Presentation – World Assembly
For Mental Health
A MAJOR GLOBAL HEALTH EPIDEMIC!
Joan E. Gadsby
Vancouver, B.C., Canada
July 24, 2001
Table I
A Global Perspective!
Leading World Pharmaceutical Markets 2000 – IMS
| Country | Pharmacy Sales U.S. $ (billions) |
Percentage change over 1999 (at constant exchange rates) |
Percentage of Total 13 markets |
|---|---|---|---|
New Zealand |
|||
Leading Markets |
Note: Purchases of prescription products by retail pharmacies only and excludes $16 billion of drugs sold through mail order which is increasing at a rate of 24% per year. This also excludes prescription drug sales through hospitals, clinics, long term care facilities and federal purchases.
Source: IMS Health Global Services (March 2001)
Table II
World Drug Purchases - Retail Pharmacies only*
IMS Health – Drug Monitor – 12 months to April 2001
Central Nervous System Drugs
| Country | Pharmacy Sales U.S. $ (billions) |
Percentage change over 2000 (at constant exchange rates) |
Percentage of Total |
|---|---|---|---|
New Zealand |
|||
Leading Markets |
CNS Drugs in the US represent 23% of total purchases by retail pharmacies and include Benzodiazepines, Antidepressants, Antipsychotics, Anesthetics etc.
*Excludes mail order, hospitals, clinics, long term care facilities and federal purchases.
Prescription Drug Expenditures in the United States
May 2000 – NIHCM
Spending on retail outpatient prescription drugs rose 18.8% from 1999 to 2000 from $111.1 billion to $131.9 billion. An additional $16 billion were sold through mail order representing a 24% increase over 1999.
2.9 billion prescriptions were dispensed on the retail market, up from 2.7 billion in 1999 representing 10.4 prescriptions per person in 2000 compared to 9.9 per person in 1999.
Average retail price for a prescription in 2000 was $45.27 up 10.5% from $40.96 in 1999.
Antidepressants remained the top selling category of prescription drugs in 2000 with $10.4 billion in retail sales – up 21% over 1999.
Among all antidepressant drugs the average price per prescription increased 7.6% from $63.28 in 1999 to $68.07 in 2000.
The top four best selling antidepressants had a 68.2% market share.
U.S. Comparison of top 5 selling antidepressants year 2000 compared to 1999.
Antidepressant 2000 Sales
(billions)Percentage
changeAverage Price
per PrescriptionPercentage change
in UtilizationProzac $2,567.1 4.9% $109.87 -1% Zoloft $1,890.4 14.2% $80.55 10.8% Paxil $1,808.0 24.5% $78.52 17.2% Wellbutrin $850.9 36.8% $85.88 25.2% Effexor $815.8 63.8% $96.06 57.7% The antidepressant market has grown five fold since 1993 when sales were $2 billion.
The market share for Prozac (Eli Lilly) eroded in 2000 (from 28% 24.6%) at the expense of surging sales of Zoloft (Pfizer), Paxil (Smith Kline Beecham), Wellbutrin (Glaxo Smith Kline) and Effexor (Wyeth – Ayerst).
Prozac is due to go off patent and lose its market exclusivity in the United States in August 2001. Eli Lilly is no longer heavily promoting Prozac, whose brand name is widely known. However, Eli Lilly won approval in February this year to market a once weekly version of the drug. This new version has its own patent (based on its coating) which currently is being promoted. In addition, Eli Lilly now separately markets Prozac as Sarafem to treat "mood imbalances associated with premenstrual syndrome" (PMS) – renamed Premenstrual Dysphoric Disorder (PMDD)! The FDA approved this use in 2000 which its manufacturer has the sole right for 7 years to market. Sarafem had $8 million in retail sales in 2000.
Expanded markets are being developed and promoted for Wellbutrin as Zyban to help smokers quit; for Paxil, promoted in ads as a treatment for panic or social anxiety disorder and Zoloft as the "first and only" FDA approved treatment for Post Traumatic Stress Disorder. Drug industry analysts expect innovative marketing strategies designed to expand sales of antidepressants to grow in future years amid ongoing debate about their effectiveness, side effects and proper use.
Anti anxiety drugs including lorazepam (Ativan) and alprazolam (Xanax) reached sales of $2.377 billion, a 12% increase over 1999 with an average price per prescription of $29.97 in 2000. Estimated number of prescriptions in the U.S. exceeded 800 million in 2000.
In 1998, pharmaceutical manufacturers spent $8.3 billion promoting their products in the United States. An estimated $1.3 billion was spent on direct to consumer advertising and $7 billion on advertising and detailing to healthcare professionals including the cost of free drug samples for patients.
Major drug makers spent twice as much to advertise their products compared to research and development in 2000 (figures based on an analysis of 50 companies listed with US Securities and Exchange Commission). Typical results showed 17% profit, 15% on advertising, marketing and administration and 6% on Research & Development.
While generic drugs account for approximately 40% of all prescriptions in numbers in the US – they account for only 9% of total prescription drug sales in dollars.
Key factors contributing to dollar increases for retail prescription drugs include (a) price increases (b) a shift to prescribing higher cost drugs (c) increases in number of prescriptions and (d) more aggressive marketing strategies with increased expenditures for marketing and promoting drugs to doctors and consumers.
Note: Source: United States – National Institute for Health Care Management – Research and Educational Foundation – May 2001
Annual Review of Prescribing and Diagnoses Trends
Canada IMS (March 28, 2001)
Patient visits for depressive disorders show the largest increase among Canadian leading diagnoses with visits up 36% over the last 6 years (1995 – 2000). It was the second leading reason to consult a doctor.
In 2000, Canadians made 7.8 million consultations with office based physicians for depressive disorders up 10% over 1999. Forty seven percent were aged 40 – 59 with the next largest group made up of 20 – 39 years olds (31%) and 16%, 60 years plus. 66% were women and 34% men.
In 2000, there were 4.6 million visits to doctors offices for anxiety with 41% in the 40 – 59 year old age group, 33% in the 20 – 39 age group and 22%, 60 years and older. 61% were female and 39% men.
An estimated 3 million Canadians reportedly have serious depression with less than one third reportedly seeking help (Centre for Addiction and Mental Health).
80% of suicides are carried out by people with depressive illness with suicide as the 11th leading cause of death in Canada. (How much is suicidal ideation created by the drugs?).
In 2000, Canadians filled 291 million retail prescriptions at a total retail price of $11 billion. This is equivalent to 9 prescriptions per person at an average price of $35.48 per prescription compared to 1996 when the average prescription cost was $29.64 and average number filled per person was 8.
Trends in Prescribing – Canada
1999
(000s)2000
(000s)Percentage
ChangeTotal Number of Prescriptions 270,267 290,659 7.6% Psychotherapeutics* 29,259 32,360 10.6% Antidepressants 13,815 15,843 14.7% - Paxil 2,538 3,022 19% Tranquillizers 14,979 15,709 4.9% - Ativan 2,336 2,378 1.8% * includes antidepressants and tranquillizers.
Pharmaceutical Dollar Sales into drug stores and hospitals rose from $6,017,744 in 1996 to $9,518,830 in 2000 for a 14.6% increase. Sales represent a 58.2% increase year 2000 over year 1996.
Table IV
Trends in Prescriptions (000s)
Dispensed in Canadian Retail Pharmacies
Source: IMS, March 28, 2001
| 1996 | 2000 |
Percentage Change |
|
|---|---|---|---|
© Copyright – Joan E. Gadsby, 2001
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Responsible and Informed Use of Antidepressants
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