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1

European Health Forum Gastein

Parallel Forum A II: „Pharmaceutical Policies in Europe“


Section I

October 1st, 2003

W. Clement

„The macro
-
economic role of the pharmaceutical industry: Some general
remarks and Austria as a case
-
study“

F
F
I
I
P
P
Institut für
Pharmaökonomische
Forschung
Wolfengasse 4/7, A
-
1010 Vienna, Austria

Tel: (+43 1) 513 20 07

ipf@ipf
-
ac.at

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ARGE: Forschungsinstitut Pharmaökonomie

ARGE: Forschungsinstitut Pharmaökonomie

ARGE: Forschungsinstitut Pharmaökonomie

ARGE: Forschungsinstitut Pharmaökonomie

IPF Institute for Pharmaeconomic Research

Overview

I Conceptual approaches


II Some statistical indicators of the pharmaceutical
industry in Europe


III A larger framework for analyis


IV Case
-
Study: Austria

Core indicators

Indirect and induced economic effects

Foreign Trade and domestic prices

Clusters and centers of competence

Education

R&D

Perspectives for pharmaceutical policies



1

3

I Conceptual approaches


ARGE: Forschungsinstitut Pharmaökonomie

ARGE: Forschungsinstitut Pharmaökonomie

ARGE: Forschungsinstitut Pharmaökonomie

ARGE: Forschungsinstitut Pharmaökonomie

IPF Institute for Pharmaeconomic Research


2



Macroeconomic assessments of the pharmaceutical industry and its impact are
dominated by policy
-
considerations and approaches of distributional justice as
well as fiscal constraints


Unfortunately, the human capital approach to health and medicines is (cf. H.
Correa 1967) somewhat neglected at present. Educational expenditures are
seldom considered as an investment. Hence, o
verall calculations of
health/medicine rates
-
of
-
return (social and private) are lacking. This issue
should be included in present discussions about e.g. the impact of health
expenditures on lifetime earnings profiles, or debates about public spending
criteria.





Theoretical foundations:



4

I Conceptual approaches


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ARGE: Forschungsinstitut Pharmaökonomie

IPF Institute for Pharmaeconomic Research


3



Other issues:


Fiscal efficiency:

In periods where health expenditures are sharply controlled, it should be obvious to
have at least a clear representation of the flows of health expenditures. The reality
differs significantly. Any company which would have a balance sheet as fuzzy as the
health expenditure accounts would soon be bankrupt. In Austria, for example,
where the picture seems to be particularly complicated any effort to trace the flows
faces resistance from one or the other authorities (cf. graph page 4).



Spill
-
overs:

It is an accepted fact that therapy with medicines can have important spill
-
over
effects onto the hospital sector, e.g. through reducing the length of stay in
hospitals. Reliable information on this issue, however, is scarce. Therefore, the
interdependence of the pharmaceutical sector with hospitals and physicians should
be evaluated on a more representative basis.

Pinpointing at one expenditure
-
item
without due consideration of the interdependent macroeconomic and therapeutical
effects should be avoided.

Theoretical foundations:



5

I Conceptual approaches


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ARGE: Forschungsinstitut Pharmaökonomie

ARGE: Forschungsinstitut Pharmaökonomie

ARGE: Forschungsinstitut Pharmaökonomie

IPF Institute for Pharmaeconomic Research


4

Federal gov.

Sick
-

Funds

Municipalities

9 Countries

KFAs*

KA
-
GmbHs

Country
-
Funds

1.74

0.36

922.58

386.47

18.53

1.38

32.56

1,171.5

179.5

283.86

505.22

1,403

12.14

2,811.49

213.73

25.65

1,190.02

0.01

26.23

Source: IPF calculations




Flows of health expenditures
(in EUR Million)
, 1999



* KFA = public institutes
for welfare service,
comparable with the
Sick
-
Funds

6

I Conceptual approaches


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ARGE: Forschungsinstitut Pharmaökonomie

ARGE: Forschungsinstitut Pharmaökonomie

IPF Institute for Pharmaeconomic Research


5

Empirical studies:




Empirical ad
-
hoc indicators (like health quota, pharmaceutical quota, public
versus private expenditures…) are only poor substitutes for sound analysis,
where reduced form or structural equations would control for the influence of
other variables.


In the absence of such formal models, empirical approaches aim at depicting
the statistical basis (on which more sophisticated studies could be based on
later)


Such indicators include:


Financial indicators (public/private spending for health/pharmaceuticals)

Economic indicators describing the (competitiveness of the) industry. E.g.
production, value
-
added, employment, R&D, patents, investment,
productivity, international trade…

Relative organisational efficiency (international benchmark indicators)

Outstanding achievements in medical/pharmaceutical research (innovation
indicators)

Access to health/medicines and distributional justice.


