committed to excellence

Changing medicine trends and its likely impact on the SA healthcare industry

Content

• • • • Top therapeutic groups by expenditure Top therapeutic groups by prevalence Top 50 medicines Chronic conditions and medicine

adherence/compliance

• • Compliance and persistence Compliance - the Mediscor experience

Presented by: Dr. Elsabé Hammann (Medical Affairs: Mediscor PBM)

2

Top therapeutic groups by expenditure

Therapeutic group Anti-hypertensives Hipolipidaemic agents Anti-depressants Acid reducers Cytostatics % Expenditure % Prevalence 11.4

5.9

18.7

9.5

5.1

4.4

3.9

13.6

20.7

0.7

Top therapeutic groups by prevalence

Therapeutic group Combination analgesics Cough & cold preparations Beta-lactam antibiotics NSAIDs Anti-histamines % Prevalence % Expenditure 51 49 3.1

2.7

45 32 23 3.4

3.4

1.6

4

Top 50 medicines

Top 50 medicines by value - 2007

23% of total expenditure 14% of total volume • 4 NCE on top 50 list • 12 generics on top 50 list • 9 new additions to list, including a biological

NCE = New chemical entity, products registered after 2003

66

Top 50 medicines - top 5 cost drivers 4.5% of total expenditure 2.4% of total volume 1. Cipralex  (1.1%) 2. Lipitor  10mg (1%) 3. Nexiam  40mg (0.8%) 4. Prexum  4mg (0.8%) 5. Celebrex  200mg (0.8%)

Top 50 medicines - New chemical entities

Cipralex



Cymbalta



Crestor



Prexige



New chemical entities - 1 st story Cipralex  • Newer generation anti-depressant • Prevalence of 1.9% and 1.1% of total spent • • Launched during 2004 • Moved from position 7 Number 1 in 2005 to 3 product in 2007 • Lesson - power of marketing in 2006 - perception that newer is better 9

New chemical entities – 2 nd story • • • • • • • •

Prexige

 COXIB Prevalence of 2.2% and 0.4% of total spent in 2007 Launched during 2006 Moved from position 330 in 2006 to 25 in 2007 Cases reported with liver related adverse effects Various countries withdrew product 18 January 2008 – withdrawn from the SA market Lesson: - clinical trials do not represent real world - neither safety in general population , nor long-term safety has been established before launch of product.

10

Top 50 medicines - generics • Prexum  • Prexum Plus  • Adco-Simvastatin  • Aspen Lamzid  • Adco-Zolpidem  • Coxflam  • Amloc  • Cilift  • Lansoloc  • Altosec  • Flomist 

Top 50 medicines – new listings • Crestor  • Prexige  • Amloc  • Arimidex  • Altosec  • Singulair  • Lantus  • Lentogesic  • Enbrel  - position 24 - position 25 - position 33 - position 40 - position 41 - position 42 - position 44 - position 47 - position 50

Chronic conditions and medicine adherence/compliance

Chronic conditions and medicine adherence Compliance

= the extent to which a patient acts in accordance with the prescribed interval and dose of a medicine dosing regimen

Persistence

= the duration of time from initiation to discontinuation of therapy

Non-compliance - causes Poor compliance can be caused by:

• Forgetfulness • Lack of knowledge by patient • A perceived lack of effect • Real or perceived side-effects • Unclear instructions for administration • Physical difficulty in complying with instructions • Unattractive formulation • Complicated regimen • Cost of medicines

Compliance - importance Good

adherence to medicine therapy is associated with

positive

health outcomes.

Improved compliance may have the following outcomes:

• • •

Economic:

increased medicine expenditure, with associated decrease in overall healthcare costs.

Clinical:

better control of the disease.

Humanistic:

improved patient and physician satisfaction.

Compliance – measuring Compliance can be measured as follows:

• Patient self reports • Clinical assessment and – estimation • Pill counts • Pharmacy refill data • Biological and chemical markers • Electronic event monitoring systems

Compliance – the Mediscor experience

• • • Criteria: Patient population patients for 2007 - all registered CDL PMB Measured the number of months medicine for CDL was claimed in which Compliance defined as 10 or more months of treatment in 12 months 18

Compliance - the Mediscor experience

Compliance - the Mediscor experience 0.0

Hae m ophilia As thm a Bronchie c SLE Ulce r colitis Glaucom a Crohn's DM type 1 COPD RA Diab Ins ip Dys rhythm ia Epile ps y DM type 2 BMD CHF Hipe rlipid Chr re nal HT CAD Hypothyroid MS Addis on's Cardiom Schizophr Park ins on's HIV 20.0

40.0

60.0

% Com pliant patie nts 80.0

100.0

In summary

• • • • • Five therapeutic groups are responsible for 31% of total medicine expenditure in 2007 Top 50 products are responsible for 23% of expenditure    Four NCEs on the top 50 list Cipralex  , a NCE, is the number one product 12 generics on the top 50 list  9 “new” products 50% of patients claimed at least once for a combination analgesic and a cough & cold preparation 64% patients compliant with a registered CDL PMB condition is with their treatment Compliance    Measures to enhance compliance should be implemented Increased compliance will increase medicine expenditure , but Overall healthcare costs will decrease .

www.mediscor.net

For more information please contact Elsabé Hammann on +27 12 674-8113