wipo_reg_ip_amm_04_8 fur update of the event.ppt

To Individual Patients and Families�
For the Benefit of the Larger Societies, including the Levant�
Specific Benefits to the Jordanian Economy (2000 – 2004)

1. The Value of The Value of
New MedicinesNew Medicines
WIPO Arab Regional Meeting
IP as a Power Tool
for Economic Growth
Susan Kling Finston
Associate Vice President
PhRMA
Amman, June 1, 2004

2. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Value of New MedicinesValue of New Medicines
•To Individual Patients and Families
•For the Benefit of the Larger Societies,
including the Levant
•Specific Benefits to the Jordanian
Economy (2000 – 2004)

3. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
The value to Patients:The value to Patients:
I.Improving quality of life by reducing
hospitalizations and helping patients
avoid surgery.
II.Reducing side effects.
III.Decreasing mortality and morbidity.

4. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
I. New Drugs Improving Quality of LifeI. New Drugs Improving Quality of Life
•Reducing hospitalizations and
emergency room visits
•Avoiding surgery
•Helping patients remain more active
and independent

5. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
New Drugs Reduce Visits to Hospital and ERNew Drugs Reduce Visits to Hospital and ER
85%
55%
35%
30%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
ER Visits Hospitalizations
P
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n
t

o
f

P
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t
i
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n
t
s
Asthma Management Program Improves Outcomes for
Children with Asthma
Source: P.J. Munzenberger and R.Z. Vinuya, “Impact of an Asthma Program on the Quality of Life of Children in an Urban
Setting,” Pharmacotherapy, 22 (2002): 8, 1055-1062.
After Program
Before Program

6. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Medicines Help Prevent Invasive Medicines Help Prevent Invasive
SurgeriesSurgeries
“[F]or ulcers, a few pills have
replaced major surgery.”
Former FDA Commissioner Dr. Mark McClellan, Speech
before Drug Information Association, Ottawa, Canada
November 18, 2003

7. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
0
10
20
30
40
50
60
70
80
Less Drug Use (<5mg/Day, <8 Weeks
Treatment)
More Drug Use (>5mg/Day, >36 Weeks
Treatment)
A
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H
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n
t
Source: G. Provenzano, et al., “Delays in Nursing Home Placement for Patients with Alzheimer’s Disease
Associated with Treatment with Donepezil May Have Health Care Cost-saving Implications,” Value in
Health, 4 (2001): 2,158.
Medicines Allow Patients to Remain Independent Medicines Allow Patients to Remain Independent
LongerLonger
New Alzheimer’s Medicine Delays Need for Costly
Nursing Home Care
43 Months
73 Months

8. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
II. New Medicines Reduce Side EffectsII. New Medicines Reduce Side Effects
•New medicines have been found to reduce side effects,
often leading to improved compliance and better health
outcomes.
•Approximately 20% to 30% of patients who take
conventional NSAIDs develop persistent side effects, and
more than 10% are estimated to discontinue treatment as a
result. (Source: “Anti-Inflammatory and Upper Gastrointestinal Effects of Celecoxib in Rheumatoid Arthritis,”
The Journal of the American Medical Association, Vol. 282, No. 20, November 24, 1999.)
•A new family of NSAIDs known as Cox-2 inhibitors have
been proven to cause less stomach irritation and carry a
lower risk of complications than conventional NSAIDs.

9. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
New Medicines Often Have Fewer Side Effects New Medicines Often Have Fewer Side Effects
and Less Complicated Dosing Regimensand Less Complicated Dosing Regimens
•In the United States, the number of patients treated for
depression has grown from 1.7 million to 6.3 million
over the last decade.
•One of the primary reasons for the increase was the
steady broadening of prescription drug options
available to treat depression, including a new class of
antidepressant medications, which have fewer side
effects and require less complicated dosing regimens.
Source: Olfson, Mark et al., “National Trends in the Outpatient Treatment of
Depression,” The Journal of the American Medical Association, 2002; 287:
203-209.

10. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
III. Pharmaceuticals Reduce Mortality III. Pharmaceuticals Reduce Mortality
and Morbidityand Morbidity
•Pharmaceuticals have eliminated or brought under control
many diseases that once had high mortality rates (e.g.,
influenza, polio, pneumonia, diphtheria).
•Medicines have helped dramatically reduce mortality rates
for other diseases and conditions (e.g., AIDS, asthma, heart
attacks, strokes, ulcers).
•Medicines are alleviating symptoms for a wide range of
diseases.

11. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Drug Discoveries Have Helped Control Death Drug Discoveries Have Helped Control Death
Rates for Chronic and Acute ConditionsRates for Chronic and Acute Conditions
Examples:
•Antibiotics have helped cut death rates from
rheumatic fever and rheumatic heart disease by 83%
from 1965 to 1996.
•Medicines such as ACE Inhibitors, beta-blockers, and
nitrates have helped cut death rates from
atherosclerosis (hardening of the arteries) by 74%.
•H2 blockers and proton pump inhibitors helped cut
death rates from ulcer of the stomach and duodenum
by 72%.

12. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
New Drugs Decrease Mortality for New Drugs Decrease Mortality for
Deadly DiseasesDeadly Diseases
•“From Killer to Chronic Disease: Drugs
Redefine Cancer for Many”
Headline to Washington Post story, January 29, 2003,
which noted that thanks to advances in care, cancer has
evolved into a “chronic disease, much like asthma,
diabetes, and, more recently, AIDS.”
•AIDS death rate fell 80% in the last decade
with introduction of HAART drug therapy.
Source: CASCADE Collaboration, “Determinants of Survival Following HIV-
1 Seroconversion After the Introduction of HAART,” The Lancet, 362 (2003):
1267-1274.

13. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Study Finds Direct Correlation Between Study Finds Direct Correlation Between
Reductions in Mortality and Number of New Reductions in Mortality and Number of New
Drugs for DiseaseDrugs for Disease
•Over 45% of the variation in mortality across diseases
1970-1991 is explained by the amount new drugs are
used to treat the disease – New drugs the most
important factor in mortality reductions.
•Each of the 436 new drugs introduced 1970-1991,
annually adds 11,200 aggregate years of life to the
U.S. population.
Source: Lichtenberg, Frank, “Pharmaceutical Innovation, Morality Reduction,
and Economic Growth,” Presented at the Conference on the Economic Value
of Medical Research, December 1999.

14. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
0.5
0.26
0.0
0.1
0.2
0.3
0.4
0.5
0.6
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40%
74%
0%
10%
20%
30%
40%
50%
60%
70%
80%
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)
Medicines Ease SymptomsMedicines Ease Symptoms
Source: T.B. Boone, et al., “Treatment Patterns and Associated Symptom Improvement During Six Months of Care for Overactive
Bladder: A Prospective, Observational Study,” Clinical Therapeutics, 24 (March 2002): 3, 397-408.
New Drug to Treat Overactive Bladder Improves
Symptoms; Reduces Patient Care Needs
Patients Not Treated With New DrugPatients Treated With New Drug
Improved Symptoms Reduced Office Visits

15. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Value to SocietyValue to Society
I.Curbing overall health care spending.
II.Increasing worker productivity.
III.Preventing disease and/or mitigating
the complications of disease.

16. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
I. New Drugs Reduce Total Medical SpendingI. New Drugs Reduce Total Medical Spending
•The use of newer drugs tends to lower all types of non-
drug medical spending, reducing the total cost of treating a
condition.
•Hospitalization rates fall
•Length-of-stay in the hospital goes down
•Visits to family doctors and specialists are reduced
•Prevent costs associated with complications and symptoms
•Help avert costly surgeries

17. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Research Shows Using New Medicines Research Shows Using New Medicines
Reduces Health Care SpendingReduces Health Care Spending
•Use of newer medicines increased drug costs by $18, but
reduced hospital and other non-drug costs by $129.
→ So for each additional $1 spent on newer
pharmaceuticals, $6.17 is saved in total health care
spending
→ Of that amount, $4.44 comes from savings in hospital
spending.
Frank R. Lichtenberg, “Benefits and Costs of Newer Drugs: An Update,”
(Cambridge, MA: National Bureau of Economic Research, June 2002).

18. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
$522
-$52
-$5,044
$430
-$3,614
-$2,329
-$6,000
-$5,000
-$4,000
-$3,000
-$2,000
-$1,000
$0
$1,000
Ambulatory
Savings
Hospital
Savings
Drug Costs Nursing
Home Care
Costs
Other
Savings
Total Health
Care
SavingsC
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Drugs Help Control Hospital and Drugs Help Control Hospital and
Ambulance CostsAmbulance Costs
Mood Stabilizers Result in Savings for Patients with
Bipolar Disorder
Source: J. Li, et al, “Cost of Treating Bipolar Disorder in the California Medicaid (Medi-Cal) Program”, Journal of Affective
Disorders, 71 (2002): 1-3, 131-139

19. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
$10,213
$11,562
$7,469$7,299
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
Three Years After Study Four Years After Study
C
o
s
t
s
Source: E.H. Wagner, et al., “Effect of Improved Glycemic Control on Health Care Costs and Utilization,” Journal of the
American Medical Association, 285 (2001): 2, 182-189.
Unimproved Group Improved Group
$2,914 in
Savings
$4,093 in
Savings
Diabetes Costs Reduced Through Improved Glycemic
Control
New Medicines Reduce Costs by Averting New Medicines Reduce Costs by Averting
Complications and ReducingComplications and Reducing SymptomsSymptoms

20. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
II. New Drugs Increasing Worker II. New Drugs Increasing Worker
ProductivityProductivity
•Pharmaceuticals make it possible for
patients to perform better on the job; worker
productivity improves
•With effective medicines absenteeism falls
•Employers save money that would have
been lost to physical and mental illness

21. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
$43.78
-$435.00
-500
-400
-300
-200
-100
0
100
Medicines Can Greatly Improve Medicines Can Greatly Improve
Productivity and Save Employers Money Productivity and Save Employers Money
New Migraine Medicine Produces Productivity Savings
that Far Outweigh Drug Costs
Source: R.F. Legg, et al., “Cost Benefit of Sumatriptan to an Employer,” Journal of Occupational and Environmental Medicine,
39 (1997): 7, 652-657.
Monthly
Costs
Monthly
Savings
Monthly Drug Costs per
Employee Treated
Monthly Employer Savings
per Employee Treated
10 : 1
Benefits : Costs

22. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Medicines Can Reduce Days Missed Medicines Can Reduce Days Missed
From WorkFrom Work
0
1
2
3
4
5
-6-5-4-3-2-11 2 3 4 5 6
Month
D
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s

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t
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Antidepressants Reduce Absenteeism
Source: A.J. Claxton, et al., “Absenteeism Among Employees Treated for Depression,” Journal of Occupational and
Environmental Medicine, 41 (1999):7, 605-611.
SSRI Drug Treatment BeginsMonth

23. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
III. New Drugs Can Prevent or Mitigate the III. New Drugs Can Prevent or Mitigate the
Complications of DiseaseComplications of Disease
•Drug treatments reduce disability resulting
from a disease
•They minimize the chance of serious disease
complications
•Medicines lower risk of serious disease
events, such as heart attack
•New medicines can slow disease progression

24. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
23%
11%
0%
5%
10%
15%
20%
25%
One Drug Combination of Drugs
P
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Source: J.B. Wong, et al., “Estimating the Cost-effectiveness of 54 Weeks of Infliximab for Rheumatoid Arthritis,” American
Journal of Medicine, 113 (2002): 400-408.
Medicines Help Prevent DisabilityMedicines Help Prevent Disability
Rheumatoid Arthritis Drug Treatment Reduces
Chance of Disability

25. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Medicines Prevent Serious Disease Events:Medicines Prevent Serious Disease Events:
Cholesterol Fighting Drugs Reduce Risk of Heart Attack or Cholesterol Fighting Drugs Reduce Risk of Heart Attack or
StrokeStroke
•Cholesterol-lowering drugs, known as statins, safely
reduced the risk of a heart attack or stroke by one-third in
the world’s largest study of people at high risk for these
conditions.
•About 25 million people worldwide take statins today.
The new findings suggest that about 200 million people
worldwide would benefit from the drugs.
•According to the study’s lead investigator, if 10 million
high-risk patients started taking statins, 50,000 deaths
would be prevented each year.
Source: Lawrence K. Altman, “Cholesterol Fighters Lower Heart Attack Risk, Study Finds,”
The New York Times, November 14, 2001.

26. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
•Before 1977, the year in which stomach-acid blocking H2
antagonist drugs were introduced 97,000 ulcer surgeries
were performed each year. By 1987, that number dropped
to fewer than 19,000.
•In the 1990s cost of drug therapy for ulcers:
$900/person/year
Cost of surgery: $28,000
•The new treatment saves at least $224 million a year in
health care costs.

