Estonian annual drug statistics is based on wholesalers’ quarterly reports. The statistics of human medicinal products includes sales to general and hospital pharmacies and to other institutions, i.e. state and scientific institutions.

WHOLESALERS

In January 2018 there were 67 wholesalers in Estonia and five of them were specialized only on veterinary medicines.

In 2017, 31 wholesalers sold human medicines to general or hospital pharmacies or to other institutions. Three major wholesalers covered 76% of human medicinal products market: Magnum Medical (29%), Tamro Estonia (26%) and Apteekide Koostöö Hulgimüük (21%). Followed by Roche Estonia (6%), Estonian Health Board (5%) and Baltfarma (5%). The total market share of the other wholesalers remained under 10%.

MEDICINAL PRODUCTS MARKET OF HUMAN MEDICINES

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 2017 the medicinal products market increased 3.8% reaching to 301 million euros.

Figure 1. Estonian medicinal products market in 2013-2017

Sales to general pharmacies covered 69% (208.6 million euros) and sales to hospital pharmacies 30% (89.7 million euros) of total medicinal products market. Sales to other institutions were modest, being 1% (2.7 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 is higher in 2nd and 4th quarter, whilst the sales of over-the-counter medicines increase in 1st and 4th quarter.

Figure 2. Prescription medicines turnover in 2013-2017 quarterly

Figure 3. Over-the-counter medicines turnover in 2013-2017 quarterly

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%) and alimentary tract and metabolism medicines (12%).

Figure 4. Estonian medicinal products market share between ATC groups in 2015-2017

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 2017 were cardiovascular system drugs (418 DDD/1000/day), followed by alimentary tract and metabolism (170 DDD/1000/day) and nervous system medicines (123 DDD/1000/day).

Figure 5. Consumption of medicinal products in Estonia in 2015-2017 (defined daily doses per 1000 inhabitants a day)

On the basis of DDD/1000/day, the most used prescription medicines were Ramipril (57 DDD/1000/day), Rosuvastatin (30 DDD/1000/day) and Amlodipine (28 DDD/1000/day), while most consumed OTC drugs were the combination of Acetylsalicylic acid and Magnesium oxide (47 DDD/1000/day), Ibuprofen (22 DDD/1000/day) and Xylometazoline (21 DDD/1000/day).

In 2017, 4204 different medicinal preparation packages and 1308 active substances were marketed in Estonia.