2016

Swiss Healthcare and

Pharmaceutical Market
Editor’s notice
3 rd edition, published in 2016 by

Interpharma
Association of research-based pharmaceutical
companies in Switzerland
Petersgraben 35
P.O. Box
4009 Basel
Phone: 061 264 34 00
Email: info@interpharma.ch

The content of the brochure can also be found on

the website of Interpharma at www.interpharma.ch.
Readers are free to download and use the charts
in their latest version for their own purposes provided
the sources are properly quoted.

Interpharma editorial team:

Samuel Enderli, Sara Käch,
Carolin Lorber, Heiner Sandmeier
Swiss Healthcare and
Cover picture:
© iStockphoto Pharmaceutical Market

2016

© Interpharma, 2016 Basel

Copying of the brochure is encouraged provided the
sources are duly quoted.
Contents

Public Health Composition of the price of a medicine . . . . . . . . . . . . . . . . . . 55

The Swiss healthcare system . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Prices of medicines: foreign-price comparison . . . . . . . . . . . . . 57
Life expectancy in Switzerland and other countries . . . . . . . . . 11 Price comparisons of European states . . . . . . . . . . . . . . . . . . . 59
The two main causes of death . . . . . . . . . . . . . . . . . . . . . . . . . 13 Switzerland as reference country . . . . . . . . . . . . . . . . . . . . . . . 61
Deaths caused by cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Comparison of cancer survival rates in Europe . . . . . . . . . . . . 17 Economic Impact
Resources in health service . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Trade balance of pharmaceutical products. . . . . . . . . . . . . . . . 62
Healthcare costs broken down by services . . . . . . . . . . . . . . . 21 Pharmaceutical trade balance compared
Cost of healthcare according to services . . . . . . . . . . . . . . . . . 23 with other countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Healthcare costs by international standards . . . . . . . . . . . . . . . 25 Workplace productivity and number of employees
Funding streams in the health system. . . . . . . . . . . . . . . . . . . . 27 in the pharmaceutical industry/overall economy . . . . . . . . . . . . 67
Price indices of the health system . . . . . . . . . . . . . . . . . . . . . . 29 Key figures of Interpharma companies in Switzerland. . . . . . . . 69
Health insurers: number of people insured Key figures of Interpharma companies worldwide. . . . . . . . . . . 70
and forms of insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Interpharma companies: spending on R&D
Benefits of mandatory health insurance by cost category. . . . . 33 worldwide; sales, R&D and exports in Switzerland . . . . . . . . . . 72
Swiss innovation system compared with other countries . . . . . 75
Public Opinion
Satisfaction with the health service. . . . . . . . . . . . . . . . . . . . . . 35 Research and Development
Attitude towards cost-cutting measures . . . . . . . . . . . . . . . . . . 37 Pharmaceutical patents at the European Patent Office. . . . . . . 77
Funding of R&D in Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . 79
Pharmaceutical Market Scientific impact by country. . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Pharmaceutical market in Switzerland . . . . . . . . . . . . . . . . . . . 39 Laboratory animal statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Pharmaceutical market by reimbursability . . . . . . . . . . . . . . . . 41 Clinical research in Switzerland . . . . . . . . . . . . . . . . . . . . . . . . 85
Generics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Sales outlets by turnover and inventory . . . . . . . . . . . . . . . . . . 45
Biotech and gene tech products. . . . . . . . . . . . . . . . . . . . . . . . 47
Market share of medicines by indication area. . . . . . . . . . . . . . 49
Approval of medicines/number of approved medicines. . . . . . . 51
Medicines in the Specialties List (SL) . . . . . . . . . . . . . . . . . . . . 53

