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A Comparative Study of the Diffusion of Antihypertensive and Antidepressant Medications in Germany and Japan

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A Comparative Study of the Diffusion of Antihypertensive and Antidepressant Medications in Germany and Japan A Comparative Study of the Diffusion of Antihypertensive and Antidepressant Medications in Germany and Japan by Ling Cui Master of Science in Aeronautics and Astronautics, MIT, 2004 Bachelor of Engineering, Beijing University of Aeronautics and Astronautics, 2001 Submitted to the Engineering Systems Division in Partial Fulfillment of the Requirements for the Degree of Master of Science in Technology and Policy at the S Massachusetts Institute of Technology JUN 0 1 2005 June 2005 S ©2005 Massachusetts Institute of Technology All rights reserved. Author........ ................... ................... ................... Tec-hrology and Policy Program, Engineering Systems Division May 13, 2005 Certified by ................................................... Ernst R. Berndt Louis E Seley Professor of Applied Economics, Sloan School of Management Thesis Supervisor Acceptedby.......................by .................... I. ........................................ Dava J. Newman Professor of Aeronautics and Astronautics and Engineering Systems Director, Technology and Policy Program ARHI' VES t A Comparative Study of the Diffusion of the Antihypertensive and Antidepressant Medications in Germany and Japan by Ling Cui Submitted to the Engineering Systems Division on May 13, 2005 in Partial Fulfillment of the Requirements for the Degree of Master of Science in Technology and Policy Abstract This thesis analyzes and compares the diffusion of antihypertensive and antidepressant medications in Germany and Japan during the time period of 1992 and 2003. The antihypertensive medications are classified as new, middle and old generations and the antidepressants are classified as new and old generations in this study. The demographic, economic, price, promotional, regulatory, and cultural factors that contributed to the sales level, number of compounds available in the market, and launch time of these medications are also examined using quantitative and qualitative methods at therapeutic class, generation, as well as product levels. The qualitative analysis includes discussions on the general health care systems, health care polices, and country-specific hypertension- and depression-related cultural backgrounds. Econometric tools (descriptive statistics and linear regression models) are used as means of quantitative analysis. The diffusion of different generations of medications is examined. The degree of the use of branded vs. generic medications are also compared. Finally, Chow-tests are conducted for cross-country and cross- therapeutic-class comparisons. This study finds that there are significant branded-v-generic, cross-generation, cross- class, cross-country differences in the diffusion of the selected therapeutic classes in the two countries. The factors examined contributed to the diffusion to various extents. Among which, the cultural factor played an important role in the adoption and sales of new medications of both therapeutic classes in both countries, especially the antidepressants in Japan. The promotional factors appear not to be very significant in the sales volumes, partially due to the regulatory settings of the two national-based health care systems. Thesis Supervisor: Ernst R. Berndt Title: Louis E Seley Professor of Applied Economics, Sloan School of Management -3 Acknowledgements My graduate research experience at MIT would not have been so delightful without the insightful advices and the down-to-earth supports from Professor Berndt, which helped me to gain much appreciation of health economics that was a relatively new field to me. The industrial and economic insights and the analytical skills I learned from him not only benefited my academic studies, but also will play an important role in my future works. His humorous personality made working even more enjoyable. Therefore, I want to express my most sincere and heartfelt thanks to him. I also want to extend my gratitude to Professor Patricia Danzon, Dr. Gregory Kruse and Dr. Andrew Epstein at Wharton School, University of Pennsylvania, as well as Dr. Dirk Hentschel at the Brigham and Women's Hospital for all of the teaching and helps offered during my study. 4 Table of Contents List of Figures ......................................................................... 7 List of Tables ......... .................................... .....................................................................9 Chapter Introduction .................................................................................................. 11 1. Motivation and objective ..................................................................................... 11 1.2 The German and the Japanese health care systems ............................................... 13 1.3 Thesis organization.............................................................................................. 18 Chapter 2 Data and Regression Models ....................................................... 19 2.1 Overview of the data ....................................................... 19 2.2 Variables and regression models................................................... 22 Chapter 3 Antihypertensives in Germany and Japan ...................................................... 29 3.1 Symptoms and causes of hypertension................................................................. 29 3.2 Types of antihypertensives ........................................ ............... 30 3.3 Descriptive analysis of the sales and promotion of antihypertensives ................... 33 3.3.1 The sales of antihypertensives ................................................. 33 3.3.2 The promotion of antihypertensives .............................................................. 40 3.4 Econometric analysis ........................................................................................... 43 3.4.1 Therapeutic-class-level analysis ................................................................. 43 3.4.2 Generation-level analysis ........................................ ..............4.........45 3.4.3 Product-level analysis ................................................................... 49 3.5 Summary for the antihypertensive markets ...................................................... 52 Chapter 4 Antidepressants in Germany and Japan ......................................................... 53 4.1 Symptoms and causes of depressive disorders ..................................................... 53 4.2 Cultural factors of the prevalence and treatment of depression............................. 55 4.3 Types of antidepressants...................................................................................... 57 5 4.4 Descriptive analysis of the sales and promotion of antidepressants .................... 59 4.4.1 The sales of antidepressants ................................ 5........................................59 4.4.2 The promotion of antidepressants........................................................... 67 4.5 Econometric analysis ........................................................... 70 4.5.1 Therapeutic-class-level analysis ........................................................... 71 4.5.2 Generation-level analysis ........................................................... 72 4.5.3 Product-level analysis ........................................................... 76 4.6 Summary for the antidepressant markets ........................................................... 79 Chapter 5 Cross-country and cross-therapeutic-class comparison and conclusion .......... 81 5.1 Cross-country and cross-therapeutic-class comparison . ............................. ...........81 5.1.1 Therapeutic-class-level regression ........................................................... 81 5.1.2 Generation-level regression........................................................... 84 5.1.3 Product-level regression........................................................... 88 5.2 Conclusion ......... ................................................... 90 Appendix 1: List of antihypertensive compounds .......................................................... 95 Appendix 2: SAS outputs of the regression results in chapter 3 ..................................... 96 Appendix 3: List of antidepressant compounds ........................................................... 112 Appendix 4: SAS outputs of the regression results in chapter 4 ................................... 113 Appendix 5: SAS outputs of the regression results in chapter 5 ................................... 129 References ........................................................... 137 6 List of Figures Figure 1. 1 Total pharmaceutical sales in Germany and Japan ....................................... 15 Figure 1. 2 Per capita pharmaceutical sales in Germany and Japan ................................ 15 Figure 1. 3 The age structure in Germany ........................................... 16 Figure 1. 4 The age structure in Japan ........................................... 17 Figure 1. 5 The gender structures in Germany and Japan ........................................... 17 Figure 3. 1 Total patient days for antihypertensives in Germany and Japan .............. 33 Figure 3. 2 Total patient days per capita for antihypertensives in Germany and Japan ............................................. .....................................................................34 Figure 3. 3 Total sales (in PPP-adjusted US$) per capita for antihypertensives ......... 35 Figure 3. 4 Price
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