Entries in International (11)

Friday
Mar172017

Taking a Peek at the Irish Healthcare System on Saint Paddy’s Day

Clive Riddle, March 17, 2017

 

In observance of St. Patrick’s Day – that day on which we are all Irish – let’s take a quick peek at the Irish healthcare system. Ireland’s Health Service Executive provides all of Ireland's public health services in hospitals and communities across the country. Here’s what their website has to say about their public services:

 

“Who can access health services in Ireland? Ireland has a comprehensive, government funded public healthcare system. A person living in Ireland for at least one year is considered by the HSE to be 'ordinarily resident' and is entitled to either full eligibility (Category 1) or limited eligibility (Category 2) for health services. People who have not been resident in Ireland for at least one year must satisfy the HSE that it is their intention to remain for a minimum of one year in order to be eligible for health services. Dependants of such individuals must also contact the HSE to confirm their eligibility.” The website informs us that over 30% of people in Ireland are Category 1.

 

A recent article in Irish Times: Ireland worst of 36 countries for ease of access to healthcare – details recently released negative findings from the annual Euro Health Consumer Index report. The report states “the fact that Ireland has the highest percentage of population purchasing duplicate healthcare insurance – over 40 per cent, down from 52 per cent three years ago – also presents a problem. Should this be regarded as an extreme case of dissatisfaction with the public system, or simply as a technical solution for progressive taxation?”

 

The article cites these negative findings from the report:

  -  Irish patients spend longer waiting for emergency treatment in hospital than any others in Europe

  -  Ease of access to the Irish healthcare system is the worst of the 36 countries surveyed, with longer waiting times for minor operations and CT scans

  - Overall, the Irish system ranks 21st [out of 36] in the 2016 Euro Health Consumer Index, the same as in the previous year.

  - The Irish health service is also fifth-worst – on a composite “bang for your buck” measure included in the report.

 

MCOL’s Global Member website includes an archive of International Healthcare Factoids. Here’s some recent selected Irish healthcare factoids from the archive:

 

Healthcare Spending in Ireland

* Health accounted for 9.91% of Irish gross domestic product (GDP) in 2014.

* Government spending on health has increased by at least €1 billion since 2014.

* Total health spending came to more than €19 billion in 2014.

* €13.3 billion was spent by the Government on health in 2014.

* Household out-of-pocket spending was almost €3 billion in 2014.

* Ireland spent €4,147 per person on health in 2014, the sixth highest total in Europe.

Source: Irish health spending among highest in Europe

 

 

Cancer in Ireland

* 38,000 people are diagnosed with cancer each year in Ireland.

* In Ireland, 8,700 people die of cancer annually.

* 1 in 3 Irish men, and 1 in 4 women, will be diagnosed with cancer at some point.

* The chances of Irish women getting cancer is 16% above the EU average.

* The incidence of cancer among Irish men is 10% higher than the EU average.

* 6 out of 10 people will now survive at least five years after diagnosis.

Source: Risk of Irish men and women developing cancer levels off

 

Hospital Wait Times in Ireland

* More than 530,000 people are on public hospital waiting lists in Ireland.

* 435,000 patients were waiting for an outpatient appointment at the end of August.

* More than 74,000 of these outpatients have been waiting for an appointment for over a year.

* 43,000 have been waiting longer than the 15-month "maximum" waiting time set by the government.

* The hospital with the longest waiting list is University Hospital Galway, at 33,000.

* 78,500 people are waiting for inpatient or day case procedures.

Source: Record 530,000-plus patients on hospital waiting lists

 

Prevalence of Undiagnosed Type 2 Diabetes in Ireland

* An estimated 24,000 to 40,000 people in Ireland have undiagnosed type 2 diabetes.

* The risk of having undiagnosed type 2 diabetes increased by 89% for every 5kg/m2 increase in weight.

* Men were nearly 3X more likely to have abnormal blood sugar and undiagnosed diabetes than women.

* 17% of participants in a 30,000-person study had abnormal initial fasting blood sugar levels.

* Pre-diabetes was confirmed in 10% of study participants.

Source: Up to 40,000 people have undiagnosed type 2 diabetes, charity says

 

Under-Age-Six Physician Visitation Rates, Ireland

* Research carried out by the Department of Health last year shows that fee-paying children under the age of six have an annual GP visitation rate of 2.7

* Medical/GP visit cardholders under the age of six have a visitation rate of 3.1

*  GP numbers in Ireland have been increasing since 2010. At December 31 2013, there were 2,840 GPs in Ireland compared to 2,731 at the end of 2012, 2,562 at the end of 2011 and 2,270 at the end of 2010.

Source: Under-six visitation data revealed

 

Private Health Insurance in Ireland

* 2.123 million people – or 46.3% cent of the population – held private health insurance in September 2012. This represents a drop of 16,000 since March and a decrease of 61,000, or 4%, since June 2011.

