HEALTH PANORAMA 2021 The most important facts and figures on Switzerland's healthcare and pharma landscape - Interpharma

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HEALTH
  PANORAMA 2021
The most important facts and figures
  on Switzerland’s healthcare and
        pharma landscape
EDITORʼS NOTICE                                            FOREWORD

40th edition, published by                                 For a fact-based dialogue
Interpharma
Association of research-based pharmaceutical
companies in Switzerland                                   Dear Reader
Petersgraben 35                                            Health is a valuable good – the present situation makes us more
P.O. Box                                                   aware of this than ever. To successfully meet the challenges,
4009 Basel
Phone: +41 (0)61 264 34 00
                                                           we need knowledge, a sharing of ideas and an open, fact-based
E-mail: info@interpharma.ch                                dialogue: where does Switzerland stand today in terms of life
                                                           expectancy? How are healthcare costs developing in our coun-
The content of the brochure can also be found on the       try? How many medicines make the long journey from research
website of Interpharma at www.interpharma.ch.
Readers are free to download and use the charts in
                                                           lab to the patient? Which country files the most patents?
their latest version at www.datacenter.interpharma.ch
for their own purposes provided the sources are properly   The statistics published by Interpharma provide answers to
quoted.                                                    these and many other questions. Seventy-five charts offer a
                                                           compact overview of the most important facts and figures on
Interpharma editorial team:                                the healthcare system, the pharma market and Switzerland’s
                                                                                                                              1
Miriam Flury, Simon Fry, Michael Schoy, Martin Schüller    position as a pharma hub. A further valuable contribution to
                                                           help strengthen the dialogue is provided by our new data centre.
Deutschsprachiges Original verfügbar
                                                           Here you will also find important facts and figures online:
Disponible en traduction française                         www.datacenter.interpharma.ch
© Interpharma, 2021, Basel
Printing permitted with acknowledgement of source          At www.interpharma.ch, under “Publications”, you can order fur-
                                                           ther copies of this brochure and other Interpharma publications
                                                           or download them in PDF format. With our Health Panorama
                                                           2021 we are also seeking to contribute to a fact-based and
                                                           constructive discussion around the healthcare system – with
                                                           the focus on patients.

                                                           We wish you an interesting and informative read.

                                                           Dr. René Buholzer
TABLE OF CONTENTS                                                  Interpharma | Health Panorama 2021

    Swiss healthcare system                                        4   Focus on the patient                                              44
    Life expectancy in Switzerland                                 6   Growth of medical knowledge                                       46
    Life expectancy – an international comparison                  7   Value of innovative therapies                                     47
    Health spending as a percentage of GDP                         8   Access to innovations                                             48
    Life expectancy and health spending as a percentage of GDP     9   Opinion poll on access to medicines                               49
    Causes of death                                              10    Importance of innovations for the patient                      50–52
    Dementia                                                      11   Pharma market by indication area                                  53
    Cancer mortality by gender                                   12    Medicines produced using biotechnology and gene technology        54
    Cancer mortality over time                                   13    Number of medicines in development close to market readiness      55
    Chronic diseases: high blood pressure                        14    Medicines for rare diseases                                       56
    Chronic diseases: diabetes                                   15    Opinion poll on treatment of rare diseases                        57
    Healthcare costs by services                                 16
    Healthcare costs over time                                    17   Leading in research and development                              58
    Medicines as a proportion of healthcare costs                18    Development path of a medicine                                   60
    Price indexes in the healthcare system                       19    Research cycle                                                   61
    Composition of the overall cost of a disease                 20    Cost of drug development                                         62
    Holistic view of disease costs                               21    Development of vaccines for COVID-19                             63
    Funding regime of the healthcare system                      22    Financing of R&D in Switzerland                                  64
    Funding sources of the healthcare system                     23    Financing of R&D by the pharma sector                            65
    Spending structure of Swiss households                       24    Distribution of research expenditure in the private sector       66
2                                                                                                                                             3
    Opinion poll on distribution of finances                     25    Sales and research of Interpharma companies in Switzerland       67
    Compulsory health insurance reserves and solvency ratio      26    Global spend on research and development                         68
    Insurance models in the basic health insurance               27    Distribution of research expenditure                             69
                                                                       Research and development intensity                               70
    Pharma market                                                28    Success rate of medicines                                         71
    Pharma market                                                30    Clinical trials                                                  72
    Composition of drug price                                    31    Laboratory animal statistics                                     73
    Growth elements of the pharma market                         32    Protection of intellectual property                              74
    Price reductions of medicines                                33    International comparison of patent applications                  75
    Comparison of drug prices                                    34    Digital Health Index                                             76
    Comparative price level indices                              35    Digitalization in the pharma sector                              77
    Sales outlets by sales revenue                               36
    Composition of pharma market                                 37    Strong economic policy framework                                 78
    Generics market                                              38    Competitiveness                                                  80
    Generics substitution rate                                   39    Political stability                                              81
    Biosimilars vs generics                                      40    Innovation                                                       82
    Biosimilars                                                  41    Qualification structure of employees by sector                   83
    Pharma market by therapeutic area                            42    Exports by sector                                                84
    Imports of active ingredients                                43    Development of pharma exports                                    85
                                                                       Number of people employed in the pharma industry                 86
                                                                       Cross-border commuters                                           87
                                                                       Employees, gross value added and exports                         88
Interpharma | Health Panorama 2021   Swiss healthcare system

    Swiss healthcare                     Of all other countries worldwide,
    system                               only in Japan is life expectancy
                                         higher than in Switzerland.

                                         The cancer mortality rate
                                         in men and women is steadily fall-
                                         ing, partly also thanks to medical
                                         advances and the research efforts
                                         of the pharmaceutical industry.
4                                                                             5

                                         The proportion of medicines
                                         accounts for around 12 percent
                                         of healthcare costs and has
                                         remained stable for decades.
Interpharma | Health Panorama 2021                                                                                                                                                                           Swiss healthcare system

    Life expectancy in Switzerland                                                                                                                                                                               Switzerland has one of the highest
    continues to rise                                                                                                                                                                                            life expectancies in the world
    Life expectancy in Switzerland has doubled in the last 100 years.                                                                                                                                            At an average of 83.8 years for the general population, Switz­
                                                                                                                                                                                                                 erland was one of the world’s top countries for life expectancy
    At the start of the 1990s, life expectancy for women was still                                                                                                                                               in 2018.
    about seven years longer than for men – by 2019 it was still
    almost four years.                                                                                                                                                                                           According to the OECD, only in Japan do people live longer.
                                                                                                                                                                                                                 Mean life expectancy there is 84.2 years.
    Thanks to better healthcare, new and innovative medicines,
    improved hygiene and a healthier lifestyle, we are not only living                                                                                                                                           Switzerland’s top ranking is thanks to the high-quality health-
    longer, but also more healthily.                                                                                                                                                                             care that is accessible to the whole population and also a high
                                                                                                                                                                                                                 quality of life, among other factors.

6                                                                                                                                                                                                                                                                                               7

    Mean life expectancy at birth                                                                                                                                                                                Life expectancy for the population as a whole at birth
    In years, 1900–2019                                                                                                                                                                                          In years, 2018

                                                                            Source: Federal Statistical Office (2020), Statistisches Lexikon der Schweiz.
         90
                                                                                                                                                                                                                      US                        78.7
         85
                                                                                                                                                                                                                      DK                                     81.0
         80                                                                                                                                                                                                           DE                                     81.0
         75                                                                                                                                                                                                           UK                                       81.3

                                                                                                                                                            Source: OECD (2021), OECD Health Statistics 2018.
         70                                                                                                                                                                                                           AT                                           81.8
         65                                                                                                                                                                                                           NL                                            81.9
         60                                                                                                                                                                                                           FR                                                   82.8
         55                                                                                                                                                                                                            IT                                                         83.4
         50                                                                                                                                                                                                           ES                                                           83.5
                                                                                                                                                                                                                      CH                                                             83.8
         45
                                                                                                                                                                                                                JP (2017)                                                               84.2
         40
          1900        1920       1940    1960   1980      2000       2019                                                                                                                                                   75   76   77   78   79     80   81    82       83       84     85

       Women        Men
Interpharma | Health Panorama 2021                                                                                                                                                         Swiss healthcare system

    In comparison, Switzerland spends                                                                                                                                                          Switzerland has a high-quality
    a lot on healthcare                                                                                                                                                                        healthcare system
    Health spending as a percentage of gross domestic product                                                                                                                                  Countries with high health spending as a percentage of GDP tend
    (GDP) reflects how much of its entire economic output a coun-                                                                                                                              to show higher life expectancy.
    try spends on health goods and services and also invests in
    healthcare infrastructure.                                                                                                                                                                 Compared with other countries, Switzerland has both a high level
                                                                                                                                                                                               of health spending and a particularly high life expectancy.
    In 2018, OECD countries spent an average of about 8.8% of
    their GDP on the healthcare system. This figure has been rela-                                                                                                                             Countries that already enjoy a high life expectancy, however,
    tively stable since 2013.                                                                                                                                                                  achieve little extra improvement in life expectancy with additional
                                                                                                                                                                                               spending.
    An international comparison puts Switzerland second behind
    the USA with a percentage of 11.9%.

8                                                                                                                                                                                                                                                                       9

    International comparison of healthcare expenditure as a                                                                                                                                    Life expectancy in relation to the share of health expenditure
    percentage of GDP, in percent, 2018                                                                                                                                                        in gross domestic product, 2018

        IT                                                                                                                                                                                          86
                                              8.7%
       ES                                                                                                                                                                                                                                   JP
                                               9.0%
                                                                                                                                                                                                    84                      IT ES                     CH
       NL                                          10.0%                                                                                                                                                                                         FR
       UK                                         10.0%                                                                                                                                                                             NL AT
                                                                                                                                                                                                    82
                                                                                                                                                                                                                                      UK
                                                                                       Source: OECD (2021), OECD Health Statistics 2018.