2 3
Public Health
The Swiss healthcare system
Governance of the health system
Switzerland is characterized by a highly federalist structure with its
federal government, cantons and communes or municipalities,
which are each responsible for different functions. The principle of
subsidiarity also plays an important role, according to which pub-
lic services that can be provided at a given political level should
not be undertaken at a higher level or instance. Consequently the
federal level is comparatively lean.
Responsibility for the provision and funding of healthcare lies
mainly with the 26 cantons, also in fields that are regulated by the
federal government. Therefore, the federal state’s competencies
are limited. The cantons maintain and, together with the manda­
tory health insurance, co-finance hospitals and nursing homes,
which they also supervise. Most hospitals are owned or controlled
by cantons and municipalities. The cantons secure healthcare by
means of hospital planning, emergency and rescue services.
Together with the federal government and local municipalities,
they are responsible for prevention and the promotion of health.
The cantons also monitor licensing for medical and paramedical
professions and finance the training of doctors through the can-
tonal universities. Furthermore, they assess and adjust premium
reductions for economically vulnerable persons. At cantonal level,
the cantons can autonomously implement and enforce the laws
and ordinances enacted by the federal government. The federal
provisions are partly supplemented by cantonal implementation
laws. The cantons have autonomy in the implementation and
enforcement of the law. Responsibility for this implementation lies
4 5
with the health ministers, who are members of the cantonal exec-
utive. The health ministers of all the cantons together form the
Swiss Conference of the Cantonal Ministers of Public Health (GDK)
that promotes cooperation and common policies between can-
tons. However, it is not a deliberative body but largely a forum that
seeks to facilitate consensus building. The conference and the
Health Minister at federal level regularly meet within the framework
of the permanent platform of the Swiss National Policy Dialogue
for Health and discuss health policy issues.
At federal level, the Federal Council (the executive) and Parliament
(the legislative) draw up and enact laws and ordinances that are
later to be implemented by the cantons. Together with the latter,
the Federal Office of Public Health (FOPH), which is attached to
the Federal Department of Home Affairs (FDHA), is responsible for
the development of national health policy. The responsibilities of
the FOPH also cover, for example, the supervision of mandatory
health insurance and decisions on the reimbursement and the
prices of medicines. The control and monitoring of epidemics and
infectious diseases as well as the monitoring of research in humans
also fall within its remit. A further function of the FOPH lies in the
area of prevention and efforts to combat addiction. It also regu-
lates university medical and healthcare professions, and it repre-
sents the health policy interests of Switzerland on international
bodies and vis-à-vis other states.
The 2,300 or so municipalities implement responsibilities delegat-
ed by cantons, e.g. the provision of nursing and home care (Spi-
tex). They do this either alone or – depending on their size – in
conjunction with other municipalities. They are also partially
involved in federal and cantonal prevention activities.
Financing healthcare
In Switzerland, mandatory health insurance, the basic social insur-
ance, is regulated by the Health Insurance Act (LAMal), which
came into force in 1996. The basic principle consists in guarantee-
ing that all persons resident in Switzerland have access to good
medical care. In the event of an illness, the basic health insurance
ensures that the cost of medical treatment is covered. Since 1996
everyone living in Switzerland has been required to conclude a
basic health insurance. Everyone is individually insured and is free
to choose his or her health insurer from around 60 privately organ-
ized health insurers that offer basic insurance coverage. The
health insurers have to accept everyone regardless of health and
age. Monthly per capita premiums are payable for all persons. The
level of the premium depends on where the person lives and also
differs from one health insurer to another, but within these differ-
ences the level is the same for each age group and for both sexes.
The premiums are also not dependent on income. The insured
persons pay all their premiums themselves. There are no employ-
er contributions. Economically vulnerable people can request a
premium reduction, which is paid by the Federation and the canton
in which they live. Besides the basic health insurance, cantons
co-finance hospital and nursing home costs. These two payers
account for the majority of healthcare expenditure, but also out-
of-pocket costs – either through cost-sharing or directly from a
person, e.g. for non-reimbursed medicines – contribute signifi-
cantly to the health system. All services (incl. medicines) included
in the catalogue of benefits are fully covered by the mandatory
health insurance and are subject to a co-insurance of 10% with an
annual cap.
6 7
The catalogue of benefits covered by the mandatory insurance is
quite extensive by comparison with other countries: The insurance
covers most outpatient and inpatient procedures, maternity ben-
efits and those medicines that the FOPH includes in the so-called
Specialties List (SL). Procedures and methods used in comple-
mentary medicine are also covered to some extent. The insurers
may offer different models (HMO, Managed Care, etc.). Insured
persons have a wide choice at their disposal with regard to the
deductible and have the option every year of changing their health
insurer or the insurance model or deductible within their insurance.
Supplementary health insurance plans also exist. They can be
concluded on a voluntary basis and cover benefits that are not
covered by the mandatory insurance. Since the benefits catalogue
of mandatory health insurance is very comprehensive, however,
supplementary health insurance plans primarily cover benefits
regarding greater freedom, for example in the choice of doctor or
hospital or certain methods used in complementary medicine.
Top-up insurance of this kind is usually offered by insurers that
also offer mandatory insurance.
Delivering health services
The Swiss healthcare system allows patients to see a specialist
directly (free choice of doctor). But normally the family doctor or
general practitioner (GP) is the first point of contact when there are
medical problems. If the GP cannot treat the disease, the patient
is referred to a specialist and/or a hospital. Specialists work both
in their own private practices and also in hospitals. In most can-
tons, both are allowed to dispense medicines themselves from
their own practice-based pharmacy. In other cantons, prescription
medicines can only be obtained in pharmacies on medical pre-
scription.
Since 2012, all patients in Switzerland have been free to choose their
hospital. The hospitals are financed both by the cantons and by the
mandatory health insurance. By comparison with other countries,
the separation of hospitals into an inpatient and an outpatient section
occupies a special position. In the outpatient section treatments are
fully covered by the mandatory insurance. In the case of inpatient
hospital treatments, however, 45% of costs are covered by the man-
datory insurance and 55% by the cantons. Since 2012 these treat-
ments are financed via case-based payments according to diagno­
stic related groups (DRG) that also include the cost of medicines as
well as diagnostic and therapeutic services, unless otherwise
negotiated. Most hospital doctors and health professionals are sal-
aried, whereas GPs and specialist doctors working in ambulatory
care settings are paid on a fee-for-service basis.

Approval of medicines
Since Switzerland is not a member of the European Union, it has
its own drug regulatory authority and is not affiliated to the Euro-
pean Medicines Agency (EMA). The Swiss agency Swissmedic is
responsible for the approval of new medicines and for monitoring
of the pharmaceutical market in Switzerland. Swissmedic works
closely with foreign agencies. Medicines are not automatically
covered by the mandatory insurance once marketing authorization
has been granted. Before reimbursement is possible, pharmaceu-
tical companies first have to apply to the FOPH for inclusion in the
SL and to provide evidence that the medicines are effective, suit-
able and efficient. Prices are determined by means of therapeutic
referencing and a comparison with prices in other countries. Once
medicines have been included in the SL, prices are reviewed every
three years. For non-reimbursed medicines, companies are free to
price their medicines as they wish.

8
10/11 Life expectancy compared with other countries
Very high life expectancy in Switzerland
Life expectancy of total population at birth (in years), 2013

Switzerland has one of the highest life expectancy rates in the JP 83.4
ES 83.2
world at 82.9 years. Of the OECD countries, only Japan and Spain
CH 82.9
enjoy an even higher life expectancy. IT 82.8
FR 82.3
SE 82.0
The average life expectancy of a newborn infant in Switzerland has
NL 81.4
steadily increased since the beginning of the last century. It is AT 81.2
thanks to improved hygiene, a higher standard of living and GB 81.1

good-quality healthcare that we have seen such a marked DE 80.9

DK 80.4

© Interpharma
increase. In 2014 life expectancy at birth stood at 85.2 years for US 78.8
women and 81.0 years for men. The difference between female 78 79 80 81 82 83 84
and male life expectancy that widened in the second half of the
Source: OECD Health Data 2015.
20th century has narrowed in the last few years. At the beginning
of the 1990s, life expectancy for women was still above seven
years longer than for men. After this, male life expectancy rose
more steeply than female life expectancy, resulting in a narrower Mean life expectancy at birth
difference between the sexes. In 2014 this difference was around
In years
four years.
85
85.2
80 81.0
75
70
65
60
55
50
45
40

© Interpharma
1900 1920 1940 1960 1980 2000 2014

 Men  Women

Source: Swiss Statistical Encyclopedia, Federal Statistical Office, 2015.