* The number of people holding private health insurance peaked in 2008 at 2.3 million, but has been in decline since.

*  Aviva increased its share of the health insurance market last year. In 2011 Aviva grew its market share in Ireland to 17.7%, up from 13.7% the previous year.

* Over the same period VHI Healthcare’s market share fell from 61.6% to 57.3%.

*  Quinn Healthcare's – renamed Laya Healthcare earlier this year – share of the market remained steady at just under 21%.

Source:  Private health insurance numbers fall another 61,000

Thursday
Jun022016

IMS Institute on the Global Oncology Market

By Clive Riddle, June 2, 2016

The IMS Institute for Healthcare Informatics this week released their new study: Global Oncology Trend Report: A Review of 2015 and Outlook to 2020, which examines the current and future global oncology market. Their 42-page report tells us that “more than 20 tumor types are being treated with one or more of the 70 new cancer treatments that have been launched in the past five years, with the sustained surge in innovative therapies driving the global oncology market to $107 billion in 2015. However, many of these drugs are not yet available to patients in most countries, and even when registered they may not be reimbursed under public insurance programs.”

The study finds that growth in global spending on oncology therapeutics and supportive care drugs increased 11.5 percent on a constant-dollar basis last year, with more than 500 companies actively pursuing oncology drug development around the world. Collectively, they are advancing nearly 600 new molecules through late-stage clinical development, most frequently for non-small cell lung cancer and breast, prostate, ovarian and colorectal cancers.

And as for the future, “annual global growth in the oncology drug market is expected to be 7.5 – 10.5 percent through 2020, reaching $150 billion. Wider utilization of new products—especially immunotherapies —will drive much of the growth, offset by reduced use of some existing treatments with inferior clinical outcomes. Payers also are expected to tighten their negotiation stance with manufacturers and adopt new payment models in an effort to drive greater value from their expenditures on these drugs.”

The report also shares that:

  • The pipeline of oncology drugs in clinical development has expanded by more than 60 percent during the past decade, with almost 90 percent of the focus on targeted agents.
  • The median time from patent filing to approval for oncology drugs in 2015 was 9.5 years, down from 10.3 years in 2013.
  • Of the 49 oncology New Active Substances analyzed that were initially launched between 2010 and 2014, fewer than half were available to patients by the end of 2015 in all but six countries: the U.S., Germany, UK, Italy, France and Canada.
  • Targeted immunotherapies are available in most developed countries, but none of the emerging markets outside of the European Union has yet registered these treatments.
  • Of the drugs approved in 2014 and 2015 by a set of developed countries analyzed, only the U.S., France and Scotland have more than half included on reimbursement lists at the end of 2015.
  • The annual growth rate in cancer drug costs has risen from 3.8 percent in 2011 to 11.5 percent in 2015, at constant exchange rates. Growth in the U.S. market increased from 2.0 percent to 13.9 percent in the same period.
  • The U.S. now accounts for about 45 percent of the global total market for therapeutics, up from 39 percent in 2011, due in part to the strengthening of the U.S. dollar and more rapid adoption of newer therapies.
  • In the U.S., cancer drugs now make up 11.5 percent of total drug costs, up from 10.5 percent in 2011
  • Net price growth in the U.S. on existing branded oncology drugs have averaged an estimated 4.8 percent in 2015, compared with 6.4 percent invoice price growth
  • In the U.S., cancer drugs dispensed through retail channels now account for more than one-third of total costs, up from 25 percent ten years ago and typically covered by pharmacy benefits. This reflects a shift in the mix of new therapies toward oral medicines, eliminating the need for injection or infusion in a physician’s office or outpatient facility.
  • Nearly 40 percent of the total costs of targeted therapies in the U.S. are now for oral formulations, up from 26 percent in 2010.
  • Only 17 percent of U.S. oncologists are in independent practices, unaffiliated with some type of integrated delivery network or corporate parent, down from 28 percent in 2010.
  • Average total treatment costs for patients in commercial insurance plans with a cancer diagnosis who are receiving active treatment reached $58,000 in 2014, up 19 percent from 2013.
  • Patients with commercial insurance who were treated in 2014 with cancer drugs received by injection or infusion were responsible for more than $7,000 of costs on average, compared to $3,000 for those patients receiving only oral medicines.
  • Some type of coupon or patient cost offset was used for more than a quarter of cancer drug retail prescriptions filled by patients with commercial insurance in 2015, up from 5 percent in 2011 and reflecting efforts by manufacturers to reduce patient out-of-pocket costs. The average cost offset has averaged about $750 per prescription over the past five years.
Friday
Nov202015

The Prescription Drug Locomotive and the U.S Big Slice of the Global Rx Pie

by Clive Riddle, November 20, 2015

With prescription drug spending now having taken over the locomotive of the healthcare cost train, it behooves stakeholders to better get to know what lies on the tracks ahead. The IMS Institute for Healthcare Informatics has just released the 47-page report: Global Medicines Use in 2020:  Outlook and Implications in which they examine the global use of medicines and spending levels in 2020, including small and large molecules, brands and generics, those dispensed in retail pharmaceutics as well as those used in hospital or clinic settings.

