PharmacoEconomics

, Volume 31, Issue 10, pp 933–957 | Cite as

Projecting Expenditure on Medicines in the UK NHS

  • Phill O’Neill
  • Jorge Mestre-Ferrandiz
  • Ruth Puig-Peiro
  • Jon Sussex
Original Research Article

Abstract

Background

Expenditure on medicines is a readily identifiable element of health service costs. It is the focus of much attention by payers, not least in the UK even though the cost of medicines represents less than 10 % of total UK National Health Service (NHS) expenditure. Projecting future medicines spending enables the likely cost pressure to be allowed for in planning the scale and allocation of NHS resources. Simple extrapolations of past trends in expenditure fail to account for changes in the rate and mix of new medicines becoming available and in the scope for windfall savings when some medicines lose their patent protection. The objective of this study is to develop and test an improved method to project NHS pharmaceutical expenditure in the UK for the period 2012–2015.

Methods

We have adopted a product-by-product, bottom-up approach, which means that our projections are built up from individual products to the total market. Our projections of the impact of generic and biosimilars entry on prices and quantities of medicines sold, and of the rate of uptake of newly launched medicines, have been obtained from regression analysis of UK data. To address uncertainty, we have created a baseline and two other illustrative scenarios. We have compared our projections with actual expenditure for 2012.

Results

Our projections estimate that, between 2011 and 2015, with no change in policy or price regulation, the UK total medicines bill would increase at an average compound annual growth rate (CAGR) of between 3.1 and 4.1 %. Total NHS spending on branded medicines and total NHS spending on generics are projected to increase at average CAGRs of 0.5–1.8 and 10.0–11.0 %, respectively, over the same time period. For the total market, the actual growth rate for 2012 lay within our projected range.

Conclusions

Our methodology provides a useful framework for projecting UK NHS medicines expenditure over the medium term and captures the impacts of existing medicines losing exclusivity and of new medicines being launched onto the market.