10 11
12/13 The two main causes of death
Most common causes of death:
Deaths per 100,000 population (standardized rates)
diseases of the circulatory system and cancer
2013 or nearest year available

Diseases of the circulatory system (ischemic heart disease, cere- AT 318.8 603.5
DE 316.7 607.9
brovascular diseases, etc.) are the most common cause of death US¹ 264.8 479.8
in Switzerland, followed by cancer. In some comparative countries, SE 264.4 517.6
IT³ 255.0 469.3
such as Denmark, the Netherlands, France and Japan, the exact CH³ 222.3 447.9
reverse is the case. In 2013, 222 of 100,000 people in Switzerland DK³ 212.2 544.7
GB 211.4 523.8
died of a disease of the circulatory system. This mortality rate is
NL 208.8 432.7
half what it was in 1990. In the other comparative countries, simi- FR² 166.2 314.6

lar levels of decline have been reported. This is due amongst JP 157.8 349.2

other things to innovative medicines and a healthier lifestyle. 0 100 200 300 400 500 600 700

DK³ 246.1 293.0

In the case of cancer, the number of deaths has likewise fallen in NL 224.3 279.6
GB 222.4 280.7
the last twenty years, albeit less sharply than in the case of car- IT³ 205.4 259.2
dio-vascular disease. In 2013, nearly 178 of 100,000 people in DE 204.8 257.4
FR² 203.5 254.2
Switzerland died of cancer. In 1990, there were over 42% more US¹ 197.9 250.2
deaths from cancer. This marked decrease is the biggest reduc- AT 197.1 261.1

tion seen in all the comparative countries. The reason for the SE 186.2 215.1
JP 179.0 207.9
decrease is to be found in better, modern treatment options and CH³ 177.6 253.5

© Interpharma
– in many types of cancer – early diagnosis of disease, which 0 100 200 300 400 500 600 700
increase the chances of a cure.
n  Diseases of the circulatory system 2013 n  Cancer 2013
n  Diseases of the circulatory system 1990 n  Cancer 1990

Source: OECD Health Data 2015.

¹ 2010 data.
² 2011 data.
³ 2012 data.

12 13
14/15 Deaths caused by cancer
Cancer as second most common cause of death
Deaths per 100,000 population (standardized rates)¹,
2013 or nearest year available
In Switzerland, cancer is the second most common cause of
death. The mortality rate varies from one type of cancer to anoth- DK² 59.0
NL 53.9
er. Internationally there are considerable differences in cancer GB 48.9
mortality, both overall and also between different types of cancer. FR³ 41.7

On the one hand this may be related to the prevailing living condi- DE 41.4
IT² 41.1
tions that either favour or tend to prevent certain types of cancer. AT 36.9
On the other hand, however, prevention, early diagnosis and JP 34.9

access to modern treatment, such as antibody therapies, also play CH² 33.7
SE 30.6
an important role.
SE 46.4
DK 46.1
Marked differences in mortality are apparent over time. In breast GB 35.5
cancer, for example, the mortality rate in 1990 stood at 44.8 of CH 35.0

100,000 women. It had thus decreased by nearly 41% in 2012. In NL 34.9

DE 31.1
the framework of early detection programmes for breast cancer, AT 29.8
the cost of mammography screening in Switzerland has been FR 29.1
IT 21.7
covered by health insurers since 2009, provided the investigation
JP 13.7
is carried out as part of a programme with quality assurance and
DK² 32.6
in women with an increased risk for breast cancer in the family
NL 30.6
history. Until now, mammography programmes have been in­­ DE 29.5
troduced in Cantons Bern, Basel-Stadt, Fribourg, Geneva, Grau­ GB 29.1
FR³ 27.6
bünden, Jura (including the Bernese Jura), Neuchâtel, St. Gallen, AT 26.7
Ticino, Thurgau, Vaud and Valais. In all other cantons mammogra- IT² 26.7

phy screening is done in consultation with the doctor. CH² 26.5

SE 23.6
JP 14.2

© Interpharma
0 10 20 30 40 50 60

n Respiratory organs n  Prostate n  Breast

Source: OECD Health Data 2015.

¹ In prostate and breast cancer the rates refer to 100,000

men and women respectively.
14 ² 2012 data. ³ 2011 data.
15
16/17 Comparison of cancer survival rates in Europe
Differences in access to innovative cancer treatments
Relative 5-year survival rates (in %)

Thanks to new diagnostic opportunities and medicines such as FR 86.1

SE 86.0
modern antibody treatments, cancer in many cases today can be IT 85.5
diagnosed earlier, treated better or even cured altogether. CH 84.6
NL 84.5
DE 83.6
In Europe, there are substantial differences in access to new can- AT 82.1
cer treatments and in waiting times for new medicines. This has DK 81.5
GB 79.3
an impact on the survival rate of cancer patients, because prompt PL 71.6
access to new treatment options and medicines is important for
DE 62.2
the success of treatment in cancer. Thus the relative 5-year sur- CH 61.4
vival rate is much higher for many types of cancer in Switzerland AT 61.2
SE 61.1
than it is in other European countries. These rates are lower par- IT 60.8
ticularly in East European countries such as Poland. FR 59.7
NL 58.1
DK 53.6
The relative 5-year survival rate indicates the mortality of people GB 51.3

with cancer compared with the mortality of people without cancer. PL 46.7

This measure thus takes into account the fact that only part of the IT 32.4

mortality among cancer patients is attributable to cancer, because CH 31.6

DE 31.3
a certain mortality is also to be expected among people without AT 31.0

cancer. A value of 100% means that mortality in people with can- FR 26.3
SE 21.7
cer is just as high as mortality in people without cancer. A rate of NL 20.4
61% as in the case of colorectal cancer in Switzerland is thus to GB 17.0
DK 16.0
be understood as showing that the proportion of people with PL 15.6

© Interpharma
colorectal cancer surviving for five years after diagnosis corre- 0 20 40 60 80 100
sponds to 61% of the expected proportion of survivors in the total
n  Breast cancer n  Colorectal cancer n  Stomach cancer
population without colorectal cancer. The likelihood of people with
cancer still being alive five years after diagnosis is reduced by 39% Source: Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5 – a population-
based study, Roberta De Angelis et al., The Lancet Oncology, Volume 15(1), 2014.
compared with the population without cancer.

16 17
18/19 Resources in health service
Healthcare industry as a major employer
Per million inhabitants, 2014 (or next available year)

In Switzerland, more than 356,000 people work in the healthcare AT CH DE FR IT UK US

industry, including the pharmaceutical sector. This is around one General medical
1,644 1,104 1,690 1,600 875 809 305
practitioner
in twelve of the working population. Overall, Switzerland has a
Specialist medical
well-equipped healthcare system, although there are regional 2,619 2,328 2,364 1,850 2,965 2,033 2,240
practitioner
differences in the healthcare provided. For example, certain rural Practicing dentists 573 517 825 660 – 543 –

© Interpharma
regions suffer from a shortage of doctors, while in the urban cen-
Hospitals 33 36 39 53 19 – 18
tres there tends to be a surfeit of general practitioners and spe-
Practicing pharmacists 699 538 638 1,095 – 837 –
cialists. There is also a very high density of small hospitals, which
Source: OECD Health Data 2015, conversion in relation to population by Interpharma.
offer little specialization and a wide range of medical services.

