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Ref. Ares(2020)2433183 - 07/05/2020
Economic and 
societal 
footprint of the 
pharmaceutical 
industry in 
Europe
June 2019


Foreword from EFPIA
I firmly believe that building a strong  the gap is continuing to grow, all 
European economy, a cohesive 
in the context of increasing 
European society and a healthy 
competition from China and the 
population are inextricably linked. It 
Far East.
is one of the things that makes our 
sector unique. As an industry we 
What does this mean for Europe? As 
invest a greater percentage of 
a recent report1 from the European 
revenue in research and 
Political Strategy Centre stated: 
development than any other sector, 
“Particular attention needs to be 
we are an integral part of Europe’s 
paid to areas: 
economic landscape and most 
Nathalie Moll
a.  where Europe possesses or is 
importantly, our medicines transform 
Director General, EFPIA
developing a competitive 
the lives of patients and the way we 
advantage, 
manage our healthcare.
b. chooses to prioritise and invest 
To help inform policy and shape 
public resources, given their 
industrial strategy, EFPIA 
importance in addressing societal 
commissioned PwC to conduct an 
challenges, 
analysis of the economic and 
c.  sees as vital to its strategic 
societal impact of the 
autonomy.”
pharmaceutical industry in Europe. 
PwC’s analysis shows the impact on  Given its dual role as a driver of 
patients’ lives across a selection of 
economic growth and significant 
diseases. In addition, it indicates 
positive impact on public health, the 
that, in 2016, 2.5 mil ion jobs were 
research-based pharmaceutical 
supported by the pharmaceutical 
industry is one of the industries of 
sector, with the average Gross Value  critical strategic importance that 
Added per employee significantly 
Europe can benefit from by fostering 
higher than that of other key R&D 
and supporting innovation, in 
sectors at €156,000. The activities of  particular by offering a predictable 
pharmaceutical companies directly 
regulatory environment and 
contributed nearly €100 bil ion to EU  incentives model.
economies, with an additional €106 
bil ion provided through the supply 
The report underlines the economic 
chain and employee spending.
and societal contribution of the 
innovative pharmaceutical industry 
The race to attract life-science 
to the European economy. From 
research, development and 
employment to investment, research 
manufacturing and investment is a 
to new treatments, as an industry, 
global endeavour. The number of 
we won’t rest in creating a healthier 
new medicine approvals in the US is  future for Europe. 
outstripping approvals in the EU and 
1   ‘EU Industrial Policy After Siemens-Alstom’, European Political Strategy Centre, European Commission, 18 March 2019.


Foreword from PwC
We are pleased to support EFPIA on  there has been continued scrutiny 
this important piece of work and we 
on the affordability of medicines, 
thank the companies and industry 
and in particular, the need for 
bodies who have contributed and 
intel ectual property incentives to 
helped make this work possible. 
stimulate research and 
commercialisation of new therapies. 
The pharmaceutical industry has 
delivered substantial value to the 
This debate should consider the 
health of European Union (EU) 
benefits of innovative medicine as 
citizens over decades and delivered 
well as costs. We hope that our 
Jo Pisani
significant economic value through 
research is valuable in driving 
Partner, PwC UK
the research, manufacturing and 
productive dialogue and further 
commercialisation activities that are 
informs the debate by assessing the 
conducted in Europe. Continued 
overall contribution of the industry to 
research and the application of new 
economic prosperity and 
technologies mean that treatments 
employment, the health and societal 
and cures for many more diseases 
benefits of innovations in specific 
are within grasp. However, with 
areas of medicine, and by reviewing 
many EU health economies having 
the importance of incentive 
to manage the increasing health 
mechanisms in driving continued 
costs of an ageing population and 
R&D and commercialisation.
an increase in chronic diseases 


Contents
Executive summary .........................................................2
Introduction .....................................................................4
Methodology ...................................................................5
Economic impact .............................................................6
Health and societal impact ............................................ 10
Role of IP incentives ...................................................... 14
Conclusion..................................................................... 16
References .................................................................... 18


Abbreviations
ART
Antiretroviral therapy
EFPIA
European Federation of Pharmaceutical Industries and Associations
EMA
European Medicines Agency
EU
European Union
GDP
Gross Domestic Product
GTAP
Global Trade Analysis Project
GVA
Gross Value Added
HAART
Highly Active Antiretroviral Therapy
HER2+
Human Epidermal growth factor Receptor 2-positive
HLY
Healthy Life Year
HR+
Hormone Receptor-positive 
IP
Intel ectual Property
QALY
Quality Adjusted Life Year
R&D
Research & Development
SME
Small and Medium sized Enterprise
STEM
Science, Technology, Engineering and Mathematics
STR
Single Tablet Regimen
TA
Therapeutic Area
WHO
World Health Organization

Executive summary
We have shown that the whole of the pharmaceutical industry 
Medicines benefit mil ions of people on a daily basis. In just a 
across the EU in 2016 contributed to...
subset of medicines within HIV (HAART) and breast cancer 
(HER2+, HR+) we saw that...
€206 billion
Over 650,000 
in Gross Value Added and...
people in the EU were treated 
with these medicines between 
2007–2017, who are estimated  
to have gained around...
2.5 million
2 million
healthy life years, leading to around...
jobs
46%
€27 billion
 of people employed directly 
by the industry are women
In productivity gains for 
EU economies, and 
approximately...
Share of female employees
€13 billion in 
healthcare cost savings due 
to avoided complications 
46%
24%
16%
Pharmaceuticals
Auto 
Aerospace & 
manufacturing
defence
2 | Economic and societal footprint of the pharmaceutical industry in Europe