                                                                                                                                           Source: OECD (2021), OECD Health Statistics 2018.
       DK                                         10.1%                                                                                                                                                                                          DE
                                                                                                                                                                                                                                       DK
       AT                                          10.3%                                                                                                                                            80
        JP                                            11.0%                                                                                                                                                                                                      US
       FR                                              11.3%                                                                                                                                        78
       DE                                               11.5%
       CH                                                  11.9%                                                                                                                                    76
       US                                                                      16.9%
                                                                                                                                                                                                    74
             0%    2%     4%      6%     8%     10%    12%         14%   16%    18%                                                                                                                   3%            6%       9%                  12%       15%    18%
Interpharma | Health Panorama 2021                                                                                                                                                                                                                                            Swiss healthcare system

     Cardiovascular diseases are the                                                                                                                                                                                                                                               As life expectancy increases, grow-
     most common cause of death in                                                                                                                                                                                                                                                 ing numbers of people are suffering
     Switzerland                                                                                                                                                                                                                                                                   from dementia
     In Switzerland, 66’971 deaths were registered in Switzerland                                                                                                                                                                                                                  In 2019, there were 144’338 people in Switzerland living with
     in 2018. In women, cardiovascular diseases were the most                                                                                                                                                                                                                      Alzheimer’s or another form of dementia. At 96’159, the number
     common cause of death (32.2%). In men, 29.1% of deaths were                                                                                                                                                                                                                   of cases in women is much higher than in men (48’179).
     attributable to the cardiovascular system.
                                                                                                                                                                                                                                                                                   Around 45% of women over 90 suffer from dementia. Among
     Tumours and diseases of the cardiovascular system were                                                                                                                                                                                                                        men, around 30% of those over 90 are affected by dementia.
     clearly the most common cause of death in both sexes in 2018.
                                                                                                                                                                                                                                                                                   Pharma companies worldwide remain engaged in research to
     Men died significantly more often from tumours (30.4%) than                                                                                                                                                                                                                   find an effective therapy. For the first time in 20 years, a treat-
     women (23.3%). Women died more often from diseases of the                                                                                                                                                                                                                     ment for Alzheimer’s was approved in the USA in June 2021.
     psyche or the cardiovascular system.
10                                                                                                                                                                                                                                                                                                                                                                                                                   11

     Most common causes of death by gender                                                                                                                                                                                                                                         Number of dementia patients
     Deaths 2018: 67’088                                                                                                                                                                                                                                                           Per age, 2019

                                                                                                                                                                                                       Source: Swiss Alzheimer’s Association (2020), Demenz in der Schweiz 2019.

                                                                                                                                                                                                                                                                                                                                                                                                            26’366
           Cardiovascular system                                                                                                                                                                                                                                                     30’000

                                                                                                                                                                                                                                                                                                                                                                                           22’785
                         Tumours                                                                                               Source: Federal Statistical Office (2021), Cause of Death Statistics.
          Mental health disorders1                                                                                                                                                                                                                                                   25’000

                                                                                                                                                                                                                                                                                                                                                                          16’969
               Respiratory system

                                                                                                                                                                                                                                                                                                                                                        15’552
                  Nervous system                                                                                                                                                                                                                                                     20’000
                 Digestive system

                                                                                                                                                                                                                                                                                                                                               10’268

                                                                                                                                                                                                                                                                                                                                                                 10’163
          Accidents and violence2                                                                                                                                                                                                                                                    15’000

                                                                                                                                                                                                                                                                                                                                                                                   8’928
           Metabolism and blood

                                                                                                                                                                                                                                                                                                                                                                                                    7’136
                                                                                                                                                                                                                                                                                                                                       7’153
                                                                                                                                                                                                                                                                                                                               5’881
                Urogenital system                                                                                                                                                                                                                                                    10’000

                                                                                                                                                                                                                                                                                                       3’992
                                                                                                                                                                                                                                                                                               3’517

                                                                                                                                                                                                                                                                                                                       3’342
                        Infections

                                                                                                                                                                                                                                                                                                               2’286
                           Suicide                                                                                                                                                                                                                                                    5’000
                            Others
                                                                                                                                                                                                                                                                                           0
                                          0%         5%        10%        15%        20%        25%         30%          35%                                                                                                                                                                    30–64           65–69           70–74           75–79             80–84             85–89              90+

        Men          Women
     ¹ Dementia (excluding Alzheimer’s), schizophrenia, dependence on psychotropic substances, affective disorders and
     other mental health disorders ² Excluding suicide                                                                                                                                                                                                                               Men       Women
Interpharma | Health Panorama 2021                                                                                                                                                                                                             Swiss healthcare system

       Gender-specific differences in                                                                                                                                                                                                                 Cancer mortality rates are falling
       cancer mortality                                                                                                                                                                                                                               also thanks to medical advances
       In 2018, a total of 17’923 people died of cancer. More men                                                                                                                                                                                     The cancer mortality rate fell in both men and women between
       (9’834) died from cancer than women (8’089).                                                                                                                                                                                                   2010 and 2018, which is due not least to medical advances and
                                                                                                                                                                                                                                                      pharma industry research in oncology.
       Most deaths attributable to cancer, both in men and in women,
       involve the digestive tract; the second-most common cause of                                                                                                                                                                                   In men, mortality from colorectal cancer decreased by around
       death from cancer involves the respiratory organs.                                                                                                                                                                                             42% between 2010 and 2018, and by 38% in women. Mortality
                                                                                                                                                                                                                                                      from lung cancer also decreased significantly for men, while it
       The third-most frequent cause of death attributable to cancer is                                                                                                                                                                               increased slightly for women.
       breast cancer in women and cancer of the genital organs in men.
                                                                                                                                                                                                                                                      Prevention, early diagnosis and access to modern treatment
                                                                                                                                                                                                                                                      play a crucial role in cancer.

12                                                                                                                                                                                                                                                                                                                             13

       Deaths by type of tumour                                                                                                                                                                                                                       Development of cancer mortality rate per 100’000 inhabitants
       2018                                                                                                                                                                                                                                           2010 and 2018

                            Women                                           Men
                                                                                                                                                                                                                                                            60
                                                                                                      Source: Federal Statistical Office (2020), Cause of Death Statistics.

                                                                                                                                                                              Source: Federal Statistical Office (2020), Cause of Death Statistics.
                      858                                                1’021
                                                                    10                                                                                                                                                                                      50
                                                                 255
                                            2’236
                                                               347                            3’030
                                                                                                                                                                                                                                                            40
     1’409                                                   690
                                                                                                                                                                                                                                                            30

      166                                                    857                                                                                                                                                                                            20
       238
         335                                                                                                                                                                                                                                                10
                                           1’390
                                                               1’427
                668                                                                   2’197                                                                                                                                                                  0
                             787                                                                                                                                                                                                                                   Stomach       Colon          Lung      Breast   Prostate/
                                                                                                                                                                                                                                                                                                                    cervix
             Digestive organs        Respiratory organs      Genital organs    Lymph glands
             Urinary organs         Nervous system      Skin     Breast     Others                                                                                                                                                                      Men 2010      Men 2018     Women 2010      Women 2018
Interpharma | Health Panorama 2021                                                                                                                                                                                                              Swiss healthcare system

     A quarter of Switzerland’s population                                                                                                                                                                                                           Diabetes affects 4.6 percent of the
     suffers from high blood pressure                                                                                                                                                                                                                population
     Chronic diseases such as hypertension and diabetes are                                                                                                                                                                                          Diabetes is a metabolic disorder in which the blood sugar
     steadily increasing in Switzerland, which is mainly attributable                                                                                                                                                                                concentration is elevated. Inadequate treatment can lead, for
     to long-term changes in lifestyle.                                                                                                                                                                                                              example, to kidney damage, amputations or blindness.

     Today more than 27% of Swiss people have hypertension,                                                                                                                                                                                          Switzerland’s population has seen an increase in the proportion
     whereas in 1997 the proportion was around 20%.                                                                                                                                                                                                  of those aged 15 years or older with diabetes from 3.3% in 1997
                                                                                                                                                                                                                                                     to 4.6% in 2017.
     In men, the proportion of those with hypertension has risen
     sharply from 19.1% in 1997 to 28.4% in 2017. In the case of                                                                                                                                                                                     Men and women in Switzerland are affected by diabetes to an
     women, the proportion increased from 21.2% to 25.8% over the                                                                                                                                                                                    approximately equal extent: 4.8% of all men and 4.4% of all
     same period.                                                                                                                                                                                                                                    women suffered from some form of diabetes in 2017.

14                                                                                                                                                                                                                                                                                                                                                                                     15

     Proportion of Switzerland’s population aged over 15 years                                                                                                                                                                                       Proportion of Switzerland’s population aged over 15 years
     with hypertension                                                                                                                                                                                                                               with diabetes1
                                                                       28%
                                                                             28%

                                                                                                                                                                                                                                                                                                                                      5.5%
                                        27%
                                  27%

         30%                                                                                                                                                                                                                                                 6%
                                                                                                     26%
                                                                                                           26%

                                                                                                                                                                                                                                                                                                                               4.9%

                                                                                                                                                                                                                                                                                                                                             4.8%
                                                                                                                                                                                                                                                                                            4.7%
                                                                                                                                                                                                                                                                                                   4.6%
                                                                 23%

                                                                                                                                                                                                                                                                                     4.5%

                                                                                                                                                                                                                                                                                                                                                                                4.4%
                            22%

         25%                                                                                                                                                                                                                                                 5%
                                                                                                                 Source: Federal Statistical Office (2020), Swiss Health Survey.

                                                                                                                                                                                   Source: Federal Statistical Office (2020), Swiss Health Survey.

                                                                                                                                                                                                                                                                                                                                                                  4.2%
                      21%

                                                           21%

                                                                                   21%
                                                                                         21%
                                                                                               21%

                                                                                                                                                                                                                                                                                                                        4.0%
                20%

                                                                                                                                                                                                                                                                                                                                                                         3.9%
                                                                                                                                                                                                                                                                              3.8%
                                                     19%

                                                                                                                                                                                                                                                                                                                                                           3.6%
                                                                                                                                                                                                                                                                       3.3%

                                                                                                                                                                                                                                                                                                                 3.3%

                                                                                                                                                                                                                                                                                                                                                    3.3%
         20%                                                                                                                                                                                                                                                 4%

         15%                                                                                                                                                                                                                                                 3%

         10%                                                                                                                                                                                                                                                 2%

          5%                                                                                                                                                                                                                                                 1%

          0%                                                                                                                                                                                                                                                 0%
                        Total                                    Men                      Women                                                                                                                                                                                  Total                                         Men                           Women

                                                                                                                                                                                                                                                        1997          2002            2007                2012          2017
       1997     2002         2007             2012         2017                                                                                                                                                                                      ¹ Diabetes Type 1 and Type 2
Interpharma | Health Panorama 2021                                                                                                                                                                                                                                             Swiss healthcare system

     Holistic view of healthcare costs                                                                                                                                                                                                                                              Healthcare costs in the last 9 years
                                                                                                                                                                                                                                                                                    have risen on average by 2.8 percent
     In 2019, healthcare expenditure in Switzerland amounted to a
     total of CHF 82.1 bn, which was 2.3% up on the previous year.
                                                                                                                                                                                                                                                                                    a year
                                                                                                                                                                                                                                                                                    Over the period from 2010 to 2019, total healthcare costs rose
     Outpatient and inpatient curative treatment, together with long-                                                                                                                                                                                                               by 2.8% per year. The biggest growth was seen in the cost of
     term care, accounted for two-thirds of total healthcare costs.                                                                                                                                                                                                                 support services (e.g. public services, laboratory analysis) with
                                                                                                                                                                                                                                                                                    an increase of 7.3% per year.
     At CHF 9.9 bn, medicines account for 11.8% of healthcare
     expenditure. In other words, for every 100 francs spent on                                                                                                                                                                                                                     With a growth of 2.4%, the increase in spending on medicines
     healthcare, almost 12 francs go on medicines.                                                                                                                                                                                                                                  was below the average.

