1、Global Use of Medicines 2023 OUTLOOK TO 2027JANUARY202 3Introduction2023 IQVIA 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 photocop

2、y,recording,or any information storage and retrieval system,without express written consent of IQVIA and the IQVIA Institute.Reaching a post-pandemic era is an alluring prospect for almost everyone around the world after the disruptions of the past three years.The outlook for global spending on medi

3、cines has become clearer as the traumas recede and uncertainties give way to more predictable challenges.Policymakers across developed and emerging economies are shifting from crisis to rebuilding modes with a focus on longer-term issues of sustainability.Complex trade-offs remain,and improved effic

4、iency and quality of healthcare informed by evidence-based decision-making will inform the critical decisions in the coming decade.The largest driver of medicine spending through the next five years is still expected to be global COVID-19 vaccinations,but leaving aside the pandemic,global spending o

5、n medicines continues to be driven by innovation and offset by losses of exclusivity and the lower costs of generics and biosimilars.In this report,we quantify the impact of these dynamics and examine the spending and usage of medicines in 2022 and the outlook to 2027,globally and for specific thera

6、py areas and countries.We intend for this report to provide a foundation for meaningful discussion about the value,cost,and role of medicines over the next five years in the context of overall healthcare spending.The study was produced independently by the IQVIA Institute for Human Data Science as a

7、 public service,without industry or government funding.The contributions to this report by Mohit Agarwal,Aurelio Arias,Urvashi Porwal,Jamie Pritchett,Sarah Rickwood,Priya Srivastava,Durgesh Soni,Alan Thomas,and dozens of others at IQVIA are gratefully acknowledged.Find Out MoreIf you wish to receive

8、 future reports from the IQVIA Institute for Human Data Science or join our mailing list,visit iqviainstitute.orgMURRAY AITKENExecutive Director IQVIA Institute for Human Data ScienceThe Global Use of Medicines 2023:Outlook to 2027Table of ContentsOverview 2Impact of COVID-19 on the use of medicines

9、 4Outlook for the use of medicines and historic drivers 13Spending and growth by regions and key countries 19Key therapy areas 37Notes on sources 50 Definitions and methodology 51About the authors 53About the Institute 55Table of ContentsAs the COVID-19 pandemic enters its fourth year,it has been th

10、e most impactful global public health crisis in decades,and yet it has illustrated the resilience of global health systems as they have readily adapted to peaks in demand and developed novel vaccines and therapeutics with significant efficacy,safety,and unusual speed.The global vaccination program t

11、hat countries and industry have implemented is unprecedented in its speed and reach to lower-income countries previously thought to be inaccessible.While challenges remain in managing the pandemic into an endemic phase,other health concerns are also coming back into focus.Overall,global use and spen

12、ding on medicines is expected to return to pre-pandemic growth rates by 2024,though the next two years are not without important uncertainties related to viral variants,vaccination rollout for COVID-19,and under-usage of booster shots,as well as economic uncertainties related to global inflation,geo

13、political conflicts,and climate change.IMPACT OF COVID-19 ON THE USE OF MEDICINES Global spending on medicines from 2020 to 2027 is expected to exceed the pre-pandemic outlook by$497Bn in aggregate,largely due to new spending on COVID-19 vaccines and novel therapeutics,as well as the impact on other

14、 therapeutic areas.Global market growth will return to pre-pandemic projected rates by 2024 despite year-to-year fluctuations and geographical variations.All regions around the world have exceeded previously projected first wave COVID-19 vaccination rates,resulting in 530 million more vaccinated peo

15、ple by the end of 2023 than initially modeled.The largest areas of over-achievement in this area have been in upper-middle and lower-middle-income countries as defined by the World Bank,with 4.4 billion people vaccinated,490 million more than earlier estimates.Immunity achieved from COVID-19 infecti

16、on or vaccines appears to wane after a year,and annual boosters are being recommended,including new versions for emerging viral variants;adoption,however,generally includes less than half of the population who had received the first-wave shots and is lagging in lower-income countries.Ongoing booster

17、 usage will likely increase,especially if there are impactful surges with new variants,and these patterns characterize the expected nature of the endemic phase.COVID-19 therapeutics will continue to be widely used and will result in a cumulative spend over eight years of$120Bn through 2027.Other med

18、icine use was disrupted during the pandemic across a range of therapy areas,some related to the symptom profile of the pandemic,others related to disrupted management of chronic diseases.Sustained complications of COVID-19 infection across almost all organ systems,known as long-COVID,is now better u

19、nderstood,with 1020%of infected patients suffering with persistent symptoms requiring ongoing demand for treatments,often with older generic drugs.OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERS The use of medicines globally plateaued in 2022 following a significant rebound in 2021 as markets

20、recovered from the pandemic.Overall volume is projected to grow 1.6%CAGR in days of therapy through 2027,driven by Asia-Pacific,India,Latin America,Africa and the Middle East,and China,all of which are expected to exceed global volume growth.Higher income countries in Western Europe and North Americ

21、a as well as Japan and Eastern Europe are expected to grow more slowly at 0.1 to 0.4%through 2027,partly due to their already higher per capita use.Eastern Europe volume growth is also hampered by disruptions from the ongoing Ukraine conflict.Per capita use of medicines varies by GDP,with use in hig

22、her-income countries typically higher than in lower-income countries.Countries such as Japan and those in Western Europe have more than double the use of most other regions measured in WHO defined daily doses.Countries vary considerably in the therapy areas which drive most of their volume use of me

23、dicines,linked to the burden of disease they experience as well as factors which influence the structure and functioning of health systems.While overall volume has increased by 2%CAGR over the past decade,oncology has increased at 15%per year,driven by the significant advances in novel treatments an

24、d improved access to cancer care around the world.2|The Global Use of Medicines 2023:Outlook to 2027Overviewiqviainstitute.org|3SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES The global medicine market using invoice price levels is expected to grow at 36%CAGR through 2027,reaching about$1.9Tn in t

25、otal market size.Spending and volume growth will follow diverging trends by region with larger established markets growing more slowly,and growth markets in Eastern Europe,Asia and Latin America growing in both volume and spending.The U.S.market,on a net price basis,is forecast to grow-1 to 2%CAGR o

26、ver the next five years,down from 4%CAGR for the past five years.Prior editions estimated 03%CAGR on a net basis.The new forecast,including projected effects of the Inflation Reduction Act,reflects an outlook that has a 1%lower range.Provisions of the new legislation are expected to drive incrementa

27、l volume by reducing cost exposure for patients and by driving lower prices through inflation penalties and price negotiations.Other aspects of the law will impact the interactions of stakeholders and the responsibility for cost shifts between government,payers,and pharmaceutical manufacturers,espec

28、ially in the Medicare program.Spending in Europe is expected to increase by$59Bn through 2027,with a focus on generics and biosimilars,and escalating pressures on the value and negotiated prices of novel medicines.The pandemics impact on Asia-Pacific countries varies considerably,but a return to ste

29、ady growth is projected after 2021.Japan medicine spending growth is projected at-1 to 2%through 2027 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 use of new ori

30、ginal medicines and offset by pressures on off patent and generic pricing.Growth in developed economies continues at relatively steady rates,with new products offset by patent expiries.Latin America,Eastern Europe and parts of Asia are expected to grow strongly from volume and adoption of novel medi

31、cines.KEY THERAPY AREAS The key growth area for medicines in the next five years is biotech,which will represent 35%of global spending and will include many of the areas of greatest activity for novel medicines.In addition,global savings from biosimilars will exceed$290Bn in cumulative spending thro

32、ugh 2027,which is below estimates without new biosimilars,representing a significant mechanism to generate wider usage of these medicines as well as ease payer budget pressures on overall spending.Specialty medicines will represent 43%of global spending in 2027 and more than 55%of total spending in

33、developed markets,continuing the shift from more traditional medicines underway for over a decade.The two leading global therapy areas oncology and immunology are forecast to grow 1316%and 36%CAGR,respectively,through 2027,reflecting diverging trends with one still driven by novel medicines and the

34、other facing biosimilar competition.Oncology is projected to add 100 new treatments over five years,contributing to an increase in spending of$184Bn to a total of more than$370Bn in 2027 and facing limiting new losses of exclusivity.Treatments for auto-immune disorders are forecast to reach$177Bn gl

35、obally by 2027,driven by steadily increasing numbers of treated patients and 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.New therapies contribute to growth of

36、neurology markets,including greater use of novel migraine therapies,potential treatments for rare diseases,and the potential for therapies for Alzheimers and Parkinsons.The outlook for next generation biotherapeutics includes significantly uncertain clinical and commercial prospects for cell,gene,an

37、d RNA therapies,which will grow from current$8Bn spending in 2022 to$27Bn by 2027.4|The Global Use of Medicines 2023:Outlook to 2027 Global spending,including COVID-19 vaccines and therapeutics,is expected to exceed pre-pandemic outlook by$497Bn to 2027.Global market growth will return to pre-pandem

38、ic projected growth rates by 2024 despite year-to-year fluctuations.All regions around the world have exceeded previously projected first wave vaccination rates while booster utilization is lagging.Global spending on COVID-19 vaccines is expected to exceed previous estimates,primarily from higher vo

39、lume.Medicine use in pharmerging countries has varied greatly since early 2020 and has been more stable in developed countries.Medicine use was disrupted in some therapies throughout the pandemic,with most countries returning to pre-pandemic levels.Research has been able to identify sustained compli

40、cations of COVID-19 infection across almost all organ systems and the degree of impact is becoming clearer.Impact of COVID-19 on the use of medicinesThe COVID-19 pandemic has transitioned to a new phase with vaccines and therapeutics available but inconsistently used and resulting periodic emergence

41、 of infection and hospitalization surges leaving significant uncertainty in the years ahead.iqviainstitute.org|5 The outlook for global medicine spending has shifted considerably during the COVID-19 pandemic but is expected to be largely similar to the pre-COVID outlook,excluding the spending for CO

42、VID-19 vaccines and therapeutics.For non-COVID spending,lower trends in the near-term are expected to be largely offset and by 2027,the cumulative reduction from the pre-pandemic outlooks is expected to be only$4Bn.The most important drivers of lower spending will be those,often asymptomatic,conditi

43、ons that have disrupted patient engagement and fail to make up the backlog of previously expected usage and spending.The phased rollout of vaccines and booster shots in the base case estimate will result in$380Bn in incremental spending globally.Expected use of novel therapeutics for COVID-19 are ex