By comparison with other countries, there are differences in the

structure of medical care. Switzerland has a relatively low density
of general practitioners compared with neighbouring countries: for
every million inhabitants in Switzerland there are only 1,104 gener-
al practitioners, whereas there are far more in Austria, France and
Germany. Since doctors are also allowed to dispense medicines
directly in many cantons of Switzerland, the density of pharmacies
is comparatively low.

18 19
20/21 Healthcare costs broken down by services
Medicines as a proportion of healthcare costs: 8.8%
Total costs 2014¹: CHF 71,167 million (100%)

While Switzerland has one of the most expensive healthcare sys-

n Inpatient care2
tems in the world, it also offers high-quality outcomes. The cost of  44.8% (CHF 31,880 million)
the healthcare system has increased by 2.8% compared with 2013 n Outpatient care
and amounted to around 71.2 billion Swiss francs in 2014. The  34.9% (CHF 24,860 million)
cost increase was thus slightly lower than in the previous five n Medicines³
years, when the average annual growth amounted to 3.3%.  8.8% (CHF 6,266 million)
Healthcare costs in 2014 also grew more strongly than economic n Prevention / administration
 6.5% (CHF 4,623 million)
output: its share of gross domestic product rose from 10.9% in
n Other services

© Interpharma
2013 to 11.1% in 2014. The cost of medicines as a proportion of
 5.0% (CHF 3,538 million)
healthcare costs fell from 9.1% in 2013 to 8.8%, after stabilizing at
just over 10% for several years before eventually falling below 10%
Source: Costs and funding of healthcare, Federal Statistical Office, 2016.
for the first time in 2010. In particular, more intensive price reviews
of medicines already established in the Specialties List (SL) led to
1
Provisional data. 2
Including medicines. 3 At retail prices, excluding hospital.

a sharp fall in the index of drug prices.

Health cost trends by services

Over a prolonged period, expenditure on health goods as a share Services as a proportion of healthcare costs (in %)
of healthcare costs has also shown a marked decline: whereas 100
spending in this sector amounted to 24.4% of healthcare costs in
80
1960, it had fallen to 10.3% in 2014.
60
In contrast to the cost of medicines, which as a share of healthcare
costs has remained stable and even fallen in recent years, the cost 40
of outpatient and inpatient care has increased substantially. Com-
20
pared with 2013, too, spending especially in the outpatient care
sector showed an above-average increase of 4.9%. At the same 0
1960 1970 1980 1990 2000 20141
time, new treatments are improving the quality of life and increas-

© Interpharma
ing the chances of a cure and survival. Today, six of ten people   Prevention / administration   Outpatient care
  Healthcare goods / medicines   Inpatient care
with cancer are still alive five years after the initial diagnosis.
Source: Costs and funding of healthcare, Federal Statistical Office, 2016.

20
1
Provisional data. 21
22/23 Cost of healthcare according to services
Healthcare costs show greatest increase
Type of service (in CHF millions)
in the outpatient sector
1996 2000 2010 2013 20141
Inpatient treatment 2 17,744 19,787 28,364 31,312 31,880
In 2014, the cost of inpatient treatments amounted to around 31.9
billion Swiss francs, whereas the cost of outpatient treatments Acute 3 11,310 12,140 16,600 18,127 18,341

amounted to 24.9 billion francs. Expenditure on medicines stood Chronic 4,429 5,195 8,137 9,212 9,415
at 6.3 billion francs, while administration generated costs of almost Others 4 2,006 2,452 3,627 3,973 4,124
3 billion francs, and 1.6 billion francs went on prevention. Outpatient treatment 10,933 12,926 20,335 23,695 24,860
Doctors 5 5,306 6,183 8,901 10,335 10,956
Since the Health Insurance Act (LAMal) was introduced in 1996, Hospitals 1,423 2,150 4,852 6,043 6,306
costs have increased in all areas. The greatest increase occurred
Dentists 2,682 2,845 3,790 4,001 4,074
in the outpatient sector, especially in the last few years.
Physiotherapists 506 569 793 890 1,003

Compared with the previous year, spending on medicines Psychotherapists 125 149 212 244 257

decreased by around 45 million francs (–0.7%). While there was a Spitex 773 889 1,585 1,950 2,021
decrease for medicines dispensed in pharmacies and drugstores Other paramedical services 118 141 201 231 243
(–1.9%), medicines dispensed directly by the doctors rose by 2.0%. Other services 6 2,002 2,263 3,291 3,390 3,538
The cost of medicines dispensed in pharmacies and drugstores Medicines7 3,808 4,642 6,055 6,311 6,266
as a proportion of overall costs has fallen by 1.6 percentage point
Pharmacies and drugstores 2,812 3,298 4,207 4,363 4,279
since 1996. By contrast, the cost of medicines dispensed by doc-
Self-dispensing doctors 996 1,345 1,848 1,948 1,987
tors increased slightly by 0.3 percentage point as a proportion of
Prevention 967 1,014 1,471 1,536 1,605
overall costs.

© Interpharma
Administration 2,015 2,210 2,979 2,983 3,018
Total 37,469 42,843 62,495 69,227 71,167
Source: Costs and funding of healthcare, Federal Statistical Office, 2016.
1
Provisional data.
2
Including medicines.
3
Including psychiatry.
4
Including rehabilitation.
5
Excluding medicines.
6
Laboratory tests, radiology, therapeutic apparatus, transport
and ambulance services.
7
Cost to social insurance scheme, including private insurance plans,
22 and to private households. 23
High proportion of inpatient care Healthcare costs by international standards

Services as a proportion of total healthcare costs (in %), 2013

Inpatient care in Switzerland was responsible for the largest share
of total healthcare costs in 2013 at more than 44%. Outpatient care CH
accounted for around 30% of total spending. Medicines account- BE
ed for 10.5%. By international standards, almost all other countries AT
spent less on inpatient care. By contrast, medicines were respon- JP¹
sible for a much lower proportion of spending in Switzerland at SE
10.5% of healthcare costs than in the benchmark countries (AT, FI
BE, DE, FI, FR, JP and US). This includes medicines dispensed in DE
pharmacies, in drugstores, by self-dispensing doctors and in out- FR
patient clinics. In many comparative countries, however, the med- US¹

© Interpharma
icines dispensed in hospital (for outpatients or inpatients) are not 0 20 40 60 80 100
included in this calculation. For Switzerland, too, this data is not n  Inpatient care    n  Outpatient care    n  Medicines
reported by the Federal Statistical Office. Of all 34 OECD coun-
Source: OECD Health Data 2015.
tries, only in Denmark, Luxembourg, the Netherlands, Norway and
¹ Data for 2012.
Sweden was the percentage spent on medicines lower than in
Switzerland. Development of healthcare spending

If healthcare spending is compared with healthcare costs abroad Healthcare spending as a proportion of GDP (in %)

(OECD countries), Switzerland lies, together with the Netherlands, 18

in second place at 11.1% of gross domestic product (GDP) behind 15 16.4

the USA. In the USA, healthcare spending in 2013 amounted to 12 11.1

11.1
16.4% of GDP. 9 11.0
10.9
6 8.5

3
0
1970 1980 1990 2000 2013

© Interpharma
  US   DE 1   CH
  NL1   FR1   GB

Source: OECD Health Data 2015.

