Market Intelligence Report, Biologic Response Modifier Agents, 2015

Rapport situation marché
September 2018
PDF - 875 KB

Supplement: 2017

Introduction

This document is a supplement to the PMPRB publication "Market Intelligence Report: Biologic Response Modifier Agents, 2015"Footnote 1 produced under the NPDUIS initiative. The supplement provides updated information for key market trends identified in the original report using data for 2016 and 2017. These trends, which are captured in the corresponding figures, represent only a subset of the results published in the original report.

The methodology is in line with that of the original study, and the associated introductory material, limitations, overall conclusions, and disclaimers still apply. The results presented in this supplement follow the general interpretation provided in the original report.

List of Figures

Figure 2.1 Biologic DMARDs sales* index, Canada and PMPRB7, 2010 to 2017

Figure 2.1
Figure description

This line graph depicts the growth in the sales of biologic DMARDs in Canada and the PMPRB7 from 2010 to 2017. The sales values are indexed to start at a value of one in 2010 and are as follows:

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2010 2011 2012 2013 2014 2015 2016 2017
Canada 1.00 1.17 1.33 1.56 1.77 1.98 2.21 2.37
France 1.00 1.05 1.23 1.32 1.40 1.52 1.63 1.63
Germany 1.00 1.12 1.30 1.48 1.64 1.77 1.96 2.06
Italy 1.00 1.09 1.18 1.28 1.37 1.44 1.50 1.57
Sweden 1.00 1.14 1.22 1.35 1.48 1.58 1.62 1.69
Switzerland 1.00 1.15 1.33 1.41 1.41 1.50 1.60 1.68
United Kingdom 1.00 1.19 1.36 1.54 1.70 1.91 2.02 2.19
United States 1.00 1.12 1.28 1.48 1.79 2.16 2.62 2.96
Canadian CAGR 13.1%

The yearly sales of biologic DMARDs in Canada are given in a small table at the bottom of the graph:

  • 2010: $1.1 billion
  • 2011: $1.3 billion
  • 2012: $1.5 billion
  • 2013: $1.8 billion
  • 2014: $2.0 billion
  • 2015: $2.2 billion
  • 2016: $2.5 billion
  • 2017: $2.7 billion

*Manufacturer price levels.
France, Germany, Italy, Sweden, Switzerland, the United Kingdom, and the United States.
Data source: MIDAS™ Database, prescription retail and hospital markets, 2010 to 2017, IQVIA. All rights reserved.

Figure 2.2 Biologic DMARD market shares of total pharmaceutical sales*, Canada and PMPRB7, 2010 to 2017

Figure 2.2
Figure description

This bar graph depicts the biologic DMARD market share of total pharmaceutical sales for Canada and the PMPRB7 countries from 2010 to 2017:

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2010 2011 2012 2013 2014 2015 2016 2017
Canada 5.8% 6.9% 7.9% 9.2% 9.8% 10.3% 10.5% 10.7%
France 3.8% 4.0% 4.7% 5.1% 5.4% 5.7% 5.9% 5.8%
Germany 5.1% 5.7% 6.4% 7.0% 7.4% 7.7% 8.1% 8.2%
Italy 3.5% 3.8% 4.1% 4.3% 4.5% 4.1% 4.2% 4.1%
Sweden 8.6% 9.6% 10.4% 11.2% 11.7% 11.6% 11.5% 11.4%
Switzerland 5.7% 6.5% 7.3% 7.7% 7.7% 7.7% 7.9% 7.9%
United Kingdom 5.0% 5.8% 6.6% 7.0% 7.1% 7.2% 7.3% 7.5%
United States 4.3% 4.7% 5.5% 6.1% 6.5% 7.0% 8.1% 8.9%

*Manufacturer price levels.
France, Germany, Italy, Sweden, Switzerland, the United Kingdom, and the United States.
Data source: MIDAS™ Database, prescription retail and hospital markets, 2010 to 2017, IQVIA. All rights reserved.