Source: “The Contribution of Pharmaceutical Companies: What’s at Stake for
America,” The Boston Consulting Group, September 1993.
Medicines Reduce the Risk of Complications:Medicines Reduce the Risk of Complications:
Strides in Ulcer Treatment Exemplify Ability of Strides in Ulcer Treatment Exemplify Ability of
Pharmaceutical Innovation to Prevent or Mitigate Pharmaceutical Innovation to Prevent or Mitigate
Complications of DiseaseComplications of Disease

27. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Hepatitis C Virus (HCV) and its Hepatitis C Virus (HCV) and its
Epidemiology in Levant AreaEpidemiology in Levant Area
•Discovered in 1989 as a small RNA blood-borne virus
with a large reservoir of chronic carriers worldwide
•Major cause of posttransfusion hepatitis prior to 1992
•Actual prevalence of HCV infection in Lebanon and Syria
is not known.
•Prevalence in Iraq 0.5%, Libya 7.9% and Jordan 2%*.
•Genotype 4 is the most prevalent type in the Middle East.

28. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Prevalence of HCV in Our Countries Prevalence of HCV in Our Countries
Iraq, 0.5
Jordan, 2.1
Libya, 7.9
East Medit., 4.6
0 2 4 6 8 10
Prevalence of HCV
%

29. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
0
10,000
20,000
30,000
40,000
50,000
Cost per life
years gained
(Euro)
PegIntron(1.5)
+ Rebetol
Stool
Guaiac
Pneum Vacc Anti-
hypertensives
CABG Mammogram
Combination Therapy is Excellent Value Compared with Combination Therapy is Excellent Value Compared with
Other Well Accepted InterventionsOther Well Accepted Interventions

30. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Value to JordanValue to Jordan
I.Growth in Pharmaceutical Industry
Economic Activities
II.Development of New Related Sectors
III.Overall Benefits to the Jordanian
Economy

31. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Growth in Pharmaceutical Industry Growth in Pharmaceutical Industry
Economic Activities (2000 - 2004) Economic Activities (2000 - 2004)
•More New Product Launches:
–More than 32 new product launches
–Jordan joining “Global Launch” A-List
•Growth in PhRMA Activities in Jordan:
–Ten Regional Offices
–300% Growth in Direct Employment

32. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Growth of PartnershipsGrowth of Partnerships
•Eli Lilly:
Agreed with Al Hikmeh to promote Cialis for erectile dysfunction
in the Jordanian market, as the first multi-national company to
provide exclusive promotion responsibility for an innovative drug.
•Bristol-Myers Squibb:
Signed a 3-yr cooperative landmark agreement with King Hussein
Cancer Center (KHCC). This agreement extended cooperation to
Jordan already existing between B-MS and NCI (National Cancer
Institute) in US.
•Novartis:
Levant Regional Office in Amman celebrates its fifth year in
operation serving several countries in the region; reached a
collaborative agreement with Dar Aldawa.

33. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Development of New SectorsDevelopment of New Sectors
in Jordan - - Clinical Reseachin Jordan - - Clinical Reseach
•PhRMA members:
Aventis, BMS, Eli Lilly, Janssen Cilag, MSD,
Novartis, Organon, Pfizer and Schering AG
•Key areas:
–Cancer - Cardiovascular
–Renal Failure - Anti-infectives
–Schizophrenia - Diabetes
–Epilepsy - Osteoporosis
–Antibiotics - Painkillers

34. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Growth of Clinical Trial Activity in Jordan
Data: Internal PhRMA Survey, Spring 2004
Clinical
trials
Pfizer Eli LillyNovartis MSD Aventis Schering
AG
Pre-
2000
1 Almost none None None None None
2004 4 2 4 3 6 1
SubjectAntifungal
Cardiovascular
Osteoporosis
Sepsis
Cancer
Thalassaemia
Cancer
Osteoporosis
Osteoarthritis
Cardiovascular
Oncology
Osteoporosis
Cardiovascular
Diabetes
Anti-infectives
Computer
tomography
Cardio
angiography
investigations

35. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Development of New SectorsDevelopment of New Sectors
in Jordan - - Medical Tourismin Jordan - - Medical Tourism
•Jordan has four major sites
•Each with several medical/holistic health
centers:
–Dead Sea
–Ma’een Falls
–Jordanian Hummah
–Afra Falls

36. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
Overall Benefits to the Jordanian EconomyOverall Benefits to the Jordanian Economy
•Benefits of Perception of strong Jordanian IP Regime
•Growth in Jordanian Economy based on Knowledge
Economy
–Springboard for attracting PhRMA member activities
to Amman.
–Jordan’s pharmaceutical exports produced by
local firms increased by 30% overall to all
markets through 2003.

37. New Medicines. New Hope. New Medicines. New Hope. New Medicines. New Hope.
PhRMA International Points of ContactPhRMA International Points of Contact
Washington DC:
[email protected] Susan Finston
Amman, Jordan:
[email protected] Samir Mansour