7

I Conceptual approaches


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ARGE: Forschungsinstitut Pharmaökonomie

IPF Institute for Pharmaeconomic Research


6

Empirical studies:




Reliability of data sources:


The three main statistical sources, i.e. OECD health data files, IMS and EFPIA all
suffer from serious flaws. Among them one could underline:


OECD
-
data:

are based on principles of National Accounting (SNA Systems of
National Accounts). There is , however, national leeway for interpretation.
Different national institutional settings of health systems lead to different in the
statistical collection of health expenditures. E.g. In Austria public hospitals are
considered producers to the market, which means that only their market value is
represented in the data. Total expenditures of the hospitals, however, include
public subsidies which are left out and do not fall under the category health
expenditures.

IMS:

The overall statistical picture of the pharmaceutical sector seems to be
fairly sound. When performing microeconomic analysis, like cost
-
effectiveness
studies problems pertaining to the accuracy of the data emerge.


EFPIA:

The data are based on national sources, one wonders sometimes if the
definitions and the coverage amongst countries are standardized.


-



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IPF Institute for Pharmaeconomic Research



II Some statistical indicators of the pharmaceutical industry in Europe

7

Source: Eurostat, EFPIA, IPF calculations

CHEMICAL
INDUSTRY

PHARMACEUTICAL
INDUSTRY

PERCENTAGE

EU

506,197

112,003

SWITZERLAND

25,035

14,891

DENMARK

6,434

3,609

AUSTRIA

6,815

1,548

GERMANY

120,922

18,558

FINLAND

4,928

600

NORWAY

6,359

291

22%

59%

56%

23%

15%

12%

5%

Production

Value (in EUR Million), 2001

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IPF Institute for Pharmaeconomic Research



II Some statistical indicators of the pharmaceutical industry in Europe

8

Source: Eurostat, EFPIA, IPF calculations

CHEMICAL
INDUSTRY

PHARMACEUTICAL
INDUSTRY

PERCENTAGE

EU

1,686,200

512,147

SWITZERLAND

60,147

26,000

DENMARK

23,632

17,574

AUSTRIA

27,141

9,200

GERMANY

495,499

113,950

FINLAND

18,619

6,544

NORWAY

15,717

4,402

30%

43%

74%

34%

23%

35%

28%

Number of employees, 2001

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III A larger framework for analysis

9

IPF Institute for Pharmaeconomic Research

Interactive structure

of the pharmaceutical and biotech industry



pharmaceutical
and
biotech
industry
education
supplying
industries
R & D
pharmaceutical
wholesalers
patient
capital markets
hospitals
pharmacies
physicians
sick
-
funds
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IPF Institute for Pharmaeconomic Research

IV Case


Study: Austria

10

statistical analysis

I
-
O
-
Analysis


interviews


„soft facts“

survey of the economic impact

quantitative methods

qualitative methods

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IPF Institute for Pharmaeconomic Research


11

Source: Statistik Austria, IPF calculations

IV Case


Study: Austria

Core Indicators




NUMBER OF
COMPANIES

EMPLOYEES

PRODUCTION
VALUE

6,278 Mio. EUR

1,781 Mio. EUR

PRODUCTION VALUE
/ EMPLOYEE


24,450 EUR

19,496 EUR

VALUE ADDED

1,954.5 Mio. EUR

615.6 Mio. EUR

VALUE ADDED

/ EMPLOYEE

7,612 EUR

6,740 EUR

INVESTMENTS

462.6 Mio. EUR

197.7 Mio. EUR

9,194

101

25,676

400

CHEMICAL
INDUSTRY

PHARMACEUTICAL
INDUSTRY

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Economic Effects (1)

Suppliers


_Value Added


_Employment


_Taxes

DIRECT

INDIRECT

INDUCED

Suppliers


_Value Added


_Employment


_Taxes

Households


_Value Added


_Employment


_Taxes

Pharma
-
/ Biotech
Industry


_Value Added


_Employment


_Taxes

IPF Institute for Pharmaeconomic Research

Calculation of indirect and induced economic effects


12

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Economic Effects (2)

INDIRECT

DIRECT

INDUCED

TOTAL

MULTIPLIER

FISCAL EFFECT

VALUE ADDED

EMPLOYMENT

615.58

9,194

715.06

13,838

268.36

1,599.00

4,535

27,567

2.60

3.00

307.69

Economic effects of the Austrian pharmaceutical and
biotech industry (in EUR Million), 2001

Source: Statistik Austria, IPF calculations

IPF Institute for Pharmaeconomic Research

13

The fiscal effect contains the
following taxes and rates:
wage tax, local tax, social
insurance premium

The total fiscal effect is
calculated


as well as value
added and employment
-

for
the direct, indirect and
induced effects.

The total fiscal effect of the
domestic pharmaceuticl and
biotech industry amounts to
307.69 Mio. EUR. That is 7,5
times the deficit of the social
insurance (40.28 Mio. EUR) in
the year 2001.