                                                                                                                                                                                                                                                                                    An assessment of growth shows a shift away from inpatient
                                                                                                                                                                                                                                                                                    (+1.6%) to outpatient (+3.1%) curative treatment.

16                                                                                                                                                                                                                                                                                                                                                                            17

                                                                                            Source: Federal Statistical Office (2021), Kosten und Finanzierung des Gesundheitswesens.

                                                                                                                                                                                        Source: Federal Statistical Office (2021), Kosten und Finanzierung des Gesundheitswesens.
     Breakdown of healthcare costs by services provided                                                                                                                                                                                                                             Cost development according to services provided
     Total costs in 2019                                                                                                                                                                                                                                                            2010–2019, average annual growth

                                            3.3% 2.2%                                                                                                                                                                                                                                           Support services                                                       7.3%
                                     4.1%
                                  4.7%                                                                                                                                                                                                                                                             Rehabilitation                                3.5%
                                                               26.1%
                                                                                                                                                                                                                                                                                    Outpatient curative treatment                             3.1%
                            8.2%                                                                                                                                                                                                                                                                    Chronic care                          2.9%
                                                CHF                                                                                                                                                                                                                                                         Total                         2.8%
                                              82’080 m                                                                                                                                                                                                                                                Medicines                        2.4%
                          11.8%                                                                                                                                                                                                                                                          Other healthcare goods                    2.1%
                                                                                                                                                                                                                                                                                     Inpatient curative treatment               1.6%
                                                             20.4%                                                                                                                                                                                                                                Administration                1.5%
                                    19.2%                                                                                                                                                                                                                                                             Prevention         0.6%
                                                                                                                                                                                                                                                                                                                    0%   1%      2%     3%       4%     5%   6%   7%     8%

       Outpatient curative treatment     Chronic care      Inpatient curative treatment
        Medicines      Support services     Rehabilitation
        Administration      Other healthcare goods      Prevention
Interpharma | Health Panorama 2021                                                                                                                                                                                                                             Swiss healthcare system

     The cost of medicines as a proportion                                                                                                                                                                                                                          Since the introduction of the Health
     of healthcare costs is stable                                                                                                                                                                                                                                  Insurance Act (HInsA) the price index
     In 2019, the cost of medicines as a percentage of healthcare
                                                                                                                                                                                                                                                                    for medicines has fallen by 40 percent
     costs remained stable at 11.8%. As a proportion of the costs                                                                                                                                                                                                   The price index for medicines is the only price index in the
     incurred under the compulsory basic health insurance, it stood                                                                                                                                                                                                 healthcare system that has continually fallen since the enact-
     at 20.4%, which was actually a slight fall.                                                                                                                                                                                                                    ment of the HInsA in 1996.

     While many innovative medicines are coming onto the market,                                                                                                                                                                                                    At 57 points, the price index in 2020 was more than 40% lower
     these medicines are growing compared to previous year                                                                                                                                                                                                          than in 1996, whereas the hospital price index, for example, was
     (+1.9%) as a proportion of healthcare costs (+2.3%).                                                                                                                                                                                                           around 11% higher in 2020 than in 1996.

     Since around three-quarters of medicines are financed through                                                                                                                                                                                                  The prices of reimbursable medicines are reviewed every three
     the health insurance, unlike other service categories (e.g. in­­                                                                                                                                                                                               years and reduced where necessary, which leads to major
     patient curative treatment), they account for a higher proportion                                                                                                                                                                                              savings in the healthcare system.
     of health insurance costs than they do of total healthcare costs.
18                                                                                                                                                                                                                                                                                                                                                19

                                                                                            Source: Federal Statistical Office (2021), Kosten und Finanzierung des Gesundheitswesens.
     Cost of medicines as a proportion of healthcare and basic                                                                                                                                                                                                      Price indexes in Switzerland’s healthcare system
     health insurance costs, 2010–2019                                                                                                                                                                                                                              1996–2020

                                                                                                                                                                                        Source: Federal Statistical Office (2021), National Consumer Price Index.
                                                                                                                                                                                                                                                                          125                                                                126
         25%

                                                                                                                                                                                                                                                                          115
         20%                                                                                                                                                                                                                                                                                                                                 111
               21.5% 21.2% 21.0% 20.0% 19.6% 19.7% 20.0% 20.5% 21.4% 20.4%                                                                                                                                                                                                105                                                                103
                                                                                                                                                                                                                                                                                                                                             100
         15%                                                                                                                                                                                                                                                                95

         10% 12.2% 12.0% 11.8% 11.6% 11.3% 11.4% 11.7% 11.8% 11.8% 11.8%                                                                                                                                                                                                    85

                                                                                                                                                                                                                                                                            75
          5%
                                                                                                                                                                                                                                                                            65
                                                                                                                                                                                                                                                                                                                                             57
          0%                                                                                                                                                                                                                                                                55
                2010   2011    2012    2013    2014   2015    2016    2017    2018   2019                                                                                                                                                                                     1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
        Cost of medicines (pharmacies, drugstores, self-dispensing doctors, hospitals                                                                                                                                                                                    Medicines        Hospitals    Dentists   Doctors
        inpatient and outpatient) as percentage of healthcare costs                                                                                                                                                                                                      Healthcare       Consumer spending
        Cost of medicines (pharmacies, self-dispensing doctors, hospitals inpatient and                                                                                                                                                                             Indexed: 1996 = 100
        outpatient) as percentage of basic health insurance costs
Interpharma | Health Panorama 2021                                                                                                                                                                                                                  Swiss healthcare system

     The cost of disease from a societal                                                                                                                                                                                                                 Impact of therapeutic innovations
     perspective                                                                                                                                                                                                                                         on healthcare costs
     The burden of disease is primarily felt by those afflicted with                                                                                                                                                                                     Innovative medicines are a form of treatment innovation and
     the disease. But others are often affected as well: for the health                                                                                                                                                                                  can have an impact on all three cost categories.
     insurer, medical treatment costs are incurred; for the employer,
     productivity losses are incurred; and the social environment of                                                                                                                                                                                     In general, direct treatment costs rise with an innovation,
     the patient also bears the consequences of a disease.                                                                                                                                                                                               whereas indirect and intangible costs fall. From an overall
                                                                                                                                                                                                                                                         economic perspective, it is particularly interesting to know
     A distinction can be drawn between direct costs (medical and                                                                                                                                                                                        whether the innovative treatment leads to a fall in the total
     non-medical treatment costs), indirect costs (lost resources)                                                                                                                                                                                       cost of disease, i.e. the sum of the direct, indirect and intan-
     and intangible costs (reduced quality of life), the sum of which                                                                                                                                                                                    gible costs. The question of how the make-up of the overall
     corresponds to the cost of a disease to society.                                                                                                                                                                                                    costs develop is secondary.

20                                                                                                                                                                                                                                                                                                                                            21

     Composition of overall costs of a disease                                                                                                                                                                                                           Disease costs from a societal perspective
     Illustration                                                                                                                                                                                                                                        Impact of innovation; illustration

                                                                                       Source: Polynomics (2020), Gesellschaftliche Betrachtung der Krankheitskosten.

                                                                                                                                                                        Source: Polynomics (2020), Gesellschaftliche Betrachtung der Krankheitskosten.
                                                                                                                                                                                                                                                                                              Innovation
                                                                                                                                                                                                                                                                                        A drug innovation comes
                                                                                                                                                                                                                                                                                            onto the market.
                                          Direct costs
                                          Medical and non-medical costs of treatment

                                          Indirect costs
                                          Lost resources, especially work time for
                                          patients and relatives

                                          Intangible costs
                                          Reduced quality of life, especially due to
                                          pain and suffering                                                                                                                                                                                                 Starting point                               New situation with innovation
                                                                                                                                                                                                                                                             Current standard therapy involves            Spending on the drug innovation
                                                                                                                                                                                                                                                             relatively low direct costs.                 increases direct costs.
                                                                                                                                                                                                                                                             Indirect costs are relatively high.          Indirect costs can be reduced.
                                                                                                                                                                                                                                                             Intangible costs are relatively high.        Intangible costs can be reduced.
                                                                                                                                                                                                                                                             The overall societal costs of the            The overall societal costs of the
                                                                                                                                                                                                                                                             disease are high.                            disease fall.
Interpharma | Health Panorama 2021                                                                                                                                                                                                                                               Swiss healthcare system

     More than 40 percent of healthcare                                                                                                                                                                                                                                               Private households directly finance
     costs covered by social insurance                                                                                                                                                                                                                                                63 percent of healthcare costs
     Of the healthcare costs incurred in 2019, amounting to CHF                                                                                                                                                                                                                       Private households finance 63% of healthcare costs; they pay
     82.1 bn, 44.3% were covered by social insurance schemes.                                                                                                                                                                                                                         the largest share of this in contributions to social insurance
     Federal, cantonal and municipal authorities covered 22.4% of                                                                                                                                                                                                                     (31.8%). They pay more than a quarter directly for services that
     healthcare costs in 2019.                                                                                                                                                                                                                                                        are not covered by the health insurers (out-of-pocket pay-
                                                                                                                                                                                                                                                                                      ments).
     In the present system, 100% of outpatient care is covered by
     health insurers, while in the case of inpatient care 45% is cov-                                                                                                                                                                                                                 Around 30% of healthcare costs are financed by the public
     ered by health insurers and 55% by the cantons. EFAS (the bill                                                                                                                                                                                                                   purse. These costs are likewise covered by private households
     for unified financing of outpatient and inpatient services) calls                                                                                                                                                                                                                to a substantial extent in the form of taxes.
     for this system to be abolished and funding to be unified so as
     to reduce disincentives in the system.                                                                                                                                                                                                                                           In addition to levies in the form of taxes, companies also play a
                                                                                                                                                                                                                                                                                      part, covering 6.6% of healthcare costs.
22                                                                                                                                                                                                                                                                                                                                                                                23

                                                                                              Source: Federal Statistical Office (2021), Kosten und Finanzierung des Gesundheitswesens.