44、pected to result in a total of$120Bn over seven years,resulting in a total impact of vaccines and therapeutics of$497Bn,or about 3%of cumulative global spend during that period.A rapid first wave of vaccinations exceeded previous expectations but has been followed by lower rates of booster utilizati

45、on.Lower-income countries generally vaccinated fewer people than higher-income countries,and 2022 has been characterized by recurrent outbreaks with new viral variants,a pattern which is largely expected to continue,though severity and impact on health systems capacity appear to be more moderate tha

46、n earlier in the pandemic.Exhibit 1:Changes in the historical and projected global medicine spending model due to COVID-19,20192027,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.Neither outl

47、ook 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 therapeutic

48、s 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.IMPACT OF COVID-19 ON THE USE OF MEDICINESGlobal spending,including COVID-19 vacc

49、ines and therapeutics,to exceed pre-pandemic outlook by$497Bn to 2027Source:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.1,278 1,312 1,450 1,482 1,557 1,651 1,742 1,828 1,917 3 117 92 75 60 53 51 50 Incremental spend for COVID-19 vaccines&therapeuticsCurrent outlook excluding COVID-19 va

50、ccinesPre-COVID-19 outlookCumulative difference in non-COVID-19 spending from pre-COVID-19 levelsCumulative COVID-19 therapeuticsTotal cumulative difference from pre-COVID-19 levelsCumulative COVID-19 vaccine spending20022202320242025202720262002220232024202520272026Cumulative

51、difference,US$billion=+Spending outlook change due to COVID-19:$497Bn,20202027COVID-19 vaccine spending:$380Bn($315$42Bn)COVID-19 therapeutics:$120Bn($105135Bn)COVID-19 disruption impact:-$4Bn20202027-19-75-62-87-106-99-76-43-4 104 158 211 256 297 338 380 3-19-72 57 124 181 247 323 407 497 0 16 53 7

52、6 91 103 112 120 6|The Global Use of Medicines 2023:Outlook to 2027 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 with a return to pre-pandemic growth rates by 2024.Including estimates of higher spending gro

53、wth from COVID-19 vaccines and lower spending from existing treatments due to disruptions from the pandemic,the five-year CAGR to 2027 is expected to be 4.6%,compared to 4.5%if the pandemic had not taken place.Perhaps the largest uncertainty in the next five years will be the potential impact of eco

54、nomic factors on countries budgeting and whether there will be shifts in policies regarding healthcare and medicine spending.It is expected that the pricing and value of medicines will be under increased scrutiny during this period,especially considering concurrent events related to economic inflati

55、on,and geopolitical disruptions such as the Ukraine conflict.While the pandemic has dominated much of the past three years,the wider trends on the use of medicines continue to evolve relatively unchanged,which offers some hope to the millions living in lower-income markets,with their improved health

56、 situation largely a result of increased access to medicines.Exhibit 2:Comparison of current outlook to pre-COVID-19 outlookNotes:Pre-COVID outlook based on IQVIA Market Prognosis,Sep.2019 edition which included projections to 2024 and which has been extended to include the periods to 2027 with a li

57、near projection.Current outlook based on IQVIA Market Prognosis Sep 2022 edition.Incremental COVID vaccine and therapeutic scenario based on current outlook combined with incremental spending for vaccines and novel COVID-19 therapeutics.IMPACT OF COVID-19 ON THE USE OF MEDICINESGlobal market growth

58、will return to pre-pandemic projected growth rates by 2024 despite year-to-year fluctuationsSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.Pre-COVID-19 outlookCurrent outlook including incremental spend on COVID-19 vaccinesCurrent outlook excluding COVID-19 vaccines1 2020:Growth-2.0

59、%slower than pre-pandemicprojection($26Bn)2 2021:+3.4%above pre-COVID-19 growth;+5.1%above 2020 growth excluding vaccineand therapeutics3 2021:+10.6%higher growth includingvaccines and therapeutics compared tospending without them4 2022:Significant decline in required spendingfor COVID-19 vaccines a

60、s much of the world isinoculated to some degree5 Expected budget pressures will emerge fromlonger-term pressures of sustained pandemicKey events in the outlook20%18%16%14%12%10%8%6%4%2%0%-2%2002220232024202520272026Constant dollar growth forecast(invoice)1534Post-pandemicvolume reboundInc

61、remental COVID-related usagefor treatments and vaccinesPost-pandemiceconomic/budgetpressuresVaccine spending declineswith shift to boosters2Demandimpact during pandemiciqviainstitute.org|7 Most countries around the world achieved higher rates of vaccination than previously modeled,with upper-middle,

62、lower-middle,and low-income countries exceeding projections the most.The WHO had identified disparities in access as of late 2021,reflecting concerns of a two-track pandemic if left unaddressed,and while generally vaccinations have taken place at higher rates,lower-income countries continue to lag f

63、ar behind.Low-income countries are expected to continue to lag behind higher income countries until achieving higher rates near the end of 2023,when globally more than six billion people will have received at least one COVID-19 vaccination.Across geographies,the rates of booster shot usage has been

64、below expectations,and even in the wealthiest countries,fewer than half of those people initially vaccinated are receiving boosters.It remains possible and even likely that relaunched vaccine drives will result in significant acceleration in these rates across a wide range of low and lower-middle-in

65、come countries,especially considering periodic surges from newly emerging viral variants.Exhibit 3:Percentage of total population vaccinated by month and comparison to prior forecastNotes:Estimates of vaccination rates based on reported vaccination data through October 2022.Countries within the four

66、 World Bank income bands have been projected to achieve a maximum vaccination rate by the end of 2023.The high-income and upper-lower-income countries average over 60%and will have a slowing rate of new vaccinations until they reach the projected peak.The lower-middle-income and low-income countries

67、 currently have much lower vaccination rates and widely diverging trends in the most recent months.The differences across countries are expected to narrow by the end of 2023 as global initiatives to encourage vaccination partly achieve their goals.The percentage of the population vaccinated with at

68、least one dose is compared from the current estimates to that published by the IQVIA Institute in the prior edition of this report.The vaccinated population are relevant to the estimations of the population eligible for booster shots at a point in time used in overall volume projections.Estimates of

69、 fully vaccinated population with boosters are an estimate of the population with a current booster in the prior 12 months in addition to initial vaccination.IMPACT OF COVID-19 ON THE USE OF MEDICINESAll regions around the world have exceeded previously projected first wave vaccination rates while b

70、ooster utilization is laggingSource:IQVIA Institute,Nov 2022;Vaccination trends to date from Ourworldindata.org,accessed October 2022.Population vaccinated with at least one dosePopulation fully vaccinated with boostersHigh-income countriesLower-middle-income countries100%80%60%40%20%0%60-70%,2.3 bi

71、llion people(+240Mn)80%,1.1 billion people(+5Mn)Range of vaccination,#of people vaccinated in the region in the prior model,(incremental vaccinated people in the updated model).100%80%60%40%20%0%.Previous editionDec-20Feb-21Apr-21Jun-21Aug-21Oct-21Dec-21Feb-22Apr-22Jun-22Aug-22Oct-22Dec-22Feb-23Apr-

72、23Jun-23Aug-23Oct-23Dec-23Upper-middle-income countriesLow-income countries50-60%,400 million people(+35Mn)70-80%,2.1 billion people(+250Mn)Dec-20Feb-21Apr-21Jun-21Aug-21Oct-21Dec-21Feb-22Apr-22Jun-22Aug-22Oct-22Dec-22Feb-23Apr-23Jun-23Aug-23Oct-23Dec-238|The Global Use of Medicines 2023:Outlook to

73、2027 Global COVID-19 spending is expected to exceed$50Bn in 2022 and$380Bn in total over seven years to 2027,higher than earlier projections of$251Bn through 2026.Previous modeling phased the initial vaccination wave more slowly and included half-sized booster shots every other year;the revised assu

74、mptions include expected faster achievement of initial vaccination rates in higher-income countries,slower in lower-income countries,and more frequent boosters of the same size as initial shots.Cost per dose assumptions in the current model reflect a slight upward trend in cost per dose in later yea

75、rs as manufacturers pressure for higher prices,and preference for higher-cost mRNA vaccines impacts average costs.In this model,vaccinations to-date and segmentation of initial and booster types have been considered to create a base case estimate for the number of people who will be vaccinated in an

76、 initial wave and then receive booster shots later.The number of doses consumed per patient is expected to continue to increase as immunity appears to wane over time and annual boosters,potentially including protection from multiple variants,will be necessary,but will be used by a smaller proportion

77、 of patients than in the first wave.Exhibit 4:COVID-19 vaccination spending and volume forecastsNotes:Scenario modeling was conducted by the IQVIA institute based on public information as of October 2022.Estimates of future vaccination trends include input from the public statements of responsible a

78、gencies and manufacturers,as well as modeling by the IQVIA 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 2027

79、.As costs are based on public statements,they may overstate the true costs after negotiated discounts.Doses are based on the expected dosing including booster shots.IMPACT OF COVID-19 ON THE USE OF MEDICINESGlobal spending on COVID-19 vaccines is expected to exceed previous estimates primarily from

80、higher volumeSource:IQVIA Institute,Nov 2022;Pricing information from public disclosures as of October 2022;Vaccination trends to date from Ourworldindata.org.Higher income countries achieved higher than expected vaccination rates earlier in the pandemic while the slower early pace in the developing

81、 world has been significantly improved to date,though the overall vaccination rate is still far below wealthier countries Previous modeling had expected half-size booster doses taken by more of the initially vaccinated.Information to date suggests that booster doses will be the same size as an initi

82、al dose but will be taken by fewer people Although increased competition will drive down cost per standardized dose later in the period,the preference in developed markets for mRNA vaccines resulted in higher-than-expected cost per dose through 2024,and slower booster uptake is a factor in some comp

83、anies stated plans for future pricingUpdated base case scenarioPrevious scenarios range02002021 2022 2023 2024 20252027Constant US$,billionCOVID-19 vaccineglobal spending scenarios$0$5$10$15$20Cost per dose scenarios,US$20224202520272022420252027202620262026Standard

84、doses scenarios,billionsUpdated 7-year total ofbase case=$380Bn(315425)Previous 6-year total ofbase case=$251Bn(185-295).Base case key assumptions0246810Previous base case scenarioiqviainstitute.org|9 The impact of the pandemic on medicine use has been highly varied,including both surges in usage of

85、 chronic medicines,referred to as stockpiling,and then returning to a more normal trend,with the average for developed markets at baseline volumes by the end of 2020.Countries with the least impact from the pandemic,largely due to early and effective containment,including Australia and Canada,have t

