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艾昆纬(IQVIA):2024年全球药品使用趋势报告-展望至2028(英文版)(60页).pdf

1、Global Use of Medicines 2024 OUTLOOK TO 2028JANUARY202 4With the World Health Organizations declaration on May 5,2023,of the end of the COVID-19 public health emergency,attention has shifted to the prevention and treatment of other communicable diseases as well as non-communicable diseases,and the c

2、ritical contributions of medicines globally.Breakthrough therapies launched over the past decade for multiple diseases are reshaping patient care in many areas and the outlook for medicines use and the related spending-through 2028 is higher than prior forecasts as more novel drugs become available

3、and despite a significant downward revision of the outlook for COVID-19 vaccines and therapeutics.The largest driver of medicine spending growth through the next five years is still expected to be the availability and use in developed markets of innovative therapeutics and offset by losses of exclus

4、ivity and the lower costs of generics and biosimilars.Traditionally,innovative medicine growth has occurred most in the years immediately following launch,whereas recent years and the forecast outlook show growth driven by older products.This mix of spending growth between volume-driven growth,and m

5、ix-driven changes in the cost of therapy are showing most geographies shifting to more expensive therapies,reflecting the broader availability and patient access to medicines with higher clinical value.In this report,we quantify the impact of these dynamics and examine the spending and usage of medi

6、cines in 2023 and the outlook to 2028,globally and for specific therapy areas and countries.We intend for this report to provide an evidence-based foundation for meaningful discussion by all stakeholders about the value,cost,and role of medicines over the next five years in the context of overall he

7、althcare spending.The study was produced independently by the IQVIA Institute for Human Data Science as a public service,without industry or government funding.The contributions to this report by Mohit Agarwal,Aurelio Arias,Tanya Bhardwaj,Urvashi Porwal,Alan Thomas,and many others at IQVIA are grate

8、fully acknowledged.Find Out MoreIf you wish to receive future reports from the IQVIA Institute for Human Data Science or join our mailing list,visit iqviainstitute.org.MURRAY AITKENExecutive Director IQVIA Institute for Human Data ScienceIntroductionGlobal Use of Medicines:Outlook to 20282024 IQVIA

9、and its affiliates.All reproduction rights,quotations,broadcasting,publications reserved.No part of this publication may be reproduced or transmitted in any form or by any means,electronic or mechanical,including photocopy,recording,or any information storage and retrieval system,without express wri

10、tten consent of IQVIA and the IQVIA Institute.REFERENCING THIS REPORTPlease use this format when referencing content from this report:Source:IQVIA Institute for Human Data Science.Global Use of Medicines:Outlook to 2028,January 2024.Available from www.iqviainstitute.orgTable of ContentsOverview 2Out

11、look for the use of medicines and drivers 4Therapy area drivers of medicine use 10Spending and growth by regions and key countries 19Key therapy areas 41Notes on sources 53Definitions&Methodologies 54About the authors 56About the Institute 572|Global Use of Medicines:Outlook to 2028Overall,global us

12、e and spending on medicines is exceeding pre-pandemic growth rates and is expected to continue significantly above those trends through 2028.Significant usage shifts and spending growth acceleration across geographies became apparent in 2023 and have contributed to an increase in the outlook for med

13、icine spending through 2028 of two percentage points to 5-8%CAGR,bringing global spending on medicines at list prices to$2.3Tn.This is at the same time the COVID-19 pandemic has shifted to endemic and the outlook for vaccinations and therapeutic spending has been revised downward by nearly$200Bn,dri

14、ven by lower usage and offset by rising prices.Global health systems have demonstrated remarkable resilience in the face of the pandemic,global inflation,and regional conflicts,and have moved forward to adopt novel therapies and increase usage overall.Overall,global use and spending on medicines is

15、exceeding pre-pandemic growth rates and is expected to continue significantly above those trends through 2028.OUTLOOK FOR THE USE OF MEDICINES AND DRIVERS The volume use of medicines globally plateaued in 2023 but is expected to grow at an average 2.3%rate through 2028,driven by China,India and othe

16、r Asian markets all growing faster than 3%.Countries in Latin America have grown more rapidly than other regions in the last five years and are expected to grow further at 1.9%annually through the forecast.North America,Western Europe and Japan are expected to grow medicine usage more slowly,partly

17、due to their already higher per capita use.In 2024,Eastern Europe volume growth is expected to return to trends present prior to the start of the Ukraine conflict.THERAPY AREA DRIVERS OF MEDICINE USE Medicine use for specific therapy areas has been growing since 2018,with notably high growth in immu

18、nology,endocrinology,and oncology.These areas of rising usage have been driven more by wider adoption of older therapies compared to newer medicines.Immunology treatments have seen a steady 12%rise in utilization but the rates of per capita usage have varied considerably even within wealthier develo

19、ped countries.Overall,nearly half of immunology biologic volume is facing biosimilar competition in developed markets,which has led to an incremental 5%in usage as more patients use treatments as costs decline.GLP-1 agonist medicines have been approved for both diabetes and obesity indications and h

20、ave seen rapid uptake since 2021,coinciding with U.S.obesity approvals.Another area of notable medicine use shifts has been the use of antibacterials,which was significantly disrupted by the COVID-19 pandemic but returned to historic levels in 2022 and 2023.There remains a concerning reduction in th

21、e rates of adult vaccinations as many countries are vaccinating at rates below their pre-pandemic trend,leaving an estimated 100 million fewer doses administered since 2020.Some notable localized disruptions in usage were triggered by climate events in recent years,a pattern expected to be more comm

22、on and severe in coming years.In cases where wildfires,floods and hurricanes have had unexpectedly severe impact,specific medicines have seen spikes in demand for necessary medicines,or disrupted or displaced prescriptions,impacting patients health and requiring resilient health systems and supply c

23、hains.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES The global medicine market using list price levels is expected to grow at 58%CAGR through 2028,reaching about$2.3Tn in total market size.It is expected that manufacturer net sales will be lower than this due to the impact of confidential rebates

24、,government mandated discounts and clawbacks.In the U.S.net manufacturer sales are expected to be 47%lower than invoice prices,Overviewiqviainstitute.org|3and five-year growth will be 2-5%,4%lower than invoice projection of 6-9%.In the U.S.,these projections include a significant upward revision fro

25、m the prior forecast of-1 to 2%growth through 2027 and reflect multiple drivers of higher growth along with similar estimates for constraints related to pricing reforms.The major European countries(Germany,France,Italy,Spain)as well as the U.K.have historically had net spending as much as 2%lower th

26、an list price trends,though official data on net spending are not available for more recent periods,and the impact of net price mechanisms are expected to be more significant if growth trends accelerate.Spending in Europe is expected to increase by$70Bn on a list-price basis through 2028,driven by n

27、ew brands and offset by generics and biosimilars.Japan medicine spending growth is projected at-1 to 2%through 2028 as robust brand growth is offset by a shift in annual price cuts and ongoing moves to generics.Spending growth in China is expected to slow,with positives driven by greater uptake and

28、use of new original medicines and offset by pressures on off patent and generic pricing.Latin America,Eastern Europe and parts of Asia are expected to grow strongly from volume and adoption of novel medicines.Spending globally is expected to grow by more than$600Bn,reaching$2.3Tn driven by existing

29、branded medicines in the leading ten developed markets,which will grow by$385Bn.New products will add$193Bn but will be offset by the impact of patent expiries,removing$192Bn.Other developed markets and fast-growing Pharmerging markets will together add another$184Bn.In each of these cases,growth dr

30、ivers are an acceleration over the past five years,reflecting a rebound from the disrupted 2019-2023 period.KEY THERAPY AREAS The key growth area for medicines in the next five years is biotech,which despite growth slowing will still increase by 9.5 to 12.5%and represent$890Bn in spending in 2028,a

31、projected 39%of the global market and will include many of the areas of greatest activity for novel medicines.Specialty medicines those treating chronic,complex or rare conditions and often characterized by high cost,special distribution or handling,and the inherent complexity their conditions imply

32、 are expected to represent 43%of global spending in 2028,and more than 55%of leading developed markets.The two leading global therapy areas oncology and immunology are forecast to grow 1417%and 25%CAGR,respectively,through 2028.Oncology is projected to add 100 new treatments over five years,contribu

33、ting to an increase in spending of$224Bn to a total of more than$440Bn in 2028 and facing limiting new losses of exclusivity.Treatments for auto-immune disorders are forecast to reach$192Bn globally by 2028,driven by steadily increasing numbers of treated patients and new products in some new immune

34、 disorders,and offset after 2023 due to biosimilars.Diabetes spending growth is slowing to low single digits in most developed markets and declining in some,especially net of rebates.Global obesity spending has accelerated in the past two years as highly effective novel GLP-1 agonists are gaining wi

35、der adoption and are expected to accelerate further,reshaping obesity treatment and the health outcomes of millions if insurers and governments support wider reimbursement.New therapies in Alzheimers and anxiety/depression are expected drive growth in neurology and mental health spending.The outlook

36、 for next generation biotherapeutics includes significantly uncertain clinical and commercial prospects for cell,gene,and RNA therapies,which will grow from current$10Bn spending in 2023 to$33Bn by 2028 and add as many as 50 novel therapies in those five years.The two leading global therapy areas on

37、cology and immunology are forecast to grow 1417%and 25%CAGR,respectively,through 2028.4|Global Use of Medicines:Outlook to 2028 The global use of medicine is expected to reach nearly 3.8 trillion defined daily doses in 2028,up 400 million from the 2023 level.The use of medicines remained flat in 202

38、3 but is expected to grow 2.3 percent annually over the next five years.Medicine use in Latin America and Asia has grown more rapidly than in other regions and this trend will continue through 2028.Per capita use of medicines varies by GDP with use in higher income countries typically higher than in

39、 lower-income countries.Per capita medicine use varies by region with Japan and Western Europe having more than double the use of most other regions.When adjusted for population,per capita use will grow across all regions except Africa and Middle East.Improvements in per capita use by the lowest inc

40、ome countries are slower than in wealthier countries,hampering aspirations for health improvements.Outlook for the use of medicines and driversPatient use of medicines grew by 14%over the past five years,driven by increased access to medicines in regions around the world and is expected to grow by a

41、 further 12%or 400 billion defined daily doses through 2028.The global use of medicines based on modeling medicine volumes shipped according to defined daily dose assumptions increased by 414 billion defined daily doses over the past five years,and is expected to grow another 400 billion by 2028.The

42、 highest volume growth over the next five years is expected in China,India and Asia-Pacific,all exceeding 3%compound annual growth.Lower volume growth in higher income regions such as North America,Western Europe and Japan are linked to more established health systems and existing access to medicine

43、.Latin America volume growth has slowed considerably from a 6.1%five-year average through 2023 to a 1.9%average projected through 2028,largely through slower expected economic growth.Eastern European growth is essentially unchanged,with the outlook for 1.6%CAGR down 0.1%from the past five years desp

44、ite any regional or localized impacts of the Ukraine conflict.Lower-income countries have dramatically lower access to medicine.Access has been declining for the past five years and is expected to remain steady over the next five years,potentially counteracting other policy initiatives to improve he

45、alth in those countries.It is important to interpret these trends with caution,as chronic diseases drive many days of therapy and treatments for them are often much less common in lower income countries.Exhibit 1:Historical and projected use of medicines by region,20182028,Defined Daily Doses(DDD)in