                                                                                                                                                                                          Source: Federal Statistical Office (2021), Kosten und Finanzierung des Gesundheitswesens.
     Funding regime of the healthcare system                                                                                                                                                                                                                                          Funding sources of the healthcare system
     Total costs 2019                                                                                                                                                                                                                                                                 Total costs 2019: CHF 82’080 m

                                                                                                                                                                                                                                                                                        Public purse                                                   30.4%      CHF 24’952 m
                                                                1.8%
                                                     7.0%
                                                                                                                                                                                                                                                                                        Private households                                             63.0%      CHF 51’707 m

                                   22.4%                                              44.3%                                                                                                                                                                                             Out of pocket¹                                                  24.5%      CHF 20’124 m
                                                              CHF
                                                            82’080 m                                                                                                                                                                                                                    Social insurance                                                31.8%      CHF 26’099 m

                                                                                                                                                                                                                                                                                        Private insurance                                                 5.5%      CHF 4’524 m

                                                                                                                                                                                                                                                                                        Others²                                                           1.2%       CHF 960 m
                                               24.5%

                                                                                                                                                                                                                                                                                        Companies                                                        6.6%      CHF 5’421 m

        Social insurance       1
                                       Private households                   Public purse
        Private insurance             Other private funding2                                                                                                                                                                                                                         ¹ Expenditure not covered by insurance (excess, spending up to franchise)
     ¹ Including compulsory basic health insurance    ² Foundations, etc.                                                                                                                                                                                                             ² Donations, legacies
Interpharma | Health Panorama 2021                                                                                                                                                                                                      Swiss healthcare system

      In comparison, Swiss households                                                                                                                                                                                                         Drug and vaccine research gains
      spend little on medicines                                                                                                                                                                                                               importance
      One fifth of household spending goes on rent, making rent by                                                                                                                                                                            gfs.bern conducts a representative survey, the “Health Monitor”
      far the biggest expenditure item of private households.                                                                                                                                                                                 each year on behalf of Interpharma. In the 2021 survey, 1’200
                                                                                                                                                                                                                                              voters were asked for their views on the Swiss healthcare
      Swiss households also spend 11.9% of their budget on food,                                                                                                                                                                              system.
      6.9% on restaurant meals and hotel stays and 7.8% on cars,
      motorcycles and bicycles.                                                                                                                                                                                                               70% of voters were in favour of investing more in research on
                                                                                                                                                                                                                                              medicines and vaccines. The coronavirus crisis has highlighted
      People in Switzerland overall spend more of their disposable                                                                                                                                                                            the relevance of these areas.
      income on alcohol and tobacco (3.8%) than on medicines (3.5%).
                                                                                                                                                                                                                                              Respondents also want to see more funding for public hospitals
                                                                                                                                                                                                                                              and intensive care. Naturopaths and alternative medicine have
                                                                                                                                                                                                                                              fallen in favour.
24                                                                                                                                                                                                                                                                                                                                   25

      Spending structure of Swiss households                                                                                                                                                                                                  Trend: distribution of finances
      Basket of goods in National Consumer Price Index, 2021                                                                                                                                                                                  In percent of respondents, proportion “more”, 2010–2021

                                                                                                             Source: Federal Statistical Office (2021), National Consumer Price Index.
                              Rent                                                             20.1%                                                                                                                                                80
                              Food                                                  11.9%
                                                                                                                                                                                                                                                    70
     Cars, motorcycles and bicycles                             7.8%
            Restaurants and hotels                            6.9%                                                                                                                                                                                  60
                  Hospital services                        5.9%
              Doctor/dentist visits1                      5.3%                                                                                                                                                                                      50
              Alcohol and tobacco2                                                                                                                                                       Source: gfs.bern, Health Monitor 2021, (N = 1200).
                                                       3.8%
                         Medicines                    3.5%                                                                                                                                                                                          40
              Telecommunications                    2.8%
                                                                                                                                                                                                                                                    30
                 Clothes and shoes                  2.8%
                Leisure and culture                 2.7%                                                                                                                                                                                            20
                  Package holidays               1.1%
            Newspapers and books                0.8%                                                                                                                                                                                                10
                   Garden and pets              0.8%
                                                                                                                                                                                                                                                     0
                                             0%        5%         10%                  15%   20%       25%                                                                                                                                               2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
                                                                                                                                                                                                                                                 Research on medicines and vaccines (up to 2020: medicines research)
                                                                                                                                                                                                                                                 Naturopaths/alternative medicine     Public hospitals     Intensive care medicine
      ¹ Outpatient services (excluding hospital outpatients), excluding medicines
      ² Incl. alcohol in restaurants and hotels                                                                                                                                                                                                  Range of health insurance benefits
Interpharma | Health Panorama 2021                                                                                                                                                                                                                                         Swiss healthcare system

     Reserves in the basic health insur-                                                                                                                                                                                                                                        More and more people are opting
     ance continue to rise year-on-year                                                                                                                                                                                                                                         for an alternative insurance model
     Reserves in the compulsory basic health insurance rose to                                                                                                                                                                                                                  Alternative insurance models, such as the HMO and the gate-
     almost CHF 10 bn in 2019, an increase of more than 20% year-                                                                                                                                                                                                               keeper model, have seen strong growth, especially since 2006.
     on-year, making it a new record high.
                                                                                                                                                                                                                                                                                Overall, it is clear that the insurance model with an ordinary
     The solvency ratio determines the factor by which the reserves                                                                                                                                                                                                             franchise has steadily decreased in the period up to 2019. Only
     exceed the legal minimum. A value of 2 means that the reserves                                                                                                                                                                                                             one in four people still uses such a model.
     are twice as high as the minimum level.
                                                                                                                                                                                                                                                                                Insurance models with a range of franchises to choose from
     In 2019, the reserves of health insurers corresponded approxi-                                                                                                                                                                                                             make up the smallest proportion today along with the model
     mately to the payments for three insurance months.                                                                                                                                                                                                                         with bonus insurance*.

26                                                                                                                                                                                                                                                                                                                                                                                                            27

                                                                                      Source: Federal Office of Public Health (2020), Statistics on compulsory health insurance.

                                                                                                                                                                                   Source: Federal Office of Public Health (2020), Statistics on compulsory health insurance.
     Reserves of compulsory basic health insurances, 1996–2019                                                                                                                                                                                                                  Types of insurance in the compulsory basic insurance scheme
     Solvency ratio, 2012–2019                                                                                                                                                                                                                                                  1996–2019, types of insurance over time

     12’000                                                                     2.4                                                                                                                                                                                                    100%
                                                                                                                                                                                                                                                                                         90%
     10’000                                                                     2.0
                                                                                                                                                                                                                                                                                         80%

      8’000                                                                     1.6                                                                                                                                                                                                      70%
                                                                                                                                                                                                                                                                                         60%
      6’000                                                                     1.2                                                                                                                                                                                                      50%
                                                                                                                                                                                                                                                                                         40%
      4’000                                                                     0.8
                                                                                                                                                                                                                                                                                         30%

      2’000                                                                     0.4                                                                                                                                                                                                      20%
                                                                                                                                                                                                                                                                                         10%
            0                                                                   0.0                                                                                                                                                                                                       0%
                1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016   2019                                                                                                                                                                                                                   1996             2000             2004              2008             2012             2016             2019

                                                                                                                                                                                                                                                                                   Ordinary franchise     Selectable franchise
         Insurances reserves                    Solvency ratio                                                                                                                                                                                                                     Other types of insurance (HMO, gatekeeper model, etc.)
     Left axis: reserves in CHF millions; right axis: solvency ratio                                                                                                                                                                                                            * The model with bonus insurance has a share of less than 0.4% since 1996 and is therefore not visible in the chart.
Interpharma | Health Panorama 2021   Pharma market

     Pharma market                        Patent-protected medicines make
                                          up the largest proportion of the
                                          pharma market at 48 percent.

                                          In the last 15 years, the generics
                                          market has almost tripled.

                                          The price reviews of medicines
28
                                          result in annually recurring sav-    29
                                          ings of more than one billion
                                          francs.
Interpharma | Health Panorama 2021                                                                                                                                         Pharma market

     Price cuts dampen growth of the                                                                                                                                            The price of a medicine is made
     pharma market                                                                                                                                                              up of various components
     In 2020, the pharmaceuticals market in Switzerland achieved a                                                                                                              At 70%, the largest component in the price of a medicine is the
     value-based volume of CHF 6.3 bn at ex-factory prices (+2.9%                                                                                                               ex-factory price, which the pharmaceutical company receives
     year-on-year). Contrary to the feared cost increases for medi-                                                                                                             for research, development and production.
     cines, cost growth remains moderate, despite groundbreaking
     innovations.                                                                                                                                                               Along with the ex-factory price, there is the trade price to be
                                                                                                                                                                                considered. This consists of a price-related and a pack-related
     Sales of patent-protected medicines in the reimbursable segment                                                                                                            surcharge. Additional price components are the service-based
     were up 4.6% over 2019.                                                                                                                                                    charge for pharmacies and value-added tax.

     The number of packs sold fell slightly by 1.8% and stand at 183                                                                                                            For a medicine priced at 100 francs, 70 go to the producer and
     million packs in 2020.                                                                                                                                                     30 to the trade, to doctors, pharmacists and, through value-
                                                                                                                                                                                added tax, to the federal government.
30                                                                                                                                                                                                                                                                                                         31

     Market value                                                                                                                                                               Composition of drug price

                                                                                               Source: santésuisse and Interpharma (2021), Gemeinsamer Auslandpreisvergleich.
     2020: CHF 6’331.7 m at ex-factory prices                                                                                                                                   2019

                                                                                                                                                                                                                                                                                           2.5%
        7’000                                                                                                                                                                        100%                                                                                                  3.8%
                                          +2.8%           +2.9%
                      +2.3%                                                                                                                                                           90%
        6’000                                                                                                                                                                                                                                                                              23.8%
                                                                                                                                                                                      80%
        5’000                                                                                                                                                                         70%

        4’000                                                                                                                                                                         60%
                      5’985.0             6’154.8         6’331.7                                                                                                                     50%
        3’000                                                                                                                                                                         40%                                                                                                  69.9%
        2’000                                                                                                                                                                         30%
                                                                                                                                                                                      20%
        1’000
                                                                                                                                                                                      10%
                                                                       Source: IQVIA (2021).