1
Data not available for several years.
24 25
Private households cover more than 60% Funding streams in the health system
of healthcare costs
A B C D E

The healthcare costs of around 71.2 billion Swiss francs are cov-
ered through various channels. In 2014, more than 60% was
financed by private households. The largest proportion was paid
into the social insurance systems. Around a fifth was used to pay
directly for benefits that were not covered by the insurance (out-
of-pocket payments). More than 32% was financed directly by the
public purse (federal, cantonal and municipal).

More than 42% of the costs accrued are paid by the social insur-
ance schemes. Federal, cantonal and municipal authorities pay
Out-of- Private insurers Social insurance State
slightly more than 20% of costs. Most of this is paid by the cantons pocket and others schemes
to inpatient facilities (15%), which are financed both by the cantons
and through the premiums. This is evident in the flow of payments.
The new hospital financing scheme, according to which the can-
tons have to cover at least 55% and the health insurers at most
45% of hospital costs, came into force at the beginning of 2012.

F G H J

A Private households F Prevention / administration

(CHF 43,759.0 m) (CHF 3,987.2 m)
B Companies (CHF 4,441.7 m) G Retail trade (CHF 5,334.1 m)
C Communes (CHF 3,162.0 m) H Outpatient care providers

© Interpharma
D Cantons (CHF 15,588.4 m) (CHF 22,879.9 m)
E Federal authorities J Hospitals and social medical
(CHF 4,215.9 m) institutions (CHF 38,185.9 m)
Source: Cost and funding of healthcare, Federal Statistical Office, 2016.
26 27
Price index for medicines steadily falling Price indices of the health system in Switzerland

Index: 1996 = 100

Since the introduction of the Health Insurance Act (LAMal) in 1996
the hospital index has shown the biggest increase at more than 17 120
117.1
points. The price index of medical services has remained quite 110 115.7
110.1
stable since 1996, whereas the price index for medicines has 100 103.6
102.5
steadily and substantially fallen. In 2015, it lay well below all the 90
other healthcare indices at around 62 points. This development is 80
attributable above all to the price comparison for new reimburs­ 70
able medicines with the average price in economically comparable 60 61.7

states of Europe (AT, BE, DE, DK, FI, FR, GB, NL and SE). The 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2015

© Interpharma
prices of medicines in Switzerland have thus fallen in line with
 Hospitals  Consumption  Doctors
those in the reference countries. Newly launched medicines in  Dentists  Healthcare  Medicines
Switzerland today are no more expensive than in other European
Source: Consumer Price Index, Federal Statistical Office, 2016;
countries that are comparable with Switzerland. conversion of index by Interpharma on the basis of 1996.

The European comparison shows that prices for health services in Price indices of the health system compared
Switzerland have remained practically unchanged since 2005. In with other countries
the Netherlands and Great Britain, however, prices over the same Harmonized Index of Consumer Prices,

period have increased more than 30%. subindex of health (index: 2005 = 100)

130 132.3
132.1

123.0
120
117.7
115.0
114.0
110 111.9
108.5
105.1
100
97.3
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

© Interpharma
 NL  AT  SE  FR  BE
 GB  FI  DK  DE  CH

Source: Eurostat, 2016.

28 29
Marked increase in alternative insurance models Number of insurers according to number
of insured members
In 2014, a total of 60 privately organized health insurers offered
Number offering mandatory health insurance
mandatory health insurance, the basic social insurance, in Swit-
zerland. All people living in Switzerland can thus choose from a 80 90
wide variety of health insurers, which they are also free to change
40
every year. The insurers are required to accept all persons, regard- 14 14 8 10 12
0 20 6 5 3 5
less of their health, age or gender. Since the law on mandatory 18

insurance came into force in 1996, there has been a sharp reduc- 1–5,000 5,001– 10,001– 50,001– 100,001– More than
tion in the number of insurers. In addition, the trend is now away 10,000 50,000 100,000 500,000 500,000
from a large number of insurers with a small number of insured   1996   2014 Number of insured persons
members to a small number of insurers with a large number of
insured members.
1996 2000 2005 2010 2013 2014

© Interpharma
Total recognized insurers 159 110 90 86 66 66
Most insurers offer their clients a variety of insurance models. They
Health insurers
choose a deductible according to which the level of monthly pre- (mandatory insurance) 145 101 85 81 60 60
miums is calculated. The higher the deductible, the lower the Source: Mandatory health insurance statistics, Federal Office of Public Health, various years.
premium. Only when this is exceeded does the health insurer pay,
although the insured person still has to pay 10% of costs up to a Insured members broken down by type of insurance
maximum of 700 francs himself. The insured persons pay all pre-
Adult insured members 2014: 6,618,624 (100%)
miums themselves. There are no employer contributions. Besides
the classical insurance models, alternative insurance models are g
n  Standard deductible 20.3%
also popular. They account for more than half of insurance agree- n  Selectable
f deductible 17.7%
ments concluded. In these models, the insured person commits a Deductible CHF 500 7.3%
g
b Deductible C HF 1,000 1.2%
to always seeing a defined service provider (e.g. general practition- e
c Deductible C HF 1,500 3.6%
er) first, in return for which he or she pays lower premiums. a d Deductible
d C HF 2,000 0.6%
b e Deductible C HF 2,500 5.0%
c c types of insurance162.0%
n  Other
d
e f with standard deductible 23.6%