46、 billionsNotes:Chart represents IQVIA Institute estimates of global defined daily doses(DDD).These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute(see Methodology).Asia-Paci

47、fic does not include China,India,and Japan which are reported separately.2023 volume is based on actual data as of June 2023 and projected for the remainder of the year.OUTLOOK FOR THE USE OF MEDICINES AND DRIVERSThe use of medicines remained flat in 2023 but is expected to grow 2.3 percent annually

48、 over the next 5 yearsSource:IQVIA Institute,Dec 2023.iqviainstitute.org|520182019202020212022202320242025202620272028CAGR%20242028Global Japan North America China Eastern Europe Africa&Middle EastIndia Western Europe Latin America Asia-Pacific 2.30.61.33.71.61.93.51.11.93.4Forecast45146147750754753

49、85595805986186373423574384474484614734844894965064354454444484694634704764814854883543593704003903994124284434584743853953934284254104134244344424513323393413583693623703773843883912552792713013083083233373493593692702722702812902902942993033063091411431411451471481491511521521532,9643,0493,1443,316

50、3,3943,3783,4653,5563,6333,7043,778 The impact of the pandemic on medicine use has been highly varied,including surges in usage of chronic medicines,referred to as stockpiling,and then returning to a more normal trend,with most countries returning to baseline volumes by the end of 2020.Latin America

51、 had exceptionally high-volume growth in 2020,slowing over time but projected to achieve the highest growth index to 2028.The increases were driven by Brazil,lifting regional DDD in 2028 48%higher than 2018,while the region excluding Brazil will reach an index of 132 in 2028,still above the global a

52、verage but slower than the fast-growing Asian region.Brazils growth has been driven by widening use of predominantly low-cost therapies but is expected to shift to higher cost therapies as the forecast progresses.China,India and other Asian markets have had above average volume growth and are expect

53、ed to continue through the forecast.Higher income countries in North America,Europe,and Japan are expected to see a slight improvement in their outlook for the use of medicines,though essentially continuing a steady trend typical of these more established health systems.Exhibit 2:Trends in defined d

54、aily doses(DDD)across regions indexed to 2018 values(2018 value=100)Notes:Defined Daily Doses(DDD)are based on WHO definitions where each medicine is assigned a volume of medicine per day(see definitions&methodology).All charted values are indexed to 2018 values set equal to 100.2023 volume is based

55、 on actual data as of June 2023 and projected for the remainder of the year.OUTLOOK FOR THE USE OF MEDICINES AND DRIVERSMedicine use in Latin America and Asia has grown more rapidly than in other regions,particularly higher income countriesSource:IQVIA Institute,Dec 2023.6|Global Use of Medicines:Ou

56、tlook to 20282019201815014013012011010090202020212022202320242025202620272028Global 127Japan 108North America 115China 145Eastern Europe 118Africa&Middle East117India 134Western Europe 112Latin America 148Asia-Pacific 141Forecast Broadly there is a correlation to gross domestic product per capita,wi

57、th higher medicine use in higher income countries.As countries vary in the cost burden patients directly bear,there is some correlation in the way patients use medicine.North America,including the U.S.and Canada,has the lowest per capita DDD volumes of developed markets,which may be the result of hi

58、gh patient out-of-pocket cost exposure in the U.S.Other factors include the disease burden patients face and the aspects of the health system they can readily access to begin using medicines for a specific disease.Eastern Europe has nearly four times higher use of medicines per capita than China des

59、pite GDP per capita being roughly 50%higher.Africa and Middle East countries lag the furthest in terms of per capita use,even as some countries in the region are significant outliers with robust GDP and usage.Exhibit 3:Defined Daily Doses(DDD)per capita by region compared to per capita gross domesti

60、c product PPP,current international dollarsNotes:Chart represents IQVIA Institute estimates of global defined daily doses(DDD).These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA In

61、stitute(see Methodology).Asia-Pacific does not include China,India,and Japan which are reported separately.2023 volume is based on actual data as of June 2023 and projected for the remainder of the year.OUTLOOK FOR THE USE OF MEDICINES AND DRIVERSPer capita use of medicines varies by GDP with use in

62、 higher income countries typically higher than in lower income onesSource:IQVIA Institute,Dec 2023;The World Bank,Jul 2023;International Monetary Fund,Oct 2023.iqviainstitute.org|71,4001,2001,0008006004002000010,00020,00030,00040,00050,00060,00070,00090,00080,000GDP PPP per capita 2023(current inter

63、national dollars)DDD per capita 2023500Bn250Bn100BnSize ofBubble:Total 2023DDDsAsia-PacificIndiaWestern EuropeEastern EuropeAfrica&Middle EastLatin AmericaChinaNorth AmericaJapan When medicine use is adjusted for population,global medicine use is projected to grow 1.4%annually over the next five yea

64、rs,compared to 2.3%unadjusted(Exhibit 1)showing that 39%of growth in medicine use is population driven.In the past five years,North America per capita DDD grew only 0.9%annually,and is projected to grow similarly through 2028(projected CAGR 0.8%).China tops regions for expected per capita growth wit

65、h 3.8%CAGR to 2028,while all other regions are more than 1%slower.Eastern Europe declined in 2023 as the Ukraine conflict continues but is expected to recover in 2024 and grow above the global average through the forecast period.Despite the disruptions of the pandemic,regional conflicts and effects

66、of the global economy,most regions have steadily rising usage on a per capita basis,slower than in the past 10 years and notably declining in North America.Exhibit 4:Historical and projected per capita use of medicine by region,20132028Notes:Chart represents IQVIA Institute estimates of global defin

67、ed daily doses(DDD).These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute(see Methodology).Asia-Pacific does not include China,India,and Japan which are reported separately.

68、2023 volume is based on actual data as of June 2023 and projected for the remainder of the year.OUTLOOK FOR THE USE OF MEDICINES AND DRIVERSPer capita medicine use varies by region with Japan and Western Europe having more than double the use of most other regionsSource:IQVIA Institute,Dec 2023;The

69、World Bank,Jul 2023.8|Global Use of Medicines:Outlook to 20285-YearCAGRs 5-YearCAGRs 5-YearCAGRs 2013 2014 2015 2016201820172019 2020 2021 2022 20232024 2025 2026 2027 2028IndiaAsia-PacificForecastWestern EuropeAfrica&Middle EastEastern EuropeChinaLatin AmericaNorth AmericaGlobalJapan1,4001,2001,000

70、8006004002000DDD per capita1.3%1.0%7.0%-0.4%1.5%2.2%5.6%4.0%-1.6%3.9%1.9%1.0%5.3%0.9%1.3%2.5%1.7%1.6%3.7%-1.0%0.8%1.0%1.2%1.5%1.2%2.4%1.4%2.6%-0.2%3.8%Per capita use of medicines is projected to grow in most regions except Africa and the Middle East,where all volume increases are driven by populatio

71、n growth.The largest influences on trends in medicine use other than population growth are burden of disease and economic activity.Wealthier countries in Western Europe,Japan and North America have higher levels of per capita use and are expected to grow more slowly through 2028.Regions with more mi

72、ddle-and lower-income countries are expected to resume historic volume growth trends as access to medicines contributes to volume growth above population growth trends.Eastern Europe has over three times higher use of medicines per capita than China,reflecting significant disparities in the use of m

73、edicines across regions Africa and Middle East countries lag the furthest in terms of per capita use,even as some countries in the region are outliers with robust GDP and higher usage.Exhibit 5:Defined Daily Doses(DDD)per capita by region 2023,and growth to 2028Notes:Chart represents IQVIA Institute

74、 estimates of global defined daily doses(DDD).These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute(see Methodology).Asia-Pacific does not include China,India,and Japan whic

75、h are reported separately.2023 volume is based on actual data as of June 2023 and projected for the remainder of the year.OUTLOOK FOR THE USE OF MEDICINES AND DRIVERSWhen adjusted for population,per capita use will grow across all regions except Africa and Middle EastSource:IQVIA Institute,Dec 2023;

76、The World Bank,Jul 2023.iqviainstitute.org|91501209060300-3002004006008001,0001,200DDD per capita 2023Absolute change inDDD per capita 20242028500Bn250Bn100BnSize ofbubble:Total 2028DDDsAsia-PacificAfrica&Middle EastChinaIndiaJapanWestern EuropeNorth AmericaEastern EuropeLatin America10|Global Use o

77、f Medicines:Outlook to 2028 Medicine use has been growing across therapy areas since 2018,with high growth in immunology,endocrinology,and oncology.Per capita utilization of immunology products and type of products used varies across developed countries.Nearly half of immunology biologic volume is f

78、acing biosimilar competition,which has led to increased use.GLP-1 agonists have seen rapid uptake in both diabetes and obesity,predominantly in the U.S.and other developed markets.Developing regions have seen higher oncology growth since 2018,driven by expanded access to traditional chemotherapy,whi

79、le wealthier countries have been increasing the use of novel targeted therapies.Use of antibacterials was significantly disrupted by the COVID-19 pandemic but returned to historic levels in 2022 and 2023.Many countries are vaccinating at rates below their pre-pandemic trend,leaving millions less pro

80、tected from preventable disease.Historic climate events have had significant impacts on medicine use and are expected to be exacerbated in the future.Therapy area drivers of medicine useImmunology,endocrinology,and oncology have exceeded the global 14%average growth in defined daily doses in the pas

81、t five years,driven primarily by substantial numbers of novel products and wider access to them across geographies.The dramatic growth in patient access to novel medicines is driving higher use of medicines in immunology,endocrinology and oncology.Immunology has seen expanded access to a variety of

82、biologic and small molecule therapies,but as specialty therapies,access is often constrained in lower-income countries.Endocrinology as a group of hormonal regulating therapies,including diabetes,has also grown at double the global average rate of increase in days of therapy.Oncology,the largest the

83、rapy area by spending(Exhibit 37),increased 21%over the past five years by volume,an average of 3.9%per year,outpacing population growth and indicative of growing rates and durations of cancer treatment.Exhibit 6:Defined daily doses(DDD)in 2023 across select therapy areas indexed to 2018 values(2018

84、 value=100)Notes:Chart represents IQVIA Institute estimates of global defined daily doses(DDD).These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute(see Methodology).Oncolog

85、y does not include supportive care.Hematologics are non-oncology.Plotted therapy areas account for 93%of estimated global defined daily doses(DDDs).2023 volume is based on actual data as of June 2023 and projected for the remainder of the year.THERAPY AREA DRIVERS OF MEDICINE USEMedicine use has bee

86、n growing across therapy areas since 2019,with highest growth in immunology,endocrinology,and oncologySource:IQVIA MIDAS,Jun 2022;IQVIA Institute,Dec 2023.iqviainstitute.org|11128128121118117117116116114114111108106105105PainEye/EarHematologicsGenitourinary/Womens healthGastrointestinalAll therapy a

87、reasNeurologyInfectious diseaseCardiovascularVitamins&mineralsDermatologicsRespiratoryOncologyEndocrinologyImmunology/Allergy Immunology products have seen significant volume increases in leading developed markets over the past decade,increasing the rate of treatment per 100,000 of population by 163

88、%over the past decade.These countries ranged from 7.2%CAGR in Japan to 14.4%in Spain and average 10%as more new and continuing patients use these medicines.In the United States,86%of the days of therapy are for biologic therapies compared to 61%in the EU4+UK,and 44%in Japan.These variations in use o