86、hen seen drops in volume in more recent periods.Pharmerging markets have had a much more varied pandemic experience,with significant variations in volume through Q3 2020 but generally returning to higher than pre-pandemic levels for the seven quarters since then.As the pandemic has continued,develop

87、ed markets have demonstrated resilience to various logistical disruptions,offering financial assistance to the public and shifting healthcare interactions to remote or virtual settings.Lower-income countries in the pharmerging group of countries have recovered to an average of 110%of pre-pandemic vo

88、lume,higher than the average 106%in the 10 developed countries.Exhibit 5:Trends in Defined Daily Doses(DDD)in 10 developed and pharmerging markets indexed to Q3 2019 values(Q3 2019 value=100)Notes:Defined Daily Doses(DDD)are based on WHO definitions where each medicine is assigned a volume of medici

89、ne per day(see definitions&methodology).All charted values are indexed to Q3 2019 values,such that the Q3 2019 value is set equal to 100%.The 10 developed countries are the 10 largest high-income countries(U.S.,Japan,Germany,France,Italy,Spain,UK,Canada,Australia,South Korea).Pharmerging includes co

90、untries with per capita GDP$1Bn(absolute or rounded)in at least two forecasts.IMPACT OF COVID-19 ON THE USE OF MEDICINESMedicine use in pharmerging countries varied greatly since early 2020 and has been more stable in developed countriesSource:IQVIA MIDAS,Jun 2022;IQVIA Institute,Dec 2022.10 develop

91、edPharmerging60401602019 Q32019 Q42020 Q12020 Q22020 Q32020 Q42021 Q12021 Q22021 Q32021 Q42022Q12022 Q22019 Q32019 Q42020 Q12020 Q22020 Q32020 Q42021 Q12021 Q22021 Q32021 Q42022 Q12022 Q2Spain,112.8 Japan,110.8 U.S.,107.0 Germany,106.8 Italy,106.4 Korea,106.4 France,106.3 UK,105.8 Average

92、,105.9 Australia,100.4 Canada,96.4 Chile,140.1 Indonesia,132.4 Colombia,111.1 Average,110.1 South Africa,89.5 Ukraine,54.3 10|The Global Use of Medicines 2023:Outlook to 2027 Early in the pandemic,with few treatments appearing to offer benefits for patients,there was an increased use of rescue inhal

93、ers normally intended for asthma in patients in ICUs,driving a significant shift in usage in the respiratory market overall and then falling as hospitalization rates fell.Mental health therapies have seen a gradual rise in usage,though more modest than some had expected,potentially due to barriers t

94、o beginning new treatments for mental health disorders,including social stigma.Pharmerging markets have seen generally less disruption to these therapies,as many countries were later impacted by COVID-19 and experienced less of the early wave of uncertainty-driven behavior changes.Higher use of vita

95、mins and minerals in pharmerging markets is,as a result of reports in the media in some of those countries,generally not supported with clinical evidence that certain treatments would either be beneficial or protective relative to COVID-19.Exhibit 6:Trends in medicine use in 10 developed and pharmer

96、ging markets,standard units indexed to Q3 2019 values(Q3 2019 value=100)Notes:Indexed values are based on standard units.Common ICU medications are those indicated by the American Society of Health-System Pharmacists:Atracurium Besilate,Cisatracurium Besilate,Dexamethasone,Dexmedetomidine,Epinephrin

97、e,Etomidate,Fentanyl,Hydromorphone,Ketamine,Midazolam,Norepinephrine,Phenylephrine,Propofol,Rocuronium Bromide,Vasopressin,and Vecuronium Bromide.Chronic and acute definitions are based on therapy classes predominantly used for maintenance therapy or not.Vitamins and minerals includes OTC when captu

98、red.IMPACT OF COVID-19 ON THE USE OF MEDICINESMedicine use was disrupted in some therapies throughout the pandemic with most countries returning to pre-pandemic levelsSource:IQVIA MIDAS,Jun 2022;IQVIA Institute,Dec 2022.Pharmerging10 developed80100120120Antidiabetics80100120120Common ICUmedications

99、Acute therapiesChronic therapiesMental healthVitamins and mineralsRespiratoryHypertensives2019 Q32019 Q42020 Q12020 Q22020 Q32020 Q42021 Q12021 Q22021 Q32021 Q42022 Q12022 Q22019 Q32019 Q42020 Q12020 Q22020 Q32020 Q42021 Q12021 Q22021 Q32021 Q42022 Q12022 Q22019 Q32019 Q42020 Q12020 Q22020 Q32020 Q4

100、2021 Q12021 Q22021 Q32021 Q42022 Q12022 Q22019 Q32019 Q42020 Q12020 Q22020 Q32020 Q42021 Q12021 Q22021 Q32021 Q42022 Q12022 Q2iqviainstitute.org|11 The ongoing COVID-19 pandemic is reported to have increased levels of depression,anxiety and stress in the population at large as well as creating chall

101、enges for those with substance abuse disorders or drug dependency,which are often stigmatized.While quarantines and shutdowns have become less common across many geographies,many patients have remained less engaged with healthcare,likely resulting in continuing numbers of disrupted or delayed diagno

102、ses and treatments especially for those with asymptomatic conditions.For many asymptomatic and lifestyle-influenced conditions such as obesity,diabetes,and heart disease,the ongoing disruptions to what was normal life before the pandemic are expected to result in greater rates of these chronic disea

103、ses,especially as people are more sedentary for sustained periods of time.The pandemic is also impacting other infectious diseases by limiting patients exposure due to pandemic precautions,which may be contributing to elevated rates and severity of respiratory infections in the 2022/2023 seasons for

104、 seasonal flu,common cold,RSV,and other respiratory infections.Disrupted seasonal patterns for these infections may also be a factor contributing to desynced supply and demand issues for antibiotics resulting in shortages.Vaccine hesitancy for COVID-19 may result in an expansion of these attitudes t

105、o other vaccines,generating risk in previously well-controlled infections such as measles,mumps,and rubella,among others.Clarity is slowly emerging around post-acute sequelae of COVID-19(PASC),with 10-20%of previously infected people reporting long-term symptoms,largely confirming early concerns abo

106、ut this feature of the virus.Exhibit 7:Summary of expected impacts of the COVID-19 pandemic on patients and therapeuticsIMPACT OF COVID-19 ON THE USE OF MEDICINESIncreased uncertainty about demand and use of medicines linked to pandemic impactSource:IQVIA Institute for Human Data Science,Nov 2022.Di

107、srupted or delayed diagnoses of conditionsPost-COVID-19 conditionsPopulation level mental healthImpact on infectious diseases Vaccine hesitancy spreads to others and results in outbreaks of previously controlled viruses such as measles,mumps,rubella Other respiratory infections such as RSV(respirato

108、ry syncytial virus)and the common cold may be similarly affected by seasonal disruptions Depression/anxiety,stress disorders Substance abuse/dependency Lack of clear understanding of causes and consequences of“long-COVID”conditions Estimated over 100 million newly diagnosed conditions in COVID-19 pa

109、tients,particularly in CNS and respiratory Treatment modalities still being investigated Interruption of typical healthcare seeking behaviors due to quarantines/shutdowns could have had lasting effects or result in more severe disease when diagnosed,especially cancer Greater rates of chronic disease

110、s such as obesity,type 2 diabetes and heart disease due to disrupted patterns of daily life Seasonal flu season disruption could result in more virulent strains in future seasons,especially if vaccination rates drop12|The Global Use of Medicines 2023:Outlook to 2027 COVID-19 infection results not on

111、ly in debilitating symptoms and sometimes death,but for an important percentage of patients,long-term complications.Post-COVID conditions are now understood as a multi-organ disorder or syndrome that consist of a constellation of different conditions,which are acute or chronic or both,and vary in te

112、rms of severity;estimates of how many people may be affected have varied considerably as multiple organizations have developed widely varying criteria for assessing the presence of post-acute sequelae of COVID(PASC).Early estimates ranged from 10-30%of COVID-19 patients having PASC,but incompatible

113、definitions relating to the nature of symptoms and duration of persistence had made comparisons across studies unreliable.For mild or asymptomatic COVID-19 cases,a complication could be thought to be the result of some other pre-existing condition,unless a COVID-19 antibody test were used to verify

114、a previously unknown infection.Research is ongoing to improve understanding of the prevalence of PASC,as well as to develop specific therapies to address these symptoms where existing medicines are ineffective or have suboptimal outcomes,and while the pandemic continues,the ultimate size of this pop

115、ulation remains uncertain but growing.Exhibit 8:Longer-term complications of COVID-19 infection on patientsIMPACT OF COVID-19 ON THE USE OF MEDICINESResearch has been able to identify sustained complications of COVID-19 infection across almost all organ systemsSource:IQVIA Institute:Assessing the Gl

116、obal Burden of Post-COVID-19 Conditions,Dec 2021.Neurological Brain fog,fatigue,headache,strokes,seizures,encephalopathies,nerve disorders,disturbance in smell and/taste,POTS,Parkinsons disease,dementia,dry eyes,pink eye.Endocrine New onset diabetes mellitus.Respiratory Chronic cough,bronchiectasis,

117、pulmonary fibrosis,pulmonary vascular disease,worsening of pre-existing respiratory conditions(asthma/COPD),shortness of breath.Cardiac Dysrhythmias/arrhythmias,hypertension,dyslipidemia,myocardial injury,myocarditis,heart failure,acute coronary syndrome,cardiomyopathy,hypercoagulation,DIC,VTE,cardi

118、ogenic shock,cardiac arrest,low blood pressure.Gastrointestinal disorders Post infectious dysmotility,abdominal pain,nausea,diarrhea,anorexia,GI vascular diseases,gastroesophageal reflux.PsychiatricDepression,anxiety,psychotic disorders,mood disorders,sleep disorders,substance misuse,post-traumatic

119、stress disorder,delirium,suicidality.Ear,Nose and Throat(ENT)Tinnitus,sore throat,earache,hearing loss,inner ear disorder.RenalRenal damage,acute renal injury,chronic kidney disease,accentuation of post hypertension/diabetes mellitus renal disorders.MusculoskeletalMyositis,chest pain rhabdomyolysis,

120、muscle pain,joint pain,muscle disorders including increase severity of pre-existing diseases.DermatologicalVasculitis rash,urticaria,chilblains,vesicular purpura,irritant dermatitis,hair loss.iqviainstitute.org|13 The use of medicines plateaued in 2022 following a significant rebound in 2021 as mark