The value of the pharmaceutical industry 
The advent of targeted breast cancer 
community, which our analysis has not 
to both patients and society is often lost 
treatments designed to treat specific 
quantified. We also have not accounted 
in the public debate surrounding 
genotypes have resulted in an estimated 
for the effect of improved health on 
medicine prices. This analysis seeks to 
gain of over one mil ion healthy life years 
increases in informal employment, such 
highlight the broader value that the 
in Europe for patients treated with 
as domestic work, childcare, and family 
research-based industry delivers to the 
selected medicines between 2007 and 
caretaking, the imputed value of such is 
wider European community.
2017, and have delivered a wider impact 
estimated at 20 to 40% of EU GDP2. 
on both patients’ family members and 
Moreover, the medicines have a ripple 
The pharmaceutical industry is a major 
the broader breast cancer population.
effect in that all of them have helped 
contributor to the European economy. 
pave the way for further innovations 
We estimate that in total, it contributed 
Prior to the advent of highly active 
across different medical disciplines.
€206 bil ion in Gross Value Added (GVA) 
antiretroviral therapy (HAART), an HIV 
and 2.5 mil ion jobs in 2016, equivalent to  diagnosis was almost a death sentence. 
The current EU incentives model, which 
1.4% of the EU’s combined GDP and 
The development of HAART therapy has 
includes Supplementary Protection 
0.9% of the region’s employment1. The 
turned HIV into a treatable disease, and 
Certificates, Regulatory Data Protection, 
largest contributions are made in 
this is evidenced in the increases in 
Orphan Market Exclusivity and Paediatric 
Germany, the United Kingdom and 
healthy life years and increases in 
Rewards, is fundamental to ensuring a 
France. As well as supporting a 
productivity it has brought to the 
strong pharmaceutical industry in Europe. 
significant number of jobs, the industry 
European HIV population. For patients 
It has helped to generate investment in 
has been making strides in areas of 
treated between 2007 and 2017, the 
areas with previously unmet needs and 
representation and gender equality and 
HAART therapies we looked at are 
fostered a thriving industry that makes a 
compares favourably with other key 
estimated to lead to a gain of 800,000 
significant contribution to the European 
industries. In 2016, 46% of the 
healthy life years and €22 bil ion of 
economy and society. A survey of 18 
pharmaceutical industry’s workforce 
productivity. Outside of the quantifiable 
EFPIA corporate members reinforces the 
were women.
gains in healthy life years and 
importance of these incentives. 
productivity, these innovations have the 
Respondents indicated that, within the 
However, the benefits brought by 
potential to reduce both health 
current incentives environment, they have 
pharmaceutical innovation are not just 
inequalities and HIV transmission rates.
increased investment in the EU over the 
economic. The industry improves the 
past three years. Members indicated that 
lives of mil ions of Europeans through its 
It is worth noting that the benefits 
intel ectual property (IP) incentives and 
contributions to public healthcare and 
quantified in our analysis represent only 
faster market access are the leading 
wider societal benefits. In order to 
a fraction of the overall health and 
factors influencing R&D investment 
il ustrate some of these benefits, we 
societal contribution of the 
decisions, and that dismantling the 
investigated two therapeutic areas – 
pharmaceutical industry in Europe. Our 
current incentive model would have a 
breast cancer and HIV – as case studies,  analysis focused only on specific 
negative impact on their R&D and 
measuring the impact of a selection of 
medicines within two therapeutic areas. 
Commercial operations in Europe. 
medicines in each case study. 
New, more effective drug therapies 
Drastical y changing the incentives model 
improve the psychosocial health of 
therefore risks damaging the 
patients, family members and the 
pharmaceutical industry’s ability to deliver 
value in Europe.
1   GVA captures the gross economic contribution that a sector makes to the economy, in terms of the value 
that its activities add to overall economic output. GVA is broadly equivalent to GDP but it excludes some 
indirect taxes. It is commonly used to measure the value of a company or sector of the economy for whom it 
is difficult to attribute certain taxes. 
2   Giannelli et al. (2012). GDP and the value of family caretaking: how much does Europe care?
Economic and societal footprint of the pharmaceutical industry in Europe | 3 