© Interpharma
b
g with selectable deductible 38.4%

f a

Ordentl.
Source: Mandatory health insurance statistics 2014, Federal Office Franch.
of Public Health, 2016.
30 1
HMO models, gatekeeper models, bonus insurance etc.
31
Medicines as a reduced proportion of costs
As in past years, outpatient treatment accounted for the highest
gross benefits paid out under mandatory health insurance in 2014.
It accounted for 49.9% of total benefits. At 29.7% the benefits for
inpatient treatment accounted for the second highest share, fol-
lowed by medicines with a share of 20.4% – compared with 2013,
this proportion fell by 0.4 percentage point. Whereas the costs for
outpatient treatment as well as for medicines increased by 4.9%
and 0.4% respectively versus 2013, the costs for inpatient care
decreased by at 2.3%. The total costs of mandatory healthcare
increased by 2.6% in 2014. In 2013 the growth was significantly
higher (+7.8%).
Compulsory health insurance benefits
according to cost categories Hospital 5,593 5,696 5,937 6,816 6,662
Mandatory health insurance benefits
according to cost categories
Cost categories (in CHF millions)
2010 2011 2012 2013 2014
Outpatient 11,374 11,873 12,431 13,406 14,292
Doctor 5,325 5,566 5,806 6,242 6,633
Hospital¹ 3,218 3,443 3,671 4,003 4,161
Laboratory 697 749 794 846 913
Physiotherapy 623 636 655 698 787
Spitex 563 583 628 671 736
Aids and articles 418 382 377 439 473
Chiropractic 73 74 76 77 79
Others² 461 439 424 431 465
Inpatient 3 7,524 7,600 7,821 8,695 8,498

Total benefits 2014: CHF 28,639 million (100%) Nursing Home 1,894 1,847 1,846 1,838 1,796
Others 37 57 38 42 40
c
b
Medicines 4 5,395 5,458 5,649 5,825 5,848
n Outpatient149.9%
a
n Inpatient 229.7% Doctors 1,620 1,621 1,663 1,727 1,762
Pharmacy 3,164 3,169 3,253 3,299 3,274

© Interpharma
n Medicines 20.4%3

a Pharmacy 11.4% Hospital outpatient 611 669 732 800 812

b Doctors 6.2%
Total 24,292 24,932 25,901 27,926 28,639
c Hospital outpatient 2.8%
Source: Mandatory health insurance statistics, Federal Office of Public Health, various years.

1
Excluding medicines.
© Interpharma

2
C ompany contributions to HMOs, complementary medicine,
ergotherapy, speech therapy, health insurance benefits covering dentists,
transportation and rescue costs.
Source: Mandatory health insurance statistics 2014, Federal Office of Public Health, 2016.
3
Including medicines.
1
Excluding medicines hospital outpatient. 2 Including medicines. 4
Excluding inpatient treatment.
3
Excluding inpatient treatment.

32 33
Public Opinion Taking stock of the Health Insurance Act

Proportion of electorate (in %), 2016

High degree of satisfaction with the health system
“Taking stock of the health system twenty years after the enactment of the
Twenty years after the Health Insurance Act (LAMal) came into LAMal, is your impression of the health system in Switzerland…?”
70
force, the health system as a whole enjoys a high degree of 62
60
acceptance among the Swiss public, 81% of whom have a fairly 50
positive to very positive impression of the system. This suggests 40
that there are currently no grounds for further major reforms in the 30
health system without clearly discernible benefits to patients or 20 19
10 12
customers. 6
0 1

© Interpharma
The view of the electorate is that the ideal health system in Swit- n  Very negative n Don’t know / n  Fairly positive
zerland should allow freedom of choice and provide high-quality n  Fairly negative no answer n  Very positive
services and benefits in sufficient quantity. At the same time, the Source: Health Monitor 2016, gfs.bern (N = 1,210), 2016.
last few years have seen an ever larger proportion of people who
want greater state control of the health system, the largest propor- More market or more state
tion in favour of this being recorded in 2014 at 45%, while in 2015
Proportion of electorate (in %), 2016
a majority of 60% wanted more market orientation. In 2016, the
“What kind of a health system would you like in Switzerland? Would you
advocates of a healthcare system guided by a free market econo-
like a health system in Switzerland where the market rules more than the
my increased further: 66% would prefer greater market orientation state or where the state rules more than the market?”
than state control. The proportion of the electorate that approved
30
of a market-oriented health system steadily increased from 2003 25 26 26
onwards until it reached a maximum of 75% in 2010. Since then, 20
the proportion of people in favour of greater state influence has 15 14 14
steadily increased with the exception of 2015. 10 10
7
5
3
0

n  Very heavily market oriented n  Largely state oriented

n  Heavily market oriented n  Heavily state oriented

© Interpharma
n Largely market oriented n  Very heavily state oriented
n  Neither nor
Source: Health Monitor 2016, gfs.bern (N = 1,210), 2016.
34 35
Access to new medicines should be ensured Attitude towards cost-cutting measures

Proportion of electorate (in %), 2016

Unhindered access to new medicines is important to the Swiss:
61% of the electorate would not on any account want to be
deprived of this access. There continues to be a substantial lack
of understanding, for example, when it comes to restrictions in
cancer medicine.
“Which of the following measures would you be prepared to accept if it led
to a reduction in costs in the health system? Please say whether you
would be prepared to accept it whatever the cost reduction, would be
prepared to accept it depending on the scale of the cost reduction, or
would not be prepared to accept it on any account.”

By contrast, four other cost-cutting measures were no longer No free choice of hospital
taboo in 2015: At 67% a clear majority would be prepared to do
without a free choice of hospital for cost reasons. Here, the pro-
No freedom of treatment
portion of those who make this dependent on the level of cost
reduction is relatively high at 49%. Further, 59% of respondents
Reduction in catalogue of benefits
said they would accept a restriction on the freedom of treatment
in order to cut costs. Here again, however, the willingness to
No free choice of doctor
accept such restrictions was dependent on the level of cost reduc-
tion for a high 42% of respondents. The majorities were less clear-
Restricted access to new medicines
cut as regards restricting the therapeutic freedom of the doctor,
which was accepted by 53% of respondents, and restricting the 0% 20% 40% 60% 80% 100%
range of healthcare services covered by the insurance, which was

© Interpharma
accepted by 51%. But with these two measures as well, the pro- n  Whatever the cost reduction n  On no account
portion of those who make them dependent on the level of cost n  Depending on the scale of cost reduction n  Don’t know / no answer
reduction is relatively high at around 40% in each case. Source: Health Monitor 2016, gfs.bern, (N = 1,210), 2016.

36 37
Pharmaceutical Market Pharmaceutical market in Switzerland by value

Market volume 2015: 5,382.6 million (at ex-factory prices, 100%)

Pharmaceutical market grows in 2015 thanks to new,
innovative medicines
n Pharmacies
In Switzerland, medicines are dispensed in pharmacies, hospitals, 52.0% (CHF 2,797.1 million)
drugstores and, in certain cantons, also by doctors. Non-prescrip- n Self-dispensing doctors
tion medicines may be sold in drugstores, while prescription 24.1% (CHF 1,295.1 million)

medicines can only be dispensed in the other outlets. In 2015, the n Hospitals
22.7% (CHF 1,221.9 million)
pharmaceuticals market in Switzerland grew 5.3% over the previ-
n Drugstores
ous year to 5.4 billion francs. In 2014, a slight growth of 0.7% was
1.2% (CHF 68.5 million)
recorded.