121、ets recovered from the pandemic.Overall volume is projected to grow 1.6%in days of therapy through 2027,driven by Asia-Pacific,India,Latin America,Africa/Middle East,and China,all of which are expected to exceed global volume growth.Higher-income countries in Western Europe,North America as well as

122、Japan and Eastern Europe are expected to grow more slowly at 0.1 to 0.4%through 2027 partly due to their already higher per capita use.Per capita use of medicines varies by GDP,with use in higher-income countries typically higher than lower-income.Per capita medicine use varies by region,with Japan

123、and Western Europe having more than double the use of most other regions.Countries vary considerably in the therapy areas that drive most of their volume use of medicines,and while overall volume has increased by 2%over the past decade,oncology has increased at 15.3%per year.Outlook for the use of m

124、edicines and historic drivers Medicine use grew by 36%over the past decade,driven by increased access to medicines in regions around the world,but is projected to slow through 2027.Meanwhile the lowest income countries continue to see declines in access to medicines,potentially putting health improv

125、ements at risk.14|The Global Use of Medicines 2023:Outlook to 2027 The global use of medicines based on modeling medicine volumes shipped according to defined daily dose assumptions has been growing for the past decade;however,this growth is expected to slow across all markets over the next five yea

126、rs.As a lagged effect of the pandemic,the use of medicines grew sharply in 2021 and then slowed in 2022 as some of the usage was related to temporary shifts in demand,referred to as stockpiling.The highest volume growth over the next five years is expected in Asia-Pacific,Latin America,India and Afr

127、ica/Middle East,largely driven by population 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.Eastern Europe is expected to slow partly as a result of the regional impacts

128、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 health in those countries.It is importan

129、t 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 9:Historical and projected use of medicine by region,20122027,Defined Daily Doses(DDD)in BillionsNotes:Chart represents IQVIA I

130、nstitute 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 Ja

131、pan which are reported separately.OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERSThe use of medicines plateaued in 2022 following a significant rebound in 2021 as markets recovered from the pandemicSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Dec 2022.2012 2013 2014 2015 2016 2017 20

132、18 2019 2020 2021 2022 2023 2024 2025 2026 2027CAGR%202320272,318 2,476 2,598 2,659 2,741 2,802 2,876 2,946 3,018 3,160 3,158 3,242 3,335 3,425 3,426 3,422 Global Japan North America China Africa&Middle East Eastern Europe Western Europe Latin America India Asia-Pacific 1.6 0.4 0.1 1.7 2.3 0.5 0.4 2

133、.4 2.4 2.5 Forecast314 330 351 369 394 433 472 487 510 542 553 577 601 624 625 626 293 305 325 343 351 355 383 393 399 434 443 463 481 499 500 499 175 201 239 263 259 269 281 292 355 368 376 390 407 426 424 424 369 374 379 385 390 392 396 401 402 409 403 407 410 414 414 412 292 322 325 316 330 363 3

134、73 382 383 400 369 369 374 379 380 378 317 360 377 372 392 353 332 323 312 311 319 331 342 353 355 357 200 214 232 244 259 270 273 298 286 313 318 328 339 348 348 346 237 250 252 251 249 249 247 248 249 256 253 254 255 256 255 255 121 121 118 118 117 118 120 121 122 126 123 124 125 126 126 125 iqvia

135、institute.org|15 Broadly there is a correlation to gross domestic product per capita,with 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.The U.S.has the lowest per capita DDD volume

136、s of developed markets,which may be the result of high patient out-of-pocket cost exposure.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 u

137、se of medicines per capita than China,despite GDP per capita being roughly 50%higher.Countries in Africa and the Middle East 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 10:Defined Daily Doses(DDD)per capi

138、ta by region compared to per capita gross domestic 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

139、calculation assumptions developed by the IQVIA Institute(see Methodology).Asia-Pacific does not include China,India,and Japan which are reported separately.OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERSPer capita use of medicines varies by GDP with use in higher income countries typically hig

140、her than lower-incomeSource:IQVIA MIDAS,Jun 2022;IQVIA Institute,Dec 2022;The World Bank,Jul 2022;International Monetary Fund,Oct 2022.1,2001,0008006004002000010,00020,00030,00040,00050,00060,00070,00080,000GDP PPP per capita 2022(current international dollars)DDD per capita 2022500Bn250Bn100BnSize

141、ofBubble:Total 2022DDDsAsia-PacificIndiaWestern EuropeEastern EuropeAfrica&Middle EastLatin AmericaChinaNorth AmericaJapan16|The Global Use of Medicines 2023:Outlook to 2027 When medicine use is adjusted for population,global medicine use is projected to remain flat over the next five years,indicati

142、ng growth in medicine use will follow population growth.After peaking in 2021,medicine use per capita declined in 2022 in some regions due to the increased use of a variety of medicines during the pandemic.Eastern Europe declined in 2022 related to the Ukraine conflict but is expected to recover slo

143、wly through the forecast period.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 11:Historical and projected per capita use of medicine by region,20122027Notes:Chart represents IQVIA Institute estimates of g

144、lobal 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 which are reported

145、separately.OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERSPer capita medicine use varies by region with Japan and Western Europe having more than double the use of most other regionsSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Dec 2022;The World Bank,Jul 2022.5-YearCAGRs 5-YearCAGRs

146、5-YearCAGRs 2012 2013 2014 2015 2016 20172018 2019 2030 2021 20222023 2024 2025 2026 2027IndiaAsia-PacificForecastWestern EuropeAfrica&Middle EastEastern EuropeChinaLatin AmericaNorth AmericaGlobalJapan1,2001,0008006004002000DDD per capita0.3%0.7%7.9%4.0%-0.4%2.7%5.3%2.8%-0.3%5.5%0.3%0.4%5.9%0.2%1.1

147、%1.4%3.8%3.5%-4.2%3.0%-0.5%0.4%1.6%0.4%0.9%0.7%1.5%1.5%0.0%1.6%iqviainstitute.org|17 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 population growth.Wealthier countries in Western Europe,Japan and North Ame

148、rica have higher levels of per capita use and are expected to grow less through 2027.Regions with more middle-and lower-income countries are expected to resume historic volume growth trends as access to medicines contributes to volume growth above population growth trends.Exhibit 12:Defined Daily Do

149、ses(DDD)per capita by region 2022 and growth to 2027Notes: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

150、 IQVIA Institute(see Methodology).Asia-Pacific does not include China,India,and Japan which are reported separately.OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERSWhen adjusted for population,per capita use will fall in North America and be flat in Africa and Middle EastSource:IQVIA MIDAS,Jun

151、2022;IQVIA Institute,Dec 2022;The World Bank,Jul 2022;International Monetary Fund,Oct 2022.0200-20-400%2004006008001,0001,200DDD per capita 2022Absolute change inDDD per capita Bn250Bn100BnSize ofbubble:Total 2027DDDsAsia-PacificAfrica&Middle EastChinaIndiaJapanWestern EuropeN

152、orth AmericaEastern EuropeLatin America18|The Global Use of Medicines 2023:Outlook to 2027 As health systems and disease burdens vary around the world,regions demonstrate important variations in the use of different therapies.Regions with higher average GDP such as North America,Western Europe and J

153、apan have notably higher use of cardiovascular,diabetes,respiratory and neurology treatments than other regions.While most major therapy areas have seen growth in medicine use in the last decade,oncology usage has far exceeded the others with a 10-year CAGR through the last full year(2021)of 15.3%.E

154、xhibit 13:Share of Defined Daily Doses(DDD)by therapy area in 9 regions and globally,2021Notes: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 cal

155、culation assumptions developed by the IQVIA Institute(see Methodology).Asia-Pacific does not include China,India,and Japan which are reported separately.Oncology includes supportive care.Hematologics are non-oncology.OUTLOOK FOR THE USE OF MEDICINES AND HISTORIC DRIVERSThe distribution of medicine u

156、sage across therapy areas varies by regionSource:IQVIA MIDAS,Jun 2022;IQVIA Institute,Dec 2022.Asia-Pacific India Western Europe Eastern Europe Latin America China Africa&Middle East North America Japan Global All others Respiratory Genitourinary/Womens health Oncology Infectious disease Endocrinolo

157、gy Immunology Gastrointestinal Neurology Eye&ear Dermatologics Hematologics Vitamins&minerals Cardiovascular 0%10%20%30%40%50%60%70%80%90%100%Global DDD CAGRs%201220215.6 3.9 3.0 15.3 0.0 5.6 6.0 2.1 2.7 1.9 5.1 3.3 4.4 4.2 iqviainstitute.org|19 The global medicine market using invoice price levels

158、is expected to grow at 3-6%CAGR through 2027,reaching about$1.9Tn in total market size.Spending and volume growth will follow diverging trends by region with larger established markets growing more slowly,and growth markets in Eastern Europe,Asia and Latin America growing in both volume and spending

159、.The U.S.market,on a net price basis,is forecast to grow-1 to 2%CAGR over the next five years,down from 4%CAGR for the past five years including projected effects of the Inflation Reduction Act.Spending in Europe is expected to increase by$59Bn through 2027,with a focus on generics and biosimilars,a

160、nd escalating pressures on the value and negotiated prices of novel medicines.The pandemics impact on Asia-Pacific countries varies considerably,but a return to steady growth is projected after 2021.Japan medicine spending growth is projected at -1 to 2%through 2027 as robust brand growth is offset

161、by a shift in 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 placed on off-patent and generic pricing.Spending and growth by regions and key countries Grow

162、th in developed economies continues at relatively steady rates,with new products offset by patent expiries;Latin America,Eastern Europe and parts of Asia are expected to grow strongly from volume and adoption of novel medicines.20|The Global Use of Medicines 2023:Outlook to 2027 Global medicine spen

163、ding the amount spent purchasing medicines from manufacturers before off-invoice discounts and rebates is expected to reach$1.9Tn by 2027,increasing at a rate of 36%per year.This outlook is excluding the separate impact of spending on COVID-19 vaccines and therapeutics modeled separately(see Exhibit

164、s 14).Overall growth trends are expected to moderate after the disruptions from the pandemic in 2020 through 2022.The differing impact of the COVID-19 pandemic across countries is expected to impact growth through 2023 before returning to historic patterns in 2024.Key drivers of growth through the f

165、orecast period include the contribution of new products,the impact of patent expiries and the growing impact of biosimilars.Payers in developed markets are expected to face budget pressures and act to curb drug spending growth,in part motivated by the costs of managing the pandemic.Exhibit 14:Global