Introduction
The value of the pharmaceutical  These innovations have al owed us to 
A better understanding of the 
industry to both patients and 
tackle complex diseases far more 
broader value that the industry 
effectively and with greater precision 
delivers can contribute to more 
society is often lost in the 
than ever before. Yet these breakthroughs  holistic dialogue and  
public debate surrounding 
are expensive: accounting for the cost of 
decision-making
failed drugs, the average cost of bringing 
medicine prices
a new drug to market is now estimated 
To better understand the direct and 
to be over $2bn.3 
indirect contribution of the 
In the past 20 years, the pharmaceutical 
pharmaceutical industry in Europe, 
industry has pioneered research into a 
Medicine prices are set through negotiation 
EFPIA commissioned PwC to conduct a 
vast range of life-saving medicines. 
with governments based on the value 
study focussed on three key areas: 
Research into smal  molecule medicines 
they deliver to patients and health 
•  The economic impact of the industry; 
and vaccines has paved the way for new 
systems. Unlike other parts of the 
•  The health and societal impacts of 
treatments in a number of key areas, 
healthcare system, they are subject to 
the industry; and 
affecting mil ions of lives, including 
rigorous value assessments before  
•  The enabling environment for 
precision medicines, biologics, cell and 
being reimbursed. Yet these value 
continued investment in innovation.
gene therapies, siRNA and 
assessments can overlook the direct and 
digital therapeutics. 
indirect benefits of pharmaceutical 
innovation, both in the field of medicine 
and to the wider patient population, their 
careers, the community, and the economy.
3  DiMasi et al. (2016). Innovation in the pharmaceutical industry: New estimates of R&D costs. Tufts Center for the Study of Drug Development, 
Tufts University, United States.
4 | Economic and societal footprint of the pharmaceutical industry in Europe

Methodology
For the economic analysis, we estimated 
Direct economic impact
the economic contribution of the 
Consists of the economic value that 
pharmaceutical industry, defined here as 
the sector created directly and the 
the pharmaceutical and life science 
number of people that organisations 
companies developing and distributing 
within the sector employ.
medicines and vaccines4, in the EU.
The analysis examines how the industry 
Indirect economic impact
Consists of the impact of the sector’s 
contributes to the economy through 
expenditure on suppliers (for example, 
Gross Value Added (GVA) and 
by purchasing raw materials) and 
employment. GVA captures the gross 
suppliers’ expenditure through 
economic contribution that a sector 
subsequent tiers of the supply chain.
makes to the economy, in terms of the 
value that its activities add to overall 
economic output.5 Employment captures 
Induced economic impact
Consists of the impact of employees 
the number of people who are directly 
of both the pharmaceuticals sector 
employed in a given sector, who have a 
and its supply chain spending 
contract of employment and receive 
their wages.
compensation in the form of salaries.
In addition to the direct economic 
For the health and societal impact case 
brought to society. The case study 
contribution of the industry, we used 
studies, we investigated two therapeutic 
approach covers only a fraction of the 
input-output analysis to estimate the 
areas: breast cancer and HIV. These 
impacts of medicines, and is intended to 
industry’s broader economic contribution 
were chosen because they cover 
provide il ustrative examples of health 
through its supply chain and employee 
different disease profiles, including 
and societal benefits rather than be a 
spending. The total contribution of the 
non-communicable and communicable, 
comprehensive analysis across the 
industry is made up of direct, indirect 
acute and chronic diseases, and affect 
pharmaceutical industry. 
and induced effects, which we define 
people of different ages and 
as fol ows:
socioeconomic backgrounds. 
To understand the importance of the 
current EU incentives model, which 
For the two therapeutic areas, we 
includes Supplementary Protection 
focused on a subset of medicines that 
Certificates, Regulatory Data Protection, 
represent important innovations in their 
Orphan Market Exclusivity and 
field and address previously unmet 
Paediatric Rewards, we surveyed EFPIA 
patient needs. To assess their impact, 
corporate members. The survey sought 
we fol owed a bottom-up process to 
to determine how the current incentives 
estimate the aggregate health, 
model affects their Europe based R&D, 
productivity and cost impact of these 
commercial and manufacturing 
medicines for patients treated from 2007 
operations and what dismantling this 
to 2017. By estimating the incremental 
incentives structure might mean for them.
gain in healthy life years6, working days 
and the change in net health care costs 
For more detail on the methodology, 
compared with standards of care prior to  please refer to the Technical Report.
the introduction of the medicines, we 
were able to come up with a picture of 
the benefits these medicines have 
4  We have defined the pharmaceutical industry as using NACE code C21 (Manufacture of basic pharmaceutical products and pharmaceutical preparations). NACE codes 
are a Europe-wide standard classification for businesses, which allow us to conduct analysis across countries consistently.
5  GVA is a similar measure to GDP, but GDP includes some additional indirect taxes which are difficult to attribute to individual sectors. The formula to calculate GVA is: 
Direct GVA = Operating Profits + Depreciation + Amortisation + Direct employee costs.
6  In this report, the term ‘healthy life year’ is used as the plain English equivalent of the technical term: Quality-Adjusted Life Year (QALYs). One healthy life year is 
therefore the same as one QALY and is equal to 1 year of life in perfect health. Or, for example, 2 years living with a severe illness which reduces quality of life by 0.5. 
The QALY is a widely used health outcome measure which reflects both the length and quality of life lived. QALYs are measured in terms of the person’s ability to carry 
out the activities of daily life, as well as freedom from pain and mental disturbance. (NICE).
Economic and societal footprint of the pharmaceutical industry in Europe | 5 