© Interpharma
The growth is due in particular to the launch of new and innovative
medicines – especially for hepatitis C, an infectious disease that
Source: Interpharma with database IMS Health Switzerland, 2016.
these products can cure in more than 90% of cases. Together with
other antiviral medicines, the growth achieved by this group of Pharmaceutical market in Switzerland by volume
products accounted for around half of the entire market growth.
Market volume 2015: 211.0 million packs (100%)

The number of packs sold increased by 0.8% to 211 million units.

n Pharmacies
58.2% (122.8 million packs)
n Self-dispensing doctors
19.7% (41.6 million packs)
n Hospitals
18.5% (39.0 million packs)
n Drugstores
3.6% (7.6 million packs)

© Interpharma
Source: Interpharma with database IMS Health Switzerland, 2016.

38 39
Most medicines are reimbursed Pharmaceutical market by reimbursability
according to value
Around 58% of all medicine packs sold in Switzerland were reim-
Market volume 2015: CHF 5,382.6 million (at ex-factory prices, 100%)
bursable in 2015. Most of these were prescription-only medicines.
Around a quarter of all reimbursable medicines were not- prescrip- n Reimbursable products
tion drugs. But these products are only reimbursed through the  82.6% (CHF 4,445.1 million)
n Prescription only
mandatory health insurance if a medical prescription is provided.
78.1% (CHF 4,202.2 million)
If no such prescription is provided, these medicines can be sold n Over the counter
freely, but patients then have to pay the full price themselves. 4.5% (CHF 242.9 million)
n Non-reimbursable products
In the case of medicines not reimbursed through the mandatory  17.4% (CHF 937.5 million)
health insurance, more than a third were prescription-only medi- n Prescription only
7.7% (CHF 414.3 million)

© Interpharma
cines. These include, for example, contraceptives. Most of the
n Over the counter
medicines not reimbursed were non-prescription products. Many 9.7% (CHF 523.2 million)
of these non-reimbursable products are covered to some extent
Source: Interpharma with database IMS Health Switzerland, 2016.
by the optional top-up insurance plans.
Pharmaceutical market by reimbursability
In terms of value, more than 82% of the total pharmaceutical mar- according to volume
ket consisted of reimbursable medicines in 2015, most of which
Market volume 2015: 211.0 million packs (100%)
were prescription-only products at the same time. Non-reimbursed
products accounted for less than one-fifth of total pharmaceutical n Reimbursable products
 58.3% (123.0 million packs)
sales. The market for reimbursable medicines increased by 6.8%
n Prescription only
compared with the previous year. This is mainly due to the intro-
43.3% (91.1 million packs)
duction of new, highly innovative medicines against hepatitis C and n Over the counter
other viral diseases. In terms of volume, reimbursable medicines 15.0% (31.5 million packs)
showed a 2.9% increase in 2015 compared with 2014. n Non-reimbursable products
 41.7% (88.0 million packs)
n Prescription only
15.2% (32.1 million packs)

© Interpharma
n Over the counter
26.5% (55.9 million packs)

Source: Interpharma with database IMS Health Switzerland, 2016.

40 41
Strong growth of generics market Generics market

Generics market (in CHF millions, at ex-factory prices)

Reimbursable generics achieved sales of 637 million Swiss francs
in 2015. Compared with the previous year, the growth amounted 700
637.0
to more than 7%. In terms of volume, generics showed a 13% 600
increase. The value of the generics market has more than doubled 500
since 2005. 400
300
In the generics-eligible market, the proportion of generics has 200 261.2
increased in the last few years. This market includes both generics 100

© Interpharma
and also original products whose patents have expired, but for
0
which no generics exist as yet. In addition, there are also original 05 06 07 08 09 10 11 12 13 14 15
products for which there are no generics because, amongst other
Source: Interpharma with database IMS Health Switzerland, 2016.
reasons, the price is already so low that they are not financially
attractive for generics producers. The market volume of this prod-
uct group amounted to around 497 million francs in 2015. Generics-eligible market

Generics-eligible active ingredients, top 20 (by value),

In the case of the twenty biggest-selling active ingredients whose defined on a monthly basis
patents have expired, generics accounted for more than 79% in Generics as a proportion of the generics-eligible market
terms of volume in 2015. Thus, nearly four of five counting units (in %, on the basis of counting units1)
(tablets, capsules etc.) sold were generics. In 2005, only around 100
21.5 20.8
one in two units took the form of a generic. One reason for the 29.7 28.9 28.4 29.3 29.1 27.6 28.0 24.4
80
marked increase in the proportion of generics between 2005 and 49.7

2006 lies in the introduction of the differentiated co-payment rule. 60

According to this rule, the insured person makes a co-payment
40 75.6 78.5 79.2
72.4
amounting to 20% of the cost of the original product, but only 10% 70.3 71.1 71.6 70.7 70.9 72.0
50.3
in the case of generics. 20

0
05 06 07 08 09 10 11 12 13 14 15

© Interpharma
n Generics  n Originals whose patents have expired and
for which generics exist

Source: Interpharma with database of IMS Health Switzerland, 2016.

42 43
1
Number of tablets, capsules, millilitres etc. sold.
Pharmacies remain the most important sales outlet Sales outlets by turnover

In CHF millions, at ex-factory prices
Pharmaceutical sales in pharmacies grew in 2015 compared with
the previous year. The 1,774 pharmacies in Switzerland accounted 2,500
2 797
for 52% of medicines sold in terms of value. They were thus the 2,000 2 273
most important sales outlet for medicines. Mail-order pharmacies
1,500
are becoming increasingly important. Drugstores saw a decrease 1 295
1,000 1 008
in sales compared with the previous year. 1 222

500 817
In Switzerland, doctors are also allowed to dispense medicines 97 69
0
directly to their patients in certain regions. In 2015, there were 05 06 07 08 09 10 11 12 13 14 15