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Foreign Trade

IPF Institute for Pharmaeconomic Research

14

0
500
1000
1500
2000
2500
3000
3500
1998
1999
2000
2001
2002
Pharmaceutical imports and exports (in EUR Million), 1998


2002

Confronting the development of the
pharmaceutical imports and exports a catch
-

up process can clearly be diagnosed. In the
year 2002 the
import surplus

amount to 49
Mio. EUR.

If one divides the entire market into sup
-
groups (active substances /
pharmaceuticals), pharmaceuticals exhibit an
export surplus

(+150 Mio. EUR) for the
first time.


0
200
400
600
800
1000
1200
1400
1600
1998
1999
2000
2001
2002
0
200
400
600
800
1000
1200
1400
1600
1800
2000
1998
1999
2000
2001
2002
1,996

1,389

3,091

3,041

Total Imports and Exports

SITC 541 (active substances)

663

749

1,219

1,419

SITC 542 (pharmaceuticals)

1,247

726

1,672

1,822

Source: Statistik Austria, IPF calculations

Exports

Imports

Exports

Imports

Exports

Imports

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IPF Institute for Pharmaeconomic Research

15

Message to the Minister of Finance and other health
expenditure
-
controlling institutions


From a macroeconomic perspective the interrelations between local production,
exports, domestic ex
-
factory prices and expenditures on medicines should be
evaluated.

The 3 big pharmaceutical companies in Austria (Novartis/Sandoz, Boehringer
Ingelheim, Baxter) account for more than 90% of total pharmaceutical exports

If, location quality of producing in Austria would deteriorate, their production would
be transferred abroad, this could lead to severe consequences pertaining to jobs,
value
-
added, exports, R&D, tax receipts, educational activities etc. The impact would
be even larger if the indirect and induced effects would be also included.

These compound effects should be confronted with potential savings in public
expenditures for medicines when reducing the level of ex
-
factory prices.


Foreign Trade and domestic considerations

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Ex Factory Price per Package

Source: IMS Health, IPF calculations

Ex
-
factory price / package (in EUR), 2002

5,27
6,43
7,11
7,81
8,33
8,93
9,61
9,69
11,24
11,88
12,54
13,76
0
5
10
15
FRA
ESP
ITA
POR
AUT
UK
IRL
BEL
GER
FIN
NLD
CH
Mean

16

IPF Institute for Pharmaeconomic Research

In 2002 the Austrian
ex
-
factory
price

per package is lower than the
European average.

Despite the low price level, the
annual growth rates correspond
only to the European trend.

The Austrian package is similar to
the average European size
-

44
standard units.

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IPF Institute for Pharmaeconomic Research


Clusters and centers of competence

17

Cluster
s



Biotechnology

is the one of the most important

R&D

programmes

in Austria. The Austrian
biopharmaceutical industry can only defend its international position by building innovative
potential.


Biotech Vienna Region


Since

1999

the

number

of

biotechnological

enterprises

has

doubled

in

Vienna
:

today,

there

are

about

30

top
-
enterprises

in

Vienna

(
75
%

of

all

Austrian

Biotech

companies)
.



Members:

e.g.
companies

(Hämosan, Intercell, Biomay), university institutes,


research institutes (IMP);


Research Programmes:

Cancer Research, Diagnostics, Immunology


Medical Cluster Tirol


Members:

KMT Center of Competence Tirol, University for Health Informatics and Technology


Tirol (UMIT), Health Information, Technologies Tirol (HITT);


Facts:

Close to hospitals, companies e.g. Sandoz, Kundl and the Universitity of





Innsbruck,

Central geographical position, Close to Germany;


Research Programms:

Tissue engineering, Implantation technologie, Information




management, eHealth, Optimization of processes





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IPF Institute for Pharmaeconomic Research

18

Centers of Competence


K net:



ACBT (Austrian Center for Biopharmaceutical Technology) Kompetenznetzwerk



Members:

Biochemie, Boehringer Ingelheim, Polymun Scientific,


Institute for Applied Microbiologie, Institute of Biochemistry;


Research Programms:

Cellular processes,


Fermentation and downstream processes;


K ind:


KMT Kompetenzzentrum Tirol


Members:

ITH, V&F, Biocrates, Metasys, Med
-
El,


Immunological Diagnostics and Consuling (IDC);


Research Programms:

Tissue engineering,


Implantation technologie;




Clusters and centers of competence

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IPF Institute for Pharmaeconomic Research

19

Centers of Competence


K plus:


Zentrum AB (Competence Center of Applied Biocatalysis) Graz



Members:

14 companies e.g.
Sandoz, Hämosan, Alicona Imaging


and Ciba Speciality Chemicals.