Economic impact
The pharmaceutical industry is  Figure 1: GVA contribution of the pharmaceutical industry in the EU, 2016
a major contributor to the EU 
250,000
economy. We estimate that in 
total, it contributed €206 bil ion 
200,000
in GVA and 2.5 mil ion jobs in 
59,914
150,000
2016, equivalent to 1.4% of the 
46,160
region’s combined GDP and 
100,000
206,010
0.9% of employment.
50,000
99,935
GVA impact (€, millions)
0
Direct
Indirect
Induced
Total
Source: PwC analysis
Figure 2:  Employment contribution of the pharmaceutical industry in the EU, 2016
3,000,000
2,500,000
2,000,000
1,072,000
1,500,000
2,494,000
1,000,000
780,000
Employment impact
500,000
642,000
0
Direct
Indirect
Induced
Total
Source: PwC analysis
The pharmaceutical industry directly 
The benefits of the pharmaceutical 
employs a large number of highly-skilled 
industry’s productivity extend beyond 
staff, who each make a significant 
the industry itself: it helps to raise living 
contribution to the economy.
standards, keep wages high and 
increases tax revenues for government.
The pharmaceutical industry directly 
contributes an average of €156,000 of 
GVA for every employee. This figure is 
significantly higher than the region’s 
average of €59,000, and it is also higher 
than other industries. For example, the 
GVA per employee in the car 
manufacturing industry is €85,000. 
6 | Economic and societal footprint of the pharmaceutical industry in Europe

Figure 3: Economic contribution of the pharmaceutical industry versus other key industries
Pharmaceuticals
Automotive 
Aerospace 
Computer 
manufacturing
manufacturing
programming
€100bn
€211bn
€45bn
€261bn
Direct Gross Value 
Direct Gross Value 
Direct Gross Value 
Direct Gross Value 
Added (2016)
Added (2016)
Added (2016)
Added (2016)
642,000
2,480,000
410,000
3,180,000
Direct Employment 
Direct Employment 
Direct Employment 
Direct Employment 
(2016)
(2016)
(2016)
(2016)
€156,000
€85,000
€102,000
€82,000
Value added per 
Value added per 
Value added per 
Value added per 
employee
employee
employee
employee
Source: PwC analysis
Breaking down GVA by country shows 
The pharmaceutical industry’s workforce is more gender balanced than 
that the pharmaceutical industry offers 
other key industries
the largest contribution to GVA in 
Germany and the United Kingdom, with 
The pharmaceutical industry has been making strides in areas of representation and 
these countries accounting for 33% of 
gender equality. In 2016, 46% of the pharmaceutical industry’s workforce across the 
the total GVA created by the industry in 
EU were women. This compares favourably against, for example, the gender 
the entire region. The GVA contribution is  distribution of the 18 mil ion scientists and engineers in the EU who are women (41%), 
concentrated in these countries as they 
and the distribution of scientists and engineers in high and medium-technology 
are home to many large pharmaceutical 
manufacturing who are women (just 17%).7 
companies, who employ a large number 
of staff in high productivity roles. Jobs 
Figure 4: Percentage of female employees in the pharmaceutical industry 
supported by the industry are also 
versus other key industries
concentrated in these countries along 
with France. Germany, France and the 
Share of female employees 
United Kingdom account for nearly half 
(EU average)
(49%) the total jobs supported by the 
industry in the region. For more detail 
on country-specific results, see 
Pharmaceuticals
46%
Technical Report.
Auto manufacturing
24%
Aerospace & Defence
16%
Computer programming
23%
Source: PwC analysis
7  Eurostat (2019). Women in science & technology
Economic and societal footprint of the pharmaceutical industry in Europe | 7 


The Orphan Regulation has helped  total of not more than €43 mil ion. Since 
to address an unmet need in the 
its adoption, the number of orphan 
Ronny’s story
pharmaceutical industry, whilst 
medicines in the EU has risen 
also encouraging the growth of 
significantly, from only 8 products prior 
When Ronny was diagnosed 
small and medium sized 
to 2000, to 164 today9. The medicines 
with neuroendocrine tumours, 
enterprises (SMEs)
treat a wide variety of diseases, however, 
he did what people do in 
there has been a clear focus on orphan 
Orphan diseases affect circa 30 mil ion 
movies and asked how long 
cancer medicines, which account for 
people in the EU, with more than half of 
he had to live. When the 
more than 40% of orphan medicines 
newly diagnosed cases occurring in 
with market access, and medicines 
oncologist said: ‘months, 
children, a third of whom will die before 
targeting il nesses with a particularly low 
years…’, Ronny switched off. 
they are five years old. Despite this, fewer 
prevalence (below 3 in 10,000).
than 15% of orphan diseases benefit from 
But he did remember the 
what the European Medicines Authority 
The number of medicines granted 
oncologist adding: ‘But with 
describes as ‘even minimal amounts of 
orphan designation by the European 
the right treatment you could 
scientific knowledge’, and 95% of the 
Commission has risen year on year, 
live a lot longer.’ Fortunately, 
7,000 known rare diseases have no 
suggesting a greater number of higher 
Ronny had access to the right 
approved therapies.
quality applications. This goes hand in 
treatment at the right time. He 
hand with the rising number of scientific 
The EU Orphan Regulation, adopted in 
publications on rare diseases, which are 
is now living a reasonable 
December 1999, provides 10 years of 
providing companies with the knowledge 
quality of life, participating in 
market exclusivity to medicines for 
they need to develop effective orphan 
orphan diseases
activities such as bicycle rides 
8, alongside protocol 
medicines.
assistance, reduced fees for regulatory 
with his wife. He thinks he’ll 
activities, and additional incentives for 
SMEs contribute significantly to the 
even be able to live to see 
SMEs, defined by the EMA as enterprises 
orphan medicines market, indeed, more 
some of his grandchildren 
with fewer than 250 employees and either  than half the medicines that have so far 
graduate from school.
an annual turnover of not more than 
received orphan designation were 
€50 mil ion or an annual balance-sheet 
developed by SMEs.
8   According to the Orphan Regulation requirements, an orphan disease cannot have a prevalence higher than 5 in 10,000
9  
EMA (2018) Annual report on the use of the special contribution for orphan medicinal products. Available online here: https://www.ema.europa.eu/en/documents/
report/annual-report-use-special-contribution-orphan-medicinal-products-2018_en.pdf
Figure 5: Types of organisations with orphan designations in development 
from 2002 to 2012

