How can the Pharma Industry assist the NHS in constrained times? Can Pharma help with QIPP? PDIG meeting, 10 June 2010 Alison Clough Commercial & Communications Director, Association of the British Pharmaceutical Industry

The environment is getting tougher Ageing demographic Increasing demand on healthcare resources Economic slowdown Acceleration of technical advancement

Win- win-win Patient Outcomes Innovation from Pharma industry QIPP For NHS Partners in Improving Care and Healthcare Delivery

Through the continued process of innovation in the UK, further benefits can 1 in 5 of the leading medicines used around the world were developed by a UK Company Increase in life expectancy over time Prescription for innovation (ABPI 2009); WHO (2006) November 2009 Innovation fuels better patient outcomes

Coronary heart disease OHE calculation based on WHO Mortality Database (WHO), Mortality Statistics Series DH2 (ONS), Mortality Statistics Deaths Registered DR_06 (ONS), Vital Events Reference Tables (General Register Office of Scotland), Demographic Statistics (Northern Ireland Statistics and Research Agency), Population Estimates and Projections (ONS).

Mortality rates from disease remain high - there remains scope for further improvement in public health Heart and circulatory disorders –leading cause of death in England in 2007, resulting in deaths (34% of all deaths) Cancer responsible for 23% of all deaths Atlas of Risk (NHS 2009) Slide reproduced courtesy of Pfizer 34% 23%

Medicines Life Cycle in UK... delivering efficiencies but out of balance...? The UK has amongst the lowest market share of new medicines across Europe UK has slow & low use of innovative medicines Source: Compendium of Health Statistics 2009 (OHE), updated Hospital prescribing data (IC) PPA and PCA data. Market Statistics IMS World Review, OECD GDP data. PPRS reports to Parliament 6th and 10 th IMS world review EGA National Association Encourage Innovation

Comparatively, UK has low new product uptake Source: IMS world review

Medicines Life Cycle in UK... delivering efficiencies but out of balance...? The UK has amongst the lowest market share of new medicines across Europe 3 price cuts since 2005 UK has slow & low use of innovative medicines UK prices are amongst the lowest in Europe Source: Compendium of Health Statistics 2009 (OHE), updated Hospital prescribing data (IC) PPA and PCA data. Market Statistics IMS World Review, OECD GDP data. PPRS reports to Parliament 6th and 10 th IMS world review EGA National Association Maximise value for patient, NHS & Industry Encourage Innovation

UK prices lowest in official PPRS Report to Parliament-December 2009 Table: price index for top 150 UK branded medicines (UK = 100) Bilateral comparisons of ex-manufacturer prices (sources PPRS reports to Parliament 6 th and 10 th ) 2000 DH estimate 2000 Rank 2006 DH estimate 2006 Rank 2008 DH estimate 2008 Rank USA Germany913105=21422 Ireland83=4105=21343 Belgium Finland83= Netherlands81694=81156 Austria771094=81117 France SwedenNa Spain Italy UK

Medicines Life Cycle in UK... delivering efficiencies but out of balance...? The UK has amongst the lowest market share of new medicines across Europe 3 price cuts since % generic prescribing 65% by volume is generics Average price of generics amongst lowest in Europe UK has slow & low use of innovative medicines UK prices are amongst the lowest in Europe UK has very efficient use of generics Source: Compendium of Health Statistics 2009 (OHE), updated Hospital prescribing data (IC) PPA and PCA data. Market Statistics IMS World Review, OECD GDP data. PPRS reports to Parliament 6th and 10 th IMS world review EGA National Association Maximise value for patient, NHS & Industry Efficiency Encourage Innovation

The UK is amongst the EU markets with largest penetration of generics, with ~65% of volume Source: EGA National Association 2007 Generics market share in Europe (2006) Generics share of volumes (%) Generics share of value (%) 2009 UK generic prescribing rate =83%

Medicines Life Cycle in UK... delivering efficiencies but out of balance...? The UK has amongst the lowest market share of new medicines across Europe 3 price cuts since % generic prescribing 65% by volume is generics Average price of generics amongst lowest in Europe UK has slow & low use of innovative medicines UK prices are amongst the lowest in Europe UK has very efficient use of generics Source: Compendium of Health Statistics 2009 (OHE), updated Hospital prescribing data (IC) PPA and PCA data. Market Statistics IMS World Review, OECD GDP data. PPRS reports to Parliament 6th and 10 th IMS world review EGA National Association Maximise value for patient, NHS & Industry Efficiency Encourage Innovation Only 1% GDP is spent on medicines in UK cf EU average 1.5%, Fr 2%, Greece 2.3%

Source: Compendium of Health Statistics 2009 (OHE), updated Hospital prescribing data (IC) PPA and PCA data % NHS spend and Medicines Bill as a percentage of the NHS costs Total Medicines Bill as a % of NHS spend has been in sustained decline since 2004 Annual Spend (£billion)

Economic picture The medicines bill is already delivering efficiencies and is under control. Important to meet NHS / health needs as well as economic /industrial policy. Pharma is one of the key industries underpinning economic recovery. Driving health & economic benefit for the UK

Opportunities for industry participation in QIPP Joint working - implement national strategies for long term conditions or tackle local priorities – Many examples contained within the ABPI/DH ‘Moving Beyond Sponsorship’ Toolkit. Support for the redesign of care pathways - ensure the appropriate use of innovative new medicines. Management support to review processes & support change programmes.

Happy Hearts Project Aim- to find and treat ‘hard to reach’ patients with multiple CVD risk factors and improve patient care and services in Nottingham. Nottingham City PCT and six companies with ABPI Primary care based CVD risk identification and management Nottingham mortality rates significantly higher than the national average. Targeted at 13 GP practices in most deprived areas Identified 1352 patients (66%) with a risk level of >20%. Patients were given support to manage and reduce that risk including appropriate medication.

Partners in Improving Care and Healthcare Delivery Driving Health and Economic Benefit for the UK