166、 medicine market size and growth 20132027Notes:Does not include estimates for COVID-19 vaccines and therapeutics.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESThe global medicine market using invoice price levels is expected to grow at 36%CAGR through 2027 to about$1.9TnSource:IQVIA Market Prognos

167、is,Sep 2022;IQVIA Institute,Nov 2022.Global spending US$Bn%Growth constant US$2,0001,8001,6001,4001,2001,000800600400200012%10%8%6%4%2%0%Spending US$Bn%Growth constant US$200002220232024202520262027Forecastiqviainstitute.org|21 Regions around the world are growing fo

168、llowing diverging trends,with some more volume driven while others have a greater contribution from adoption of innovation.Countries in Latin America,Asia-Pacific,and Africa and the Middle East are expected to grow more than 10%by volume over the five years to 2027,while spending growth will increas

169、e by over 30%,indicating both population-driven volume growth and a shift in the mix of products to more expensive products.China as the worlds second largest country by pharmaceutical spending,will increase volume by 8%in aggregate over five years,while spending will increase 19%,a more modest rate

170、 than in the prior years and still embedding a focus on expanding access to novel drugs via the National Reimbursement Drug List(NRDL).Eastern Europe spending is expected to increase 45%over the next five years while volume will increase only 1%,hampered by the regional disruptions from the Ukraine

171、conflict,and at the same time reflecting the expected adoption of novel drugs,albeit later than in Western Europe and other developed markets.North America and Western Europe are expected to show flat to very low overall volume growth over five years,while spending will increase more than 20%,exclud

172、ing the impact of off-invoice discounts and rebates.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 15:Spending and volume growth by regionNotes:Does not include es

173、timates for COVID-19 vaccines and therapeutics.Asia-Pacific does not include China,India,and Japan which are reported separately.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIES Spending and volume growth follow diverging trends by regionSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 202

174、2.60%50%40%30%20%10%0%-10%20232027 Percent spending growthconstant US$20232027 percent volume growth standard units-5%0%5%10%15%Spending growth through 2027 expected to be high,driven by mix(wider use of novel drugs at higher average prices)Above average volume and spending growth through 2027Below

175、average volume and spending growth through 2027Below average spending growth,with expanded access to novel drugs driving spending growth faster than volumeAfrica&Middle EastAsia-PacificChinaEastern EuropeWestern EuropeIndiaJapanLatin AmericaNorth America22|The Global Use of Medicines 2023:Outlook to

176、 2027 Global medicine spending is expected to slow to 36%through 2027,reaching$1.9Tn,with the ongoing impacts of the pandemic impacting medicine spending and usage patterns through 2023 and returning to pre-pandemic trends afterward.North America medicine spending is expected to slow dramatically in

177、 2023 from the combined effects of a relatively smaller contribution from new products and the impact of significant patent expiries and biosimilars including adalimumab(Humira)in 2023.Latin America spending growth has been especially high in the first two years of the pandemic,including patients us

178、e of established and generic medicines as symptom management for COVID-19.Starting in 2023,growth will average 7-10%CAGR led by Brazil,Mexico,Argentina and Colombia.The Asia-Pacific region(excluding China,India and Japan)has some of the highest spending growth sustained through the forecast driven b

179、y population growth and an expected contribution from economic growth.Japans spending growth is expected to average -2 to 1%with relatively flat trends,a result of a shift to annual price cuts in place of the historic biennial price cut policy.Chinas spending has swung wildly during the pandemic,par

180、tly influenced by zero tolerance pandemic policies but expected to return to more moderate 25%growth through 2027.Exhibit 16:Spending growth globally and in 9 regions,total market,const US$20192027Notes:2019 is included to show the impacts of the pandemic on spending growth.Asia-Pacific does not inc

181、lude China,India,and Japan which are reported separately.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESThe COVID-19 impact varies by region with a return to a more stable trend by 2024 and higher growth in key regions20262027200222023202420252026202720022202320242025202620272

182、00222023202420252026202720022202320242025202620272002220232024202536%$1,9001,930Bn2.55.5%$790820Bn3.56.5%$355385Bn5.58.5%$108138Bn-21%$7191Bn4.57.5%$5474Bn710%$115135Bn69%$100120Bn7.510.5%$3539Bn25%$180210Bn2027 Spending202327 CAGRsSpending growth20%15%10%5%0%-5%20%1

183、5%10%5%0%-5%GlobalWestern EuropeNorth AmericaAsia-PacificAfrica&Middle EastJapanLatin AmericaEastern EuropeIndiaChinaSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.iqviainstitute.org|23 Spending at net levels in the U.S.is projected to grow at-1 to 2%as rising off-invoice discounts

184、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 36%lower than invoice level in 2022 and projected to be 45%lower than invoice level in 2027.Projections prior to the passa

185、ge of the IRA showed this gross to net difference reaching 39%in 2026,with growth averaging 03%on a net basis,1%higher than the revised outlook.In addition to discounts and rebates,ongoing market dynamics around the use of medicines,the adoption of newer treatments,the impact of patent expiries,and

186、new generic or biosimilar competition will all contribute to historically slow market growth in the U.S.for the next five years.Exhibit 17:U.S.medicine spending and growth at invoice-level and estimated net 20132027Notes:Estimates of net manufacturer sales are based on analysis by the IQVIA institut

187、e from public sources combined with IQVIAs audited invoice-level data(see Methodology).SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESThe U.S.market,on a net price basis,is forecast to grow-12%CAGR over the next 5 years,down from 4%CAGR for the past 5 yearsSource:IQVIA Institute,Nov 2022.259 291 31

188、8 331 331 344 363 363 385 402 412 420 416 415 420 337 390 437 456 465 493 521 545 588 629 657 680 705 734 763 5-YearCAGRs 5-YearCAGRs Invoice CAGR7.6%Net 29%belowinvoiceNetCAGR5.2%Invoice CAGR6.2%Net 36%below invoiceNetCAGR4.0%Invoice CAGR2.5-5.5%Net 45%below invoiceNetCAGR-1 to 2%5-YearCAGRs 2013 2

189、014 20152016 20172018 2019 2020 2021 20222023 2024 2025 2026 2027Net salesInvoice to net differenceForecast24|The Global Use of Medicines 2023:Outlook to 2027 Spending on medicines in the U.S.at invoice prices is expected to increase by$134Bn through 2027,slower than the$164Bn increase over the past

190、 five years.The largest driver of growth will be increased usage of existing protected branded products which are expected to add$154Bn in spending over five years,much higher than the$122Bn increase from 2017 to 2022 for products more than two years after their launch up until their loss of exclusi

191、vity(LOE).The contribution from new brands is expected to increase to$110Bn over five years as more than 250 new active substances(NASs)are expected to launch in the period.The impact of losses of exclusivity is expected to increase dramatically to$141B from$49Bn in the prior five years as both smal

192、l molecule and biologic 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$763B

193、n by 2027 even as off-invoice discounts and rebates are expected to reach 45%and net spending increases by only$18Bn over five years.Exhibit 18:Spending and growth drivers in US 20172027 const US$BnNotes:New brands growth contribution defined as the growth during periods when products had been marke

194、ted 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 products

195、or branded generics as well as biosimilars.Other includes OTC/other products.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESSpending in the U.S.is expected to increase by$134Bn through 2027 driven by new and existing brandsSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.

196、0-1763ForecastNewbrandsLOEExistingbrandsGenericsOthersNewbrandsLOEExistingbrandsGenericsOthers2022spending 2027spending2017spending iqviainstitute.org|25 Losses of exclusivity in the U.S.are expected to be$141Bn through 2027,with significant impact on spending for both small molecules

197、 and biologics.Small molecule expiries are expected to reduce brand spending by$98Bn through 2027,more than double the impact of the last five years,including the impact of high-profile products in the anticoagulants therapy area,including rivaroxaban(Xarelto).Biologics are expected to result in$42B

198、n in lower brand spending over five years as biosimilar market dynamics mature and major products face competition,including the continuing impact on ranibizumab(Lucentis)in 2022,as well as adalimumab(Humira)and ustekinumab(Stelara)in 2023.The approval of interchangeable biosimilars for insulins in

199、the second half of 2021 and for adalimumab pending launch in 2023 suggests more dramatic volume uptake is possible,contributing to the$14Bn impact of biologics overall in 2024.Questions remain around the relationship of interchangeability,alternative originator formulations,and the commercial and ne

200、gotiating strategies of stakeholders which could dramatically increase or reduce the impact of these biosimilar events.Exhibit 19:U.S.impact of brand losses of exclusivity 20182027,US$BnNotes:Does not reflect offsetting spending increases from generic or biosimilar competitors.Losses in future perio

201、ds 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 products with expiries in progress from historic periods where losses extend into

202、 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 expectation of launch of biosimilars.Information is current as of September 2022.SPEN

203、DING AND GROWTH BY REGIONS AND KEY COUNTRIESThe impact of exclusivity losses will increase to$140.8Bn over 5 years including significant biosimilars in 2023 and 2024-1.2-1.8-4.4-2.2-0.8-7.6-14.2-8.3-5.1-7.1-7.1-9.5-8.8-5.7-7.2-13.6-14.8-21.8-23.2-24.9-8.4-11.3-13.2-7.9-8.0-21.2-29.1-30.1-28.4-32.0 B

204、iologicSmall$10.4Bn$38.4Bn$48.8Bn$42.3Bn$98.4Bn$140.8Bn200224202520262027Forecast$Total brand loss due to LOESource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.26|The Global Use of Medicines 2023:Outlook to 2027 There were dramatically fewer new active substance(NA

205、S)launches in the U.S.in 2022 following the record year in 2021,reflecting both fewer approvals and some approved but not yet launched medicines.Four of the last five years have had more than 50 NAS launches and the next five years are expected to average at least 50 per year,with an aggregate total

206、 of more than$22Bn in new brand spending per year.Over the next five years,more than 250 NASs are expected to launch in the U.S.and new products in aggregate are expected to contribute$110Bn in spending.New launches in the next five years are expected to include 100 new cancer drugs globally,with mo

207、st of those available in the U.S.at launch.Other clusters of innovative drugs include as many as 60 next generation biotherapeutics,which include cell and gene therapies and RNA therapeutics,and which partly overlap with oncology treatments.Exhibit 20:U.S.new brand spendingNotes:New brands spending

208、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 2022 Estimated based on information confirmed as of Dec 14,2022.SPENDING AND GROWTH

