title: EU pharmaceutical expenditure forecast.
abstract: OBJECTIVE
  With constant incentives for healthcare payers to contain their pharmaceutical budgets, forecasting has become critically important. Some countries have, for instance, developed pharmaceutical horizon scanning units. The objective of this project was to build a model to assess the net effect of the entrance of new patented medicinal products versus medicinal products going off-patent, with a defined forecast horizon, on selected European Union (EU) Member States' pharmaceutical budgets. This model took into account population ageing, as well as current and future country-specific pricing, reimbursement, and market access policies (the project was performed for the European Commission; see http://ec.europa.eu/health/healthcare/key_documents/index_en.htm).
  
  
  METHODS
  In order to have a representative heterogeneity of EU Member States, the following countries were selected for the analysis: France, Germany, Greece, Hungary, Poland, Portugal, and the United Kingdom. A forecasting period of 5 years (2012-2016) was chosen to assess the net pharmaceutical budget impact. A model for generics and biosimilars was developed for each country. The model estimated a separate and combined effect of the direct and indirect impacts of the patent cliff. A second model, estimating the sales development and the risk of development failure, was developed for new drugs. New drugs were reviewed individually to assess their clinical potential and translate it into commercial potential. The forecast was carried out according to three perspectives (healthcare public payer, society, and manufacturer), and several types of distribution chains (retail, hospital, and combined retail and hospital). Probabilistic and deterministic sensitivity analyses were carried out.
  
  
  RESULTS
  According to the model, all countries experienced drug budget reductions except Poland (+€41 million). Savings were expected to be the highest in the United Kingdom (-€9,367 million), France (-€5,589 million), and, far behind them, Germany (-€831 million), Greece (-€808 million), Portugal (-€243 million), and Hungary (-€84 million). The main source of savings came from the cardiovascular, central nervous system, and respiratory areas and from biosimilar entries. Oncology, immunology, and inflammation, in contrast, lead to additional expenditure. The model was particularly sensitive to the time to market of branded products, generic prices, generic penetration, and the distribution of biosimilars.
  
  
  CONCLUSIONS
  The results of this forecast suggested a decrease in pharmaceutical expenditure in the studied period. The model was sensitive to pharmaceutical policy decisions.
authors.affiliation: Creativ-Ceutical, Milano, Italy.
authors.forename: Duccio
authors.initials: D
authors.lastname: Urbinati
authors.affiliation: Creativ-Ceutical, Paris, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Rémuzat
authors.affiliation: Creativ-Ceutical, Paris, France.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Kornfeld
authors.affiliation: Creativ-Ceutical, Paris, France.
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Vataire
authors.affiliation: Creativ-Ceutical, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Cetinsoy
authors.affiliation: Creativ-Ceutical, Paris, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Aballéa
authors.affiliation: Creativ-Ceutical, Paris, France.
authors.forename: Olfa
authors.initials: O
authors.lastname: Mzoughi
authors.affiliation: Faculté de Médecine, Laboratoire de Santé Publique, Aix-Marseille Université, Université de la Méditerranée, Marseille Cedex, France.
authors.forename: Mondher
authors.initials: M
authors.lastname: Toumi
keywords: biosimilar; forecast model; generic; health policy; innovative medicine; pharmaceutical expenditure