Figure 2.4 Distribution of sales by biologic DMARD, Canada and PMPRB7*, 2017

Figure 2.4
Figure description

This bar graph gives the 2017 sales of each drug as a percentage of the total biologic DMARD sales for Canada and each of the PMPRB7 countries:

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Canada France Germany Italy Sweden Switzerland United Kingdom United States
Infliximab 40.0% 15.6% 6.9% 5.3% 6.6% 21.2% 3.8% 13.4%
Infliximab biosimilar 0.6% 7.6% 4.4% 5.9% 9.9% 1.6% 12.5% 0.2%
Adalimumab 26.7% 28.8% 34.3% 28.4% 29.7% 22.5% 37.2% 42.1%
Etanercept 11.6% 13.0% 14.2% 18.1% 9.3% 13.4% 8.6% 21.7%
Etanercept biosimilar 0.1% 0.5% 5.7% 1.7% 12.7% 0.0% 8.7% 0.0%
Rituximab 9.5% 17.2% 10.9% 17.9% 13.0% 13.5% 10.7% 10.0%
Rituximab biosimilar 0.0% 0.3% 1.4% 0.3% 0.0% 0.0% 2.4% 0.0%
Golimumab 5.5% 5.6% 7.2% 8.0% 6.7% 12.9% 5.0% 3.0%
Abatacept 2.5% 3.9% 3.2% 6.0% 3.8% 4.1% 3.2% 4.4%
Tocilizumab 2.0% 4.1% 6.5% 4.5% 4.7% 6.9% 4.6% 2.0%
Certolizumab pegol 1.5% 2.8% 4.9% 3.7% 3.0% 3.8% 3.2% 3.1%
Sarilumab 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
Anakinra 0.0% 0.6% 0.4% 0.4% 0.5% 0.0% 0.2% 0.0%

In 2017, the uptake of the biosimilar for infliximab in Canada was still relatively low (2.7% of all infliximab use) compared with the average (35.2%) and median (32.9%) uptake across all OECD countries.
*France, Germany, Italy, Sweden, Switzerland, the United Kingdom, and the United States.
Data source: MIDAS™ Database, prescription retail and hospital markets, 2017, IQVIA. All rights reserved.

Note: The OECD median for 2017 was originally reported as 35.2%. The text has subsequently been revised.

Figure 3.1 Trends in Canadian sales* of biologic DMARDs by drug product, 2010 to 2017

Figure 3.1
Figure description

This series of graphs illustrates the trends in Canadian sales of biologic DMARDs, by drug product from 2010 to 2017.

Two bar graphs on the left depict the growth in sales for biologic DMARDs from $1.1 billion in 2010 to $2.7 billion in 2017. The contribution of each individual medicine to this growth is as follows:

  • Infliximab: 43%;
  • Adalimumab: 31%;
  • Etanercept: 3%;
  • Rituximab: 6%;
  • Golimumab: 9%;
  • Abatacept: 3%;
  • Tocilizumab: 3%;
  • Certolizumab: 2%;
  • Anakinra: 0%;
  • Sarilumab; 0%.

The area graph on the right depicts the sales of each medicine for each year from 2010 to 2017:

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2010 2011 2012 2013 2014 2015 2016 2017
Infliximab $0.42B $0.49B $0.55B $0.67B $0.77B $0.88B $1.02B $1.09B
Adalimumab $0.24B $0.29B $0.36B $0.42B $0.49B $0.56B $0.65B $0.72B
Etanercept $0.26B $0.28B $0.31B $0.32B $0.33B $0.34B $0.33B $0.32B
Rituximab $0.17B $0.18B $0.19B $0.21B $0.23B $0.23B $0.25B $0.26B
Golimumab $0.01B $0.03B $0.05B $0.06B $0.08B $0.11B $0.13B $0.15B
Abatacept $0.02B $0.03B $0.03B $0.04B $0.04B $0.05B $0.06B $0.07B
Tocilizumab $0.00B $0.01B $0.02B $0.03B $0.03B $0.04B $0.05B $0.05B
Certolizumab pegol $0.00B $0.01B $0.01B $0.02B $0.02B $0.03B $0.03B $0.04B
Anakinra $0.00B $0.00B $0.00B $0.00B $0.00B $0.00B $0.00B $0.00B
Sarilumab $ - $ - $ - $ - $ - $ - $ - $0.00B
Canadian sales $1.1B $1.3B $1.5B $1.8B $2.0B $2.2B $2.5B $2.7B
Compound annual growth rate 13.1%