89、f biologics are likely related to differences in reimbursement,medical practice and epidemiology,and may increase after products lose exclusivity and biosimilars or generics become available.Exhibit 7:Immunology per capita DDDs and share of DDDs by type for 10 developed countriesNotes:Chart represen

90、ts IQVIA Institute estimates of global defined daily doses(DDD).These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute(see Methodology).Includes medicines for treating autoim

91、mune disorders only and does not include allergy medicines.2023 volume is based on actual data as of June 2023 and projected for the remainder of the year.THERAPY AREA DRIVERS OF MEDICINE USEPer capita utilization of immunology products and type of products used varies across developed countriesSour

92、ce:IQVIA MIDAS,Jun 2023;IQVIA Institute,Dec 2023.12|Global Use of Medicines:Outlook to 2028BiologicSmall molecule100%90%80%70%60%50%40%30%20%10%0%500,000450,000400,000350,000300,000250,000200,000150,000100,00050,00002014201520162017201820192020202120222023U.S.CanadaAustraliaKoreaUKSpainFranceItalyGe

93、rmanyJapanImmunology DDDs per 100,000 peopleShare of 2023 immunology DDDs by typeCanadaGermanyFranceU.S.SpainUKAustraliaJapanItalyKorea As immunology volume has increased,most of the growth has been from biologic medicines,and these in turn have increasingly been subject to biosimilar competition as

94、 regulatory pathways have evolved.It is also possible to see a 5%incremental use of the medicines,which are subject to biosimilar competition,confirming there is additional demand that is able to be met at lower costs.The most impactful clusters of immunology biosimilars entered the market in 2016 w

95、ith etanercept in the EU4+UK and infliximab in the U.S.,and in 2023 with adalimimumab in the U.S.In addition to the leading therapies,which treat a range of arthritis,gastrointestinal and dermatological autoimmune conditions,there are many newer therapies that continue to bring new treatment options

96、 to patients and become more widely adopted.Immunology volume is expected to continue to grow steadily through 2028,driven by expanded access(Exhibit 40).Exhibit 8:Immunology volume in 10 developed countries by molecule type and protectionNotes:Chart represents IQVIA Institute estimates of global de

97、fined daily doses(DDD).These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as additional DDD calculation assumptions developed by the IQVIA Institute(see Methodology).Includes medicines for treating autoimmune disorders only and does not include

98、allergy medicines.2023 volume is through June 2023.THERAPY AREA DRIVERS OF MEDICINE USENearly half of immunology biologic volume is facing biosimilar competition,which has led to increased useSource:IQVIA MIDAS,Jun 2023;IQVIA Institute,Dec 2023.iqviainstitute.org|13Small moleculeProtected biologicBi

99、osimilar accessibleIncremental volume from biosimilar completion8007006005004003002001000+5%Q1 2014Q3 2014Q1 2015Q3 2015Q1 2016Q3 2016Q1 2017Q3 2017Q1 2018Q3 2018Q1 2019Q3 2019Q1 2020Q3 2020Q1 2021Q3 2021Q1 2022Q3 2022Q1 2023 The dramatic growth of therapies based on glucagon-like peptides(GLP-1)has

100、 accelerated in the past 18 months,primarily through wider usage for obesity.These medicines were initially approved for use in Type 2 diabetes,and many demonstrated some degree of weight loss as a concomitant treatment effect.Some of the medicines have been additionally researched and approved as o

101、besity therapies,with a product name distinct from the branding used for diabetes.The degree of weight-loss being demonstrated by newer therapies significantly exceeds that from previous generations and is driving significantly increased usage.The inflections in volume observed coincide with the obe

102、sity indication approval in the U.S.in 2021 for semaglutide(Wegovy),though there are notable co-morbidities between diabetes and obesity patient populations,which may explain these patterns.The approval of tirzepatide(Zepbound)for obesity in 2023 is expected to contribute to significant future volum

103、e growth(launch is after data periods plotted).While the U.S.has been the largest area of growth to date,manufacturing constraints experienced in 2023 resulted in less volume available to countries outside the U.S.and especially for the obesity formulations,where the drugs are also approved for diab

104、etes.Exhibit 9:Quarterly GLP-1 agonist volume in defined daily doses(DDD)in millions,Q1 2018Q2 2023Notes:Chart represents IQVIA Institute estimates of global defined daily doses(DDD).These estimates are based on IQVIA audited data and application of WHO-DDD factors in IQVIA MIDAS as well as addition

105、al DDD calculation assumptions developed by the IQVIA Institute(see Methodology).For molecules with approvals in both diabetes and obesity,the products have been marketed with distinct brand names for each indication and are assigned to the therapy area based on those brands.The use of medicines for

106、 the alternative indication is not estimated or modeled in this analysis.See definitions for details of other developed and pharmerging country groupings.THERAPY AREA DRIVERS OF MEDICINE USEGLP-1 agonists have seen rapid uptake in both diabetes and obesity,predominantly in the U.S.and other develope

107、d marketsSource:IQVIA MIDAS,Jun 2023;IQVIA Institute,Dec 2023.14|Global Use of Medicines:Outlook to 2028U.S.EU4+UKOther developedPharmergingRest of world2001801601401201008060402001,6001,4001,2001,0008006004002000Q1 2018Q3 2018Q1 2019Q3 2019Q1 2020Q3 2020Q1 2021Q3 2021Q1 2022Q3 2022Q1 2023Q1 2018Q3

108、2018Q1 2019Q3 2019Q1 2020Q3 2020Q1 2021Q3 2021Q1 2022Q3 2022Q1 2023Diabetes GLP-1 volumeObesity GLP-1 volume Oncology volume has been increasing significantly,reaching 21%higher than the level in 2018,lifted predominately by markets in Latin America and Asia.These high growth markets are treating pa

109、tients with older chemotherapies,as shown by the lower share of days of therapy(DDD)from targeted therapies(see center chart).Multiple types of novel targeted oncologics are included in this analysis,with most having become available more recently,although a limited number are older,unprotected and

110、facing generics or biosimilars.One of the most impactful areas of novel oncologics are PD-1/PD-L1 inhibitors,with clinical efficacy across most solid tumors,but widely varying uptake with North America,Japan and Western Europe averaging 15 times higher per capita usage than lower uptake regions.Nota

111、bly,China has begun to increase use of these medicines starting in 2020 and driven by domestic manufacturers versions of these treatments,which account for 97%of the volume in the latest historic period(2nd quarter 2023).Even within the higher-use regions there remain significant variations in per c

112、apita use of the most novel therapies,but the growing use of these breakthrough therapies will continue to reshape cancer care as even more novel therapies follow.Exhibit 10:Oncology Defined Daily Dose(DDD)volume growth,targeted medicines share of volume,and PD-1/PD-L1 uptake by regionNotes:Oncology

113、 does not include supportive care.Asia-Pacific does not include China,India,and Japan.2023 volume is based on actual data as of June 2023 and projected for the remainder of the year.Targeted oncologics include those which target a biomarker,modality or cell process as opposed to systemically-focused

114、 chemotherapy or hormonal therapy.THERAPY AREA DRIVERS OF MEDICINE USEDeveloping regions have seen higher oncology growth since 2018 driven by expanded access to traditional chemotherapySource:IQVIA MIDAS,Jun 2023;IQVIA Institute,Dec 2023.iqviainstitute.org|15Index volume to 2018(2018 value=100)1801

115、6014012010080201820192020202120222023Share targeted medicines45%40%35%30%25%20%15%10%5%0%201820192020202120222023PD-1/PD-L1 inhibitor volumeper 100k people18,00016,00014,00012,00010,0008,0006,0004,0002,00002018201720162015201420192020202120222023Global Japan North America China EasternEurope Africa&

116、Middle EastIndia Western Europe Latin America Asia-Pacific Antibacterials are a critical healthcare resource whose usage represents a challenge for stakeholders.Greater access to these medicines are the mark of a well-managed health system,while excessive use suggests inappropriate stewardship and r

117、isks antimicrobial resistance.The impact on volume seen across regions in 2020 and 2021 shows the clear effects of social distancing and mask-wearing around the world,as these policies were widely adopted in the height of the pandemic,and antibacterial use was reduced dramatically at the same time.A

118、s the global pandemic has eased,the volume rebounded to just below the pre-pandemic trend and declined in 2023,although many regions show increases on a per capita basis.Only Japan,Western Europe,Eastern Europe and North America had an increase in per capita use in 2023,although only Eastern Europes

119、 use exceeds the pre-pandemic rate.One of the key drivers of antibacterial use has been a rising intensity of seasonal respiratory infections in the winter 2022 and 2023 seasons,potentially as a result of weakened immune systems from COVID-19,flu,or respiratory syncytial virus(RSV).The rebounds note

120、d to date also coincide with reported shortages in antibacterials in many major markets(see Drug Shortages in the U.S.2023,IQVIA Institute,Nov 2023).Exhibit 11:Antibacterial volume in DDDs and DDD per capita by regionNotes:Asia-Pacific does not include China,India,and Japan.2023 volume is based on a

121、ctual data as of June 2023 and projected for the remainder of the year.THERAPY AREA DRIVERS OF MEDICINE USEUse of antibacterials was significantly disrupted by the COVID-19 pandemic but returned to historic levels in 2022 and 2023Source:IQVIA MIDAS,Jun 2023;IQVIA Institute,Dec 2023.16|Global Use of

122、Medicines:Outlook to 2028Antibacterial DDDs4035302520151050201320152017201920212023Antibacterial DDDs per capita98765432201320152017201920212023Global Japan North America China EasternEurope Africa&Middle EastIndia Western Europe Latin America Asia-Pacific Over the last decade,adult vaccines(in term

123、s of volume of use)for influenza,diphtheria and tetanus(Td),diphtheria,tetanus and pertussis(TDaP),hepatitis B,herpes zoster and pneumococcal peaked at 400 million doses in 2020.Use had been growing at an annual rate of 7.9%from 2013 to 2019 and inflected up sharply in 2020 as flu vaccination rates

124、were higher in the absence of COVID-19 vaccines at that point.Overall doses declined sharply in 2021 and 2022.Based on the degree of decline across geographies it is estimated that 100 million fewer doses have been administered in those two years than if the pre-pandemic trend had continued.While im

125、munization rates for adult vaccines are low across countries globally,the pandemic had a disproportionately negative impact on adult vaccine doses in countries that are in the medium or low category on the United Nations human development index.This measurement of adult vaccine doses is based on IQV

126、IA MIDAS data,based primarily on collection of data from wholesalers and providers including hospitals and pharmacies.This serves as a proxy for adult vaccination coverage as real time adult vaccine coverage data is highly variable by country and oftentimes very limited.MIDAS provides a directional

127、view on trends in vaccine coverage globally.Exhibit 12:Global adult vaccinations,20132022Notes:Adult vaccinations includes influenza;diphtheria and tetanus(Td);diphtheria,tetanus and pertussis(TDaP);hepatitis B;herpes zoster and pneumococcal.Diphtheria,tetanus and pertussis vaccinations in combinati

128、on with polio or hepatitis B are not included.A 75:25%adult:pediatric split for influenza and 1/3:2/3 split for pneumococcal has been applied in accordance with available adult and pediatric coverage(UK and US).Only hepatitis B doses of 1mL or larger were assumed for adult use.Includes retail and no