            0                                                                                                                                                                           0%
                       2018                2019            2020
                                                                                                                                                                                    Pharma (FAP)      Trade                 Service-based charges (excl. for pharmacies)
                                                                                                                                                                                    Federal govt (VAT 2.5%)
                                                                                                                                                                                The trade includes both a price-related surcharge in % of the ex-factory price (FAP) and a pack-related surcharge in CHF
                                                                                                                                                                                depending on the level of the FAP.
Interpharma | Health Panorama 2021                                                                                                                                                                                                                                     Pharma market

     Several growth elements drive the                                                                                                                                                                                                                                      Major savings in the healthcare sys-
     development of the pharma market                                                                                                                                                                                                                                       tem thanks to drug price reductions
     The pharma market in Switzerland grew by 2.9% in 2020. This                                                                                                                                                                                                            In the price review, the FOPH divides the medicines into three
     growth was driven mainly by the volume of medicines sold                                                                                                                                                                                                               groups, one of which is assessed every three years for the
     (+2.4%).                                                                                                                                                                                                                                                               efficacy, suitability and cost-effectiveness of the medicines in
                                                                                                                                                                                                                                                                            that group.
     New products – e.g. for cancer or autoimmune diseases – have
     likewise contributed to this growth. There are ever more medi-                                                                                                                                                                                                         In 2020, the prices of more than 300 medicines in group A
     cines for hitherto untreatable diseases.                                                                                                                                                                                                                               were reduced by an average of 11%.

     The triennial price reviews by the FOPH have led to a 2.4%                                                                                                                                                                                                             The reviews lead to annually recurring savings of more than
     decline in the overall market. With these savings, pharma                                                                                                                                                                                                              one billion francs. The pharma industry is the only actor in the
     companies are making a major contribution to help contain the                                                                                                                                                                                                          Swiss healthcare sector that makes a significant contribution to
     growth of costs in the healthcare system.                                                                                                                                                                                                                              cost containment through institutionalized price reviews.
32                                                                                                                                                                                                                                                                                                                                                   33

     Development of individual components at ex-factory prices                                                                                                                                                                                                              Savings through price reductions

                                                                                                                                                                                  Source: Federal Office of Public Health (2021), Letters of information from 13.12.2017,
     Growth 2020

                                                                                                                                                                                                                                                                             Group A               Group B               Group C

                                                                                                                                                                                  06.12.2018, 02.12.2019 and 04.12.2020, press release from 30.10.2020.
                        Overall market                                                  Volume
                                                                                        changes*                                                                                                                                                                             Gastroenterology      Nervous system        Cardiovascular
                                                                                                              Others**
                                             New products                                                                                                                                                                                                                                          Kidneys and water
                                             and line exten-                                                                                                                                                                                                                 Metabolism                                  Pulmonary and respiratory
                                                                                                                                                                                                                                                                                                   balance
                          +2.9%              sions
                                                                                          +2.4%
                                                                                                                               Source: IQVIA (2021), Pharma Market Switzerland.

                                                                   Price                                       +2.0%                                                                                                                                                         Antidotes             Blood                 Infectious diseases
                                               +0.9%               reductions
                                                                                                                                                                                                                                                                             Cation exchangers     Dermatology           Gynaecology

                                                                                                                                                                                                                                                                                                   Odontostomatology     Ophthalmology
                                                                    –2.4%                                                                                                                                                                                                                          Diagnostics           Otorhinolaryngology

     * Volume changes: percentage of revenue growth resulting from increased sales of products launched on the market
     before 2019. ** Interactive effects: caused by simultaneous interactions of price and volume changes. Residual effects:
     change in existing strengths from smaller to larger packs or vice versa.
Interpharma | Health Panorama 2021                                                                                                                                                                                                                                                                         Pharma market

     Original medicines are only 6.9 per-                                                                                                                                                                                                                                                                       Switzerland in general has an
     cent more expensive than abroad                                                                                                                                                                                                                                                                            above-average price level
     In April 2021, the 250 strongest-selling patent-protected original                                                                                                                                                                                                                                         In an international comparison of price level indices with the
     products were on average 6.9% cheaper in comparable foreign                                                                                                                                                                                                                                                27 member states of the EU in 2020 (Switzerland = 100%), the
     countries than in Switzerland. The price difference has grown                                                                                                                                                                                                                                              level of prices in Switzerland is generally above average.
     year-on-year especially as a result of the stronger Swiss franc.
     At constant currency exchange rates the difference would                                                                                                                                                                                                                                                   The aggregate of all goods classes, or gross domestic product
     actually have fallen.                                                                                                                                                                                                                                                                                      (GDP), makes clear in particular the difference in disposable
                                                                                                                                                                                                                                                                                                                income. Based on GDP, Switzerland is 55% above the EU-27
     As a result of the effective price reviews of the FOPH, prices in                                                                                                                                                                                                                                          basket of countries.
     Switzerland are only slightly higher than abroad.
                                                                                                                                                                                                                                                                                                                Both government (public service) and individual consumption
     With these regular price reviews, the pharma industry makes                                                                                                                                                                                                                                                services are on average about twice as expensive in Switzer-
     annually recurring savings in the healthcare sector of more than                                                                                                                                                                                                                                           land as in other European countries.

                                                                                                                                                                                                      Source: Eurostat (2021), Comparative price level indices and real expenditures for ESA 2010 aggregates.
     one billion francs according to Federal Councillor Berset.*
34                                                                                                                                                                                                                                                                                                                                                                                  35

                                                                                                                 Source: Santésuisse and Interpharma (May 2021), Gemeinsamer Auslandpreisvergleich.
     Top 250 original products, basket of 9 countries                                                                                                                                                                                                                                                           Comparative price level indices
     Exchange rate CHF/EUR: 1:11**, prices of April 2021                                                                                                                                                                                                                                                        Switzerland = 100, 2019
                                                 105
                     100                                            99
            100                                                                                   97                                                                                                                                                                                                                100
                               93       91                 91                                          93
                                                                             84        87
                                                                                                            80
             80                                                                                                                                                                                                                                                                                                      80

             60                                                                                                                                                                                                                                                                                                      60

             40                                                                                                                                                                                                                                                                                                      40

             20                                                                                                                                                                                                                                                                                                      20

               0                                                                                                                                                                                                                                                                                                      0
                                                                                                                                                                                                                                                                                                                          CH
                                                                                                                                                                                                                                                                                                                          DK
                                                                                                                                                                                                                                                                                                                           FI
                                                                                                                                                                                                                                                                                                                          SE
                                                                                                                                                                                                                                                                                                                          NL
                                                                                                                                                                                                                                                                                                                          UK
                                                                                                                                                                                                                                                                                                                          AT
                                                                                                                                                                                                                                                                                                                          BE
                                                                                                                                                                                                                                                                                                                          DE
                                                                                                                                                                                                                                                                                                                          FR

                                                                                                                                                                                                                                                                                                                                           CH
                                                                                                                                                                                                                                                                                                                                           DK
                                                                                                                                                                                                                                                                                                                                            FI
                                                                                                                                                                                                                                                                                                                                           SE
                                                                                                                                                                                                                                                                                                                                           NL
                                                                                                                                                                                                                                                                                                                                           UK
                                                                                                                                                                                                                                                                                                                                           AT
                                                                                                                                                                                                                                                                                                                                           BE
                                                                                                                                                                                                                                                                                                                                           DE
                                                                                                                                                                                                                                                                                                                                           FR

                                                                                                                                                                                                                                                                                                                                                         CH
                                                                                                                                                                                                                                                                                                                                                         DK
                                                                                                                                                                                                                                                                                                                                                          FI
                                                                                                                                                                                                                                                                                                                                                         SE
                                                                                                                                                                                                                                                                                                                                                         NL
                                                                                                                                                                                                                                                                                                                                                         UK
                                                                                                                                                                                                                                                                                                                                                         AT
                                                                                                                                                                                                                                                                                                                                                         BE
                                                                                                                                                                                                                                                                                                                                                         DE
                                                                                                                                                                                                                                                                                                                                                         FR

                                                                                                                                                                                                                                                                                                                                                                       CH
                                                                                                                                                                                                                                                                                                                                                                       DK
                                                                                                                                                                                                                                                                                                                                                                        FI
                                                                                                                                                                                                                                                                                                                                                                       SE
                                                                                                                                                                                                                                                                                                                                                                       NL
                                                                                                                                                                                                                                                                                                                                                                       UK
                                                                                                                                                                                                                                                                                                                                                                       AT
                                                                                                                                                                                                                                                                                                                                                                       BE
                                                                                                                                                                                                                                                                                                                                                                       DE
                                                                                                                                                                                                                                                                                                                                                                       FR
                    CH                 DE        DK        NL       AT        FI       SE         BE   UK   FR
                        sk s
                      ba trie

                                                                                                                                                                                                                                                                                                                          Gross domestic   Consumption     Services    Government
                           et
                         un

                                                                                                                                                                                                                                                                                                                             product                      individual    services
                      co
                    9-

                                                                                                                                                                                                                                                                                                                                                         consumption
     * Source: Tages-Anzeiger, 23.09.2020   ** Exchange rate applied by the FOPH when reviewing
Interpharma | Health Panorama 2021                                                                                                                                        Pharma market

     Pharmacies remain the most im­                                                                                                                                            Patent-protected products continue
     portant sales outlet for medicines                                                                                                                                        to make up the bulk of the pharma
     Pharmacies are still the most important sales outlet for pharma­
                                                                                                                                                                               market
     ceuticals: 65% of all packs are sold through pharmacies. In terms                                                                                                         Patent-protected medicines account for the largest share of
     of value, these sales account for almost 48% of total sales.                                                                                                              the Swiss pharma market at 48%.

     Self-dispensing doctors and hospitals each account for around                                                                                                             The generics-eligible market, comprising off-patent original
     a quarter of pharma sales in terms of value.                                                                                                                              products with generic competition and generics, has a market
                                                                                                                                                                               share of around 26%.
     Chemists or drugstores account for only a small percentage of
     pharma sales at 1% in terms of value.                                                                                                                                     In 2020, generics accounted for a greater share of the reim-
                                                                                                                                                                               bursable drugs market than original products.

36                                                                                                                                                                                                                                                                      37

     Sales outlets by sales generated                                                                                                                                          Composition of the pharmaceutical market
     In CHF millions, at ex-factory prices, 2008–2020                                                                                                                          2020

                                                               67                                                                                                                                                  6%   1%
                                                                                                                                                                                                             8%
                                        1’632

                                                                                                                                                                                                      10%
                                                                                                                            Source: IQVIA (2021), Pharma Market Switzerland.                                                              48%
                                                                                        3’030
                                                          CHF 6.3 bn

                                                                                                                                                                                                       12%

                                           1’600
                                                                                                                                                                                                                  14%
                                                                                                    Source: IQVIA (2021).

