Estonian annual drug statistics is based on wholesalers’ reports. The statistics of human medicinal products includes sales to general and hospital pharmacies and to other institutions, i.e. state and scientific institutions.
In January 2017 there were 64 wholesalers in Estonia and six of them were specialized only on veterinary medicines.
(human and veterinary medicines)
(only veterinary medicines)
In 2016, 34 wholesale companies sold drugs to general or hospital pharmacies or to other institutions. 77% of medicinal products market was covered by three major wholesalers: Magnum Medical (31%), Tamro Estonia (24%), Apteekide Koostöö Hulgimüük (22%). Followed by Roche Estonia (5.5%), Estonian Health Board (4.9%), Baltfarma (4.8%). The total market share of the other wholesalers remained under 10%.
Medicinal products market
The medicinal products market is expressed in wholesale prices which includes the price of the manufacturer and wholesaler’s mark-up and does not include the VAT.
In 2016 the medicinal products market increased 9.3% reaching to 290 million euros.
Figure 1. Estonian medicinal products market in 2012-2016
Sales to general pharmacies covered 71% (more than 205 million euros) and sales to hospital pharmacies 28% (82 million euros) of total medicinal products market. Sales to other institutions, i.e. state and scientific institutions were modest, being 1% (less than 3 million euros) of total sales.
The proportion of prescription sales was 85% which comparing to over the counter sales (14%) and hospital package sales (1%) covered most of the medicinal products market.
Medicinal products market can be characterized by seasonality: the turnover of prescription medicines increases in 2nd and 4th quarter, while the sales of over-the-counter medicines are significantly higher in 1st and 4th quarter.
Figure 2. Prescription medicines turnover in 2012-2016 by quarters
Figure 3. Over the counter medicines turnover in 2012-2016 by quarters
Medicinal product market share and drug consumption
Based on ATC classification antineoplastic and immunomodulating agents had the greatest market share (20%), followed by antiinfectives for systemic use (15%), alimentary tract and metabolism medicines (12%) and cardiovascular drugs (11%).
Figure 4. Estonian medicinal products market share between ATC groups in 2014-2016
DDD/1000/day describes often population drug consumption better than turnover which can be quite unstable, for example new generic drugs that come to market affect prices greatly.
Defined Daily Dose (DDD) is the assumed average dose per day for the drug used in its main indication in adults.
Defined Daily Dose per thousand inhabitants a day (DDD/1000/day) expresses the proportion of the population within a defined area treated daily with certain drugs.
The DDD system cannot be applied to all medicines, mainly due to very individual dosing and different administrations. Therefore the Figure 5 does not contain ATC groups “Herbal medicinal products” and “Various”. Many dermatologicals as well as antineoplastic and immunomodulating agents have not been assigned DDDs.
According to DDD/1000/day, the most consumed medicines in 2016 were cardiovascular drugs (412 DDD/1000/day), followed by alimentary tract and metabolism (168 DDD/1000/day) and nervous system medicines (118 DDD/1000/day).
Figure 5. Consumption of medicinal products in Estonia 2014-2016 (defined daily doses per 1000 inhabitants a day)
On the basis of DDD/1000/day, the most used prescription medicines were Ramipril, Amlodipine and Rosuvastatin, while most consumed OTC drugs were the combination of Acetylsalicylic acid and Magnesium oxide (for cardiac use), Ibuprofen and Xylometazoline.
In 2016, 2505 different medicinal preparations of 1274 active substances were used in Estonia.