13%
SMEs
Academia and public bodies
16%
Large companies
51%
Other
17%
Intermediate-sized companies
3%
Source: Charles River Associates (2017)
8 | Economic and societal footprint of the pharmaceutical industry in Europe


The number of orphan-focused SMEs has risen since the adoption of the Regulation: of the 276 SMEs focusing on orphan 
medicines that currently exist, 90% were incorporated after 2000. 
Figure 6: Number of SMEs focusing on orphan medicines
30
25
20
15
10
5
0
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
2017
Source: European Medicines Agency SME Register
Alongside benefits provided by the 
Regulation exclusively to SMEs, SMEs 
developing orphan medicines can 
benefit from attracting early investment. 
Venture capitalists investing in orphan 
medicine start-ups typical y do so on 
average one year before they would in a 
non-orphan medicine equivalent.10 
Benefits aside, the orphan medicines 
market is suited to SMEs, as it offers a 
wide breadth of niche areas that require 
bespoke research, creating an 
environment with less direct competition.
10 Charles River Associates (2017). An evaluation of 
the economic and societal impact of the orphan 
medicine regulation
Economic and societal footprint of the pharmaceutical industry in Europe | 9 

Health and societal impact
The benefits brought by 
Breast cancer
Pharmaceutical innovations since 2005 
pharmaceutical innovation are 
have led to an improved prognosis for 
Before 2005, many patients with 
these patients. The subset of medicines16 
not just economic. It improves 
aggressive or advanced breast cancer 
we investigated for both the HER2+ and 
had very low chances of survival11 and 
the lives of mil ions of 
HR+ forms of the disease represent a 
were limited in their treatment options. 
pipeline of treatment innovation, in that 
Europeans through its 
Drug resistance12 in these cancers meant  they capture both the first treatment 
contributions to healthcare and  that patients were forced to undergo 
forms and their subsequent evolutions.
gruel ing and in some cases ineffective 
wider societal benefits. The 
chemotherapy courses.13 For certain 
We estimate that between 2007 and 
following case studies illustrate  metastatic breast cancer patients, for 
2017, over 500,000 breast cancer 
example, average life expectancy after 
some of these benefits. 
patients received these targeted 
diagnosis was 20 months, with patients 
treatments, resulting in a gain of nearly 
responding to chemotherapy for an 
1.2 mil ion healthy life years.
average of just six months.14 
Innovation in medicines has helped to 
address this previously unmet need. In 
our case study, we consider patients 
with early and advanced HER2+15 and 
advanced HR+ breast cancer. 
546,000 breast cancer 
patients treated between 
2007-2017 of which 406,000 

8% of the 
had early stage and 
patient population*
140,000 had late stage
1,160,000 healthy life 
Average of 2.12 healthy 
years gained in Europe
life years per patient
2.45 healthy life 
1.17 healthy life 
years gained 
years gained 
per patient with 
per patient with 
early stage
advanced stage
*   With only 4% of patients with advanced breast cancer eligible for HER2+ treatment, and 10% of patients with 
early stage cancer eligible for HER2+ treatment, this is a significant proportion of the eligible population.
11  Slamon et al. (2001). Use of Chemotherapy plus a Monoclonal Antibody against HER2 for Metastatic Breast Cancer That Overexpresses HER2.
12  Moiseenko et al. (2017). Resistance mechanisms to drug therapy in breast cancer and other solid tumors: An opinion.
13 Sledge et al. (2014). Past, Present, and Future Challenges in Breast Cancer Treatment.
14  Slamon et al. (2001). Use of Chemotherapy plus a Monoclonal Antibody against HER2 for Metastatic Breast Cancer That Overexpresses HER2.
15  HER2+ breast cancer is a breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of 
cancer cells. Approximately 20% of breast cancer cases are HER2+ breast cancer.
16 See Technical Report for list of medicines considered in the study.
10 | Economic and societal footprint of the pharmaceutical industry in Europe