209、 BY REGIONS AND KEY COUNTRIESNew brand spending in the U.S.is projected to be higher than the last 5 years but a smaller share of spendingSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.8 25 35 34 22 18 22 15 18 12 15 22 24 24 25 12%10%8%6%4%2%0%4035302520001720

210、0224202520262027New brands%of total brand spendingNew brand spending US$BnUS NAS Launches451546941(3943)Average launches projected at 5055/year(250275 launches within 5-years)New brand spendingNew brands share of brand spendingForecastTotal 201317=$124BnTotal 201822=

211、$86BnTotal 202327=$110Bniqviainstitute.org|27 Overall,the Inflation Reduction Act is expected to result in a net reduction of manufacturer revenue through price negotiation,inflation penalties and a shift in cost-subsidy responsibility in the Medicare program.Patient costs are also expected to be re

212、duced substantially in the Medicare program through a combination of lower price inflation,a$2,000 per year out-of-pocket cap,insulin price caps,and provisions that limit patient exposure to premium increases.There is an expected increase in medicine use for some patients who are thought to have bee

213、n non-adherent to planned treatment under the current cost-sharing model but who would be more able to afford their medicines under new provisions and ultimately fill their prescriptions.The changes to the Medicare Part D benefit and cost-sharing model are expected to influence insurance plans,who w

214、ill absorb responsibility for costs previously paid by the government and will seek to offset those costs through changes in formulary management,negotiation with manufacturers or through premium increases to the extent allowed.Perhaps the most discussed provision of the law is the phased in price n

215、egotiation which initially affects a limited number of drugs but introduces government negotiated prices to the U.S.market for the first time.Some of the provisions of the law take effect in early 2023 while others will progress through executive branch rulemaking and comment periods through the nex

216、t few years,with important changes likely to emerge.Most patients already face extremely low costs and only those with the most extreme cost exposures are likely to experience significant savings.Exhibit 21:Selected components of the Inflation Reduction ActSPENDING AND GROWTH BY REGIONS AND KEY COUN

217、TRIESKey elements of the Inflation Reduction Act(IRA)are expected to impact medicine pricing and cost sharing among stakeholdersSource:IQVIA Market Access Strategy Consulting,Nov 2022.Prescription drug inflation rebates New policy for manufacturers to pay rebates if prices increase faster than gener

218、al inflation,took effect beginning October 2022Maximum patient out-of-pocket caps Beginning in 2024,Medicare part D cost sharing maximum$2,000 per year,and eliminates the previously uncapped catastrophic phase Beginning in 2023,insulins capped at$35 per monthPart D benefit redesign Cost-sharing chan

219、ges take effect beginning in 2024 Patient cost-sharing in catastrophic phase ends in 2024,while manufacturer cost sharing shifts in 2025,with reduced responsibility in the former donut hole phase and increased responsibility in the higher-cost catastrophic phase Costs shift from CMS to Part D plans

220、in former catastrophic phase of cost sharing model Consumers premiums will be capped at 6%in the first few years of the reformLowering prices through“negotiation”Phased in implementation of drugs subject to Medicare negotiation starting in 2026 High-expenditure,single-source medicines not otherwise

221、subject to generic or biosimilar competition Marketed for 9+years for small molecules and 13+years for biologics Mechanism and basis for negotiation is pending28|The Global Use of Medicines 2023:Outlook to 2027 Medicine spending in the top five European markets is expected to increase by$59Bn over t

222、he next five years,up from$53Bn in the past five years but with large shifts in the drivers of growth.New brands were the largest driver of growth from 2017 to 2022 and are expected to continue in the next five years but be hampered by lingering effects of the pandemic on marketing operations early

223、in the period and reimbursement decisions later as budget pressures increase.Generics,including biosimilars,are expected to add$12Bn in growth over the next five years,about the same as in the past five years despite a larger impact of losses of exclusivity as volume gains will be offset by price de

224、flation.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 next five years despite expected great

225、er 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,and these dynamics represent an area of

226、 significant uncertainty.Exhibit 22:Spending and growth drivers in France,Germany,Italy,Spain,and UK 20172027 const US$BnNotes:Spending in US$with constant Q2 2022 exchange rates.New brands growth contribution defined as the growth during periods when products had been marketed for less than two yea

227、rs.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 branded generics as we

228、ll as biosimilars.Other includes OTC/other products.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESSpending in Europe is expected to increase by$59Bn through 2027,driven by new brandsSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.-3131122263ForecastNewbrandsLOEExist

229、ingbrandsGenericsOthersNewbrandsLOEExistingbrandsGenericsOthers2022spending 2027spending2017spending iqviainstitute.org|29 The impact of losses of exclusivity(LOE)in the five largest European markets(Germany,France,Italy,Spain and the UK)are expected to more than triple over the next five years,and

230、more than half of the impact is expected to be biologics,with$17.5Bn of the$31Bn total impact.The major impact is seen in 2023 and 2024 with patent expiry of ranibizumab(Lucentis)in 2022 and ustekinumab(Stelara)in 2024.Europes biosimilar market is largest in the world,with the first biosimilar launc

231、hed in 2006.The biologic molecules facing biosimilar competition increased from 2013 to 2018 in the European Union,with the EMA approvals increasing in 2017 and 2018.The approval of biosimilars is based on solid and robust legal pathways introduced in 2004 and since then has led to the highest numbe

232、r 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 23:EU4+UK impact of brand losses of exclusivity 20182027,US$BnNotes:Does not reflect offsetting spendin

233、g 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 products

234、 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 expectation

235、of launch of biosimilars.Information is current as of September 2022.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESThe impact of exclusivity losses will reach$31Bn over 5 years,with more than half due to the availability of biosimilarsSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022

236、.-0.2-0.3-0.6-0.5-1.3-2.3-2.2-5.7-4.9-2.3-1.5-0.9-0.6-0.7-2.4-3.5-2.0-2.7-2.7-2.5-1.7-1.2-1.3-1.2-3.6-5.9-4.2-8.5-7.7-4.8 BiologicSmall$2.9Bn$6.0Bn$8.9Bn$17.5Bn$13.5Bn$31.0Bn200224202520262027Forecast$Total brand loss due to LOE30|The Global Use of Medicines 2023:Outlook to 202

237、7 Over the next five years,more than 200 new active substances(NASs)are expected to launch in the leading European countries and new products in aggregate are expected to contribute$45Bn in spending.Three of the last five years have had 40 or more NAS launches and the next five years are expected to

238、 average at least 4045 per year,with an aggregate total of over$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 gener

239、ation biotherapeutics,which include cell and gene therapies and RNA therapeutics,and which partly overlap with oncology treatments,though reimbursement decisions may be complex due to the budget impact for relatively few benefitting patients.Exhibit 24:EU4+UK new brand spendingNotes:New brands spend

240、ing 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 2022 Estimated based on YTD Dec 14 2022.SPENDING AND GROWTH BY REGIONS AND KEY

241、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 2022;IQVIA Institute,Nov 2022.3 6 12 12 10 11 8 6 6 7 8 9 9 9 10 0%5%10%15%0542000224202520262027New bran

242、ds%of total brand spendingNew brand spending US$BnEU4+UK NAS Launches24423729423629405040(3842)Average launches projected at 4045/year(200225 launches within 5 years)New brand spendingNew brands share of brand spendingForecastTotal 201317=$42BnTotal 201822=$38BnTotal 202327=$45Bniqviainstitute.org|3

243、1 Latin America and Eastern Europe represent two of the fastest growing regions in terms of medicine spending globally.Latin Americas growth is led by Brazil and Mexico at 912%and 7.510.5%,respectively,and together representing two-thirds of the spending in the region overall.Argentina has been impa

244、cted by inflation significantly in recent years,and these issues are at least partly driving the 25%and 37%growth in 2021 and 2022;growth is expected to slow to 3.56.5%through the forecast period.Colombia is the highest growth country of the rest of the region and represents an important stabilizati

245、on of the market after many years of political and economic instability.In Eastern Europe,growth is led by Russia,which is projected to grow 69%CAGR through 2027.Turkeys high growth in the forecast may be a result of ongoing inflation issues and bears careful attention.Poland and Romania are expecte

246、d to return to pre-pandemic growth rates from 2023 through 2027.The largest uncertainty in the region is the Ukraine conflict,which is having direct and demonstrable impacts on that countrys medicine use and spending.The conflict is also likely impacting neighboring countries with the medical needs

247、of displaced persons,as well as the ongoing effects on economic activity,fuel costs and regional business activity.Exhibit 25:Spending growth in select pharmerging countries 20192027,total market,const US$Notes:2019 is included to show the impacts of the pandemic on spending growth.Argentina growth

248、in 2021(25.4%),2022(37.2%)and Turkey 2022(-6%)not plotted.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESLatin America and Eastern Europe are expected to return to steady growth outpacing the global marketSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.20262027Eastern EuropeRussiaTu

249、rkeyPolandRomania2002220232024202520262027200222023202420252026202720022202320242025202620272002220232024202520262027200222023202420252026202720022202320242025OthersLatin AmericaBrazilMexicoArgentinaColombiaOthers25%20%15%10%5%0%-5%25

250、%20%15%10%5%0%-5%2027 Spending202327 CAGRsSpending growth710%$115135Bn 912%$5777Bn69%$100120Bn69%$2529Bn 7.510.5%$1519Bn 3.56.5%$1519Bn1519%$1420Bn5.58.5%$1216Bn69%$68Bn36%$1519Bn710%$79Bn3.56.5%$4145Bn32|The Global Use of Medicines 2023:Outlook to 2027 The ongoing conflict in Ukraine has reduced me

251、dicine spending by 10.3%in the first half of 2022 and an expected 22%through the full year.As the duration of intensity of the conflict represents unknowns,scenarios may be helpful to quantify the impacts;in the most pessimistic scenario,the conflict would continue similar to the 2011 conflict in Sy

252、ria and result in a three-year decline of 20-30%per year followed by a decade-long disruption at 70%below the pre-war level.A more optimistic view could see the conflict resolved in 2023 with rebuilding and health system reforms hampering spending growth initially,with growth returning to pre-war ra

253、tes by 2025.The base case scenario embeds a stabilization of the conflict in 2023,lingering economic disruption and challenges in funding rebuilding that last longer into the forecast period.Domestic impacts in Ukraine are only part of the impact of the conflict,which has region-wide and global impl

254、ications.Ukraine and Russia each have played important roles in regional supply chains for active ingredients and finished pharmaceuticals as well as clinical trial operations for drug development,all of which have been and will continue to be disrupted as the conflict continues.A Europe-wide winter

