Medicines Consumption in the Nordic Countries 2004-2008 Legemiddelforbruket i de nordiske land 2004-2008 Medicines Consumption in the Nordic Countries 2004-2008 Legemiddelforbruket i de nordiske land 2004 -2008 ' Medicines Consumption in the Nordic Countries' may be ordered from: Schultz Information Herstedvang 12 DK-2620 Albertslund Phone: +45 70 26 26 36 Fax: +45 43 63 62 45 E-mail: [email protected] or at www.nom-nos.dk Medicines Consumption in the Nordic Countries 2004-2008 Legemiddelforbruket i de nordiske land 2004-2008 © Nordic Medico Statistical Committee 2009 Tryk: AN:Sats Islands Brygge 67 DK-2300 Copenhagen S ISBN 87–89702–70-4 Cover: Sisterbrandt Layout and graphics: Tenna Børsting Christiansen PREFACE Preface Forord In 2008, the NOMESCO Annual Plan- I 2008 besluttede NOMESKO sit årlige ning Meeting decided that NOMESCO planlægningsmøde at NOMESKO skulle should publish an updated version of udgive en opdateret version af Medicine Medicine Consumption in the Nordic Consumption in the Nordic Countries Countries in 1999 -2003 with data for 1999 -2003 med data for 2004-2008. 2004-2008. The publication was planned Publikationen var planlagt til at blive ud- to be released in 2009 but has been de- givet i 2009, men er blevet forsinket lige- layed. In addition, the Faroes this time som Færøerne ikke denne gang har været have not been able to provide data. i stand til at levere data. Irene Litleskare, Norway has in collabora- Irene Litleskare, Norge har i samarbeid tion with the staff of the Department of med personalet i Afdeling for lægemid- Pharmacoepidemiology at the Norwegian delepidemiologi ved Nasjonalt Folkehel- Institute of Public Health had primary re- seinstitutt haft hovedansvaret for projektet sponsibility for the project along with a sammen med en referencegruppe med reference group with the following mem- følgende medlemmer: bers: Jan Poulsen, Danish Medicines Agency, Denmark Inge Mortensen Chief Pharmaceutical Officer, Greenland Heri Mørkøre, Chief Pharmaceutical Officer, Faroe Islands Tinna Voipio, National Agency for Medicines, Finland Pirkko Paakkari, National Agency for Medicines, Finland Mímir Arnórsson, Icelandic Medicines Agency, Iceland Irene Litleskare, Norwegian Institute of Public Health, Norway Örjan Ericsson, National Board of Health and Welfare, Sweden Johannes Nielsen, NOMESCO Secretariat Nordic Medico-Statistical Committee Nordisk Medicinalstatistisk Komité (NOMESCO) (NOMESKO) 5 CONTENTS Contents Innhold Preface Forord 5 Contents Innhold 6 1. General trends and regulatory Generelle trender og regulato- 11 changes during 2004-2008 riske endringer 2004–2008 1.1 Granting of marketing authorisa- Utstedelse av markedsføringstil- 14 tion latelse 1.2 Pricing of medicines Prisfastsettelse for legemidler 15 1.3 Generic substitution Generisk bytte 17 1.4 Reimbursement systems Refusjonssystemer 18 1.5 Other factors related to medicines Andre faktorer som kan påvirke 24 consumption forbruket av legemidler 2. Methods Metoder 26 2.1 Data limitations Databegrensninger 28 2.2 Use of the ATC classification and Bruk av ATC klassifikasjon og defi- 29 the defined daily dose (DDD) nerte døgndoser (DDD) 3. Medines expenditure devel- Utviklingen i legemiddelut- 32 opment giftene 3.1 Total cost of medicines Totale kostnader av legemidler 32 3.2 Medicines with highest expenditure Legemidler med størst omsetning i 35 kroner 4. Medicines consumption de- Utviklingen av legemiddelfor- 48 velopment bruket 4.1 Total consumption of medicines Totalt legemiddelforbruk 48 4.2 Medicines with highest consump- Legemidler med høyest forbruk 51 tion 4.3 Drugs for acid related disorders Midler mot syrerelaterte lidelser 58 4.4 Anti-obesity preparations Midler mot fedme 62 4.5 Drugs used in diabetes Midler til diabetesbehandling 62 4.6 Inhibitors of platelet aggregation Hemmere av blodplateaggregasjon 67 4.7 Cardiovascular medicines Midler mot sykdommer i hjerte og 68 kretsløp 4.8 Estrogens and progestogens Østrogener og progestogener 77 4.9 Drugs used in erectile dysfunction Midler mot erektil dysfunksjon 80 4.10 Antibacterial medicines Antiinfektiva 80 6 CONTENTS 4.11 Antineoplatic and immunomodu- Antineoplastiske og immunmodule- 88 lating agents (ATC-group L) rende midler (ATC-gruppe L) 4.12 Medicines for treatment of pain Smertestillende midler 90 4.13 Antipsychotic medicines Antipsykotika 94 4.14 Anxiolytics, hypnotics and seda- Anxiolytika, sedativa og hypnotika 95 tives 4.15 Antidepressants Antidepressive midler 97 4.16 Medicines for treatment of Alz- Midler mot demens 100 heimer’s disease 4.17 Medicines used in nicotine depend- Midler mot nikotinavhengighet 100 ence 4.18 Medicines for treatment of asthma Midler mot astma og kronisk ob- 101 and chronic obstructive pulmonary struktiv lungsykdom (KOLS) diseases 4.19 Antihistamines Antihistaminer 105 5. Summary Oppsummering 106 NOMESCO publications NOMESKO’s publikasjoner 109 since 1995 siden 1995 7 CONTENTS List of figures Figure 1.1 Sales of medicinal products in the Nordic countries 2004 – 2008, in vol- ume, DDD/1 000 inhabitants/day ............................................................ 