Through more effective treatment these 
al owing increased access to a similar 
medicines have also reduced days lost 
standard of care. For example, in 
to il ness thus creating additional 
Europe, four trastuzumab biosimilars 
economic benefits. We estimate that the 
have recently come to market,20 
new treatments create productivity gains  indicating a drive from pharmaceutical 
of €9,700 per patient, or €5.3bn in total, 
companies to continue innovating and 
which is equivalent to about 3.5% of the 
delivering impact.
total economic cost for breast cancer 
care in Europe.17
Final y, the medical benefits of these new 
treatments are not limited to HER2+ and 
Outside of the quantifiable gains in 
HR+ breast cancer treatment: they paved 
healthy life years and productivity, these 
the way for antibody-targeted treatment 
innovations deliver a wider impact on 
across many different cancer types. 
both patients’ family members and the 
broader breast cancer population. The 
health and societal impact presented 
here will likely be much greater than 
that captured by our analysis. This is 
Suzanne’s story 
owing to the disproportionate 
When Suzanne Leempoels found 
contribution of women, more specifical y 
mothers, to the economy in terms of 
out at the end of her early breast 
unpaid work. Global y, women spend up 
cancer treatment that she had 
to ten times more time on unpaid work 
metastasis in her lungs, the first 
than men,18 and as breast cancer largely 
thought that crossed her mind was 
affects women, the impact of improved 
breast cancer treatment on unpaid work 
that she wanted to live to one day 
is significant. 
meet her grandchildren. Fortunately, 
her oncologist opted for curative 
Improved treatments have also helped to 
treatment, and five years later, her 
alleviate the burden placed on primary 
caregivers and patients’ immediate 
cancer is inactive. 
family members. It has been reported 
that among breast cancer caregivers, 
Suzanne now campaigns for 
30% suffered from depression and 
awareness on behalf of other 
almost 80% of employed caregivers 
metastatic cancer patients. In 
missed work.19
particular, she wants to highlight 
Furthermore, the patent lifecycle of these 
that cancer is more than just a 
medicines opens the way for new 
medical problem; it affects all areas 
entrants, such as biosimilars or improved 
of life, from work and financial 
versions through life cycle management, 
security, to patients’ emotional 
resulting in a healthy competitive 
ecosystem. These new entrants are 
condition and sense of self-worth.
typical y offered at a lower price, thereby 
17  Luengo-Fernandez et al. (2013). Economic burden of cancer across the European Union: a population-based 
cost analysis.
18 Promundo (2019). State of the World’s Fathers: unlocking the power of men’s care.
19  Grunfeld, E. (2004). Family caregiver burden: results of a longitudinal study of breast cancer patients and their 
principal caregivers.
20  Generics and Biosimilars Initiative (2018). Biosimilars of trastuzumab.
Economic and societal footprint of the pharmaceutical industry in Europe | 11 

HIV
Prior to the advent of highly active 
vomiting, anaemia, neutropenia, 
The advent of HAART, which saw the 
antiretroviral therapy (HAART), an HIV 
myopathy, pancreatitis, and peripheral 
introduction of protease inhibitors and 
diagnosis was considered by many to be  neuropathy,21 as well as a high chance of 
the development of backbone NRTIs, in 
a death sentence. In the early 1990s, HIV  developing AIDS. The low tolerability of 
the mid-1990s marked a breakthrough 
patients were treated with dual NRTI 
these side effects contributed to 
for patients. These backbone therapies 
therapy (AZT with zalcitabine or 
poor adherence.
became more efficacious with fewer side 
didanosine) which had limited success in 
effects over time. Our analysis looks at 
lowering viral load and was accompanied 
the health and societal benefits that 
by severe side effects, including nausea, 
HAART has brought. 
Timeline of HIV treatment development
2000s onwards: Backbone therapies made over this time period became 
Early 1990s: Mainstream practice was 
more efficacious with fewer side effects. Major drug developments have 
dual therapy combining two NRTIs, 
been the ability to combine triple therapy into a single tablet (STR), as well 
AZT with zalcitabine (ddC) or 
as CCR5 and integrase inhibitors.
didanosine (ddI).
Mid 1990s: Advent of triple therapy, later cal ed HAART, thanks to the 
development of protease inhibitors, the first of which was saquinavir. Early 
forms of HAART later saw great improvement through the creation of PI-
boosters and the development of the back-bone NRTIs.
The development of HAART has turned 
have better tolerability and thus improve 
treatment pre mid-1990s23, bringing life 
HIV into a treatable, chronic disease. 
the quality of life for people living with 
expectancy for people with HIV on 
These new drugs tackle the potency of 
HIV. The development of STRs has also 
anti-retroviral treatment and responding 
the virus with no further risk to the 
enabled greater medication adherence 
to treatment in line with the general 
patient. In doing so, they have overcome 
within the HIV community, which has had  population24, meaning patients can 
the single biggest chal enge facing HIV 
a significant positive impact on viral 
expect to live full lives. In total, for 
drug development. 
suppression in HIV patients.
patients treated between 2007 and 2017, 
we estimate a gain of 775,000 healthy life 
There are now more than 30 HIV drugs 
Looking at a subset of STRs introduced  
years. This increase in health extends 
available, of which there are 13 fixed 
in the last decade22, we can see the 
their ability to work and contribute to 
dose combinations that are cal ed single 
difference these treatments have made to  society, resulting in an estimated 
tablet regimens (STR). Continued 
patients’ lives and to society at large.  
€207,000 in productivity gains on average 
investment in the research and 
We estimate that HAART gives the 
per patient over their lifetime.
development of new anti retrovirals, 
average HIV patient an extension of 
including within STRs, has resulted in the  9 years in life expectancy (approximately 
development of new combinations that 
7.4 healthy life years) compared to 
21  Darbyshire et al. (2000). Zidovudine (AZT) versus AZT plus didanosine (ddI) versus AZT plus zalcitabine (ddC) in HIV infected adults.
22  See Technical Report for medicines included in analysis.
23  See Technical Report for details on methodology
24 NHS UK. What is the life expectancy for someone with HIV?
12 | Economic and societal footprint of the pharmaceutical industry in Europe