255、 fuel crisis and inflation are also linked to the events in Ukraine.In addition to these effects,persons displaced to neighboring Eastern European countries are expected to impact medicine needs in Poland,which has taken in more than 1 million refugees,as well as other countries.Exhibit 26:Ukraine m

256、edicine spending scenarios 20122027,constant US$BnNotes:Ukraine estimates based on historic data through June 2022 and IQVIA Institute scenario modeling.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESUkraine medicine spending has been disrupted by the ongoing war,with substantial sustained impact t

257、hrough the forecastSource:IQVIA Institute,Nov 2022.Modeling with Syria-war growth ratesBase caseReturn to pre-pandemic growth rates in 2025200018 2019 2020 2021 2022 2023 2024 2025 2026 2027Constant US$Bn4.54.03.53.02.52.01.51.00Earlier end to conflict but lingering healthcare

258、reform issues,rebuilding and funding dependent on GDP recovery,growth returns to 2019 rates by 2025Base case embeds a stabilization of the conflict in 2023,lingering economic disruption and challenges in funding rebuilding that last longer into the forecast periodModeled on historic growth rates in

259、Syria at the beginning of the civil war in 2011(20-30%declines for 3 years,steady-70%of prewar level after that)iqviainstitute.org|33 The impact of the pandemic on medicine spending growth has been significant in some markets across the Asia-Pacific region,but these are expected to moderate and retu

260、rn to 5.58.5%growth through 2027.Key countries in the region include two higher income developed markets South Korea with growth 4.57.5%and Australia growing at 25%before discounts and rebates.Chinas growth has swung wildly in recent years,but is expected to stabilize at 25%through 2027.India contin

261、ues to grow through volume while costs remain low and medicines focus on generics;spending will increase 7.510.5%through 2027,reaching$3539Bn.Japan,with growth of-2 to 1%through 2027,is expected to drop from third to become the fourth largest global market by 2027,as policies to control spending gro

262、wth remain the key focus of the health ministry.Exhibit 27:Spending growth in select Asia-Pacific countries 20192027,total market,const US$Notes:2019 is included to show the impacts of the pandemic on spending growth.Asia-Pacific excludes China,India and Japan which are shown separately.SPENDING AND

263、 GROWTH BY REGIONS AND KEY COUNTRIESThe pandemics impact on Asia-Pacific countries varies considerably but a return to steady growth is projected after 2021Source:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 20222027 Spending202327 CAGRsSpending growth25%20%15%10%5%0%-5%25%20%15%10%5%0%-5%Asi

264、a-PacificJapan5.58.5%$108138Bn25%$180210Bn4.57.5%$2125Bn25%$1620Bn-21%$71-91Bn7.510.5%$3539Bn3.56.5%$913Bn710%$6181BnChinaIndiaSouth KoreaAustraliaIndonesiaOther Asia-Pacific2002220232024202520262027200222023202420252026202720022202320242025202620272002220

265、23202420252026202734|The Global Use of Medicines 2023:Outlook to 2027 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 continue.While 2020 had the impact of being

266、 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,though the annual off-year impacts may be lower th

267、an 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 earlier in Japan and government focus on

268、enabling earlier access to novel medicines.Long-listed products have declined from 25%of spending in 2013 to 13%in 2022 and are expected to drop to 9%by 2027.Generic share of spending is also expected to rise,supported by policies that have been largely effective over this entire 15-year period,enco

269、uraging doctors to substitute available generics with a combination of incentives and penalties.Pharmaceutical spend associated with long-COVID is expected to represent up to an additional 3-5%of spend over the forecast period,declining over time and likely focused in generic and long-listed segment

270、s,though the uncertainty in this area will continue.Exhibit 28:Japan medicine spending by product type 20132027,constant US$BnNotes:Medicine spending at ex-manufacturer level,segmented according to Japan-specific product types which differ from segmentations used elsewhere in this report.Price revis

271、ions historically have taken effect in April,every other year.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESJapan medicine spending is forecast nearly unchanged over 5 years as innovation is offset by shift to annual price cutsSource:IQVIA Market Prognosis,Sep 2022;IQVIA Japan,Sep 2021;IQVIA Insti

272、tute,Nov 2022.68 69 73 74 73 72 74 72 73 73 74 74 74 74 75 420 5-YearCAGRs 5-YearCAGRs 2.0%3.9%16.4%10.3%-5.2%0.2%1.1%2.8%1.1%-5.4%0.3%1.5%-0.1%-8.5%2.1%4.3%1.4%0.6%3.5%-1.3%-6.6%5-YearCAGRs 2013 2014 2015 2016 20172018 2019 2020 2021 20222023 2024 2025 2026 2027Long-listed productsGenericsNHI other

273、sNon-NHI productsOTC/othersProtected brandsForecastiqviainstitute.org|35 Medicine spending in China has risen from$93Bn in 2013 to$166Bn in 2022.Over the past five years spending growth was driven by original branded products,most often from multinational companies,which grew at an average of 10.1%p

274、er year to reach 28%of spending in 2022,up from 22%five years earlier.Over the next five years,the government 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,tho

275、ugh these are generally subject to lower negotiated net prices.Over the next five years original brands will grow by more than 5%per year,while other types of products will grow at 4%or less,contributing to the overall growth rate slowing to 25%.Non-original brands,including versions of medicines or

276、iginated 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 growth in hospitals.By 2027,China is projected to exceed$194Bn,an increase of almost$30Bn in the next five yea

277、rs.Exhibit 29:China medicine spending by product type 20132027Notes:Original brands are those marketed by their originator(or licensed partner)and includes vaccine products by all manufacturers.Analysis does not include COVID-19 vaccines.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESSpending growt

278、h in China is expected to slowly recover post-COVID,driven almost entirely by new original medicinesSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.93 105 113 123 131 137 155 157 163 166 169 175 182 187 194 420 5-YearCAGRs 5-YearCAGRs 9.6%12.2%9.1%7.8%11.2%5.0%10.1%1.5%2.8%8.5%3.1%5.

279、7%0.7%2.3%4.3%5-YearCAGRs 2013 2014 2015 2016 20172018 2019 2020 2021 20222023 2024 2025 2026 2027Non-original brandsOTC&othersUnbranded productsOriginal branded productsForecast200150100500Medicine spending const US$Bn36|The Global Use of Medicines 2023:Outlook to 2027Exhibit 30:Global medicine spe

280、nding and growth by product typeNotes:Developed markets is a term related to World Bank Income bands and includes high-income and upper-middle-income countries.The 10 developed countries are the 10 largest high-income countries(U.S.,Japan,Germany,France,Italy,Spain,UK,Canada,Australia,South Korea).P

281、harmerging includes countries with per capita GDP$1Bn(absolute or rounded)in at least two forecasts.SPENDING AND GROWTH BY REGIONS AND KEY COUNTRIESMedicine spending and growth by product type varies by regionSource:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.ORIGINAL BRANDSNON-ORIGINAL

282、 BRANDSUNBRANDED GENERICSOTHERTOTALSpending 2022 US$Global902.1244.5150.2185.51,482.3Developed788.8109.3101.089.31,088.3 10 Developed722.483.990.871.9968.9 Other developed66.425.410.217.4119.4Pharmerging105.7124.447.893.0370.8Lower-income countries7.710.81.53.223.2Constant dollar CAGR 20182022Global

283、6.8%6.1%3.0%5.2%6.1%Developed6.6%7.6%0.4%3.6%5.7%10 Developed6.6%7.7%-0.1%3.1%5.7%Other developed6.2%7.2%6.2%5.8%6.4%Pharmerging9.2%5.0%10.0%6.8%7.2%Lower-income countries4.4%5.8%9.7%9.2%6.0%Spending 2027 US$Global$1,1551,185$325355$160190$215245$1,9001,930Developed$1,0001,030$150165$105115$98108$1,

284、3701,400 10 Developed$910940$117127$92102$7585$1,2071,237 Other developed$83103$3438$1216$2125$156176Pharmerging$133153$157177$6264$114134$487518Lower-income countries$911$1216$2-3$2.55.5$2933Constant dollar CAGR 20232027Global36%58%14%36%36%Developed36%58%-12%0.53.5%2.55.5%10 Developed36%58%-12%-0.

285、52.5%2.55.5%Other developed47%58%3.56.5%3.56.5%47%Pharmerging58%58%4.57.5%58%58%Lower-income countries47%47%6.59.5%69%4.57.5%The types of medicines driving spending and growth vary considerably across countries broadly correlated with a degree of economic development.Generally wealthier countries ha

286、ve higher levels of spending on original branded products,especially 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,and when patent enforcement is l

287、ess stringent these are referred to as copy products.Developed countries 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 includin

288、g those that are off-patent.Pharmerging and lower-income countries have 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.iqviainstitute.org|37 Global savings from biosimilars w

289、ill exceed$290Bn in cumulative spending through 2027 below estimates without new biosimilars.Specialty medicines will represent 43%of global spending in 2027 and over 55%of total spending in developed markets.The two leading global therapy areas oncology and immunology are forecast to grow 1316%and

290、36%CAGR,respectively,through 2027.Oncology is projected to add 100 new treatments over five years,contributing to an increase in spending of$184Bn to a total of more than$370Bn in 2027 and facing limited new losses of exclusivity.Treatments for autoimmune disorders are forecast to reach$177Bn global

291、ly by 2027,driven by steadily increasing numbers of treated patients and 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.New therapies contribute to growth of neur

292、ology markets,including greater use of novel migraine therapies,potential treatments for rare diseases,and the potential for therapies for Alzheimers and Parkinsons.The outlook for next generation biotherapeutics includes significantly uncertain clinical and commercial prospects for cell,gene and RN

293、A therapies,which will grow to$27Bn in spending by 2027.Key therapy areas Biotech will represent 35%of spending globally and include both breakthrough cell and gene therapies as well as a maturing biosimilar segment.Major advances are expected to continue,especially in oncology,and immunology.Notabl

294、e small molecule innovations are also expected in these diseases as well as neurology.38|The Global Use of Medicines 2023:Outlook to 2027 Global spending on biotech drugs those created through recombinant DNA technology are expected to reach$666Bn by 2027,about 35%of global medicine spending.Biotech

295、 includes a range of therapies traditional therapies such as insulin analogues and more complex specialty medicines.Spending for biotech drugs will include$1417Bn by 2027 from cell and gene therapies,which currently represent approximately$4Bn and are expected to grow from wider use,especially in de

