Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Projecting Medicines Expenditures in the English NHS Mestre-Ferrandiz AES 2013
1. Projecting Expenditure on
Medicines in the NHS
XXXIII Spanish Health Economics Association
Meeting Santander, Spain • 18-21 June 2013
1
Office of Health Economics
Jorge Mestre-Ferrandiz
4. • Bottom-up projection: built up from pack level to total market
• Detailed company input on more dynamic therapy areas (covering
approx. 80%+ of the market)
• Public data and industry intelligence used to:
• Generate current position
• Define erosion curves post LoE
• Identify possible future new products and their uptake
• Keep model at list prices (based on IMS data)
• Account for degree of ‘cannibalisation’ of sales from new launches,
i.e. substitution effect
• Scenarios – important to focus on ranges, rather than point
estimates
The Model
4
5. Overview of Projection Method
Whole
Medicines
Market
Core
Therapy
Areas (~80%
of market)
Non-core
Therapy
Areas
Key
Subclasses/
Products
Other
Subclasses
New Products
Products Losing
Exclusivity (LoE*)
Retail
• Alimentary
• Cardiovascular
• Central Nervous System
• Respiratory
Hospital
• Cancer
• Rheumatoid Arthritis
• HIV
• Other anti-infectives (non HIV)
Homecare
• EPO
Biosimilars
In-depth analysis
• ATC4 level volumes
• Epidemiology
• Government policy
• Clinical guidelines
Product level pipeline analysis
• Expected pipeline
• Uptake curves based on historical analysis
• Industry intelligence
Product level LoE analysis
• Specific price & volume erosion curves
for key products
• Set of erosion curves for
- PC and Hospital
- For easy vs. complex formulations
- Biosimilars
High level analysis
• Trending based on historical
performance
Expected LoE
• Set of erosion curves
*Loss of Exclusivity (LoE) is defined as the time when a product has lost all legal
protection and is expected to face generic competition
High level analysis
• Trending based on historical
Performance
Products Losing
Exclusivity (LoE*)
New Products
5
Product level pipeline analysis
• Expected pipeline
• Uptake curves based on historical analysis
• Industry intelligence
6. Four ‘types’ of products
1. LoE products between 2012 – 2015
• Distinguishing between generics and biosimilars
2. Future launches (launched between 2012
and 2015)
3. Recent launches (launched 2007-11)
4. Non-recent (launched before 2007), non-LoE
products
Building Blocks of the Model: Structure
6
7. • Key issue for the forecast: how will generic competition
evolve for those medicines losing patent protection
between 2012 and 2015?
• Four (price and volume) erosion curves, depending on
manufacturing complexity (‘easy’ or ‘difficult’) and primary
or secondary care
• Primary care: Based on historical analysis for LoE products in
primary care (2003-11) [IMS data sufficient]
• Secondary care: case study approach
• Use erosion curves to predict impact of generic
competition
LoE: Methodology
7
8. LoE: Methodology Primary Care
8
Bases on historical analysis for LoE products between 2003 and 2011 (weighted by sales)
RETAINED VOLUME by the originator
RETAINED PRICE: Generic prices as a % of
originator
Formulation Year 1 Year 2 Year 3 Year 4 Year 5 Formulation Year 1 Year 2 Year 3 Year 4 Year 5
Easy 51% 25% 15% 13% 10% Easy 90% 54% 35% 26% 14%
Difficult 59% 45% 35% 33% 30% Difficult 98% 96% 89% 81% 74%
Number of observations
Easy 71 53 44 35 26
Difficult 19 17 13 6 4
Note on sample size: There were only 6 and 4 observations for year 4 and year 5 respectively for ‘difficult’ formulations, and results
derived for the volume erosion curve presented some anomalies. For this reason we decided to trend for years 4 and 5, assuming a
33% and 30% erosion rate respectively. For the price erosion curve, we used the result obtained from the historical analysis for year 4
and year 5 (81% and 74% respectively).
9. • In secondary care, IMS data do not capture real prices as we know
discounting takes place in hospitals. For this reason, we used a
different approach to estimate erosion curves in secondary care.