105,000 HIV patients were 
8% of the 
Patrick’s story
treated between 2007-2017
patient population*
Patrick Reyntiens was 
diagnosed as HIV-positive in 
1985. At the time, the disease 
775,000 HLYs gained 
Average of 7.4 
was close to a death 
in Europe
HLYs per patient
sentence. The great 
breakthrough came in 1996, 
*   The medicines we have analysed are single tablet therapies. Many people are treated with multi tablet 
regimens with the same active ingredients.
with the introduction of ‘AIDS 
Cocktails’ (early HAART). 
By reducing patients’ risk of developing 
failures in treatment make the possibility 
Initial y, Patrick was on 20 – 
AIDS and other HIV-related 
of virologic rebound high among patients 
30 pil s a day and he felt 
complications, HAART has also 
in these groups.27 Through better 
sicker on the medication than 
al eviated pressure on healthcare 
adherence and improved viral 
systems. We estimate that, compared to 
suppression, access to STRs would 
from the virus itself. These 
treatment in the early 1990s, treating 
disproportionately benefit less privileged 
days, however, Patrick takes 
someone with HIV using HAART could 
socioeconomic groups. 
only five pil s a day. Many 
result in net savings to the healthcare 
patients only need to take 
system of €11,000 per patient over their 
Moreover, HAART has had a major 
lifetime
impact on HIV transmission rates. A 
one. Patrick’s quality of life 
25. This suggests that despite the 
high cost of new HIV medicines, they 
recent study found that due to the 
has improved enormously and 
deliver value for money in the long-term.
reduction in virologic load, patients on 
he uses his time to raise 
HAART treatment presented no 
awareness of HIV. He’s 
In addition to the quantifiable gains in 
transmission risk to their partners28. 
healthy life years and productivity, these 
Reducing the transmission risk could 
hopeful treatment will continue 
innovations have the potential to reduce 
further significantly lower the prevalence 
to improve and that one day 
both health inequalities and HIV 
of HIV across Europe and in turn, reduce 
there might even be a cure.
transmission rates. HIV is most prevalent  the healthcare burden of HIV and HIV 
among vulnerable groups and especial y 
related il nesses. Furthermore, studies 
among those of lower socioeconomic 
are now evaluating the use of such 
status. Treatment outcomes for these 
medicines as pre-exposure prophylaxis 
groups tend to be worse, due to a 
(i.e. taken to prevent HIV infection by 
combination of factors including failure 
those who do not have HIV but are at 
to diagnose HIV early enough, late 
substantial risk of getting it), which have 
initiation of antiretroviral therapy (ART)26 
proven successful in lowering HIV 
and poor adherence to ART. These 
transmission in America.
25  This could range from net savings of €40,000 to net cost of €31,000 depending on assumptions applied. See Technical Report for further information.
26  Lodi, S. (2014). Delayed HIV diagnosis and initiation of antiretroviral therapy.
27 Burch et al. (2016). Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses.
28 European Centre for Disease Prevention and Control. (2018). The benefits of HIV treatment: undetectable means you do not pass on the virus.
Economic and societal footprint of the pharmaceutical industry in Europe | 13 


Role of IP incentives
For the industry to continue to 
The IP incentives considered in the 
Figure 7: Percentage of respondents 
deliver such value to the 
survey are the Supplementary Protection  reporting a change in European 
Certificates (SPCs), Regulatory Data 
footprint in the last three years
European community, it is 
Protection, Orphan Market Exclusivity, 
essential that the legal and 
and Paediatric Rewards, among others. 
Change in European footprint 
Research and development of new 
% or respondents reporting a change in 
regulatory environment 
medicines can be a long, complex, risky 
the last 3 years
encourages innovation and 
– and ultimately expensive – process. 
fosters growth. This kind of 
These incentives are designed to 
encourage continued innovation by 
14%
environment has been enabled 
offering additional protection for 
in the EU through the 
medicines that make it to market. 
35%
introduction of several initiatives,  Within the current environment, over 
including IP incentives, which 
80% of respondents reported that they 
have increased or maintained current 
have encouraged the 
levels of investment, which is consistent 
51%
development of innovative 
with reported figures29 from the 
medicines. To help understand 
pharmaceutical industry. Research and 
Development (R&D) and Commercial are 
the importance of the current 
the segments of the value chain that 
Increase
No change
Decrease
incentives model, and the 
have benefited most from this trend as a 
potential effects of dismantling 
result of maturing pipelines, incremental 
Source: Results of PwC survey of EFPIA 
investments in existing facilities and 
corporate members
it, we undertook a survey of  
capabilities, new product launches and 
18 EFPIA corporate members.
partnership-led R&D approaches.
29  Informa UK (2017) Pharma R&D Annual Review 2017.
“We made multi-milion € 
investments focused on 
modernising existing 
R&D facilities, ramping 
up R&D activities, and 
enhancing R&D 
capabilities
Respondent to PwC survey
14 | Economic and societal footprint of the pharmaceutical industry in Europe

