Understanding the Dynamics of Drug Expenditure: Shares, Levels, Compositions, and Drivers

This report describes the dynamic changes in the composition of drug expenditure over the period 1995 to 2015 for five developed countries—France, Germany, Japan, the United Kingdom, and the United States. Over the past 20 years, therapies that once dominated spending are now dramatically less important, while other entirely new therapies have risen to a significant share of spending.

Key insights include:

  • Nominal drug expenditure measured at invoice price level has risen substantially over the past 20 years across all countries analyzed, though less so when normalized for economic and population growth.
  • When composition of drug expenditure is examined, the classes that dominated spending 20 years ago have shrunk considerably as innovation and product lifecycles shift costs downward.
  • Older therapies have declining importance as many have lost patent protection and costs have reduced considerably, while others have seen continuous innovation and have risen in share of spending.

Across all five countries, some common patterns emerge in terms of the therapy areas that now make up the large portion of spending and those that have declined. That said, each country has a distinct set of dynamics, spending compositions, and underlying clinical, disease, and policy drivers.

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