                                                                                                                                                                                  Patent-protected products       Generics       Original  Products whose patent pro-
        Pharmacies              SD doctors1            Hospitals          Chemists/drugstores                                                                                  tection has expired     Out of market       Reference products (products with expired
     ¹ Doctors with own in-practice pharmacy are defined as self-dispensing doctors (SD doctors).                                                                              patent protection and at least 1 generic or 1 biosimilar)  Biosimilars
Interpharma | Health Panorama 2021                                                                                     Pharma market

     Since 2005, the generics market has                                                                                    Increasing level of substitution in
     almost tripled in value                                                                                                the off-patent market
     Generics are identical copies of off-patent original products                                                          The level of substitution with generics in the off-patent market
     based on synthetic active substances.                                                                                  shows the proportion of generics that are sold in place of
                                                                                                                            original products.
     Reimbursable generics achieved a value of around 760 million
     francs in 2020.                                                                                                        Measured by the number of tablets, generics were also dis-
                                                                                                                            pensed in Switzerland in more than 60 of 100 cases in which
     In the last 15 years, value of the reimbursable generics market                                                        generics were available in 2020.
     has almost tripled.
                                                                                                                            Since 2012, the level of substitution with generics in the
                                                                                                                            off-patent market has steadily increased.

38                                                                                                                                                                                                                39

     Generics market                                                                                                        Generics substitution rate
     Reimbursable, in CHF millions, at ex-factory prices, 2005–2020                                                         Total, 2012–2020

         800                                                         760                                                       100%

         700                                                                                                                    90%

                                                                                                                                                                                                           40%
                                                                                                                                80%
         600
                                                                                                                                70%
         500                                                                                                                    60%
         400                                                                                                                    50%

         300                                                                                                                    40%

                                                                                                                                                                                                           60%
                                                                                                                                30%
         200
                                                                                                                                20%
         100                                                                                                                    10%
                                                                            Source: IQVIA (2021).

                                                                                                    Source: IQVIA (2021).

            0                                                                                                                    0%
                2005       2008           2011   2014   2017         2020                                                                2012   2013    2014     2015    2016     2017     2018     2019   2020

                                                                                                                              Generics      Off-patent original products with generic competition
Interpharma | Health Panorama 2021                                                                                                       Pharma market

     Biosimilars vs generics                                                                                                                  Biosimilars are gaining in importance
     Generics consist of simple molecules. Biosimilars on the other                                                                           Over the last decades, modern biotechnology has brought
     hand are produced from live cells, which cannot be copied                                                                                about huge medical breakthroughs in mostly life-threatening
     exactly. A biosimilar is therefore never identical to the original                                                                       diseases, such as cancer.
     product, but at most similar.
                                                                                                                                              Following patent expiries, the first copies of these innovative
     The complexity involved in the development and production of                                                                             technologies have entered the market.
     biosimilars is vastly greater than with generics. For this reason
     the development costs alone are 100 times higher for a biosimi-                                                                          In Switzerland, biosimilars are currently still little used – in 2020,
     lar than for a generic.                                                                                                                  they account for only 1% of the medicines market. However,
                                                                                                                                              the number of biosimilars available in Switzerland has almost
     In Switzerland, high standards of patient safety are called for in                                                                       quadrupled since 2017, from 7 to 27 products.
     the approval of biosimilars and extensive clinical trials and proof
     of safety are required.
40                                                                                                                                                                                                                     41

     Difference between generics and biosimilars                                                                                              Biosimilars market
                                                                                                                                              Number of biosimilars, 2012–2020

                          Generics                         Biosimilars                                                                             30
                                                                                                                                                                                                                 27

                                                           Very high, clinical trials                                                              25
      Complexity          Minimal
                                                           required
                                                                                                                                                   20
                          Identical copy of the original   Similarity must be proven
      Comparability
                          product                          through clinical trials
                                                                                                                                                   15

      Development costs   At least CHF 1 million           At least CHF 100 million
                                                                                                                                                   10

      Number of
                          Many                             Few                                                                                      5
                                                                                        Source: Interpharma (2020).

      producers
                                                                                                                      Source: IQVIA (2021).

                                                                                                                                                    0
                                                                                                                                                        2012   2013   2014   2015   2016   2017   2018   2019   2020
Interpharma | Health Panorama 2021                                                                                                                            Pharma market

     Many new therapies for cancer,                                                                                                                                Imports of active ingredients,
     autoimmune and viral diseases                                                                                                                                 antibiotics and vaccines
     Ever more treatments for cancer, autoimmune and viral diseases                                                                                                When it comes to supplies of active ingredients, vaccines and
     increase the chances of a cure for patients.                                                                                                                  antibiotics, Switzerland is dependent on global trade.

     In 2020, a total of 329 therapies against cancer were available.                                                                                              The EU is our most important trading partner: 52% of active
     Since 2012, 67 new and innovative therapies have been added.                                                                                                  ingredients, 93% of antibiotics and 77% of vaccines come from
                                                                                                                                                                   the EU.
     The number of available autoimmune therapies and antiviral
     medicines has increased by 56% and 47%, respectively, since                                                                                                   The USA is the second-most important trading partner for
     2012.                                                                                                                                                         active ingredients. Almost a quarter of active ingredients come
                                                                                                                                                                   directly from Asia.

42                                                                                                                                                                                                                                                                43

     Total market, number of available therapies                                                                                                                   Imports of active ingredients
     In CHF millions, at ex-factory price, 2012–2020                                                                                                               Share by value (CHF), 2020

          350                     329                                                                                                                                                               52.0%                      23.1%       10.5%     14.4%
          300             284                                                                                                                                    Ingredients
                   262
          250

                                                                                                           Source: Eidgenössische Zollverwaltung (EZV) (2021).
                                                                                                                                                                                                             76.9%                       2.3%    12.6%    8.2%
          200
                                                                                                                                                                   Vaccines
          150                                          122
          100                                     89                         87                                                                                                                                      92.9%                               6.4%
                                            78                        71
                                                                59
                                                                                                                                                                 Antibiotics
           50
                                                                                                                                                                                                                                                         0.1% 0.5%
                                                                                   Source: IQVIA (2021).

              0
                         Cancer           Autoimmune diseases   Antiviral agents                                                                                           0%         10%     20%    30%     40%     50%     60%   70%     80%     90%     100%

       2012       2016     2020                                                                                                                                      EU        Asia         USA     Others
Interpharma | Health Panorama 2021   Focus on the patient

     Focus on the patient                 In 2020, only 4 of 38 medicines
                                          were included in the Specialities
                                          List within the stipulated
                                          60 days.

                                          Swiss people want access to
                                          medicines from the day of mar-
                                          keting authorization.
44                                                                            45
                                          30 percent of medicines prod­
                                          uced using biotechnology and
                                          gene technology are used for
                                          cancer.
Interpharma | Health Panorama 2021                                                                                                                                                                 Focus on the patient

     Better health thanks to medical                                                                                                                                                                    The benefit of innovative therapies
     advances                                                                                                                                                                                           accrues at several levels
     The past 70 years have seen rapid growth in medical advances.                                                                                                                                      The direct benefit of innovative therapies can be seen on three
     While it took 50 years for medical knowledge to double in 1950,                                                                                                                                    levels: patients benefit from the chance of a cure, a more rapid
     it took only 73 days in 2020.                                                                                                                                                                      recovery or a better quality of life.

     Medical progress has led to many new treatment options, such                                                                                                                                       Society benefits from innovations. Shortened and improved
     as gene therapy, cell therapy and CAR-T therapy.                                                                                                                                                   healing processes reduce treatment and care costs, and enables
                                                                                                                                                                                                        patients to return to work sooner.
     Investments in medical progress remain necessary. There are
     still many diseases that can only be treated partially, if at all,                                                                                                                                 Ultimately the economy also benefits, because new medicines
     such as cancer and Alzheimer’s.                                                                                                                                                                    allow reinvestments in research and development. This leads to
                                                                                                                                                                                                        the creation of jobs, generates value added and brings higher
                                                                                                                                                                                                        tax revenues for the state.
46                                                                                                                                                                                                                                                                                          47

                                                                          Source: Densen, Peter (2011), Challenges and Opportunities Facing Medical Education, American
     Growth of medical knowledge                                                                                                                                                                        Overall consideration of the benefits

                                                          1950
                                                          50 years

             1980
             7 years
                                                                          Clinical and Climatological Association, 122, p. 48–58.

                                                                                                                                                                                                        Direct benefit to the      Benefits to society            Benefits to the economy
                                                                                                                                                                                                        patient                    • Lower costs through          • Jobs
          2010
                                                                                                                                                                                                        • Higher life expectancy     shorter healing process      • R&D investments
          3.5 years
                                                                                                                                                                                                        • Faster recovery          • Quicker return to work       • Contribution to gross
                                                                                                                                                                                                        • Chance of a cure         • Reduced nursing costs          value added
       In 2020                                                                                                                                                                                          • Better quality of life   • Effects on other social      • Taxes
                                                                                                                                                                          Source: Interpharma (2020).

       medical knowledge doubles every 0.2 years, i.e. every 73 days                                                                                                                                    • Reduced emotional          institutions (unemploy-
                                                                                                                                                                                                          burden                     ment insurance, disability
                                                                                                                                                                                                                                     insurance)
Interpharma | Health Panorama 2021                                                                                                                                                                                                   Focus on the patient

     Access to innovations in Switzerland                                                                                                                                                                                                 Access to medicines from the day
     comes with a delay                                                                                                                                                                                                                   of marketing authorization
     As at end of 2020, a total of 169 applications for approval had                                                                                                                                                                      According to the Health Monitor 2021, almost 93% of respond-
     not yet led to inclusion in the Specialities List (SL).                                                                                                                                                                              ents want access to new medicines from the day marketing
                                                                                                                                                                                                                                          authorization is granted by Swissmedic.
     Since 2014, there has been a sharp increase in the number of
     medicines not yet reimbursable. In 2020, only 4 of 38 products                                                                                                                                                                       More than half of respondents believe there is a need for
     (barely 11%) were included in the Specialities List within 60                                                                                                                                                                        change. This reflects the dissatisfaction of the population with
     days as stipulated in the regulations.                                                                                                                                                                                               today’s reimbursement processes for new medicines.

     Around 66% of all inclusions in the SL in 2020 occurred after                                                                                                                                                                        Most respondents were in favour of both the proposed pro-
     more than 120 days (25 of 38).                                                                                                                                                                                                       visional approvals with flexible price models and also direct
                                                                                                                                                                                                                                          negotiation between health insurers and drug producers.