EFPIA members indicated that IP incentives and quicker market access are the 
According to EFPIA members, 
leading factors influencing R&D investment decisions. IP incentives were 
dismantling the current incentives model 
consistently ranked by the respondents in the top three factors influencing 
would have a negative impact on 
investment decisions.
pharmaceutical companies’ EU 
research-based investment activity. 
Respondents indicated that phasing out 
Figure 8: Market factors in order of importance in terms of deciding which 
current incentives in Europe would have 
countries to invest 
a material negative effect on their 
European operations, with over half 
Overall 
indicating that this scenario would lead 
rank
to a reduction in their R&D and 
Commercial footprints of more than 
IP incentives
25%. Organisations choosing to reduce 
1
their footprint in Europe would seek 
opportunities to increase investment in 
regions where their IP is better protected 
Accelerated approval/early access schemes
and innovation more actively rewarded. 
2
This finding is consistent with previous 
studies30, 31 which show that weaker 
intel ectual property regimes limit the 
Skills and wage costs of labour
wil ingness of companies to invest 
3
in R&D.
Size of economy and potential for growth
4
Macro-economic/political issues 
(e.g. inflation, political uncertainty)

5
Attractiveness to conduct clinical trials
“Investments have been 
increased by more than 
6
10% per year over the 
last 3 years to launch 
Tax rates
7
new products, continue 
increasing our 
investments in our 
Infrastructure and transport
8
existing portfolio, 
support the creation of 
Source: Results of PwC survey of EFPIA corporate members 
new affiliates, and 
reinforce our expertise 
and global organisation, 
particularly in terms 
of R&D
Respondent to PwC survey
30  NERA Economic Consulting (2007). Key Factors in Attracting Internationally Mobile Investments by the Research Based Pharmaceutical Industry.
31 Porter, M. (2000). Location, Competition, and Economic Development: Local Clusters in a Global Economy.
Economic and societal footprint of the pharmaceutical industry in Europe | 15 


Conclusion
Our research provides evidence of the 
The results of our survey of pharmaceutical 
significant economic contribution that the 
companies indicate that the current 
pharmaceutical industry makes to 
incentives model is important to ensuring a 
economic prosperity and employment in 
strong industry in Europe. It has helped to 
the EU. We estimate that in 2016, it 
generate investment in areas with 
generated over €206 bil ion in GVA 
previously unmet needs and fostered a 
(including indirect and induced effects) and 
thriving industry that makes a significant 
employed over 2.5 mil ion people across 
contribution to the European economy and 
the EU. 
society. Drastical y changing the incentives 
model risks damaging the pharmaceutical 
This study also highlights the valuable 
industry’s ability to deliver value in Europe.
health and societal benefits of 
pharmaceutical innovations in specific 
There is an ongoing debate about the 
areas of medicine. We estimate that for 
affordability of medicines and the need for 
over 650,000 HIV and breast cancer 
the current level of IP incentives – 
patients treated between 2007 and 2017, 
justifiably so given the numerous 
the subset of medicines analysed resulted 
competing objectives of government. 
in gains of nearly 2 mil ion healthy life years 
However this debate should consider 
and €27 bil ion in terms of productivity. It is 
benefits as well as costs, and the 
worth noting this only quantifies a fraction 
pharmaceutical industry has contributed to 
of the overall health and societal 
many significant advances over recent 
contribution of the pharmaceutical 
decades. For example, cancer death rates 
industry. Aside from addressing only two 
have fal en by 20% over the last 20 years33, 
therapeutic areas, we have not touched on 
and close to 30 diseases are preventable 
the ways in which new, more effective drug 
by vaccination, preventing between 2 to 3 
therapies improve the psychosocial health 
mil ion deaths global y per year34. By 
of patients, family members and the 
providing better understanding of the 
community, and our productivity 
direct and indirect contribution of the 
calculations do not account for increases 
pharmaceutical industry in Europe, we 
in informal employment, such as domestic 
hope that our research will prove valuable 
work, childcare, and family caretaking. The 
by further informing the debate and 
imputed value of such unpaid work has 
facilitating productive dialogue.
been estimated at 20 to 40% of the EU 
GDP32. Even the impact of the medicines 
analysed here are likely to be greater than 
stated, given that all of them have helped 
pave the way for further innovations across 
different medical disciplines. 
32 Giannelli et al. (2012). GDP and the value of family caretaking: how much does Europe care?
33 Jönsson et al. (2016). The cost and burden of cancer in the European Union 1995–2014.
34 World Health Organization. (2018). 10 facts on immunization.
16 | Economic and societal footprint of the pharmaceutical industry in Europe


Economic and societal footprint of the pharmaceutical industry in Europe | 17 

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Economic and societal footprint of the pharmaceutical industry in Europe | 19 




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