129、n-retail from 76 countries covered by IQVIA MIDAS panels.These may not cover all vaccination delivery channels in each country.Quarterly Trend charts are rolling 12 months to reduce volatility.Countries are assigned to Human Development Index categories and values are indexed to rolling 12 months to

130、 March 2013 to allow comparison.THERAPY AREA DRIVERS OF MEDICINE USEPositive developments in adult vaccination over the past decade have been hindered by the COVID-19 pandemicSource:Trends in Global Adult Vaccination:Impact of COVID-19,IQVIA Institute,July 2023.iqviainstitute.org|1711912815217120321

131、723229526524753585053535252124544452117161615151530101116251917162232192833121518171717174001514221244256275304322349363351Td/DTPCVHepatitis BHerpes zosterPneumococcusTotalInfluenza300250200150100500Mar-13Mar-14Mar-15Mar-16Mar-17Mar-18Mar-19Mar-20Mar-21Mar-22Mar-23300250200150100500MediumHDILowHDIVe

132、ry highHDIStart of pandemicStart of pandemicHighHDIMar-13Mar-14Mar-15Mar-16Mar-17Mar-18Mar-19Mar-20Mar-21Mar-22Mar-232013 2014 2015 2016 2017 2018 2019 2020 2021 2022Human development indexHuman development indexGlobal adult vaccination doses,millions,20132022 Acute climate events that are impacted

133、by climate change such as floods,hurricanes,and bushfires have had a measurable impact on medicine use.Bushfires in Australia in late 2019 and early 2020 led to poor air quality and a corresponding increase in the use of respiratory agents,with Australian use 44%higher than other developed countries

134、 in Q4 2019.Other climate events have had impacts in Southeast Asia,with extreme flooding increasing the use of anti-infectives to treat water-borne illnesses.Pakistan and Bangladesh saw 26%and 22%increases in anti-infective use during 2022 flooding compared to the prior monsoon season.Additionally,

135、Hurricanes Irma and Maria impacted both acute and chronic medicines in Puerto Rico,highlighting that weather events can also impact patients access to medicines.Climate events are expected to be exacerbated in the future and will have varying impacts on the use of medicines across therapy areas.The

136、effects of climate change will likely lead to increasing medicine requirements,which will vary across geographies.Exhibit 13:Climate event impacts on medicine useNotes:Analysis from poster presented at FIP World Congress Sep 2023.Other developed includes the 9 other largest developed markets excludi

137、ng Australia:Canada,France,Germany,Italy,Japan,South Korea,Spain,UK,and U.S.Growth is compared to same quarter in prior year.Australia index to 2017/2018 levels indexed to other developed index to 2017/2018 levels to adjust for COVID-19 stockpiling impacts in Q1 2020.THERAPY AREA DRIVERS OF MEDICINE

138、 USEHistoric climate events have had significant impacts on medicine use and are expected to be exacerbated in the futureSource:Aitken M,Pritchett J,Tewary V,Zeleke T.Preparing for climate change:the essential role of pharmacy in addressing the next global crisis.Poster presented at:81st Internation

139、al Pharmaceutical Federation(FIP)World Congress;Sep 2023;Brisbane,Australia.18|Global Use of Medicines:Outlook to 2028Chronic TRxAcute TRxChronic NBRxRespiratory agent volume growth in Australia from2017/2018 levels indexed to other developed countriesAnti-infective volume use in Pakistan(standard u

140、nits)18014010060FloodingJunOct 2022Bushfires Jun2019May 2020Poor air qualitySep 2019Feb 20203.02.52.01.51.00.50.0Standard units(Bn)Standard units(Mn)Prescriptions(Mn)Baseline 100=2017/2018average quarterly DDDs5432101,0008006004002000.Q1 2018BaselineQ1 2019Q2 2019Q3 2019Q4 2019Q1 2020Q2 2020Q3 2020Q

141、4 2020Q1 2021Q2 2021Q3 2021Q4 2021Q1 2022Q2 2022May 2017Jul 2017Sep 2017Nov 2017Dec 2018Mar 2018May 2018Jul 2018Sep 2018Nov 2018Q3 2018Q1 2019Q3 2019Q1 2020Q3 2020Q1 2021Q3 2021Q1 2022Q3 2022Q1 2023Q1 2018Q3 2018Q1 2019Q3 2019Q1 2020Q3 2020Q1 2021Q3 2021Q1 2022Q3 2022Q1 2023Monthly prescription volu

142、me in Puerto RicoAnti-infective volume use in Bangladesh(standard units)FloodingJul 2020FloodingJunOct 2022Hurricanes Irma&MariaOtherantiparasiticsAntimalarialsAntibacterialsiqviainstitute.org|19 The global medicine market using list price levels is expected to grow at 5-8%CAGR through 2028,reaching

143、 about$2.3Tn in total market size.The growth outlook to 2028 is 2%higher than the previous forecast outlook to 2027 despite a significant downward revision in the expected spending on COVID-19 vaccines and therapeutics.Spending and volume growth following diverging trends by region with larger estab

144、lished markets growing more rapidly,driven by new and existing branded products,while Pharmerging markets will grow more slowly and be driven more by volume than the mix of more expensive therapies.The U.S.market,on a net price basis,is forecast to grow 2-5%CAGR over the next five years,down from 5.

145、3%CAGR for the past five years,including projected effects of the Inflation Reduction Act.Spending in Europe is expected to increase by$70Bn through 2028,driven by new brands and offset by generics and biosimilars.Japan medicine spending growth is projected at-1 to 2%through 2028 as robust brand gro

146、wth is offset by a shift annual price cuts and ongoing shifts to generics.Spending growth in China is expected to slow,with positives driven by greater uptake and use of new original medicines and offset by pressures on off-patent and generic pricing.Spending and growth by regions and key countriesG

147、rowth in developed economies is accelerating driven by new products and wider use of existing branded medicines,and offset by patent expiries;Latin America,Eastern Europe and parts of Asia are expected to grow strongly from volume and adoption of novel medicines.Global medicine spending the amount s

148、pent purchasing medicines from manufacturers before off-invoice discounts and rebates is expected to reach$2.3Tn by 2028 and increasing at a rate of 5-8%per year,including spending on COVID-19 vaccines and therapeutics,and 6-9%otherwise.Overall growth trends are expected to moderate after the disrup

149、tions from the pandemic in 2020 through 2023.Key drivers of growth through the forecast period include the contribution of new products and the impact of patent expiries,including the growing impact of biosimilars.Payers in developed markets are expected to face budget pressures and act to curb drug

150、 spending growth,in part motivated by the costs of managing the pandemic and to moderate the impact from increased spending on novel therapies.Exhibit 14:Global medicine market size and growth 20142028 including estimated COVID-19 vaccine and therapeutic spendingNotes:Global medicine spending is bas

151、ed on IQVIA Market Prognosis with the addition of estimates of COVID vaccine and therapeutic spending which are not otherwise included.Those COVID additions are informed by company financials and published prices and vaccination rates.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESThe global medici

152、ne market using invoice price levels is expected to grow at 58%CAGR through 2028 to about$2.3TnSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.20|Global Use of Medicines:Outlook to 202825%20%15%10%5%0%2,5002,0001,5001,000500020142015201620172018201920202021202220232024202520262027202

153、8%Growth constant US$Spending US$BnGlobal spending US$Bn%Growth constant US$Forecast The outlook for global medicine spending has shifted considerably during the COVID-19 pandemic,and following the pandemic,the outlook for non-COVID-19 medicines has been revised substantially based on higher than ex

154、pected spending in 2022 and 2023,robust pipeline of innovative therapies,and a widespread shift in the mix of spending to adopt more expensive novel therapies.The rapid first wave of COVID-19 vaccinations exceeded previous expectations but has been followed by lower rates of booster utilization and

155、results in a lower outlook through 2028.The cumulative spending on COVID-19 vaccines and therapeutics covering 2020 through 2028 has been revised down in the latest forecast to$309Bn as countries around the world have reduced current and planned booster vaccination rates dramatically.For non-COVID-1

156、9 spending,2022 and 2023 have been far above prior expectations,led by oncology,immunology,diabetes,and obesity(Exhibits 3942).In total,the global outlook is expected to be$400Bn higher than the prior outlook despite the reduction in COVID-19 projections as a result of significantly higher growth ou

157、tlook on a list/invoice price basis.Exhibit 15:Changes in the historical and projected global medicine spending model due to COVID-19,20192028,US$BnNotes:Estimates of pre-pandemic outlook are based on US$at variable exchange rates under the same ex-rate assumptions as the current non-COVID outlook.N

158、either outlook were modeled including COVID-19 vaccines and the estimates of vaccine spending are entirely incremental spending.Vaccine costs reflect medicine costs only and do not include costs from provider administration or government contributions to manufacturing or distribution costs.COVID-19

159、therapeutics are novel therapeutics including antivirals and antibody treatments new to the market but excluding existing medicines repurposed for COVID-19.No confidential or proprietary information is included in these estimates.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESGlobal spending,includ

160、ing COVID-19 vaccines and therapeutics,is forecast to exceed pre-pandemic outlook by$1.2Tn to 2028Source:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.iqviainstitute.org|21-62-53-75-444719638661789410315116718419119820521331651637581869196-59661261863064686709131,203$1,2711,3061,4461,4851

161、,6071,7361,8681,9852,1072,238311683282913121213Incremental spend for COVID-19 vaccines&therapeuticsCurrent outlook excluding COVID-19 vaccinesPre-COVID-19 outlookCumulative difference in non-COVID-19 spending from pre-COVID-19 levelsCumulative COVID-19 therapeuticsTotal cumulative difference from pr

162、e-COVID-19 levelsCumulative COVID-19 vaccine spending20192020202120222023202420252028202720262019202020212022202320242025202820272026Cumulative difference,US$billion=+Spending outlook change due to COVID-19:$1,203Bn,20202028COVID-19 vaccine spending:$213Bn($190$230Bn)COVID-19 therapeutics:$96Bn($851

163、15Bn)COVID-19 disruption impact:+$894Bn 20202028 Global COVID-19 vaccine spending is expected to reach$15Bn in 2023 and$213Bn in total over eight years to 2028,much lower than earlier projections of$380Bn through 2027.Previous modeling phased the initial vaccination wave more slowly and included hal

164、f-sized booster shots every other year at higher rates than most countries have continued in 2023 or announced in plans.Cost per dose assumptions in the current model reflect a slight upward trend in cost per dose in later years as manufacturers pressure for higher prices and preference for higher-c

165、ost mRNA vaccines impacts average costs but have not been revised in the latest edition.The dramatic fall-off in vaccinations in late 2022 and in 2023 coincide with most countries discontinuation of their publication of timely official statistics in early 2023.It remains possible that updated public

166、ations could revise these estimates upward.Most countries have announced plans to prioritize immuno-compromised individuals and the elderly and limit funding support for wider vaccination,with the U.S.shifting payment to traditional insurance payers in the fall of 2023.The lower rates of COVID-19 va

167、ccination also coincide with many countries shifting to co-administration of the vaccines with flu shots.As the virus is now endemic,with periodically identified new variants,the vaccine formulations will continue to be re-issued and likely used more often if infections surge.Exhibit 16:COVID-19 vac

168、cination spending and volume forecastsNotes:Scenario modeling was conducted by the IQVIA institute based on public information as of October 2023.Estimates of future vaccination trends include input from the public statements of responsible agencies and manufacturers,as well as modeling by the IQVIA