48                                                                                                                                                                                                                                                                                                                        49

     Interval between Swissmedic approval and inclusion in SL,                                                                                                                                                                            Acceleration of access to medicines
     along with cumulated non-inclusions, in days, 2014–2020                                                                                                                                                                              Health Monitor, 2021

                                                                                               Source: Swissmedic (2014–2021), Specialities List, calculations by Interpharma.
         180
         160                                                                                                                                                                                                                                 Access to new medicines
                                                                                                                                                                                                                                         directly after market approval
         140
                                                                                                                                                                                                                                       Health insurance funds and drug
         120
                                                                                                                                                                                                                                        manufacturers should negotiate
         100                                                                                                                                                                     Source: gfs.bern, Health Monitor 2021, (N = 1’200).            directly with each other
                                                                                        169
           80                                                                                                                                                                                                                           Provisional marketing authoriza-
                                                                 133        136
           60                                                                                                                                                                                                                          tions with flexible pricing models
                34                                    92
           40              18              72
              4 57          6 54                  27                     23
                                       17                                            25                                                                                                                                                       Change is not necessary
           20 26                                  10          27         12
                           25          9
                                       9          11       3 5           11       4 9
          0
              2014         2015         2016       2017        2018       2019        2020                                                                                                                                                                                  0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
       Number of applications without inclusion (cumulated)
       Number of inclusions > 120 days (new active substances and indications)
       Number of inclusions > 60 days and ≤ 120 days (new active substances and indications)                                                                                                                                                 Fully agree     rather agree     do not know/no answer
       Number of inclusions ≤ 60 days (new active substances and indications)                                                                                                                                                                rather disagree     do not agree at all
Interpharma | Health Panorama 2021                                                                                                                                                                                             Focus on the patient

     The cure rate for hepatitis C has                                                                                                                                                                                              Access to AIDS medicines for more
     more than doubled                                                                                                                                                                                                              and more people
     The cure rate for hepatitis C has more than doubled from about                                                                                                                                                                 In 1983, the AIDS virus was discovered for the first time under
     40% with the 1st generation of medicines to more than 95%                                                                                                                                                                      the electron microscope. At the height of the epidemic, almost
     with the 4th generation.                                                                                                                                                                                                       2 million people were dying of the virus each year.

     With the new oral combination therapy, the duration of treat-                                                                                                                                                                  Since 2000, more and more people have had access to AIDS
     ment at 8 to 12 weeks is less than a quarter of the original                                                                                                                                                                   therapies. According to UNAIDS, the number of patients in
     duration of treatment.                                                                                                                                                                                                         therapy worldwide has risen from 0.6 million to more than 27
                                                                                                                                                                                                                                    million.
     Medical progress has led not only to a simpler treatment for
     patients, but also to a better tolerability of the medication.                                                                                                                                                                 As a result of these successful therapies, the number of AIDS
                                                                                                                                                                                                                                    deaths worldwide has more than halved in the last 20 years.
                                                                                                                                                                                                                                    Antiretroviral therapies enable AIDS patients to lead an almost
                                                                                                                                                                                                                                    normal life today.
50                                                                                                                                                                                                                                                                                                                            51

     Chronology of hepatitis C treatment                                                                                                                                                                                            Access to AIDS drugs increased sharply
     1999–2015, cure rate                                                                                                                                                                                                           In million people, 2000–2020

                                                                                           Source: PhRMA (2017), Prescription Medicines: International Costs in Context.
                                                                             95–96%
                                                          90%
                                                                                                                                                                                                                                       30                                                                       27.4    1.8
                                      63–80%
                                                                                                                                                                                                                                       25                                                                               1.5

                                                                                                                                                                           Source: UNAIDS (2021), Fact sheet World AIDS Day 2020.
                41%                                                                                                                                                                                                                    20                                                                               1.2

                                                                                                                                                                                                                                       15                                                                               0.9
                                                                                                                                                                                                                                                                                                                 0.7

                                                                                                                                                                                                                                       10                                                                               0.6
          1st generation           2nd generation     3rd generation      4th generation
           (1999–2010)              (2011–2013)        (2013–2014)         (2014–2015)                                                                                                                                                  5                                                                               0.3
            48 weeks*              24–28 weeks*         12 weeks*          8–12 weeks*
                                                                                                                                                                                                                                        0                                                                               0.0
                                                                                                                                                                                                                                             2000     2005     2010     2015        2016   2017   2018   2019    2020
                            Improved compatibility and easier treatment
                                                                                                                                                                                                                                        Number of patients in therapy (left axis)
     * Treatment duration                                                                                                                                                                                                               Number of deaths (right axis)
Interpharma | Health Panorama 2021                                                                                                                                                                         Focus on the patient

     Huge improvements in the treatment                                                                                                                                                                         Many new forms of therapy for
     of cancer                                                                                                                                                                                                  cancer
     Thanks to new, innovative treatment methods, the past decades                                                                                                                                              Cancer patients are benefiting from many new forms of treat-
     have brought a huge improvement in the treatment of cancer. As                                                                                                                                             ment: in 2020, the market share of cancer therapies amounted
     many as 50% of all cancers can already be treated today.                                                                                                                                                   to 19% of the entire market.

     Since 1972, the chances of a cure for cancers in children have                                                                                                                                             Medicines for diseases of the central nervous system – which
     doubled from 40% to 80%. Both in breast cancer and in colon                                                                                                                                                include analgesics, medicines for disorders such as epilepsy
     cancer, the mortality rate has fallen by around 50% in the last                                                                                                                                            and also treatments of mental disorders – attained the second-
     three decades.                                                                                                                                                                                             largest market share in 2020.

     Further intensive research is needed to ensure that cancers can                                                                                                                                            With a market share of almost 11%, infectious diseases were
     be treated better still in the future.                                                                                                                                                                     a further important indication area in 2020. Treatments here
                                                                                                                                                                                                                include e.g. medicines for hepatitis C, HIV and antibiotics, as
                                                                                                                                                                                                                well as vaccines.
52                                                                                                                                                                                                                                                                                                53

                                                                                    Source: Childhood cancer research Switzerland (2021); BFS, Statistics for causes of death (2021).
     Chances of a cure in cancer                                                                                                                                                                                Market share of medicines by indication area
     Year 1972, 1990, 2018                                                                                                                                                                                      Market volume 2020: CHF 6’331.7 m, at ex-factory prices
                            100%                 100%
                                                                                                                                                                                                                                   Cancer                                                     19.0%
                                                                                                                                                                                                                   Central nervous system                                             15.2%
                80%                                                  50%
                                                                                                                                                                                                                                Infections                                   10.8%
                                                                     of all can-
                                                                                                                                                                                                                           Cardiovascular                             8.5%
                                                                     cers can be
                                                                     successfully                                                                                                                                         Blood formation                      6.5%
                                          50%                50%     treated                                                                                                                                           Respiratory system                   5.3%
      40%                                                                                                                                                                                                                Digestive system                  4.9%
                                                                     Cancer is                                                                                                                                     Musculoskeletal system                 4.5%
                                                                     easier to                                                                                                                                             Sensory organs                4.2%
                                                                     control                                                                                                                                            Urogenital system              3.4%
                                                                                                                                                                                                                                      Skin             3.4%
                                                                                                                                                                                                                                   Others                                            14.5%
                                                                                                                                                                                        Source: IQVIA (2021).

     1972       2018        1990          2018   1990        2018                                                                                                                                                                            0%   2%   4%   6%   8% 10% 12% 14% 16% 18% 20%
     Chances of a cure        Reduction of        Reduction of
       in cancer in          mortality rate in   mortality rate in
         children            breast cancer        colon cancer
Interpharma | Health Panorama 2021                                                                                                                                                                                  Focus on the patient

     The proportion of innovative biotech                                                                                                                                                                                Broad research portfolios give hope
     and gene technology products is                                                                                                                                                                                     to patients
     growing continuously                                                                                                                                                                                                In 2019, a total of 6’100 products were in various stages of
     Many innovative medicines are produced in genetically modified                                                                                                                                                      development. Compared with the previous year, the number of
     organisms using biotechnological methods. Unlike with classical                                                                                                                                                     products in development were up by 5.6%.
     chemical substances, these are mostly complex, high-molecular-
     weight proteins.                                                                                                                                                                                                    The steady growth of new products reflects not only medical
                                                                                                                                                                                                                         progress, but also the fact that pharma companies reinvest a lot
     The proportion of medicines produced using biotechnology or                                                                                                                                                         in research and development.
     gene technology has grown steadily since the 1990s, which is
     good news for patients because innovative medicines promise                                                                                                                                                         Cancer therapies are a particular focus of research on new
     new treatment options in many areas.                                                                                                                                                                                medicines, but new treatment options are also being constantly
                                                                                                                                                                                                                         sought for infectious diseases, diseases of the central nervous
     About 30% of gene technology products are used to treat                                                                                                                                                             system and respiratory disorders.
     cancers.
54                                                                                                                                                                                                                                                                                                                                          55

     Market for biotech and gene technology products                                                                                                                                                                     Number of active agents in development stages close to

                                                                                                                                      Analyse der wichtigsten Finanzkennzahlen der Geschäftsjahre 2017, 2018 und 2019.
     In CHF millions, at ex-factory prices1, 1990–2020                                                                                                                                                                   marketing authorization, 2017–2019

            1’600                                                                                  1’473

                                                                                                                                      Source: Ernst & Young (2020), Die grössten Pharmafirmen weltweit.
                                                                                                                                                                                                                                                     2’140                                    2’862                            778 145 177
            1’400                                                                                                                                                                                                             2019
            1’200

            1’000                                                                                                                                                                                                                                  2’027                                    2’677                       764 141 171
              800                                                                                                                                                                                                             2018

              600
                                                                                                                                                                                                                                                  1’900                                  2’582                      746 163 173
              400
                                                                                                                                                                                                                              2017
              200
                                                                                                              Source: IQVIA (2021).

                  0
                      1990   1993      1996      1999     2002      2005   2008   2011   2014   2017   2020                                                                                                                          0             1’000            2’000           3’000            4’000           5’000          6’000

                                                                                                                                                                                                                            Phase 1          Phase 2          Phase 3          Filed        Approved
     1
         As from 2011 new calculation of gene technology products                                                                                                                                                        21 largest pharma companies worldwide (Interpharma members excl. Allergan, Lundbeck, UCB and Vifor)
Interpharma | Health Panorama 2021                                                                                                                                                                        Focus on the patient

     Ever more medicines for rare                                                                                                                                                                              Respondents are in favour of
     diseases                                                                                                                                                                                                  treatment for rare diseases
     A disease is considered rare when it affects fewer than 5 out                                                                                                                                             When it comes to rare diseases, most respondents want the
     of 10’000 people. Since there are known to be 6’000 to 8’000                                                                                                                                              treatment of such diseases to be covered by the basic health
     such diseases, the entirety of rare diseases can be likened to a                                                                                                                                          insurance, according to the Health Monitor.
     widespread disease.
                                                                                                                                                                                                               95% believe there is a duty to provide reimbursement. This
     The number of indications with orphan drug status is continu-                                                                                                                                             percentage has remained consistently high over the years and
     ously rising, because many pharma companies are engaged in                                                                                                                                                shows the importance that Swiss people attach to therapies for
     research on rare diseases.                                                                                                                                                                                rare diseases.