The two pie graphs below give the share of sales of each medicine in 2010 and 2017.

Share of sales in 2010:

  • Infliximab: 37.1%;
  • Adalimumab: 21.1%;
  • Etanercept: 23.3%;
  • Rituximab: 14.9%;
  • Golimumab: 1.1%;
  • Abatacept: 1.9%;
  • Tocilizumab: 0.1%;
  • Certolizumab: 0.2%;
  • Anakinra: 0.2%;
  • Sarilumab: 0%.

Share of sales in 2017:

  • Infliximab: 40.6%;
  • Adalimumab: 26.7%;
  • Etanercept: 11.8%;
  • Rituximab: 9.5%;
  • Golimumab: 5.5%;
  • Abatacept: 2.5%;
  • Tocilizumab: 2.0%;
  • Certolizumab: 1.5%;
  • Anakinra: 0%;
  • Sarilumab: 0.1%.

*Manufacturer price levels.
Data source: MIDAS™ Database, prescription retail and hospital markets, 2010 to 2017, IQVIA. All rights reserved.

Figure 3.6 Annual treatment costs in public drug plans, by biologic DMARDs, 2010 to 2017

Figure 3.6
Figure description

This bar graph gives the average annual treatment cost per beneficiary (excluding markup and dispensing costs) in public drug plans from 2010 to 2017. Treatment costs are given for each biologic DMARD and for the class average.

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2010 2011 2012 2013 2014 2015 2016 2017
Infliximab $21.1K $23.5K $24.4K $25.9K $27.0K $27.3K $28.5K $29.5K
Adalimumab $13.1K $14.3K $14.9K $15.4K $15.7K $15.8K $16.3K $16.4K
Etanercept $11.9K $14.0K $14.0K $14.5K $14.7K $14.6K $15.4K $15.3K
Rituximab $10.7K $11.7K $13.4K $13.0K $12.3K $12.1K $12.2K $12.1K
Golimumab  -  - $11.8K $12.7K $13.5K $13.4K $13.8K $14.3K
Abatacept $10.1K $11.3K $12.6K $12.4K $11.1K $11.3K $12.9K $13.1K
Tocilizumab  -  - $9.6K $10.9K $11.8K $11.5K $10.4K $11.2K
Certolizumab pegol  -  - $10.6K $11.4K $12.0K $12.2K $11.3K $12.0K
Anakinra $9.4K $10.5K $11.7K $11.3K $11.0K $11.5K $10.9K $11.5K
Average $15.0K $16.5K $17.1K $17.9K $18.3K $18.4K $18.6K $18.6K

The accompanying table below the graph gives additional information for each drug

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  Infliximab Adalimumab Etanercept Rituximab Golimumab Abatacept Tocilizumab Certolizumab pegol Anakinra
National sales $1,092.1M $717.4M $316.3M $255.7M $148.9M $66.9M $52.6M $39.1M $0.2M
Market share 40.61% 26.68% 11.76% 9.51% 5.54% 2.49% 1.96% 1.46% 0.01%
Average annual drug cost per beneficiary: Public plans $29.5K $16.4K $15.3K $12.1K $14.3K $13.1K $11.2K $12.0K $11.5K
Average annual drug cost per beneficiary: Private plans $26.8K $15.0K $13.3K $12.3K $13.3K $11.9K $11.0K $11.6K $9.4K
Annual treatment cost based on HDAP recommended doses – using AQPP prices $21.9K $19.7K $20.9K $8.8K $16.5K $22.9K IV: $16.8K
SC: $18.9K
$17.4K $18.3K
PMPRB HDAP recommended dose for annual maintenance 2,275 mg 1,040 mg 2,600 mg 2,000 mg 600 mg 9,750 mg IV: 7,280 mg
SC: 8,424 mg
5,200 mg 36,500 mg