169、 Institute.Estimates of cost per patient are based on assumptions of the number and mix of doses of available vaccines,the published prices,and IQVIA Institute estimates of the prevailing prices that will exist across geographies through 2028.As costs are based on public statements,they may overstat

170、e the true costs after negotiated discounts.Doses are based on the expected dosing including booster shots.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESThere was a dramatic fall-off in global COVID-19 vaccine spending in 2023 as pandemic shifts to endemic,offset by rising pricesSource:IQVIA Insti

171、tute,Dec 2023;Pricing information from public disclosures as of October 2023;Vaccination trends to date from Ourworldindata.org.22|Global Use of Medicines:Outlook to 2028Previous scenarios rangePrevious base case scenarioUpdated base case scenario Higher income countries constituted to more than 40%

172、vaccinations globally in 2023,and they are expected to drive vaccination throughbooster doses Lower middle income countries driven by India and China drive vaccination forward Vaccination globally will be led by booster doses to immuno-compromised and aged individuals,while only a small proportion o

173、f new individuals would be vaccinated The COVID-19 pandemic has become endemic,with a small proportion of the population getting vaccinated 106k doses were administered globally per million population in 2023,with 45k doses per million expected each year for 202528Base case key assumptions1401201008

174、06040200$30$25$20$15$10$5$0121086420Constant US$,billion2021202220232024202520262027202820212022202320242025202620272028COVID-19 vaccine global spending scenariosCost per dose scenarios,US$Standard doses scenarios,billionsUpdated 8-year total of basecase=$213Bn(190230)Previous 7-year total of baseca

175、se=$380Bn(315425)The near-term impact of the COVID-19 pandemic on medicine spending has been the notable short-term disruptions in 2020 and rebound in 2021 and a correction in 2022.The higher growth in 2023 driven by non-COVID-19 therapies is expected to continue,raising the five-year outlook by 2%.

176、COVID-19 vaccines and therapeutics are seeing declining spending in 2023 and are expected to continue,representing a negative contribution to overall growth through 2026 when the trends stabilize.Including updated estimates,the five-year CAGR to 2028 is expected to be 5-8%compared to 36%prior to the

177、 pandemic and driven predominantly by higher projections for non-COVID-19 spending.It is expected that the pricing and value of medicines will be under increased scrutiny during this period,especially considering the broader global economy and post-pandemic environment as well as the above-expectati

178、ons uptake of novel medicines.Exhibit 17:Comparison of current outlook to pre-COVID-19 outlookNotes:Pre-COVID outlook based on IQVIA Market Prognosis,Sept.2019 edition which included projections to 2024 and which has been extended to include the periods to 2027 with a linear projection.Current outlo

179、ok based on IQVIA Market Prognosis Sept.2023 edition.Incremental COVID vaccine and therapeutic scenario based on current outlook combined with incremental spending for vaccines and novel COVID-19 therapeutics.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESGlobal market growth will significantly exc

180、eed the pre-pandemic outlook even as COVID-19 vaccine and therapeutic usage declinesSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.iqviainstitute.org|23Pre-COVID-19 outlookCurrent outlook including incremental spend on COVID-19 vaccines and therapeuticsCurrent outlook excluding COVI

181、D-19 vaccines and therapeutics1 2020:Growth-3.0%slower than pre-pandemicprojection($39Bn)2 2021:+14.2%higher growth including vaccines and therapeutics compared to spending without them3 2022/3:COVID vaccine and therapeutic use has slowed,resulting in lower growth4 Sustained recovery of market will

182、drive long-term growth 12%higher than the pre-pandemic outlookKey events in the outlook20%18%16%14%12%10%8%6%4%2%0%-2%2019202020212022202320242025202820272026Constant dollar growth forecast(invoice)134Post-pandemicvolume reboundIncremental COVID-related usagefor treatments and vaccinesSustained reco

183、very2Demand impact during pandemic Global medicine spending growth is expected to accelerate over the next five years,driven mostly by increased growth contribution from existing branded products even as most growth segments are expected to increase compared to the last five years.New brands in the

184、10 leading developed markets are expected to contribute$193Bn in growth,up$40Bn from the past five years.The impact from brands losing exclusivity(LOE)is expected to more than double to$192Bn,although a large part of that increase is from biologics facing biosimilars where the impacts have had more

185、uncertainty.The largest driver of growth,which is also expected to double,is that from existing protected brands.This is a group of products in the forecast period which were launched prior to 2021 and whose growth contribution has been the most significant driver of the higher growth outlook to 202

186、8.Other higher income developed countries are expected to see their growth outlook increase,as well as Pharmerging countries,all contributing to the nearly$2.3Tn in global spending expected in 2028.Exhibit 18:Global spending and growth,US$Bn 20182028,excluding COVID-19 vaccines and therapeuticsNotes

187、:Developed countries refer to the top 10 developed markets(U.S.,Japan,Germany,France,Italy,Spain,UK,Canada,South Korea,Australia.Other developed include countries from the World Banks income segmentation,and include high and upper-middle income countries,with the exception of pharmerging markets.Pha

188、rmerging markets are those with per capita GDP by purchasing power parity(PPP)$1bn(absolute or rounded)in at least two forecasts.Note that Pharmerging and Other Developed segments have been revised with this edition,with several countries now being included in Other developed which were previously P

189、harmerging.See definitions for details of these regional definitions.Spending and growth do not include COVID-19 vaccines and therapeutics.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESGlobal growth will continue to mostly be driven by new and existing brands in leading developed countriesSource:I

190、QVIA Market Prognosis,Sep 2023;IQVIA Institute,Nov 2023.24|Global Use of Medicines:Outlook to 20282018Dev country new brandsDeveloped country LOEDev country existing brandsDeveloped country GxDeveloped country othersOther developed countriesPharmergingRest of WorldDev country new brandsDeveloped cou

191、ntry LOEDev country existing brandsDeveloped country GxDeveloped country othersOther developed countriesPharmergingRest of World202320281,214153-81180244466251,607193-1923854867411072,238 Across the leading 10 developed markets,the impact of brand losses of exclusivity in the next five years is expe

192、cted to increase by$111Bn to$192Bn,with$133Bn from small molecules and$59Bn from biologics.The medicines expected to drive the greatest amount of impact are typically the U.S.expiries(Exhibit 26),including autoimmune drug adalimumab(Humira)in 2023,lisdexamfetamine(Vyvanse)for ADHD in 2024,blood thin

193、ner rivaroxaban(Xarelto),and autoimmune ustekinumab(Stelara)in 2025.Some of these events are more uncertain,as the actions of originators,payers and providers to switch patients from brands to equivalent generics or biosimilars has a high degree of variability historically.As of November 2023,the ex

194、pected brand declines of adalimumab in the U.S.,facing biosimilars since January 2023 and accounting for$5Bn of the modeled impact in 2023,have resulted instead in an increase in brand spending on an invoice basis as biosimilar uptake has reached only 1.4%of prescriptions.The next five years of expi

195、ry events will provide critical revenue opportunities for generic and biosimilar makers to sustain their businesses,especially considering the more modest period of expiry events in the past five years,which were historically low levels.Payers ability to generate savings from these expiry events wil

196、l offset novel and inline brand spending and be a key element as health systems and payers work to control the rate of growth in drug spending.Exhibit 19:10 developed countries impact of brand losses of exclusivity 20192028,US$BnNotes:Totals may not sum due to rounding.Historic periods from IQVIA MI

197、DAS,Biologic vs small molecule based on recombinant DNA vs all others.Includes the 10 leading developed markets.Modeling of projected expiry impacts based on historic erosion rates.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESThe impact of exclusivity losses will reach$192Bn over the next 5 years

198、,with around 30%due to the availability of biosimilarsSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Nov 2023.iqviainstitute.org|25-5.9-3.0-0.6-12.2-14.1-16.1-7.5-9.3-12.2-3.4-11.0-7.4-10.0-8.6-19.0-21.6-32.1-25.7-34.6-15.6-16.9-10.5-10.7-27.3-18.7-31.2-35.7-48.2-33.1-43.9BiologicSmall$21.6B

199、n$59.4Bn$81.0Bn$59.1Bn$133.0Bn$192Bn2019202020212022202320242025202620272028Forecast$Total brand loss due to LOE In the next five years,novel active substance(NAS)launches are expected to total 350(325375),compared to 369 in the past five years.The last five years of global NAS launches included 24

200、COVID-19 vaccines or therapeutics,and the total without them was 345.Trends in new brand spending include some significant outlier products such as the cluster of hepatitis C products in 2014 and 2015 and several oncology,immunology,and diabetes therapies in the 2015 and 2016 years.Most recently,the

201、 approval of GLP-1 therapies for obesity in 2021 and 2023 have started a wave of new product uptake that will run through 2024 when the products will have been marketed for more than two years and cease to be categorized as new.Through the remainder of the forecast period,new therapies across oncolo

202、gy,obesity,neurology,mental health,and cell and gene therapies are expected to drive new brand spending.The country with the largest concentration of first global launches of NASs is the United States,followed by Europe,although not all medicines launched in the U.S.are reaching European markets as

203、sponsors may not operate across all the relevant countries.Notes:New brand spending includes time periods within the first 2 years of launch in country in the analysis.Brand spending includes all brands and is not limited to novel active substances(NAS).NAS are defined as medicines available for the

204、 first time where at least one ingredient is new.Estimates for 2023 global NAS are based on information available as of September 2023(59 confirmed launches)and historic patterns of the remaining three months relative to the full year from prior years.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES

205、New brand spending in the 10 developed countries is projected to be higher than in the last 5 years but a smaller share of spendingSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.26|Global Use of Medicines:Outlook to 2028Exhibit 20:10 Developed new brand spending,excluding COVID-19 v

206、accines and therapeutics35 545638363625282538454139353312%10%8%6%4%2%0%6050403020100201420152016201720182019202020212022202320242025202620272028New brands%of total brand spendingNew brand spending US$BnGlobalNAS Launches54414148605681936376(7182)Average launches projected at 6575/year(325375 launche

207、s within 5-years)New brand spendingNew brands share of brand spendingForecastTotal 201418=$219BnTotal 201923=$153BnTotal 202428=$193Bn Global medicine spending is expected to slow to 69%through 2028,reaching$2.3Tn excluding COVID-19 vaccines and therapeutics.The ongoing impacts of the pandemic conti

208、nue to effect medicine spending and usage patterns through 2023 and are expected to return to pre-pandemic trends afterward.North America medicine spending is expected to grow at an elevated rate of 69%through 2028,driven by continued growth of new brands and older brands and offset by losses of exc

209、lusivity.Western Europe has had three years of 8%spending growth through 2023 and is expected to slow to 47%through 2028 as a combination of expiry events and payer pressure partly offset by the wider use of novel medicines.Eastern Europe has the highest growth outlook with a range from 7.5 to 10.5%

210、,although slowing through the forecast period.Latin America spending growth has been especially high in the first two years of the pandemic,including patients use of established and generic medicines as symptom management for COVID-19.After a slow 2024,growth will average 710%CAGR led by Brazil,Mexi

211、co,Argentina and Colombia.Japans spending growth is expected to average -2 to 1%with relatively flat trends despite strong uptake of branded medicines resulting from a shift to annual price cuts in place of the historic biennial price cut policy.Chinas spending has swung wildly during the pandemic p

