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    Overview of Estonian medicinal products market

    27.03.2019
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    Estonian annual drug statistics is based on wholesalers’ quarterly reports. The statistics of human medicinal products includes sales to general and hospital pharmacies and to other institutions, i.e. state and scientific institutions.

    Wholesalers

    In January 2019 there were 64 wholesalers in Estonia and five of them were specialized only on veterinary medicines.

     20152016201720182019
    Wholesalers
    (human and veterinary medicines)
    5154586261
    Wholesalers
    (only veterinary medicines)
    66653
    Together5760646764

    In 2018, 29 wholesalers sold human medicines to general or hospital pharmacies or to other institutions. Three major wholesalers covered 77% of human medicinal products market: Magnum Medical (28%), Tamro Estonia (27%) and Apteekide Koostöö Hulgimüük (21%). Followed by Roche Estonia (5%), Baltfarma (5%) and Estonian Health Board (5%). The total market share of the other wholesalers remained under 10%.

    Medicinal products market of human medicines

    The medicinal products market is expressed in wholesale prices which includes the price of the manufacturer and wholesaler’s mark-up and does not include the VAT.

    In 2018 the medicinal products market increased 8.1% reaching to 325 million euros.


    Figure 1. Estonian medicinal products market in 2014 – 2018

    Sales to general pharmacies covered 70% (228.0 million euros) and sales to hospital pharmacies 29% (93.6 million euros) of total medicinal products market. Sales to other institutions were modest, being 1% (3.8 million euros) of total sales.

    The proportion of prescription sales was 85% which comparing to over-the-counter sales (14%) and hospital package sales (1%) covered most of the medicinal products market.

    Medicinal products market can be characterized by seasonality: the turnover of prescription medicines is higher in 2nd and 4th quarter, whilst the sales of over-the-counter medicines increase in 1st and 4th quarter.


    Figure 2. Prescription medicines turnover in 2014 – 2018 quarterly


    Figure 3. Over-the-counter medicines turnover in 2014 – 2018 quarterly

    Medicinal product market share and drug consumption

    Based on ATC classification antineoplastic and immunomodulating agents had the greatest market share (20%), followed by antiinfectives for systemic use (14%) and alimentary tract and metabolism medicines (12%).


    Figure 4. Estonian medicinal products market share between ATC groups in 2016 – 2018

    DDD/1000/day describes often population drug consumption better than turnover which can be quite unstable, for example new generic drugs that come to market affect prices greatly.

    Defined Daily Dose (DDD) is the assumed average dose per day for the drug used in its main indication in adults.

    Defined Daily Dose per thousand inhabitants a day (DDD/1000/day) expresses the proportion of the population within a defined area treated daily with certain drugs.

    The DDD system cannot be applied to all medicines, mainly due to very individual dosing and different administrations. Therefore, the Figure 5 does not contain ATC groups “Herbal medicinal products” and “Various”. Many dermatologicals as well as antineoplastic and immunomodulating agents have not been assigned DDDs.

    According to DDD/1000/day, the most consumed medicines in 2018 were cardiovascular system drugs (431 DDD/1000/day), followed by alimentary tract and metabolism (175 DDD/1000/day) and nervous system medicines (128 DDD/1000/day).


    Figure 5. Consumption of medicinal products in Estonia in 2016 – 2018 (defined daily doses per 1000 inhabitants a day)

    On the basis of DDD/1000/day, the most used prescription medicines were Ramipril (56 DDD/1000/day), Rosuvastatin (33 DDD/1000/day) and Amlodipine (27 DDD/1000/day), while most consumed OTC drugs were the combination of Acetylsalicylic acid and Magnesium oxide (45 DDD/1000/day), Ibuprofen (22 DDD/1000/day) and Xylometazoline (22 DDD/1000/day).

    In 2018, 4292 different medicinal preparation packages and 1347 active substances were marketed in Estonia.

    More information about drug consumption in Defined Daily Doses can be found here.