IMS tells us the report “found that total global spend for pharmaceuticals will increase by $349 billion on a constant-dollar basis, compared with $182 billion during the past five years. Spending is measured at the ex-manufacturer level before adjusting for rebates, discounts, taxes and other adjustments that affect net sales received by manufacturers. The impact of these factors is estimated to reduce growth by $90 billion, or approximately 25 percent of the growth forecast through 2020.”

The report also tells as that “developed markets will contribute 63% of the spending, led by the U.S.  Original brands will represent 52% of spending and 85% of global spending will be for medicines to treat non-communicable diseases.” 

A pie chart exhibit in the report is telling in how large the U.S. slice of the medicine spending pie is projected for 2020 – 41% of global spending, with the next closest slice being the entire European Union at 13%.

Report findings on spending impacting U.S. costs include:

  • Brand spending in developed markets will rise by $298 billion as new products are launched and as price increases are applied in the U.S., most of which will be offset by off-invoice discounts and rebates. 
  • Patent expiries are expected to result in $178 billion in reduced spending on branded products, including $41 billion in savings on biologics as biosimilars become more widely adopted. 
  • Many of the newest treatments are specialty medicines used to address chronic, rare or genetic diseases and yielding significant clinical value. By 2020, global spending on these medicines is expected to reach 28 percent of the total.
  • More than 90 percent of U.S. medicines will be dispensed as generics by 2020. Generic medicines will continue to provide the vast majority of the prescription drug usage in the U.S., rising from 88 percent to 91-92 percent of all prescriptions dispensed by 2020. 
  • Spending on medicines in the U.S. will reach $560-590 billion, a 34 percent increase in spending over 2015 on an invoice price basis. 
  • While invoice price growth – which does not reflect discounts and rebates received by payers – is expected to continue at historic levels during the next five years, net price trends for protected brands will remain constrained by payers and competition, resulting in 5-7 percent annual price increases. 

Some international findings include:

  • Global medicine use in 2020 will reach 4.5 trillion doses, up 24 percent from 2015.
  • Most of the global increase in use of medicines over the next five years will take place in pharmerging markets, with India, China, Brazil and Indonesia representing nearly half of that growth.
  • Generics, non-original branded and over the counter (OTC) products will account for 88 percent of total medicine use in pharmerging markets by 2020, and provide the greatest contribution to increased access to medicines in those countries. 
  • Newer specialty medicines, which typically have low adoption rates in pharmerging countries lacking the necessary healthcare infrastructure, will represent less than one percent of the total volume in those markets.
  • Global spending will grow by 29-32 percent through 2020, compared with an increase of 35 percent in the prior five years. 
  • Spending levels will be driven by branded drugs primarily in developed markets, along with the greater use of generics in pharmerging markets—offset by the impact of patent expiries. 
Thursday
May072015

Annual Global Oncology Medicine Spending Tops $100 Billion

by Clive Riddle, May 7, 2015 

The IMS Institute for Healthcare Informatics has just released a new report:  Developments in Cancer Treatments, Market Dynamics, Patient Access and Value: Global Oncology Trend Report 2015 which tells us “total global spending on oncology medicines – including therapeutic treatments and supportive care – reached the $100 billion threshold in 2014, even as the share of total medicine spending of oncologics increased only modestly.” 

The report found that “growth in global spending on cancer drugs – measured using ex-manufacturer prices and not reflecting off-invoice discounts, rebates or patient access programs – increased at a compound annual growth rate (CAGR) of 6.5 percent on a constant-dollar basis during the past five years. Oncology spending remains concentrated among the U.S. and five largest European countries, which together account for 66 percent of the total market, while the rising prevalence of cancer and greater patient access to treatments in pharmerging nations continues to grow and now accounts for 13 percent of the market” 

Murray Aitken, IMS Health senior vice president and executive director of the IMS Institute for Healthcare Informatics tells us“the increased prevalence of most cancers, earlier treatment initiation, new medicines and improved outcomes are all contributing to the greater demand for oncology therapeutics around the world. Innovative therapeutic classes, combination therapies and the use of biomarkers will change the landscape over the next several years, holding out the promise of substantial improvements in survival with lower toxicity for cancer patients.” 

