATC3 categories accounted for
80.91% of total consumption
20.0% 40.0% 60.0%
Number of ATC3-groups
80.0% 100.0%
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Q4 07-Q1 08 compared to Q4 08-Q1 09
ATC2: Top 10 decliners of the 30% of categories that account for 80% of consumption
Top 10 Estonia Abs value % change Latvia
1 M2 (ANTIRHEUMATICS TOPICAL )
Abs value % change
-14509339 -20,33%
2 C6 (OTH CARDIOVASCULAR PRDS )
3 V3 (OTHER THERAPEUTIC PRODS ) -2647914 -15,71%
4 R1 (NASAL PREPARATIONS ) -4034513 -15,64%
5 A12 (MINERAL SUPPLEMENTS ) -2969060 -14,56%
6 D8 (ANTISEPTICS+DISINFECTANT ) -3430098 -13,86%
7 A11 (VITAMINS)
8 A7 (A-DIAR ORAL ELEC+A-INFLA ) -1940346 -11,98%
9 N6 (PSYCHOANALEPTICS ) -2120912 -11,89%
10 B1 (ANTITHROMBOTIC AGENTS ) -9118301 -10,62%
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Q4 07-Q1 08 compared to Q4 08-Q1 09
ATC2: Bottom 10 decliners of the 30% of categories that account for 80% of consumption
Bottom 10 Estonia Abs value % change Latvia Abs value % change
1 R3 (ANTI-ASTHMA & COPD PROD ) -46801 -0,17%
2 A2 (A-ACID A-FLAT A-ULCERANT ) -16663 -0,02%
3 C8 (CALCIUM ANTAGONISTS ) 54377 0,17%
4 C5 (A-VARICOSE/HAEMORRHOIDAL ) 1090156 8,78%
5 C10 (LIP.REG./ANTI-ATH. PREPS ) 3099690 9,34%
6 M5 (OTHER MUSCULO-SKELETAL ) 1437829 9,41%
7 V7 (OTHER NON-THERAPEUTIC ) 2483633 10,74%
8 C7 (BETA BLOCKING AGENTS ) 1943115 10,75%
9 A10 (DRUGS USED IN DIABETES ) 2321425 11,66%
10 C9 (RENIN-ANGIOTEN SYS AGENT ) 1820269 18,31%
21

th
• ATC2 analysis
• Identification of marker product categories for detecting declines that are likely to be therapeutically significant
• More work to be done on ATC3 and ATC 4 data
24

• Meet to discuss further work to be done in Baltic states to link IMS consumption data with social security utilization & claims data. Possibly involve Iceland
• Interim report for WHO Executive Board 2010
• Full report for World Health Assembly 2010
• Source data available on request for further analysis
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• No firm evidence of a negative impact except in Baltic countries and Malaysia
• So far most countries seem to have absorbed the moderate price increases without a loss in medicine consumption
• Confident that the data collection methods and the analytic tools available will enable us to detect significant changes as soon as they occur
• When such changes are detected, governments have a range of policy instruments to alleviate the situation
• More reports will be provided quarterly http://www.who.int/medicines/areas/policy/imsreport/en/index.html
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