In 2022 there were 65 licensed medicines wholesalers in Estonia. 30 wholesalers sold human medicines to general or hospital pharmacies or to other institutions. Two major wholesalers covered 80% of human medicinal products market: Magnum Medical (46.4%) and Tamro Estonia (33.2%). Followed by Estonian Health Board (7.1%), Baltfarma (5.6%) and Roche Estonia (4.6%). The total market share of the other wholesalers was under 3%.
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Medicinal products market of human medicines
As we can see from Fig. 1, the medicinal products market has grown rapidly during the last five years. In 2022 the human medicinal products market share reached 431 million euros, showing 5.5% increase compared to the previous year.
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.
Figure 1. Estonian medicinal products market in 2018-2022
Sales to general pharmacies covered 64% (293 million euros), sales to hospital pharmacies 28% (122 million euros) of total medicinal products market and sales to other institutions 4% (16 million euros). If in previous years the sales to other institutions covered about 1% (around 4 million euros) of the market, then in 2021 and 2022 the share was remarkably higher, mainly due to Covid-19 vaccines, which reached the market.
The proportion of prescription sales was 86.1% which comparing to over-the-counter sales (13.4%) and hospital package sales (0.5%) covered most of the medicinal products market. Analysing the turnover by quarters, then usually medicinal products market can be characterized by seasonality: the turnover of prescription medicines is higher in 2nd and 4th quarter (Fig. 2), whilst the sales of over-the-counter medicines increase in 1st and 4th quarter (Fig 3). Year 2020 was exeptional due to Covid-19 crisis. Due to that, the turnover was unexpectedly high in first quarter just before the lockdown and was unusually low in the second quarter. Nevertheless, the situation stabilised in the second half of 2020. During 2021 the normal seasonal trend continued and for the 4th quarter the medicinal products market reached its highest level. During 2022 the pharmaceutical market remained at a high level.
Figure 2. Prescription medicines turnover in 2018-2022 quarterly
Figure 3. Over-the-counter medicines turnover in 2018-2022 quarterly
Medicinal product market share and drug consumption
Based on ATC classification the greatest market share of medicines belonged to antineoplastic and immunomodulating agents (23%) and antiinfectives for systemic use (14%), of which one fifth were Covid-19 vaccines. Alimentary tract and metabolism medicines covered 12% and blood and blood forming organs 11% of total market share. These four ATC groups covered 60% of total market share of medicines (Fig. 4).
Figure 4. Estonian medicinal products market share between ATC groups in 2020-2022
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 or the fact that some medicines are remarkably expensive, i.e. antineoplastic and immunomodulating agents, antiviral medicines.
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. However, the DDD system cannot be applied to all medicines, mainly due to very individual dosing. For example, most of the dermatological medicines as well as antineoplastic and immunomodulating agents or preparations in ATC group Various (diagnostic agents, contrast media) have not been assigned DDDs.
Analysing the medicinal product consumption in Estionia by using the unit DDD/1000/day, we can see that the most consumed medicines in 2022 were cardiovascular system drugs (471 DDD/1000/day), forming more than one third of the total consumption of medicines. Alimentary tract and metabolism medicines cover 15% (196 DDD/1000/day) and nervous system medicines 12% (161 DDD/1000/day) of the total consuption (Fig. 5).
Figure 5. Consumption of medicinal products in Estonia in 2022 (defined daily doses per 1000 inhabitants a day)
Based on DDD/1000/day, the most used active substances of prescription medicines were Ramipril (54 DDD/1000/day), Rosuvastatin (52 DDD/1000/day) and Atorvastatin (39 DDD/1000/day) and of OTC drugs were the combination of Acetylsalicylic acid and Magnesium oxide (37 DDD/1000/day), Xylometazoline (27 DDD/1000/day) and Ibuprofen (24 DDD/1000/day).
In 2022, 4552 different medicinal preparation packages and 1400 active substances were marketed in Estonia.
More information about medicines consumption in Defined Daily Doses can be found:
Summary of 2022 medicinal product market:
- Medicinal products market: 431 million euros / 33.6 million packages
- Sales to general pharmacies: 293 million euros / 31 million packages
- Sales to hospital pharmacies: 122 million euros / 2.2 million packages
- Sales to other institutions: 16 million euros / 0.4 million packages
- Prescription medicines: 371 million euros / 20,5 million packages
- OTC medicines: 58 million euros / 12,9 million packages
- Hospital packages: 2 million euros / 0,2 million packages
- Antineoplastic and immunomodulating agents: 99 million euros
- Antiinfectives for systemic use: 60 million euros
- Alimentary tract and metabolism medicines: 50 million euros
- Medicines for blood and blood forming organs: 46 million euros
Last updated: 31.03.2023