• Based on real examples of products that faced generic competition
during the last few years in the hospital market, we constructed
three case studies, representing the following market
characteristics:
• Existing biosimilars
• ‘Easy to manufacture’ product
• ‘Difficult to manufacture’ product
• We used a panel of four hospital pharmacists to validate our 3 case
studies (‘Delphi-type’ analysis)
LoE: Methodology Secondary Care
9
10. Building Blocks of the Model – LoE:
Methodology Secondary Care
10
RETAINED VOLUME by the originator
RETAINED PRICE: Generic prices as a % of
originator
Formulation Year 1 Year 2 Year 3 Year 4 Year 5 Formulation Year 1 Year 2 Year 3 Year 4 Year 5
Easy 15% 13% 11% 11% 11% Easy 15% 13% 9% 9% 9%
Difficult 71% 48% 38% 35% 30% Difficult 80% 70% 60% 30% 30%
11. • Great uncertainty. No good analogues to predict impact
(similar feedback received by Delphi-type analysis)
• Two areas:
• Anti-TNFs (etanercept (Embrel), infliximab (Remicade):
• Cancer
• L01X3 (antineoplastic MABs; Herceptin, Mabthera, Erbitux):
• L01X4 (A-NEO PROTEIN KINASE INH; Glivec, Iressa, Afinitor) and others
• Use less aggressive curves for anti-TNFs and cancer relative
to ‘2ry difficult’
• Cancer less aggressive than anti-TNFs (earlier years only)
Future Biosimilars
11
12. Future Biosimilars
12
RETAINEDVOLUMEby originator
Therapeutic area Year 0 Year 1 Year 2 Year 3 Year 4 Year 5
Anti-TNFs 100% 90% 80% 70% 60% 40%
Cancer 100% 90% 85% 80% 60% 40%
Price of generics as a% of originator brand
Therapeutic area Year 0 Year 1 Year 2 Year 3 Year 4 Year 5
Anti-TNFs 100% 85% 80% 75% 70% 65%
Cancer 100% 95% 90% 85% 70% 65%
14. • Baseline – status quo; no major changes in policy
assumed
• History is a good predictor of the future (with few
adjustments)
• High
• Uptake of new medicines improves relative to past
experience
• Oncology biosimilars have little penetration
• Low
• Uptake of new medicines worsens
• More aggressive generic and biosimilar competition
Scenarios - Narrative
14
15. Summary – Top Line Projections
15
CAGR 2011 - 15
Baseline 3.5%
High 4.1%
Low 3.1%
Total UK NHS medicines bill: actual and forecast (£m) [at list prices]
Total UK NHS Medicines Bill: CAGRs [At list prices]Total UK NHS Medicines Bill: CAGR 2007-11
CAGR 2007 - 11
IMS 3.9%
16. Summary – Brands vs. Biosimilars vs. Generics
[at list prices]
16
CAGR 2011 – 15
[At list prices]
Brands 1.1 %
Generics 10.2%
Biosimilars 37.2%
18. How Good Are Our Projections for 2012?
18
• For the total market: actual sales are within our projected range
• For total brands: our baseline negative growth rate is higher in magnitude
than the actual (-2.3% vs. -1.5%); but, again, actual sales are within our
range
• Generics: overall, we have slightly overestimated growth (14.0% in the
baseline scenario vs. 12.6% actual)
Growth Rates: 2012 vs. 2011 Actual Baseline High Low
Total Market 1.3% 1.0% 4.4% 0.8%
Total Brands -1.5% -2.3% 0.3% -2.6%
Total Generics 12.6% 14.0% 27.4% 14.0%
Total Primary Care -3.7% -1.9% 3.2% -2.2%
Total Secondary Care 10.3% 6.5% 6.6% 6.3%
Source: Actual: IMS BPI and HPAI (2012); Baseline, High and Low: author’s analysis
19. Why Bother?
19
• The CAGR for the period 2003–2011 (3.8%) for the total
medicines bill would lie within our projected growth range for
2011–2015 (3.1–4.1%)
• Our projections for brands and generics are considerably
lower and higher respectively than they were historically for
the 2003–2011 period
CAGR
2003−2011
CAGR
2011−2015e
Total medicines bill 3.8% 3.1%‒4.1%
Total brands 3.4% 0.5%‒1.8%
Total generics 5.8% 10.0%‒11.0%
Source: 2003–2011 authors’ calculations from IMS BPI and HPAI (2003–2011); 2011–2015
authors’ analysis
21. • Method for projecting UK NHS expenditure on medicines over the
medium term
• The basis for our projections includes historical trends, knowledge of the
unfolding lifecycles of existing medicines, published information about
R&D pipelines that will produce future new medicines, and expert input
• Key challenges: future impact of new launches and generic competition
• Two broad approaches may be used to project future medicines
expenditure in any health care system: bottom-up or top-down
• The choice of approach depends on the reason for projecting medicines
expenditure.
• We have used a bottom-up model because we were particularly interested
in exploring the impact of generic competition and new products over the
medium term
Summary and Conclusions
21