212、artly influenced by zero tolerance pandemic policies but is expected to return to more moderate 25%growth through 2028.Notes:Asia-Pacific does not include China,India,and Japan which are reported separately.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESHigher global spending growth occurred in key

213、 regions after the pandemic,particularly in 2023 in North AmericaSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.iqviainstitute.org|27Exhibit 21:Spending growth globally and in 9 regions,total market excluding COVID-19 vaccines and therapeutics,const US$201920282026202720282019202020

214、21202220232024202520262027202820192020202120222023202420252026202720282019202120222023202420252026202720282019202020212022202320242025202620272028201920202021202220232024202569%$2,2252,255Bn69%$1,0501,080Bn47%$390410Bn58%$120140Bn-21%$84104Bn4.57.5%$6367Bn710%$115135Bn7.510.5%$108128Bn710%$3842Bn25%

215、$185215Bn2028 Spending202428 CAGR Const US$Spending growth20%15%10%5%0%-5%20%15%10%5%0%-5%GlobalWestern EuropeNorth AmericaAsia-PacificAfrica&Middle EastJapanEastern EuropeIndiaChina2020Latin America Regions around the world are growing following diverging trends,with some more volume driven while o

216、thers have a greater contribution from adoption of innovation.Countries in North America,Eastern and Western Europe,Latin America,and Africa&Middle East are expected to increase spending growth by more than 30%,indicating both population-driven volume growth and a shift in the mix of products to mor

217、e expensive products.China,the worlds second largest country by pharmaceutical spending,will increase volume by 20%in aggregate over five years,while spending will increase 21%,a more modest rate than in the prior years and still embedding a focus on expanding access to novel drugs via the national

218、reimbursement drug list(NRDL).Eastern Europe spending is expected to increase 55%over five years while volume will increase 8%as the peak of disruptions from the Ukraine conflict have passed,and at the same time reflect the expected adoption of novel drugs,albeit later than in Western Europe and oth

219、er developed markets.Japan spending growth is expected to be flat over the forecast as price controls evolve to encourage innovation while offsetting with savings on older and off-patent medicines.Exhibit 22:Spending and volume growth by regionNotes:Spending growth in constant US$and reflecting 5-ye

220、ar aggregate growth.Volume growth in defined daily doses(DDD)(see methodology).Bubble size reflects spending in 2028,see Exhibit 21 for relevant values.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESSpending and volume growth are following diverging trends by regionSource:IQVIA Market Prognosis,Sep

221、 2023;IQVIA Institute,Dec 2023.28|Global Use of Medicines:Outlook to 202860%55%50%45%40%35%30%25%20%15%10%5%20242028 Percent spending growthconstant US$20242028 percent volume growth defined daily doses(DDD)0%5%10%15%20%25%Spending growth through 2028 expected to be high,driven by mix(wider use of n

222、ovel drugs at higher average prices)Above average volume and spending growth through 2028Below average volume and spending growth through 2028JapanAfrica&Middle EastAsia-PacificChinaEastern EuropeWestern EuropeIndiaLatin AmericaNorth AmericaBelow average spending growth,with expanded access to novel

223、 drugs driving spending growth faster than volume Regions have had a different pattern of spending growth and varying projections through 2028,both in total impact as well as the proportions which are driven by the mix of products compared to the volume of medicine usage.In this analysis of spending

224、 growth,volume growth refers to spending growth at base-period cost per defined daily dose,and mix growth refers to that spending growth driven by changes in the average cost per day.Generally,higher degrees of mix growth reflect countries and regions where adoption of novel medicines is higher,and

225、new medicines at higher prices grow faster than the offsetting cost reductions from patent expiries.In North America and Western Europe,mix growth accounts for more than 80%of spending growth,while in Asian countries volume growth is a much higher share of the changes in spending.Regions typified by

226、 rising economies appear to have a greater degree of mix growth as more of the patients in those countries are able to access the newest medicines.Within regions countries vary;for example,wealthier countries in the Middle East have more mix growth and poorer countries have less of spending and mix

227、growth,and growth mostly through volume with older generic products.Exhibit 23:Spending growth globally and in 9 regions,total market excluding COVID-19 vaccines and therapeutics,const US$20142028Notes:Asia Pacific excludes China,India and Japan.Growth in Constant US$in aggregate over the 5-year per

228、iod.Argentina in Latin America is measured in US$with variable exchange rates to adjust for inflationary impact.Mix growth is defined as the difference between actual spending growth and growth at base-period spend per DDD.Volume growth is defined as the residual of total growth excluding mix growth

229、.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESSpending growth is driven by mix the change in the average cost of medicines in many key regionsSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.iqviainstitute.org|2934.813.342.134.742.945.144.439.148.27.51.436.036.765.861.751.241.930.3

230、29.576.820.554.728.143.849.633.7Mix growth5-year aggregate spending growth Volume growth60%50%40%30%20%10%0%60%50%40%30%20%10%0%90%60%30%0%-30%80%60%40%20%0%100%80%60%40%20%0%50%40%30%20%10%0%60%50%40%30%20%10%0%60%50%40%30%20%10%0%60%50%40%30%20%10%0%10%5%0%-5GlobalWestern EuropeNorth AmericaAsia-P

231、acificAfrica&Middle EastJapanLatin AmericaEastern EuropeIndiaChina2014-20182019-20232024-20282014-20182019-20232024-20282014-20182019-20232024-20282014-20182019-20232024-20282014-20182019-20232024-2028-0.326.541.220.518.313.911.916.528.231.14.16.510.19.228.223.648.234.69.8-20.19.31.27.435.16.820.110

232、.232.86.324.05.511.98.667.89.137.028.848.912.832.418.88.939.316.719.318.318.4-3.14.516.524.720.819.85.60.72.64.8-3.53.246.68.143.937.039.930|Global Use of Medicines:Outlook to 2028 Spending at net levels in the U.S.is projected to grow at 2%to 5%as brand spending continues to grow on an invoice basi

233、s,and off-invoice discounts and rebates are expected to be amplified by the provisions of the Inflation Reduction Act(IRA).In total,off-invoice discounts and rebates result in spending that is estimated at 37%lower than invoice levels in 2023 and projected to be 47%lower than invoice levels in 2028.

234、Projections prior to the passage of the IRA showed this gross to net difference reaching 39%in 2026,with growth averaging 03%on a net basis,2%lower than the revised outlook as the adoption of novel therapies has outpaced expectations in several therapy areas.In particular,oncology,immunology,diabete

235、s and obesity have shown accelerating growth,and only immunology has significant ongoing loss of exclusivities expected to hamper innovation-driven spending growth In addition to discounts and rebates,ongoing market dynamics around the use of medicines,the adoption of newer treatments,the impact of

236、patent expiries,and new generic or biosimilar competition will all contribute to the outlook through 2028.Exhibit 24:U.S.medicine spending and growth at invoice-level and estimated net 20142028 excluding COVID-19 vaccines and therapeuticsNotes:Estimates of net manufacturer sales are based on analysi

237、s by the IQVIA institute from public sources combined with IQVIAs audited invoice-level data(see methodology).Net sales estimates for 2023 are based on information available from selected public companies through September 2023.Projections of future net manufacturer revenues are based on expected of

238、f-invoice discounts and rebates in key therapy areas modeled for the impact of expiries and the impacts of pricing legislation in the IRA.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESThe U.S.market,on a net price basis,is forecast to grow 25%CAGR over the next 5 years,down from 5.3%CAGR for the p

239、ast 5 yearsSource:IQVIA Institute,Dec 2023.3904374564654935215455896457117698278819431,0105-YearCAGRs 5-YearCAGRs 5-YearCAGRs Invoice CAGR7.9%Net 30%belowinvoiceNetCAGR5.9%Invoice CAGR7.6%Net 37%below invoiceNetCAGR5.3%Invoice CAGR69%Net 47%below invoiceNetCAGR25%2014 2015 20162017 20182019 2020 202

240、1 2022 20232024 2025 2026 2027 2028Net salesInvoice to net differenceForecast291 318331331 344363363 386413446458489498521537 Spending on medicines in the U.S.at invoice prices is expected to increase by$299Bn through 2028,$81Bn more than the$218Bn increase over the past five years.The largest drive

241、r of growth will be increased usage of existing protected branded products,which are expected to add$322Bn in spending over five years,much higher than the$172Bn increase from 2018 to 2023 for products more than two years after their launch until their loss of exclusivity(LOE).The contribution from

242、new brands is expected to increase to$119Bn over five years as more than 250 new active substances(NASs)are expected to launch in the U.S.in the period.The impact of losses of exclusivity is expected to increase dramatically to$145Bn from$59Bn in the prior five years as both small molecule and biolo

243、gic product exposure to LOE has increased substantially.Generics,including biosimilars,have had an only modest impact on growth as price deflation has largely offset growth from the related patent expiry events.Overall medicine spending at invoice prices is expected to reach$1,010Bn by 2028 even as

244、off-invoice discounts and rebates are expected to reach 47%and net spending increases by$91Bn over five years(Exhibit 24).Exhibit 25:Spending and growth drivers in US 20182028,constant US$BnNotes:New brands growth contribution defined as the growth during periods when products had been marketed for

245、less than two years.Growth from products defined as new in each year of the five-year period are aggregated together.Existing brands are those which are no longer new and not yet off-patent.Off-patent brands have faced Loss of Exclusivity(LOE).Generics includes non-original branded products or brand

246、ed generics as well as biosimilars.Other includes OTC/other products.Spending and growth do not include COVID-19 vaccines and therapeutics.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESSpending in the U.S.is expected to increase by$299Bn through 2028,driven by new and existing brandsSource:IQVIA M

247、arket Prognosis,Sep 2023;IQVIA Institute,Dec 2023.iqviainstitute.org|3149399-5917252711119-145322201,010ForecastNewbrandsLOEExistingbrandsGenericsOthersNewbrandsLOEExistingbrandsGenericsOthers2023spending 2028spending2018spending Losses of exclusivity in the U.S.are expected to be$145.5Bn through 20

248、28 with significant impact on spending for both small molecules and biologics.Small molecule expiries are expected to reduce brand spending by$106Bn through 2028,more than double the impact of the last five years,including the impact of high-profile products in the anticoagulants therapy area,includ

249、ing rivaroxaban(Xarelto).Biologics are expected to result in$39.5Bn in lower brand spending over five years as biosimilar market dynamics mature and major products face competition,including the continuing impact on ranibizumab(Lucentis)from 2022,adalimumab(Humira)from 2023,and ustekinumab(Stelara)i

250、n 2025.The approval of interchangeable biosimilars for insulins in the second half of 2021 and for adalimumab in 2023 suggests more dramatic volume uptake is possible,although progress to date in the uptake of these biosimilars suggests interchangeability does not definitively drive more rapid uptak

251、e.Questions remain around the relationship of interchangeability,alternative originator formulations,and the commercial and negotiating strategies of stakeholders,which could dramatically increase or reduce the impact of these biosimilar events.Exhibit 26:U.S.impact of brand losses of exclusivity 20

252、192028,US$BnNotes:Does not reflect offsetting spending increases from generic or biosimilar competitors.Losses in future periods are modeled based on expected pre-expiry growth for the brand and subsequent post-expiry loss of sales for the brands.The rates of loss are based on historic averages in e