     In 2020, there were 181 approved medicines with orphan drug                                                                                                                                               In 2021, only 5% of voters surveyed take the view that rare dis-
     status. These are used for 253 indications, e.g. to treat rare                                                                                                                                            eases should not be treated.
     diseases of the immune or nervous system, rare metabolic dis­
     orders and also rare forms of cancer.
56                                                                                                                                                                                                                                                                                                       57

     Number of indications with orphan drug status                                                                                                                                                             Trend statements on the treatment of rare diseases
     Total: 181 medicines with orphan drug status, 2020                                                                                                                                                        In percent of respondents, share strongly/very strongly agree,
                                                                                                                                                                                                               2021
                                                                           253

                                                                                   Source: Swissmedic (2021), Human medicines with orphan drug status.
         250                                                                                                                                                                                                        100
                                                                                                                                                                                                                     90
         200                                                                                                                                                                                                         80
                                                                                                                                                                                                                     70

                                                                                                                                                         Source: gfs.bern, Health Monitor 2021, (N = 1’200).
         150                                                                                                                                                                                                         60
                                                                                                                                                                                                                     50
         100                                                                                                                                                                                                         40
                                                                                                                                                                                                                     30
           50                                                                                                                                                                                                        20
                                                                                                                                                                                                                     10
            0                                                                                                                                                                                                          0
                2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020                                                                                                                                          2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
                                                                                                                                                                                                                   Treatment always takes priority    Treatment with improved quality of life
                                                                                                                                                                                                                   Case-by-case decision        Depending on chances of survival
                                                                                                                                                                                                                   Define upper limit      Depending on age       If costs are too high = no treatment
                                                                                                                                                                                                                   Not to be used on any account
Interpharma | Health Panorama 2021   Leading in research and development

     Leading in research                  Developing a new medicine
     and development                      takes an average of 12 years and
                                          comes at a cost of $ 2.5 billion.

                                          50 percent of pharmaceutical
                                          research spending goes into
                                          basic research.

58
                                          Patent protection allows re-          59
                                          investments in pharmaceutical
                                          research.
Interpharma | Health Panorama 2021                                                                                                            Leading in research and development

     The long path from laboratory to                                                                                                              Patent protection allows reinvest-
     patient                                                                                                                                       ments in new medicines
     Pharma research is a high-risk undertaking: the development                                                                                   Many development stages and administrative hurdles have to
     of a medicine takes 12 years on average, and the risk of failure                                                                              be overcome before a medicine is ready for the market. This
     is 90%.                                                                                                                                       process is associated with high costs.

     Often unsatisfactory effects or serious side effects are only                                                                                 Patent protection often begins already in the early phases of
     identified during expensive clinical trials.                                                                                                  development. So the validity of a patent is often well-advanced
                                                                                                                                                   by the time the medicine goes on sale.
     Out of 10’000 substances, 20 make it into the preclinical phase.
     Of these 20 substances from the preclinical phase, 10 make it                                                                                 Not until the decision on reimbursement is made do medicines
     into the clinical phase. Of these 10, only one eventually reaches                                                                             begin to generate income for the companies. This income must
     the market as a finished product.                                                                                                             be high enough for the companies to recoup sufficient funds
                                                                                                                                                   for research into new medicines.
60                                                                                                                                                                                                                                             61

     Steps in the development of a medicine                                                                                                        Research cycle
                                                                                                                                                   Illustration
                                                                                                                                                                                                                 Basic
       > 1 million substances                                                                                                                                                                                  research

          10’000 substances
                                                                                                                                                                 Patent expiration                                        Preclinical phase
                       20 substances
                                        10 products        1 product
                                                                                                                                                           Production and                                                     Clinical phase
                                                                                                                                                              distribution
                  0                 5             10          15          20   years
                                                                                       Source: Interpharma (2021).

                                                                                                                     Source: Interpharma (2021).

                                                                                                                                                          Further studies after                                           Approval
                      Preclinical           Clinical                                                                                                                  approval
       Research                                               Marketing
                        phase               phase
                                        1    2         3        4
                                                                                                                                                                                                        Remuneration
                                                                                                                                                       Expenses               Revenues
                                                                                                                                                   Outer circle: research cycle, inner circle: patent expiry
Interpharma | Health Panorama 2021                                                                                                                                                                                                                                                                           Leading in research and development

     A new medication requires billions                                                                                                                                                                                                                                                                           COVID-19 vaccine development in
     in investment                                                                                                                                                                                                                                                                                                record time
     An average of 12 years passes before a new medicine is ready for                                                                                                                                                                                                                                             Before 2020, the development of the measles vaccine lasted
     the market.                                                                                                                                                                                                                                                                                                  10 years, making it one of the fastest vaccine developments in
                                                                                                                                                                                                                                                                                                                  the world.
     The process from research and development to market readiness
     costs an average of 2.5 billion dollars, making the development                                                                                                                                                                                                                                              To combat the COVID pandemic, the pharma industry already
     of a new medicine almost 15 times more expensive today than in                                                                                                                                                                                                                                               developed and launched onto the market a safe and highly
     the 1970s.                                                                                                                                                                                                                                                                                                   effective COVID vaccine within a year.

     The investments in research and development are a high-risk                                                                                                                                                                                                                                                  It took less than 300 days from the first genome sequencing

                                                                                                                                                                                     Source: OurWorldInData.org (2020), Nature analysis; Excler, Jean-Louis / Saville, Melanie / Seth, Berkley / Kim, Jerome H.
     business in view of the very high failure probability.                                                                                                                                                                                                                                                       of the SARS-CoV-2 virus to the availability of the first vaccine
                                                                                                                                                                                                                                                                                                                  efficacy study. This was also made possible thanks to concen-

                                                                                                                                                                                     (April 2021), Vaccine development for emerging infectious diseases, Nature Medicine, Vol. 27, S. 591–600 (2021).
                                                                        Source: Joseph A. DiMasi, Henry G. Gravowski, Ronald W. Hansen, Innovation in the pharmaceutical industry:
                                                                                                                                                                                                                                                                                                                  trated resources and strong collaboration.
62                                                                                                                                                                                                                                                                                                                                                                                                    63

     Cost of development up to market readiness                                                                                                                                                                                                                                                                   Time between the emergence of the pathogen and the
     In $ millions                                                                                                                                                                                                                                                                                                availability of a vaccine in the United States

                                                                        New estimates of R&D costs, Journal of Health Economics, 47 (2016), 20–33.
                                                              2’558
        2’500                                                                                                                                                                                                                                                                                                         Typhoid fever                                                       1884–1989
                                                                                                                                                                                                                                                                                                                        Meningitis                                                        1889–1981
        2’000                                                                                                                                                                                                                                                                                                      Whooping cough                                                         1906–1948
                                                                                                                                                                                                                                                                                                                              Polio                                                       1908–1955
                                                                                                                                                                                                                                                                                                                         Zika fever                                                       1947–ongoing
        1’500
                                                                                                                                                                                                                                                                                                                       Chickenpox                                                         1953–1963
                                                  1’044                                                                                                                                                                                                                                                                   Measles                                                         1953–1995
        1’000                                                                                                                                                                                                                                                                                                                 AIDS                                                        1963–ongoing
                                                                                                                                                                                                                                                                                                                          Hepatitis                                                       1965–1981
         500                          413                                                                                                                                                                                                                                                                         Diarrheal disease                                                       1973–2006
                     179                                                                                                                                                                                                                                                                                                     Ebola                                                        1976–2019
                                                                                                                                                                                                                                                                                                                        COVID-19                                                          Jan.–Dec. 2020
           0
                                                                                                                                                                                                                                                                                                                                  1880   1900   1920   1940   1960   1980   2000   2020
                   1970 –           1980 –       1990 –      2000s –
                 early 1980s      early 1990s   mid 2000s   mid 2010s
Interpharma | Health Panorama 2021                                                                                                                                                                                                                                                        Leading in research and development

     The private sector finances most                                                                                                                                                                                                                                                          Most research and development
     of the research and development                                                                                                                                                                                                                                                           in the private sector is financed by
     carried out in Switzerland                                                                                                                                                                                                                                                                pharma
     In 2019, a total of CHF 22.9 bn was invested in Switzerland’s                                                                                                                                                                                                                             Each year, the private sector invests CHF 15.5 bn in Switzer-
     position as a research hub.                                                                                                                                                                                                                                                               land’s position as a research hub. The pharma industry is the
                                                                                                                                                                                                                                                                                               largest private investor, accounting for 33% of investments.
     Of these investments, 67.5% came from the private sector. The
     pharma sector was the most important investor, accounting for                                                                                                                                                                                                                             The importance of pharma warrants even greater acknowledg-
     one-third of private-sector research expenditure.                                                                                                                                                                                                                                         ment, because a large proportion of the labs and research insti-
                                                                                                                                                                                                                                                                                               tutions are also financed through external research contracts
     The universities are the second-largest investor in research and                                                                                                                                                                                                                          that fall under “research and development” in the sector.
     development in Switzerland accounting for 28.9% of research
     expenditure.                                                                                                                                                                                                                                                                              Further important research industries are the ICT and machine
                                                                                                                                                                                                                                                                                               engineering sectors. The chemicals sector accounts 3% to the
                                                                                                                                                                                                                                                                                               Swiss research hub.
64                                                                                                                                                                                                                                                                                                                                                                        65

                                                                                           Source: Federal Statistical Office (2021), Research and Development (R&D) in Switzerland, 2019.

                                                                                                                                                                                             Source: Federal Statistical Office (2021), Research and Development (R&D) in Switzerland, 2019.
     Total research and development expenditure                                                                                                                                                                                                                                                Research and development expenditure in the private sector
     2019                                                                                                                                                                                                                                                                                      2019

                                     2.7% 0.9%

                                                                                                                                                                                                                                                                                                                      28%
                          28.9%                                                                                                                                                                                                                                                                                                                       33%
                                         22’884                                                                                                                                                                                                                                                                                   15’500
                                       CHF millions                                                                                                                                                                                                                                                                             CHF millions
                                         (100%)                                                                                                                                                                                                                                                                                   (100%)
                                                                                                                                                                                                                                                                                                                     3%
                                                             67.5%
                                                                                                                                                                                                                                                                                                                       11%
                                                                                                                                                                                                                                                                                                                                                13%
                                                                                                                                                                                                                                                                                                                                 11%

                                                                                                                                                                                                                                                                                                 Pharma      Research and development     ICT     Machinery   Chemicals
       Private sector   Cantons    Private non-profit organizations   Federal government                                                                                                                                                                                                         Rest
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