*Includes drug cost and excludes markup and dispensing cost; the costs reported reflect the amounts what were accepted for reimbursement by the drug plans.
PMPRB Human Drug Advisory Panel.
‡Association Québécoise des pharmaciens propriétaires.
Data source: Public drug plans: National Prescription Drug Utilization Information System Database, Canadian Institute for Health Information, 2010 to 2017. Private drug plans: IQVIA Private Pay Direct Drug Plan Database, 2010 to 2017.

Figure 4.1 Average foreign-to-Canadian price* ratios for biologic DMARDs, Canada versus PMPRB7 and OECD countries, 2017

Figure 4.1
Figure description

This bar graph gives the 2017 bilateral foreign-to-Canadian price ratios for biologic DMARDs for each of the PMPRB7 countries, as well as the multilateral foreign-to-Canadian price ratios for the PMPRB7 and Organisation for Economic Co-operation and Development median prices. Foreign prices are compared to the Canadian price level, which is set to one.

France: 0.64; Germany: 0.93; Italy: 0.75; Sweden: 0.81; Switzerland: 1.01; United Kingdom: 0.65; United States: 1.70; PMPRB7 median: 0.82; Organisation for Economic Co-operation and Development median: 0.71.

*Manufacturer price levels.
France, Germany, Italy, Sweden, Switzerland, the United Kingdom, and the United States.
Data source: MIDAS™ Database, January–December 2017, IQVIA. All rights reserved.

Figure 4.2 Foreign-to-Canadian price* ratios by biologic DMARD, Canada versus PMPRB7 and OECD countries, 2017

Figure 4.2
Figure description

This graph gives the 2017 foreign-to-Canadian price ratios by biologic DMARD for the PMPRB7 and Organisation for Economic Co-operation and Development countries. The Canadian price (which is given in the table below the graph) is set to one and the international measures reported relative to this value. On the graph, the price ranges for the six European countries in the PMPRB7 are represented by rectangular boxes. The median PMPRB7 price, the median Organisation for Economic Co-operation and Development price, and the average United States price are also reported.

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  Remicade Humira Enbrel Rituxan Simponi Orencia Cimzia Kineret Actemra IV Actemra SC
Strength 100 mg 40 mg/
0.8 mL
50 mg/
mL
500 mg 50 mg/
0.5 mL
250 mg 200 mg/
mL
150 mg
/mL
400 mg/
20 mL
162 mg
Canadian price (= 1) $973 $762 $396 $2,288 $1,543 $490 $668 $50 $919 $364
European minimum foreign-to-Canadian price ratio 0.34 0.65 0.53 0.54 0.66 0.84 0.64 0.75 0.81 0.81
PMPRB7 median foreign-to-Canadian price ratio 0.76 0.95 0.79 0.80 0.99 1.11 1.01 0.86 1.21 1.01
United States-to-Canadian price ratio 0.96 3.34 3.23 1.81 3.13 2.03 3.16 2.52 2.20 3.02
European maximum foreign-to-Canadian price ratio 0.96 1.37 1.27 0.98 1.36 1.29 1.35 0.93 1.51 1.42
Organisation for Economic Co-operation and Development median foreign-to-Canadian price ratio 0.65 0.85 0.71 0.77 0.85 1.00 0.87 0.87 0.99 0.93

The 24% price differential between foreign and Canadian list prices for Remicade translates into $262 million in drug sales in Canada in 2017.
Note: In Canada, Remicade infusions are almost exclusively delivered in manufacturer‐sponsored infusion centers, while in other countries the infusions are generally delivered in hospitals.
*Manufacturer price levels.
France, Germany, Italy, Sweden, Switzerland, the United Kingdom, and the United States.
Data source: MIDAS™ Database, January–December 2017, IQVIA. All rights reserved.

