40 per cent increase in drug costs over four years
New and more expensive drugs contributed significantly to the 40 per cent rise in total drug costs from 2013 to 2017. The growth has been higher than in previous years, according to a new report on drug consumption in Norway.
The Drug Consumption in Norway 2013-2017 report provides an overview of total medicine sales in Norway. The figures presented in the report are based on sales from wholesalers to pharmacies, hospitals, nursing homes and non-pharmacy outlets.
The report shows that the total costs have increased by around 40 per cent in the period 2013 to 2017.
“Increased use of new and expensive drugs that are now mainly funded by health trusts have affected the costs. These include biologics and cancer medicines, hepatitis C virus infections and rare diseases,” says Solveig Sakshaug, senior adviser at the Norwegian Institute of Public Health.
Higher growth in costs than in doses
The cost growth in the period 2013-2017 has been around 40 per cent, while the number of doses measured in the same period has increased by ten per cent. Figure 1 shows that the costs over the last four years have increased more than earlier this century. Cost growth has been higher than volume growth measured in doses (DDD) throughout the period.
"The introduction of new drugs has improved treatment for many patients," says Sakshaug.
She explains that all new drugs are evaluated for their cost-effectiveness before they are included in the public reimbursement of pharmaceutical costs.
Population growth and a larger proportion of elderly in the population have also contributed to increased drug consumption in Norway over time.
Figure 1. Total sales of medicines for human use, measured in billions of Norwegian kroner (AIP, left-hand scale) and the number of billion doses (DDD, right-hand scale) in the period 1999-2017. Source: Drug consumption in Norway 2013-2017, April 2018
In 2017, wholesalers sold drugs for 19 billion Norwegian kroner (pharmacy purchase price (AIP)). Of these, sales of veterinary medicines amounted to around one billion kroner. This corresponds to a turnover of a total of approximately 28 billion kroner in estimated retail prices (pharmacy retail prices (AUP)). The growth in sales of medicines for human use was well over eight per cent in 2017, while the volume growth in doses was only two per cent.
Over-the-counter (OTC) drugs contributed 13 per cent of the total doses sold and eight per cent of sales in 2017. These proportions have been stable over time.
Paracetamol - increased sales continue in 2017
Paracetamol is the most commonly used analgesic (painkiller) in Norway and sales measured in doses increased by five per cent in 2017.
Figure 2. Total sales of paracetamol according to prescription and OTC status in pharmacies and non-pharmacy outlets 2003-2017. Source: Drug consumption in Norway 2013-2017, April 2018
"Increased prescribing of paracetamol in the treatment of chronic pain has probably contributed to the increase in sale of large prescription only packages," says Solveig Sakshaug.
OTC packages therefore represent a steadily declining share of total paracetamol sales, and in 2017 the proportion was 35 per cent.
Long-acting contraceptives increased by 80 per cent
Sales of long-acting contraceptives increased by around 80 per cent between 2013 and 2017 (Figure 3). During the same period, the sale of oral contraceptive pills and mini-pills levelled out. See the curve on page 53 of the report.
“In 2015, the reimbursement of contraceptives for young women was changed. In 2016, an extension of the nurses and midwives prescribing was authorised to include long-acting contraceptives," says Sakshaug.
During 2017, total doses of emergency contraceptives were reduced by five per cent and 122,500 doses were sold.
The proportion sold in non-pharmacy outlets has been low after the sale of emergency contraception outside pharmacies was authorised in 2009. Sales of emergency contraceptives measured in doses have decreased by around 25 per cent in the period 2008-2017.
"Better use of contraceptives may have contributed to the decline in sales of emergency contraceptives," says Solveig Sakshaug.
She adds that the changes in contraceptive use concur with the recommendations from the Norwegian Medicines Agency.
Figure 3. Sales of hormone intra-uterine devices and hormonal implants 1999-2017. Source: Drug consumption in Norway 2013-2017, April 2018
Detailed overview of medicine sales
The Drug Consumption in Norway report provides a detailed overview of sales of prescription and over-the counter (OTC) drugs from wholesalers to pharmacies, hospitals, nursing homes and non-pharmacy outlets in the period 2013-2017.
Several figures show changes in the use of some drug groups over the past 25 years, such as contraceptives, analgesics and psychotropic drugs.
This year's report is the 40th edition and data for total drug sales are available back to 1977.
The following sources provide a total overview of drug consumption in Norway:
Defined daily dose (DDD)
Defined daily dose (DDD) is a unit of measurement used to study changes in drug consumption over time and compare local, national and international use.
For example, sales equivalent to 10 DDD/1000 inhabitants/day means that 10 out of 1000 people (i.e. one per cent of the population) may use this drug daily.
Since the doses used and treatment duration can vary from person to person, the proportion of users will most often not be the same as the estimated «DDD figures». The number of DDD/1000 inhabitants/day indicates how large a proportion of the population may have received this treatment.