13 Figure 1.2 Total sales of medicinal products in the Nordic countries 2004 – 2008, in pharmacy retail prices (million euro), 2008 prices ................................... 13 Figure 1.3 Price index for medicines 2008 (Norway=100) ........................................ 17 Figure 3.1 Public reimbursement to medicines in the primary health sector in per cent of total sales, 2004– 2008 ........................................................... 47 Figure 4.1 Sales of H2-receptor antagonists, proton pump inhibitors, prostaglandins and other drugs for treatment of peptic ulcer and gastro- oesophageal reflux disease, DDD/1 000 inhabitants/day 2004-2008 ....... 61 Figure 4.2 Sales of insulin and blood glucose lowering drugs (ATC-group A10A and A10B), DDD/1 000 inhabitants/day 2004-2008 ...................................... 65 Figure 4.3 Sales of medicinal products for the cardiovascular system (ATC-group C), DDD/1 000 inhabitants/day 2004-2008 ....................... 69 Figure 4.4 Sales of antimicrobials in Europe, DDD/1 000 inhabitants/day, 2008 (ESAC) .................................................................................................... 81 Figure 4.5 Sales of antimicrobial agents for systemic use (ATC-group J01), DDD/1 000 inhabitants/day 2004-2008 .......................................... 85 Figure 4.6 Sales of penicillins (ATC-group J01C), DDD/1 000 inhabitants/day 2004-2008 ....................................................................... 85 Figure 4.7 Sales of non-opioid analgesics (ATC-group M01A, N02B ), DDD/1 000 inhabitants/day, 2004-2008 ................................................. 93 Figure 4.8 Sales of opioid analgesics (ATC-group N02A), DDD/1 000 inhabitants/day 2004-2008 ....................................................................... 94 Figure 4.9 Sales of hypnotics and sedatives (ATC-group N05C), DDD/1 000 inhabitants/day, 2004-2008 ................................................. 96 Figure 4.10 Sales of antidepressants (ATC-group N06A), DDD/1 000 inhabitants/day, 2004-2008 ...................................................................... 99 Figure 4.11 Sales of anti-asthmatics (ATC-group R03), DDD/1 000 inhabitants/day, 2004-2008 ..................................................................... 104 8 CONTENTS List of tables Table 1.1 Facts related to medicines consumption, 2008 ................................................ 25 Table 3.1 Sales of medicines by ATC-group, calculated in pharmacy retail prices (million euro), 2008 ........................................................................................ 33 Table 3.2 Sales of medicines by ATC-group, calculated in pharmacy retail prices per inhabitant, euro, 2008 .............................................................................. 34 Table 3.3 Distribution of total cost for medicine in different areas, calculated in pharmacy retail process (mill euro) 2008 ....................................................... 35 Table 3.4 The share of the 20 top-selling active substances out of total sales, per cent, 2008 ................................................................................................. 37 Table 3.5 The 20 top-selling medicines calculated in terms of pharmacy retail prices, 2008 ................................................................................................................ 38 Table 3.6 Sales of reimbursed medicines by sex and age, calculated in pharmacy retail prices (million euros), 2008 ................................................................... 45 Table 3.7 Sales of reimbursed medicines by sex and age per inhabitant, calculated in pharmacy retail prices (euro), 2008 ............................................................... 45 Table 3.8 Public reimbursement to medicines in the primary health sector, 2004 –2008 (million euro), 2008 prices ......................................................... 46 Table 3.9 Public reimbursement to medicines in the primary health sector per inhabitant (euro), 2008 ................................................................................... 47 Table 4.1 Sales of products in total, DDD/1 000 inhabitants/day by ATC-group, 2008 ........................................................................................... 48 Table 4.2 Sales of reimbursed medicines by sex and age, 2008, DDD/1 000 inhabi- tants/day ........................................................................................................