Figure 4.3 Annual treatment cost for biologic DMARDs, Canada versus PMPRB7* and OECD countries, 2017

Figure 4.3
Figure description

This graph gives the 2017 annual treatment costs for biologic DMARDs for Canada, as well as the PMPRB7 and Organisation for Economic Co-operation and Development countries. The ranges in treatment costs for the six European countries in the PMPRB7 are represented by rectangular boxes. The average Canadian treatment cost, the median PMPRB7 cost, the median Organisation for Economic Co-operation and Development cost and the average United States treatment cost are also provided.

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  Remicade Humira Enbrel Rituxan Simponi Orencia Cimzia Kineret Actemra IV Actemra SC
European minimum annual treatment cost $7.8K $12.5K $10.9K $4.2K $11.3K $16.1K $11.1K $9.0K $13.6K $15.3K
PMPRB7 median annual treatment cost $13.7K $18.8K $16.7K $5.8K $16.9K $28.5K $17.5K $15.6K $20.3K $20.2K
Canadian annual treatment cost $21.9K $19.7K $20.9K $8.8K $16.5K $22.9K $17.4K $18.3K $16.8K $18.9K
United States annual treatment cost $21.3K $66.3K $69.3K $16.4K $29.8K $53.0K $24.9K $46.4K $36.6K $57.2K
European maximum annual treatment cost $20.8K $26.9K $27.7K $8.6K $22.0K $31.9K $23.5K $22.2K $25.0K $26.8K
Organisation for Economic Co-operation and Development median annual treatment cost $12.9K $16.6K $15.3K $6.0K $14.1K $22.6K $15.1K $16.0K $16.8K $17.5K

Note: Annual doses are based on PMPRB Human Drug Advisory Panel (HDAP) recommendations.
*France, Germany, Italy, Sweden, Switzerland, the United Kingdom, and the United States.
Data source: MIDAS™ Database, January–December 2017, IQVIA. All rights reserved.

Figure 4.4 Rate of consumption* of biologic DMARDs, Canada versus PMPRB7 and OECD countries, 2017

Figure 4.4
Figure description

This graph compares the 2017 Canadian consumption rates for biologic DMARDs to the rates in the PMPRB7 countries. The ranges in consumption rates for the six European countries in the PMPRB7 are represented by rectangular boxes. The average Canadian, average United States and median PMPRB7 consumption rates are also given. Consumption rates are measured as the number of annual doses per one million inhabitants.

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  Remicade Humira Enbrel Rituxan Simponi Orencia Cimzia Kineret Actemra IV Actemra SC
European minimum 33 6 3 139 3 1 3 1 22 16
PMPRB7 median 626 717 352 959 157 63 90 7 50 47
Canada 1,418 1,034 430 829 256 83 64 59 27
United States 1,008 973 494 959 157 131 183 1 50 23
European maximum 918 1,663 884 1,368 396 88 118 24 123 110
Organisation for Economic Co-operation and Development median 350 652 289 687 145 31 60 5 39 41

*Based on the annual maintenance dose determined by the PMPRB Human Drug Advisory Panel and reported per one million inhabitants per year.
France, Germany, Italy, Sweden, Switzerland, the United Kingdom, and the United States.
Data source: MIDAS™ Database, January–December 2017, IQVIA. All rights reserved.

Acknowledgements

The PMPRB would like to acknowledge the following staff for their contributions to this supplement:

  • Tanya Potashnik – Director, Policy and Economic Analysis
  • Elena Lungu – Manager, NPDUIS
  • Karine Landry – A/Manager, Statistics and Data Management
  • Fatemeh Saberianranjbar – Economic Analyst
  • Jun Yu – Data Systems Analyst
  • Carol McKinley – Publications Advisor
  • Sarah Parker – Junior Communications Officer
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