14 university institutes e.g. Institute of Biochemistry,


Institute of Biotechnology and


Institute for Chemistry and Technology of Organic Materials.


Research Programms:


Biocatalytic synthesis,



Enzyme development and analytics,


Enzymatic conversion of carbohydrates;


Zentrum BMT (Bio
-
Molekular Therapeutics) Vienna


Members:

Baxter, Nanosearch, Novartis, Polymun Scientific, Technoclone,


Center for Ultrastructure Research, Dept. of Dermatology,


Dept. of Vascular Biology andThrombosis Research;


Research Programms:

Screening systems,




Stem cells,




Delivery system;

Clusters and centers of competence

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ARGE: Forschungsinstitut Pharmaökonomie

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IPF Institute for Pharmaeconomic Research


International Company centers in Austria

20

Novartis

/

Novartis

Forschungszentrum

/

Wien

One

of

seven

Novartis
-
Centers

world

wide,

part

of

Novartis
´

R&D

backbone
.



200
+

employees


41

Mio
.

Euro

investments/year


1
,
040

Patent
applications



since

1990

850
+

p
ubli
c
ation
s

in

i
nternational

j
ournals



Sandovac©

/

Elidel©

/

Sandoglobulin©

Baxter

/

Wien

Pharma

production

plant

for

biotechnological

products

(blood)


60

Mio
.

Euro

investment



80

employees
.





a

key

function

for

the

whole

Baxter

Bioscience“


Sandoz / Kundl


Formerly known as

„Biochemie
-
Kundl“


today owned by Novartis/Sandoz. Not only an
important center for R&D on antibiotics but also for the production and developpement for
Sandoz
´

generics.




Boehringer

Ingelheim

/

IMP

/

Wien

Boehringer
-
Ingelheim
´
s R&D
-
center for cancer studies.

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IPF Institute for Pharmaeconomic Research

Education


21

17,2%
82,8%
49,8%
50,2%
0%
50%
100%
Academics
Non-Academics
Pharma
Biotech
University
-
studies pertaining to pharmacy


University education

10 universities and
210
i
nstitute
s


The total number of students of pharmacy in the academic year of 2001/2002 was 2.524.


Post
-
secondary non
-
university education

4 courses in the field pharmacy and biotechnologie

8 related courses


In
-
service training

Every year, more than 100 in
-
service training

courses are run, which are attended by more

than 8,000 pharmacists.






Academics within the
pharmaceutical industry


In 2001 9,194 people were working in the
Austrian pharmaceutical and biotech
industry. In the pharmaceutical industy
17.2% of them were academics, in the
biotech industry 49,8%.

Source: IPF collections

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R&D

22

€ 49.400
€ 28.417
€ 0
€ 20.000
€ 40.000
€ 60.000
Pharma
Biotech
Pharma
Biotech
R&D expenditure per employee, 2001

Source: IPF calculations

The
R&D rate

of the domestic
pharmceutical industry is about
14,1%.

Altogether the Austrian pharma and
biotech enterprises spend
approximately 316 millions EUR for
R&D (year 2003).

The R&D expenditures in the
pharmaceutical industry amounts to
28,417 EUR per employee, in the
biotech industry to 49,400 EUR.

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IPF Institute for Pharmaeconomic Research

V Perspectives for pharmaceutical policies


23

In almost all industrialised countries, pharmaceutical policies have developed highly
sophisticated instruments hoping to control expenditures of medicines. A similar effort
to strengthen the competitiveness of this high tech sector cannot be seen. The
consequences are felt already: Fewer and fewer active substances are being detected,
and companies are contrived to search for cost
-
effective locations of production.


The interdependence of a competitive pharmaceutical industry and a best
-
practice
health system is seldom acknowledged. Sometimes, for the sake of saving a relatively
small amount on expenditures for medicines jobs, R&D, production and taxes are
sacrified. Obviously, it is not the task of the Health Minister to care for objectives of
industrial competitiveness. Yet, national guidelines for social security should not neglect
this point.


Comprehensive health policy often seems to be only a word. Despite concepts like
Managed Care or Evidence
-
Based
-
Medicine one strongly feels the impact of secluded
“chapters”and the lobbies attached to them of physicians, hospitals and
pharmaceuticals. Both for the patient and the finance authorities, encompassing best
-
practice is not the rule.


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IPF Institute for Pharmaeconomic Research

V Perspectives for pharmaceutical policies


24

Health bureaucracy is trained in a different environment (“there is no superior good
than health”) than other areas of public commitment. This may be an important
impediment to innovation and their quick implementation in the health system.

More technically, lack of transparency prevails when considering the flows of health
expenditures. Ideology dominates when it comes to debate public versus private
financing, co
-
payments, pricing and reimbursement. Overall efficiency
-

criteria are
difficult to get through.


It is difficult to communicate the message that macroeconomics and health economists
are not the enemies of health providers.