296、veloped markets.Overall biotech growth will occur despite brand losses of$65Bn due to biosimilars in the five years to 2027.Spending growth is expected to slow significantly in the next five years from the impact of key biosimilars especially in developed markets but remain robust through the contin

297、ued flow of new medicines.Biotech drugs will see a 54%aggregate increase over five years with a 7.510.5%CAGR through 2027,adding$235Bn over the period globally.Exhibit 31:Global biotech spending and growthNotes:Biotech medicines defined as those produced through recombinant DNA technology.KEY THERAP

298、Y AREASGlobal biotech spending to exceed$660Bn by 2027,with growth slowing to 7.510.5%from biosimilar savingsSource:IQVIA Institute,Nov 2022.119 130 152 174 198 223 257 299 331 381 431 474 522 569 617 666 SpendingForecastGrowth0%2%4%6%8%10%12%14%16%18%005006007002012 2013 2014 2015 2016 2

299、017 2018 2019 2020 2021 20222023 2024 2025 2026 2027%Spending growth constant US$Spending constant US$Bn20232027 Key metrics+54%totalspending growth(7.510.5%CAGR)$65Bn impacton brands frombiosimilars+$235Bniqviainstitute.org|39Exhibit 32:Global savings from biosimilars 20232027Notes:Savings estimate

300、d by calculating spending in a scenario where historic trends continue and compared to modeled impact of brand losses of exclusivity and biosimilar uptake.Range reflects uncertainty of the level of uptake,price deflation,and incremental volume after LOE.Modeling includes the impact in the 5-year per

301、iod of savings from earlier biosimilar introductions.KEY THERAPY AREASGlobal savings from biosimilars will have a significant impact on country medicine spending through 2027Source:IQVIA Market Prognosis,Sep 2022;IQVIA Institute,Nov 2022.Savings high-low rangeSavings25020023202420255-year

302、 savings scenarios$383Bn base case($290476Bn range)20262027 Incremental savings from biosimilars are expected to be a cumulative$383Bn globally from 2023 to 2027.Annual savings could exceed$100Bn in 2026 and 2027 as some of the largest spending biologic molecules will have well developed biosimilar

303、competition for several years by this time.This level of savings will also likely mean the opening of access to relevant biologic medicines to more people globally,as costs of treating patients for cancer or autoimmune disorders are reduced to affordable levels for patients or governments across all

304、 countries.Incremental usage of biologic therapies has been observed in periods after biosimilar entry,and this is expected to be particularly important in lower-income countries,but the largest savings will still be focused on developed markets,which already have very high levels of usage and spend

305、ing on the originator versions of these medicines.Key upcoming biosimilars are expected to reach patients throughout the next five years,but particularly notable are autoimmune therapy adalimumab,currently the worlds leading medicine by spending,with the first biosimilar launching in the U.S in Janu

306、ary 2023.40|The Global Use of Medicines 2023:Outlook to 2027 Specialty 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 49%and 39%,respectively,in 2022,

307、up from 28%and 27%10 years earlier.Pharmerging countries have lagged behind largely due to cost,and had 16%of spending in 2022 on specialty medicines,expected to be unchanged as a share of spending in 2027.Globally specialty medicines will be 43%of global spending by 2027,with more than half of spen

308、ding on these products in major developed markets.Specialty medicines are those which treat 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 expensiv

309、e than other more traditional medicines.As specialty medicine share of spending increases,it is notable that they treat only 23%of patients;and while the unmet needs of these few patients are being addressed,by contrast other patients getting traditional therapies are seeing their costs decline.Exhi

310、bit 33:Specialty medicines share of spendingNotes:For details on specialty medicine definition,see the methodology and definitions section.KEY THERAPY AREASSpecialty medicines will represent about 43%of global spending in 2027 and 56%of total spending in developed marketsSource:IQVIA Institute,Nov 2

311、022.GlobalPharmergingOther developed10 developedForecast2002728%40%49%56%27%36%43%47%10%12%16%16%24%32%39%43%iqviainstitute.org|41 The therapy areas with the highest forecast spending in 2027 are oncology,immunology,and anti-diabetics,followed by cardiovascular.Oncology is expected to gro

312、w 1316%CAGR through to 2027 as novel treatments continue to be launched for the treatment of cancer.Immunology is expected to grow slowly in the range of 3-6%due to the launch of biosimilars;while several biosimilars are already launched in Europe,leading to slow growth of the immunology segment,the

313、 launch of adalimumab biosimilar in 2023 in the U.S.is further expected to impact growth.With nearly$168Bn by 2027,diabetes is expected to be the third largest therapy area globally,with growth estimated to be 36%over the next five years.Most other therapy areas are expected to grow in low-to mid-si

314、ngle digits through 2027 with the exception of obesity,which is projected to grow from 10 to 13%as highly effective treatments have become available and are expected to gain wider usage across many countries.Exhibit 34:Top 20 therapy areas in 2027 in terms of global spending with forecast 5-year CAG

315、Rs,const US$KEY THERAPY AREASOncology and obesity lead growth while immunology slows due to biosimilars,many other classes growing in mid-single digitsSource:IQVIA Forecast Link,IQVIA Institute,Nov 2022.5Year CAGR20232027 const US$2026 spending1316%36%36%14%36%25%25%25%36%03%36%14%-12%14%47%14%58%-1

316、2%1013%58%377 177 168 126 92 81 74 58 52 48 42 36 33 31 29 25 20 20 17 15 Oncology Immunology Diabetes Cardiovascular Respiratory CNS Infectious diseases GU sexual health GI products Mental health Pain HIV antivirals Ophthalmology Musculoskeletal Dermatology Blood coagulation Lipid regulators Vaccin

317、es ex flu and COVID-19 Obesity Cough Cold incl flu vaccines&antivirals 42|The Global Use of Medicines 2023:Outlook to 2027 The biggest contributors to the growth in the next five years are oncologics,immunology,anti-diabetics and obesity drugs,the result of a continuous influx of innovative products

318、 and offset by exclusivity losses.Many therapy areas are expected to grow more slowly in the next five years than in the past five.Lipid regulators,which have been declining steadily since leading product expiries a decade ago,are expected to return to growth with new therapies for some patients.Spe

319、nding growth for vaccines(excluding flu and COVID-19 vaccines)is expected to decline slightly over the next five years as some of the growth in the past five years was from adoption of newer vaccines,which are now more established in usage.Cough,cold and flu,including flu vaccines,are expected to gr

320、ow over 5%through 2027 as seasonal respiratory infections are projected to be generally higher.Nervous system(CNS),musculoskeletal(including pain)and mental health treatments collectively include a range of neurology treatments where patent expiries will offset growth from novel therapies.Exhibit 35

321、:Global historic and forecast growth for top 20 therapy areasNotes:COVID vaccine and therapeutics are not included.Oncology and obesity plotted separately.KEY THERAPY AREASOncology and obesity to lead growth through 2027 while immunology and diabetes growth to slowSource:IQVIA Forecast Link,IQVIA In

322、stitute,Nov 2022.$350Bn$100Bn$25Bn10%15%20%10%16%14%12%20%18%Size of bubble:Spending in2027Historic 5-yr CAGR 20172022Historic 5-yr CAGR 20172022Forecast 5-yr CAGR 20222027-5%0%5%10%-5%0%5%10%15%Forecast 5-yr CAGR 2022202730%35%40%40%44%42%50%48%46%Forecast 5-yr CAGR 20222027ImmunologyDiabetesCardio

323、vascularRespiratoryCNSInfectiousdiseasesGU sexual healthGIproductsMentalhealthPainHIV antiviralsOphthalmologyMusculoskeletalDermatologyBlood coagulationLipid regulatorsVaccines ex flu and COVID-19Cough cold incl fluvaccines andantiviralsOncologyObesityiqviainstitute.org|43 Global oncology spending i

324、s expected to grow slowly at a rate of 1316%through 2027 as new medicines are offset by losses of exclusivity.Oncology spending is expected to increase by 95%over the next five years,adding$184Bn in spending by 2027.The increase in oncology spending is expected to be driven by early diagnoses of pat

325、ients,continued introduction of new drugs,and wider access to novel cancer drugs in more countries beyond the major developed countries where they often launch first,and longer treatments for medicines with survival benefits.The current oncology pipeline is expected to add more than 100 new drugs in

326、 the next five years,which includes innovative treatment through cell therapy,RNA therapy,and immuno-oncology treatments,including those which are mutation-specific and thus tumor-agnostic.Increasing adoption of precision medicine for cancer treatment includes a range of therapies from those where t

327、reatment is determined with biomarker testing or next generation sequencing,as well as CAR T-cell therapies,which are prepared for each patient individually.The introduction of biosimilars for bevacizumab,trastuzumab and rituximab in the past five years in major markets has contributed significantly

328、 to the slowing growth seen in 2020 and 2021 but which has had less impact in 2022,and relatively few biosimilars are expected in oncology until later in the decade when the next major events are in 2027 from palbociclib(Ibrance)and potentially others.Exhibit 36:Global oncology spending and growthNo

329、tes:Oncology includes therapeutics only,excluding supportive care treatments.KEY THERAPY AREASGlobal oncology spending to reach$370Bn by 2027,with growth accelerating from novel drugs and limited biosimilarsSource:IQVIA Forecast Link,IQVIA Institute,Nov 2022.61 69 79 90 102 117 138 155 173 193 218 2

330、53 297 343 377 SpendingForecastGrowth20%15%10%5%0%40035030025020013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027%Spending growth constant US$Spending constant US$Bn20232027 Key metrics+95%totalspending growth(1316%CAGR)+100 newoncology drugs+$184Bn44|The Global Us

331、e of Medicines 2023:Outlook to 2027 Immunology is expected to grow by 24%by 2027,adding$34Bn in spending with growth offset by the impact of biosimilars;total immunology spending is expected to grow at a rate of 36%CAGR through 2027 to reach$177Bn globally.New products in psoriasis,atopic dermatitis

332、 as well as severe asthma have driven spending growth in recent years and are expected to continue,while biosimilar impact will slow growth in the forecast years from 2023 to 2027.In many developed markets,more than half of current immunology spending is expected to face generic or biosimilar compet

333、ition due to brand losses of exclusivity in the next five years.During this same period,the average cost of a day of therapy is expected to decline to$24,driven by the introduction of biosimilar adalimumab(Humira)in the U.S.in 2023,and likely to decline further in the years that follow.Immunology treatments have consistently been driven by increasing volume,averaging 12%volume growth in standardiz