253、ach country and inclusive of adjustments for products with expiries in progress from historic periods where losses extend into the forecast periods.Historic period analyses are based on audited data.Expected loss of exclusivity dates are highly variable and can change due to outcomes of litigation,g

254、ranting of new patents or changes in the expectation of launch of biosimilars.Information is current as of September 2023.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESThe impact of exclusivity losses will increase to$146Bn over 5 years,including significant biosimilarsSource:IQVIA Market Prognosi

255、s,Sep 2023;IQVIA Institute,Nov 2023.32|Global Use of Medicines:Outlook to 2028-4.2-2.1-0.4-10.3-7.9-9.2-4.1-7.9-10.6-1.8-9.7-5.7-6.9-6.2-14.1-16.4-26.9-19.2-29.3-12.4-14.0-7.8-7.3-17.6-11.4-24.4-24.4-36.1-23.3-37.2BiologicSmall$14.7Bn$44.4Bn$59.1Bn$39.5Bn$106.0Bn$145.5Bn20192020202120222023202420252

256、02620272028Forecast$Total brand loss due to LOE The number of NAS launches in the U.S.in 2023 rebounded and is expected to reach 58(5560).Three of the last five years have had more than 50 NAS launches and the next five years are expected to average 5055 per year,with an aggregate of$23.8Bn in new b

257、rand spending per year.Significant contribution to new brand spending is expected in 2023 and 2024 from drugs for obesity and diabetes,contributing most of the inflection in new brand spending.Over the next five years,more than 250 NASs are expected to launch in the U.S.and new products in aggregate

258、 are expected to contribute$119Bn in spending.New launches in the next five years are expected to include 100 new cancer drugs globally,with most of those available in the U.S.at launch.Other clusters of innovative drugs cover as many as 50 next-generation biotherapeutics,which include cell and gene

259、 therapies and RNA therapeutics,and which partly overlap with oncology treatments.Exhibit 27:U.S.new brand spendingNotes:New brands spending defined as products marketed for less than two years in each year.Number of New Active Substances(NAS)per year reflect launches rather than approvals as there

260、can be a lag between approval and launch.NAS launches in 2023 Estimated based on information confirmed as of Dec 7,2023.NAS counts include COVID-19 vaccines and therapeutics,while spending totals do not.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESNew brand spending in the U.S.is projected to be

261、higher than in the last 5 years but a smaller share of spendingSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.iqviainstitute.org|3325 35 34 2218221518142833262220 1912%10%8%6%4%2%0%4035302520151050201420152016201720182019202020212022202320242025202620272028New brands%of total brand

262、spendingNew brand spending US$BnUS NAS Launches47483042574954693858(5560)Average launches projected at 5055/year(250275 launches within 5-years)New brand spendingNew brands share of brand spendingForecastTotal 201418=$135BnTotal 201923=$99BnTotal 202428=$119Bn Medicine spending in the top five Europ

263、ean markets is expected to increase by$70Bn over the next five years,up from$65Bn in the past five years but with large shifts in the drivers of growth.New brands were the largest driver of growth from 2018 to 2023 and are expected to continue in the next five years but will be hampered by lingering

264、 effects of the pandemic on marketing operations early in the period and reimbursement decisions later as budget pressures increase.Generics,including biosimilars,are expected to add$18Bn in growth over the next five years,about the same as in the past five years despite a larger impact of LOEs as v

265、olume gains will be offset by price deflation.Payer actions will be shaped by the pace of economic and COVID-19 recovery,including broader inflation concerns and the impact on fuel commodity costs in the region related to the Ukraine conflict.Innovation is expected to be significantly strong in the

266、next five years despite expected greater scrutiny of the value of new medicines in the form of health technology assessments.It is possible that new brand growth will be lower while older established brands may grow more after they have demonstrated value in the market and negotiated market access;t

267、hese dynamics represent an area of significant uncertainty.Exhibit 28:Spending and growth drivers in France,Germany,Italy,Spain,and UK 20182028 const US$BnNotes:Spending in US$with constant Q2 2023 exchange rates.New brands growth contribution defined as the growth during periods when products had b

268、een marketed for less than two years.Growth from products defined as new in each year of the five-year period are aggregated together.Existing brands are those which are no longer new and not yet off-patent.Off-patent brands have faced Loss of Exclusivity(LOE).Generics includes non-original branded

269、products or branded generics as well as biosimilars.Other includes OTC/other products.Spending and growth do not include COVID-19 vaccines and therapeutics.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESSpending in Europe is expected to increase by$70Bn through 2028,driven by new brandsSource:IQVIA

270、 Market Prognosis,Sep 2023;IQVIA Institute,Nov 2023.34|Global Use of Medicines:Outlook to 202816136-142417222650-3230183296ForecastNewbrandsLOEExistingbrandsGenericsOthersNewbrandsLOEExistingbrandsGenericsOthers2023spending 2028spending2018spending The impact of LOEs in the five largest European mar

271、kets(Germany,France,Italy,Spain,and the UK),are expected to more than triple over the next five years and more than half of the impact is expected to be biologics with$17.6Bn of the$32.2Bn total impact.The major impact is seen in 2023,2025 and 2026 with patent expiry of ranibizumab(Lucentis)in 2022,

272、and ustekinumab(Stelara)in 2025,and aflibercept(Eylea)in 2026.Europes biosimilar market is the largest in the world,with the first biosimilar launched in 2006 following the approval of biosimilars based on a solid and robust legal pathway introduced in 2004;since then,the process has led to the high

273、est number of biosimilar approvals in the world.Small molecule LOE is expected to double in terms of impact on brands in the next five years even as they have been a smaller share of overall impact.Exhibit 29:EU4+UK impact of brand losses of exclusivity 20192028,US$BnNotes:Does not reflect offsettin

274、g spending increases from generic or biosimilar competitors.Losses in future periods are modeled based on expected pre-expiry growth for the brand and subsequent post-expiry loss of sales for the brands.The rates of loss are based on historic averages in each country and inclusive of adjustments for

275、 products with expiries in progress from historic periods where losses extend into the forecast periods.Historic period analyses are based on audited data.Expected loss of exclusivity dates are highly variable and can change due to outcomes of litigation,granting of new patents or changes in the exp

276、ectation of launch of biosimilars.Information is current as of September 2023.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESThe impact of exclusivity losses will reach$32Bn over 5 years,with more than half due to the availability of biosimilarsSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute

277、,Nov 2023.iqviainstitute.org|35-1.0-0.7-1.7-5.7-6.1-2.9-1.2-0.9-1.4-0.7-0.7-2.1-2.1-2.7-2.4-2.6-3.6-3.2-2.2-1.6-1.4-2.2-6.3-4.2-4.4-8.1-8.7-6.5-4.4BiologicSmall$5.2Bn$8.5Bn$13.8Bn$17.6Bn$14.5Bn$32.2Bn2019202020212022202320242025202620272028Forecast$Total brand loss due to LOE-0.1 Over the next five

278、years,more than 175 NASs are expected to launch in the leading European countries and new products in aggregate are expected to contribute$50Bn in spending.Three of the last five years have had more than 40 NAS launches and the next five years are expected to average at least 3540 per year,with an a

279、ggregate total of more than$9Bn in new brand spending per year.New launches in the next five years are expected to include one-third from cancer drugs and important clusters in neurology,including rare diseases.Other clusters of innovative drugs include next-generation biotherapeutics,which include

280、cell and gene therapies and RNA therapeutics,and which partly overlap with oncology treatments,although reimbursement decisions may be complex due to the budget impact for relatively few benefitting patients.Exhibit 30:EU4+UK new brand spending,excluding COVID-19 vaccines and therapeuticsNotes:New b

281、rands spending defined as products marketed for less than two years in each year.Number of New Active Substances(NAS)per year reflect launches rather than approvals as there can be a lag between approval and launch.NAS launches in 2023 Estimated based on YTD Dec 14 2023.NAS counts include COVID-19 v

282、accines and therapeutics,while spending totals do not.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESNew brand spending in EU4+UK is projected to be higher than the last 5 years but a smaller share of spendingSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.36|Global Use of Medicines

283、:Outlook to 20287 1212 11 12 97776 8 11121090%5%10%15%051015201420152016201720182019202020212022202320242025202620272028New brands%of total brand spendingNew brand spending US$BnEU4+UK NAS Launches42382841352940504127(2529)Average launches projected at 35-40/year(175200 launches within 5 years)New b

284、rand spendingNew brands share of brand spendingForecastTotal 201418=$54BnTotal 201923=$36BnTotal 202428=$50Bn Spending growth in Japan is expected to maintain a consistent-2 to 1%growth rate over the next five years as COVID-19 recovery continues and long-term trends affecting long-listed brands con

285、tinue.While 2020 had the impact of being a price-cut year on top of the pandemic,the more muted rebound in 2021 included an off-cycle price-cut as well as the lingering effects of the pandemic on the market.Annual frequency of pricing revisions is expected through the full forecast period,although t

286、he annual off-year impacts may be lower than the established biennial price cut years.Over the past decade,protected brands share of spending has risen from 48%to 54%,reversing a long historical trend where share would decline over time and reflecting a shift in investment by manufacturers launching

287、 earlier in Japan and government focus enabling earlier access to novel medicines.Long-listed products have declined from 24%of spending in 2014 to 11%in 2023 and are expected to drop to 7%by 2028.Generic share of spending is also expected to rise,supported by policies that have been largely effecti

288、ve over the entire period,encouraging doctors to substitute available generics with a combination of incentives and penalties.Exhibit 31:Japan medicine spending by product type 20142028,constant US$BnNotes:Shares for protected brands,long-listed products,generics,NHI others,and Non-NHI products are

289、based on segmentations of products available locally in Japan covering the MLHW regulated markets.OTC and other products were estimated and added to complete the view of the market.Analyses do not include COVID vaccines and therapeutics.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESJapan medicine

290、spending is forecast nearly unchanged over 5 years as innovation is offset by shift to annual price cutsSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.iqviainstitute.org|37Medicine spending const US$Bn100908070605040302010068 7272 69 68 7068 69 72 73 73 7373 73 73 420 5-YearCAGRs 5-

291、YearCAGRs 0.3%2.1%11.6%7.8%-8.4%1.5%2.6%3.5%1.4%-5.5%-0.1%1.3%-0.6%-7.6%6.6%1.1%1.0%1.3%1.0%-0.4%-8.6%5-YearCAGRs 2014 2015 2016 2017 20182019 2020 2021 2022 20232024 2025 2026 2027 2028Long-listed productsGenericsNHI othersNon-NHI productsOTC/othersProtected brandsForecast Medicine spending in Chin

292、a has risen from$103Bn in 2014 to$163Bn in 2023.Over the past five years,spending growth was driven by original branded products,most often from multinational companies,which grew at an average of 8.5%per year to reach 29%of spending in 2023,up from 20%in 2014.Over the next five years,the government

293、 policies to update the national reimbursement drug list(NRDL)annually is contributing to a greater share of new original medicines being reimbursed,resulting in higher levels of spending,although these are generally subject to lower negotiated net prices.Increasingly,original branded products are b

294、eing launched by domestic originators rather than by multinationals,a pattern reshaping the market in China with implications for other countries in the region and around the world.Over the next five years,original brands will grow by 7.5%per year while other types of products will grow at 6%or less

295、,contributing to the overall growth rate slowing to 25%.Non-original brands,including versions of medicines originated by multi-nationals,are the second largest segment of spending in China but are expected to grow by less than 1%per year,partly as a result of a government focus on curbing spending

