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 2016 there were 60 wholesalers in Estonia and six of them were specialized only on veterinary medicines.
(human and veterinary medicines)
(only veterinary medicines)
In 2015, 29 wholesale companies sold drugs to general or hospital pharmacies or to other institutions. 75% of medicinal products market was covered by three major wholesalers: Magnum Medical (30.1%), Tamro Estonia (24.5%), Apteekide Koostöö Wholesale (21.0%). Followed by Estonian Health Board (5.9%), Roche Estonia (4.7%), Baltfarma (4.2%). The total market share of 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 2015 the medicinal products market increased 6.3% reaching to 265.2 million euros.
Figure 1. Estonian medicinal products market in 2011-2015
Sales to general pharmacies covered 69% (183.2 million euros) and sales to hospital pharmacies 30% (79.5 million euros) of total medicinal products market. Sales to other institutions, i.e. state and scientific institutions were modest, being 1% (2.4 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 product market can be characterized by seasonality: prescription medicines turnover is always greater in 2nd and 4th quarter than in 1st and 3rd quarter, while growth in the sales of over-the-counter medicines can be seen in 1st and 4th quarter.
Figure 2. Prescription medicines turnover in 2011-2015 by quarters
Figure 3. Over the counter medicines turnover in 2011-2015 by quarters
Medicinal product market share and drug consumption
Figure 4. Estonian medicinal products market share between ATC groups in 2013-2015
Based on ATC classification antineoplastic and immunomodulating drugs had the greatest market share (20%), alimentary tract and metabolism medicines followed with 12%, antiinfectives for systemic use with 12% and cardiovascular drugs 12%.
In 2015, 2491 different medicinal preparations of 1262 active substances were used in Estonia.
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.
Figure 5. Consumption of medicinal products in Estonia 2013-2015 (defined daily doses per 1000 inhabitants a day)
According to DDD/1000/day in 2015 cardiovascular drugs was used the most (417 DDD/1000/day), followed by alimentary tract and metabolism (162 DDD/1000/day) and nervous system medicines (114 DDD/1000/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.
The DDD system cannot be applied to all medicines, mainly due to very individual dosing and different administrations. Therefore the figure above does not contain ATC groups herbal medicinal products and various. Many dermatologicals as well as antineoplastic and immunomodulating agents have not been assigned DDDs.
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 greatly prices. The consumption of cardiovascular drugs during recent years is a good illustration for this – meanwhile the turnover has been decreasing, the number of DDD/1000/day (actual consumption) has increased.
More information about drug consumption in Defined Daily Doses can be found on our website.