References

  1. 1.
    Hawe E, Yuen P, Baillie L. OHE guide to UK health and health care statistics. London: Office of Health Economics; 2011.Google Scholar
  2. 2.
    EFPIA. Statistics tables. Brussels: The European Federation of Pharmaceutical Industries and Associations; 2013.Google Scholar
  3. 3.
    Mason A. New medicines in primary care: a review of influences on general practitioner prescribing. J Clin Pharm Therap. 2008;33(1):1–10.CrossRefGoogle Scholar
  4. 4.
    Chauhan D, Mason A. Factors affecting the uptake of new medicines in secondary care – a literature review. J Clin Pharm Therap. 2008;33(4):339–48.CrossRefGoogle Scholar
  5. 5.
    Richards M (2012) Extent and causes of international variations in drug usage. A report for the Secretary of State for Health, London.Google Scholar
  6. 6.
    Puig-Junoy J. The impact of European pharmaceutical price regulation on generic price competition. Pharmacoeconomics. 2010;28(8):649–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Reiffen D, Ward M. Generic drug industry dynamics. Rev Econ Stat. 2005;87(1):37–49.CrossRefGoogle Scholar
  8. 8.
    Saha A, Grabowski H, Birnbaum H, Greenberg P, Bizan O. Generic competition in the US pharmaceutical industry. Int J Econ Bus. 2006;13(1):15–38.CrossRefGoogle Scholar
  9. 9.
    Grabowski H, Kyle M. Generic competition and market exclusivity periods in pharmaceuticals. Manag Dec Econ. 2007;28(4–5):491–502.CrossRefGoogle Scholar
  10. 10.
    Mestre-Ferrandiz J. El mercado de medicamentos genéricos: regulación ‘versus’ competencia. ¿Qué podemos aprender de la experiencia internacional? Spanish. J Health Econ. 2007;6(1):33–6.Google Scholar
  11. 11.
    Thiébaut SP, Barnay T, Ventelou B. Ageing, chronic conditions and the evolution of future drugs expenditure: a five-year micro-simulation from 2004 to 2029. Appl Econ. 2013;45(13):1663–72.CrossRefGoogle Scholar
  12. 12.
    Keehan SP, Sisko AM, Truffer CJ, Poisal JA, Cuckler GA, Madison AJ, Lizonitz JM, Smith SD. National health spending projections through 2020: economic recovery and reform drive faster spending growth. Health Affairs. 2011;30(8):1594–605.PubMedCrossRefGoogle Scholar
  13. 13.
    Connor P, Alldus C, Ciapparelli C, Kirby L. Long-term pharmaceutical forecasting: IMS Health’s experience. J Bus Forecast. 2003;22(4):10–5.Google Scholar
  14. 14.
    Hoffman JM, Li E, Doloresco F, Matusiak L, Hunkler RJ, Shah ND, Vermeulen LC, Schumock GT. Projecting future drug expenditures. Am J Health Syst Pharm. 2012;69(5):405–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Wettermark B, Persson ME, Wilking N, Kalin M, Korkmaz S, Hjerndahl P, Godman B, Petzold M, Gustafson LL. Forecasting drug utilization and expenditure in a metropolitan health region. BMC Health Serv Res. 2010;10:128.PubMedCrossRefGoogle Scholar
  16. 16.
    IMS (2013) World review executive. London: IMS Health.Google Scholar
  17. 17.
    Lloyd D. Prescriptions dispensed in the community: England, statistics for 2001 to 2011. London: The Health and Social Care Information Centre; 2011.Google Scholar
  18. 18.
    Duerden M, Hughes D. Generic and therapeutic substitutions in the UK: are they a good thing? Br J Clin Pharmacol. 2010;70(3):335–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Bennie M, Godman B, Bishop I, Campbell S. Multiple initiatives continue to enhance the prescribing efficiency for the proton pump inhibitors and statins in Scotland. Exp Rev Pharmacoecon Outcomes Res. 2012;12:125–30.CrossRefGoogle Scholar
  20. 20.
    ABPI and DH (The Association of the British Pharmaceutical Industry and Department of Health) (2008) The Pharmaceutical Price Regulation Scheme 2009. London: Department of Health. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_098498.pdf. Accessed 20 March 2013.
  21. 21.
    Department of Health (2011) A new value-based approach to the pricing of branded medicines—government response to consultation. London: Department of Health.Google Scholar
  22. 22.
    DH (Department of Health) (2012) The cancer drugs fund—guidance to support operation of the cancer drugs fund in 2012–13. London: Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_133682. Accessed 20 March 2013.
  23. 23.
    Chauhan D, Towse A, Mestre-Ferrandiz J (2008) The market for biosimilars: evolution and policy options. OHE briefing (45). London: Office of Health Economics.Google Scholar
  24. 24.
    Rickwood S, Iervolino A. Shaping the biosimilars opportunity: a global perspective on the evolving biosimilars landscape. London: IMS Health; 2011.Google Scholar
  25. 25.
    Rovira J, Espin J, Garcia L, Orly de Labry A (2011) The impact of biosimilars’ entry in the EU market. Report prepared for the EC (DG Enterprise and Industry). http://ec.europa.eu/enterprise/sectors/healthcare/files/docs/biosimilars_market_012011_en.pdf. Accessed 9th July 2011.
  26. 26.
    Simoens S. Biosimilar medicines and cost-effectiveness. ClinicoEcon Outcomes Res. 2011;3:29–36.PubMedCrossRefGoogle Scholar
  27. 27.
    Höer C, Häussler B, Haustein R. Saving money in the European healthcare systems with biosimilars. Gen Biosimilars Initiative J (GaBI J). 2012;1(3–4):120–6.Google Scholar
  28. 28.
    Paul S, Mytelka D, Dunwiddie C, Persinger C, Munos B, Lindborg S, Schacht A. How to improve R&D productivity: the pharmaceutical industry’s grand challenge. Nature Rev Drug Discov. 2010;9(3):203–14.Google Scholar
  29. 29.
    DH and ABPI (Department of Health and The Association of the British Pharmaceutical Industry) (2002) PPRS: the study into the extent of competition in the supply of branded medicines to the NHS, component 3: competition in the out-of-patent sector. London: Department of Health. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_5024085. Accessed 20 March 2013.
  30. 30.
    Dranitsaris G, Amir E, Dorward K. Biosimilars of biological drug therapies: regulatory, clinical and commercial considerations. Drugs. 2011;71(12):1527–36.PubMedCrossRefGoogle Scholar
  31. 31.
    Mellstedt H. The future of biosimilars. Hosp Pharm Europe. 2010;49:33–3.Google Scholar
  32. 32.
    Blackstone E, Fuhr J. Biopharmaceuticals: the economic equation. Biotechnol Healthc. 2007;4(6):41–5.PubMedGoogle Scholar
  33. 33.
    Rovira J, Espin J, Garcia L, Orly de Labry A (2011) The impact of biosimilars’ entry in the EU market. Report prepared for the EC (DG Enterprise and Industry. Granada: Andalusian School of Public Health. http://ec.europa.eu/enterprise/sectors/healthcare/files/docs/biosimilars_market_012011_en.pdf. Accessed 10th Dec 2012.

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Phill O’Neill
    • 1
  • Jorge Mestre-Ferrandiz
    • 1
  • Ruth Puig-Peiro
    • 2
  • Jon Sussex
    • 1
  1. 1.Office of Health EconomicsLondonUK
  2. 2.Center for Research in Economics and Health (CRES)Universitat Pompeu Fabra, Merce Rodoreda BuildingBarcelonaSpain

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