296、growth in hospitals.By 2028,China is projected to exceed$197Bn,an increase of more than$30Bn in the next five years.Exhibit 32:China medicine spending by product type 20142028Notes:Original brands are those marketed by their originator(or licensed partner)and includes vaccine products by all manufac

297、turers.Analysis does not include COVID-19 vaccines or therapeutics.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESSpending growth in China is expected to slowly recover post-COVID-19,driven almost entirely by new original medicinesSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.38|G

298、lobal Use of Medicines:Outlook to 2028103 110 121 123 129 148 146 158 156163169 176 183 190 197 420 5-YearCAGRs 5-YearCAGRs 7.1%11.3%6.8%3.5%9.0%4.8%8.5%-0.3%5.3%9.0%3.8%7.5%0.4%1.4%5.8%5-YearCAGRs 2014 2015 2016 2017 20182019 2020 2021 2022 20232024 2025 2026 2027 2028Non-original brandsOTC&othersU

299、nbranded productsOriginal branded productsForecast200150100500Medicine spending const US$BnExhibit 33:Global medicine spending and growth by product typeNotes:Developed countries refer to the top 10 developed markets(U.S.,Japan,Germany,France,Italy,Spain,UK,Canada,South Korea,Australia.Other develop

300、ed include countries from the World Banks income segmentation,and include high and upper-middle income countries,with the exception of pharmerging markets.Pharmerging markets are those with per capita GDP by purchasing power parity(PPP)$1bn(absolute or rounded)in at least two forecasts.Note that Pha

301、rmerging and Other Developed segments have been revised with this edition,with several countries now being included in Other developed which were previously Pharmerging.See definitions for details of these regional definitions.Spending and growth do not include COVID-19 vaccines and therapeutics.SPE

302、NDING AND GROWTH BY REGIONS AND KEY COUNTRIESMedicine spending and growth varies by region and product type with more than half of spending from brands in developed marketsiqviainstitute.org|39ORIGINAL BRANDSNON-ORIGINAL BRANDSUNBRANDED GENERICSOTHERTOTALSpending 2023 US$BnGlobal1,057.2248.1158.5143

303、.01,606.8Developed967.4128.7113.465.91,275.5 10 Developed858.981.098.143.51,081.6 Other developed108.447.815.322.4193.9Pharmerging81.0105.743.373.7303.7Lower-income countries8.813.61.73.427.6Constant dollar CAGR 20192023Global8.0%6.9%4.6%5.8%7.3%Developed7.9%7.6%2.8%4.5%7.2%10 Developed7.9%6.4%2.1%3

304、.1%7.0%Other developed8.1%9.8%8.4%7.5%8.5%Pharmerging9.7%6.2%10.3%7.0%7.8%Lower-income countries3.2%6.6%7.2%7.1%5.6%Spending 2028 US$BnGlobal$1,520$1,550$315$345$185$205$165$185$2,225$2,255Developed$1,390$1,420$165$185$125$145$68$88$1,775$1,805 10 Developed$1,230$1,260$105$125$100$120$47$51$1,505$1,

305、535 Other developed$150$170$58$62$18$22$27$31$255$285Pharmerging$110$130$130$150$53$73$84$104$400$430Lower-income countries$9$13$15$19$1.5$2.5$3.5$4.5$33$37Constant dollar CAGR 20242028Global69%811%36%36%69%Developed69%47%14%14%58%10 Developed69%47%03%03%58%Other developed69%47%47%47%58%Pharmerging1

306、013%1215%912%58%1013%Lower-income countries36%47%36%47%36%The types of medicines driving spending and growth vary considerably across countries broadly correlated with a degree of economic development.Generally,wealthier countries have higher levels of spending on original branded products,especiall

307、y earlier in the patented periods of these products.Lower income countries have a greater reliance on generic drugs and sometimes prefer non-original branded versions,sometimes called branded generics;when patent enforcement is less stringent,these are referred to as copy products.Developed countrie

308、s typically have higher shares from original branded products but vary to the degree they shift usage to generics or non-original products after patent expiry,contributing to differences in spending share for originators including those that are off-patent.Pharmerging and lower income countries have

309、 much lower shares of spending from originator products,with a greater focus on either generics or non-original branded products,and all products typically have lower prices.Source:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Dec 2023.40|Global Use of Medicines:Outlook to 2028 The relative amount

310、 of medicine spending has been shifting over time with some fast-growing countries becoming more important to the total level of global spending.Volume growth,often of older generic medicines,has been the primary driver of growth in many Pharmerging markets,although the more recent rising rankings a

311、head of leading developed markets are also driven by shifts in the mix of spending.China has been the second largest global pharma market for more than a decade but has begun to grow more slowly than the U.S.,reflected in the declining index of spending from 23.0%in 2023,projected to be 20.0%in 2028

312、.The growth in pharma spending levels along with rising PPP-adjusted GDP per capita has resulted in some formerly Pharmerging countries now being classified as other developed in other analyses in this report,including Russia and Turkey,among others.Exhibit 34:Global top 20 countries ranking and inv

313、oice spending relative to the United StatesSPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESFaster growing Pharmerging markets are generally improving in their global rankings while developed markets rank lowerRANK2018%OF U.S.INVOICE SPENDING1United States 100 2China 27.7 3Japan 17.2 4Germany 10.4 5F

314、rance 7.4 6Italy 6.9 7United Kingdom 5.6 8Brazil 5.2 9Spain 5.1 10Canada 4.5 11India 4.1 12South Korea 3.2 13Russian Federation 3.1 14Australia 2.6 15Indonesia 1.7 16Mexico 1.7 17Saudi Arabia 1.7 18Argentina 1.7 19Poland 1.6 20Turkey 1.5 RANK2023%OF U.S.INVOICE SPENDING1United States 100 2China 23.0

315、 3Japan 10.6 4Germany 9.2 5France 6.6 6Italy 5.9 7United Kingdom 5.8 8Brazil 5.0 9Spain 4.7 10Canada 4.4 11India 3.9 12Russian Federation 2.9 13South Korea 2.6 14Australia 2.3 15Mexico 2.0 16Argentina 1.9 17Poland 1.6 18Saudi Arabia 1.6 19Turkey 1.4 20Vietnam 1.2 RANK2028%OF U.S.INVOICE SPENDING1Uni

316、ted States 100 2China 20.0 3Japan 9.3 4Germany 8.9 5France 6.5 6Italy 6.0 7United Kingdom 5.7 8Brazil 5.3 9Spain 4.8 10Canada 4.6 11India 4.0 12South Korea 2.8 13Russian Federation 2.6 14Argentina 2.5 15Australia 2.0 16Turkey 1.8 17Poland 1.8 18Mexico 1.8 19Saudi Arabia 1.7 20Vietnam 1.4 3 1 3 32712

317、23Change in ranking over prior 5 yearsSource:IQVIA Market Prognosis,Sep 2023;IQVIA Institute,Nov 2023.Notes:Rankings are based on US$with variable exchange rates at list prices.Changes in rank are compared to 5 years previously,and the number of ranking positions indicated with a number.All country

318、spending is compared to the U.S.which is set to 100.Spending does not include COVID vaccines or therapeutics.See Definitions&Methodology for Pharmerging countries.16iqviainstitute.org|41 Global biotech spending is set to exceed$890Bn by 2028,with growth slowing to 9.512.5%due to the impact of biosim

319、ilars Specialty medicines will represent 43%of global spending in 2028 and more than 55%of total spending in leading developed markets.The two leading global therapy areas oncology and immunology are forecast to grow 1417%and 25%CAGR,respectively,through 2028.Oncology is projected to add 100 new tre

320、atments over five years,contributing to an increase in spending of$224Bn to a total of more than$440Bn in 2028 and facing limiting new losses of exclusivity.Treatments for autoimmune disorders are forecast to reach$192Bn globally by 2028,driven by steadily increasing numbers of treated patients and

321、new products,and offset after 2023 due to biosimilars.Diabetes spending growth is slowing to low single digits in most developed markets and declining in some,especially net of rebates.Global obesity spending has accelerated in the past two years from novel drugs with upside if more widely reimburse

322、d.New therapies in Alzheimers and anxiety/depression are expected to drive spending growth in neurology.The outlook for next-generation biotherapeutics includes significantly uncertain clinical and commercial prospects for cell,gene and RNA therapies,which will grow to$33Bn in spending by 2028.Key t

323、herapy areasBiotech will represent 39%of spending globally and will include both breakthrough cell and gene therapies as well as a maturing biosimilar segment.Major advances are expected to continue,especially in oncology,immunology,diabetes and obesity.Notable small molecule innovations are also ex

324、pected in these diseases as well as neurology.Global spending on biotech drugs those created through recombinant DNA technology are expected to reach$892Bn by 2028,about 39%of global medicine spending.Biotech covers a range of therapies,including traditional therapies such as insulin analogues and m

325、ore complex specialty medicines and cell and gene therapies.Spending for biotech drugs will include$2024Bn by 2028 from cell and gene therapies,which currently represent approximately$6Bn and are expected to grow predominately from wider use,especially in developed markets.Overall biotech growth wil

326、l occur despite brand losses of$59Bn due to biosimilars in developed markets in the five years to 2028.Spending growth is expected to slow in the next five years from the impact of key biosimilars,especially in developed markets,but remain robust through the continued flow of new medicines.Biotech d

327、rugs will see a 77%aggregate increase over five years with a 9.512.5%CAGR through 2028,adding$389Bn over the period globally.Exhibit 35:Global biotech spending and growthNotes:Biotech medicines defined as those produced through recombinant DNA technology.Does not include COVID vaccines or therapeuti

328、cs.KEY THERAPY AREASGlobal biotech spending is set to exceed$890Bn by 2028,with growth slowing to 9.512.5%due to the impact of biosimilarsSource:IQVIA Institute,Dec 2023.42|Global Use of Medicines:Outlook to 2028SpendingForecastGrowth0%2%4%6%8%10%12%14%16%18%01002003004005008006001,0009007002012 201

329、3 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 202620282027%Spending growth constant US$Spending constant US$Bn20232028 Key metrics+77%totalspending growth(9.512.5%CAGR)$59Bn impacton brands frombiosimilars+$389Bn119 129 151 173 197 220 254 295 326 377 433 503572 645720892803 Specialt

330、y medicines have been increasing as a share of spending in higher-income countries,such as the 10 largest developed countries and other high and upper-middle income countries,where they have reached 50%and 36%,respectively,in 2023,up from 29%and 23%10 years earlier.Pharmerging countries have lagged

331、largely due to cost and in 2023,had 13%of spending on specialty medicines,unchanged as a share of spending in 2028.Globally specialty medicines will be 43%of global spending by 2028,with more than half of spending on these products in major developed markets.Specialty medicines are those which treat

332、 chronic,complex and rare diseases,and while they have a range of characteristics including the complexity of disease management or distribution the most commonly noted attribute is that they are more expensive than other more traditional medicines.As specialty medicine share of spending increases,i

333、t is notable that they treat only 2-3%of patients.While the unmet needs of these few patients are being addressed,by contrast other patients getting traditional therapies are seeing their costs decline.Exhibit 36:Specialty medicines share of spendingNotes:For details on specialty medicine definition,see the methodology and definitions section.Does not include COVID-19 vaccines and therapeutics.KEY

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