Findings shared in the report include: 

  • Growth in the U.S. has risen more slowly at 5.3 percent CAGR, reaching $42.4 billion in 2014, representing 11.3 percent of total drug spending compared to 10.7 percent in 2010.
  • in the EU5 countries oncology now represents 14.7 percent of total drug spending, up from 13.3 percent in 2010.
  • Targeted therapies now account for nearly 50 percent of total spending and have been growing at 14.6 percent CAGR since 2009.
  • Within the U.S., two-thirds of Americans diagnosed with cancer now live at least five years, compared to just over half in 1990.
  • The availability of new oncology medicines varies widely across the major developed countries, with patients in Japan, Spain and South Korea having access in 2014 to fewer than half of the new cancer drugs launched globally in the prior five years.
  • Average therapy treatment costs per month have increased 39 percent in the U.S. over the past ten years in inflation-adjusted terms. Over the same period, patient response rates have improved by 42 percent and treatment duration has increased 45 percent, reflecting improved survival rates.
  • Within the U.S., patient out-of-pocket costs have risen sharply for intravenous cancer drugs, increasing 71 percent from 2012 to 2013, reflecting changes in plan designs and increased outpatient facility costs. 

An interactive version of the full report is available via iTunes, but requires am iPad for viewing. Pdf versions of exhibits can be downloaded here

Thursday
Jul122012

The Emerging Pharmaceutical Pendulum

By Clive Riddle, July 12, 2012

Conventional wisdom tells us that pharmaceutical growth is not the beast it once was. Growth has decelerated and been tamed to the point of 3-4 percent this year, due to a variety of factors including the lingering economic downturn, patent expirations with the corresponding conversion to generics, and a dip in patient demand due to increased cost sharing requirements and coverage concerns.

The IMS Institute for Healthcare Informatics now tells us the pendulum is poised to swing back the other way, and they are forecasting 5-7 percent growth in 2016. However, this resurgence is significantly projected to be driven by emerging versus developed markets.

Their just released report: The Global Use of Medicines: Outlook through 2016, “found that annual global spending on medicines will rise from $956 billion in 2011 to nearly $1.2 trillion in 2016, representing a compound annual growth rate of 3-6 percent. Growth in annual global spending is forecast to more than double by 2016 to as much as $70 billion, up from a $30 billion pace this year, driven by volume increases in the pharmerging markets and an uptick in spending in developed nations.”

Murray Aitken, the Executive Director of the IMS Institute for Healthcare Informatics tells us, “as health systems around the world grapple with macroeconomic pressures and the demand for expanded access and improved outcomes, medicines will play an even more vital role in patient care over the next five years. The trillion-dollar spending on medicines we forecast for 2016 represents a rebound in growth that will accentuate the challenges of access and affordability facing those who consume and pay for healthcare around the world.”

Their report also projects that around the globe:

  • Spending on medicines in developed nations will increase by a total of $60-70 billion from 2011 to 2016, following an increase of $104 billion between 2006 and 2011.
  • Spending in the U.S. will grow by $35-45 billion over the next five years, representing an average annual growth rate of 1-4 percent
  • In Europe, growth will be in the -1 to 2 percent range due to significant austerity programs and healthcare cost-containment initiatives.
  • The Japanese market for medicines is forecast to grow 1-4 percent annually through 2016, slightly lower than the rate during the prior five years and reflecting biennial price cuts scheduled for 2012, 2014 and 2016.
  • Overall, patent expiries in developed markets will yield a five-year “patent dividend” of $106 billion, reflecting reduced brand spending of $127 billion offset by $21 billion in higher generics spending
  • Annual spending on medicines in the pharmerging markets will increase from $194 billion last year to $345-375 billion by 2016, or $91 in drug spending per capita. Generics and other products, including over-the-counter medicines, diagnostics and non-therapeutics, will account for approximately 83 percent of the increase.
  • Pharma manufacturers will see minimal growth in their branded products through 2016. The market for branded medicines will experience flat to 3 percent annual growth through 2016 to $615-645 billion, up from $596 billion in 2011.
  • In the major developed markets, branded medicine growth will be severely constrained at only $10 billion over the five-year period due to patent expiries, increased cost-containment actions by payers and modest spending on newly launched products.
  • The pharmerging markets are expected to contribute $25-30 billion in branded product growth over the same period. Off-invoice discounts and rebates will offset about $5 billion of global branded medicine growth.
  • Global generic spending is expected to increase from $242 billion in 2011 to $400-430 billion by 2016, fueled by volume growth in pharmerging markets and the ongoing transition to generics in developed nations.
  • Global launches for New Molecular Entities (NMEs) will rebound during the next five years, as 32-37 NMEs are expected to be launched per year through 2016. Between 2011-16, 160-185 NMEs are expected to launch, compared with 142 between 2007-11.
  • Biologics are expected to account for about 17 percent of total global spending on medicines by 2016, as important clinical advances continue to emerge from research.