© Interpharma
around 5,800 practitioners in Switzerland with a patient pharmacy,
  Pharmacies   Hospitals
also known as self-dispensing (SD) doctors. This group thus
  Self-dispensing doctors1     Drugstores
accounted for around 40% of all medical practitioners. Since the
Source: Interpharma with database IMS Health Switzerland, 2016.
sale of medicines by SD doctors is regulated differently from one
canton to another, the proportions of self-dispensing differ
between regions. The density of pharmacies also varies from one Sales outlets by inventory
canton to another. The cantons with a high proportion of SD doc-
Number of self-dispensing doctors1, pharmacies, drugstores and hospitals
tors (Basel-Landschaft, St. Gallen and Zug) generally show a much
lower density of pharmacies compared with the other cantons. 7,000
The sharp increase in 2010 is due to the fact that, since 2010, the 6,000 5 809

data has been gathered according to cantonal regulations. More- 5,000

over, a new source of data has been in use since 2011. The figures 4,000 3 928

from 2009 to 2014 are therefore only comparable with each other 3,000
to a limited extent. 2,000 1 672 1 774
1,000 693 533
333
0 570
05 06 07 08 09 10 11 12 13 14 15

© Interpharma
  Pharmacies   Hospitals
  Self-dispensing doctors1     Drugstores

Source: Interpharma with database IMS Health Switzerland, Cegedim Switzerland SA, Zurich branch;
pharmaSuisse, 2016.
1
Doctors with their own pharmacy are described
44 as self-dispensing doctors. 45
Successful use of biotech and gene tech products Market of biotech and gene tech products

Market development (in CHF millions, at ex-factory prices)

Unlike classical chemical compounds, most active ingredients that
are produced in genetically modified organisms using biotechno- 1,000
logical methods are substances that are complex, large and
800 929
high-molecular-weight proteins. In 2015, over 30% more medi-
cines from biotechnological production were dispensed than five
600
years ago. Their value at ex-factory prices amounted to 929 million
Swiss francs, which is around 17% of the total market.
400

Biotechnologically produced medicines are being successfully 200

used for the treatment of severe or life-threatening diseases such

© Interpharma
as multiple sclerosis and blood disorders and especially for cancer 0 15
and diabetes. Precisely in the field of oncology, there is a steady 90 95 00 05 10 15
increase in the proportion of gene tech products. Gene technolo-
Source: Interpharma with database IMS Health Switzerland, 2016.
gy methods today are used not only in the production process
itself, but also in the research and development of almost every Indications for biotech and gene tech products
new medicine.
Market volume 2015: CHF 929.1 million (at ex-factory prices, 100%)

A particular feature of biopharmaceuticals is that it is not possible

to produce generics with absolutely identical active ingredients. n Cancer 31.4%
After the patent has expired, similar copies of the highly complex n Rheumatic diseases 23.2%
n Multiple sclerosis 10.0%
biopharmaceuticals, known as biosimilars, may be approved. A
n Diabetes 7.2%
special procedure has been established for these approvals, in
n Eye diseases 6.9%
which tests of efficacy and tolerability have to be carried out in the n Hematopoiesis 4.6%
laboratory and in clinical studies. However, the producer of biosim- n Vaccines 4.2%
ilars requires a smaller programme of studies for regulatory n Growth hormones 2.8%

© Interpharma
approval than has to be provided by the original producer. n Others 9.7%

Source: Interpharma with database IMS Health Switzerland, 2016.

46 47
Medicines for diseases of the central nervous system sold Market share of medicines by indication area
the most
Market volume 2015: CHF 5,382.6 million (at ex-factory prices, 100%)

In 2015, medicines for diseases of the central nervous system had

the biggest market share at 14.5%. This category includes analge- n Central nervous system 14.5%
sics, medicines for diseases such as epilepsy and Parkinson’s and n Cancer 12.4%
also treatments of mental disorders (hallucinations, delusions and n Infections 12.4%
n Cardiovascular 9.7%
depression). Analgesics formed the biggest group in this category.
n Respiratory system 5.9%
n Digestive system 5.5%
The second biggest market share was achieved by cancer medi-
n Hematopoiesis 5.4%
cines and treatments for infectious diseases at 12.4% each. The n Musculoskeletal system 5.0%
former include classical cytostatic agents, which are used in n Urogenital system 4.3%
chemotherapy, so-called monoclonal antibodies, which are used n Sensory organs 3.9%
alone or in combination with chemotherapy, and also various oth-

© Interpharma
n Skin 3.6%
er products used in cancer therapy. The latter consists of medi- n Others 17.4%
cines to treat hepatitis C and HIV or antibiotics. Vaccines also fall
into this category. Source: Interpharma with database IMS Health Switzerland, 2016.

48 49
Fewer approved medicines Number of approved medicines in Switzerland

2000 2013 2014 2015

All medicines either available in Switzerland or intended for export
from Switzerland have to be approved by the Swiss Agency for Human medicines1 7,224 7,726 7,662 7,593

© Interpharma
Therapeutic Products (Swissmedic). The applicants have to pro- Human medicines1 890 698 714 719
vide extensive documentation for the approval. This documenta- Total approved medicines 8,114 8,424 8,376 8,312
tion must show evidence of, amongst other things, efficacy, Source: Annual reports, various years, Swissmedic.

quality and safety, as well as identity, purity and content of the 1

H uman medicines, allergens, biotech medicines, homeopathic medicines,
vaccines, herbal medicines, radiopharmaceuticals and other product
active ingredients of the medicine. The entire approval procedure
categories.
usually takes 330 days. In 2015, 28 medicines with new active
ingredients were approved. In the case of medicines for life-threat-
ening diseases, fast-track procedures, that usually take 140 days Dispensing categories over time
are also possible. In 2015, twelve applications were processed
Medicines by dispensing category1 (in %)
using the fast-track procedure.
50
In 2015, the number of medicines approved by Swissmedic 40
46.1

decreased by 0.8% over the previous year and amounted to a total

of 8,312 human and veterinary medicines. Viewed over a pro- 30
longed period, the overall number of approvals declined substan- 20
23.7
20.4
tially. In 1990, this number stood at 10,119 units – 1,800 more than
is the case today. 10
7.8
0 2.0
On the basis of the benefit-risk ratio, Swissmedic classifies human 1990 1995 2000 2005 2010 2015
and veterinary medicines according to different dispensing cate-
gories. In 2015, categories A and B (prescription only) accounted A: Dispensed once on medical or veterinary prescription
B: Dispensed on medical or veterinary prescription
for around 66% of all approved medicines.
C: Dispensed after consultation with medical professional (pharmacies)2

© Interpharma
D: Dispensed after specialist consultation (pharmacies and drugstores)2
E: Dispensed without specialist consultation2

Source: Annual reports, various years, Swissmedic.

1
C ertain products are assigned to more than one dispensing category and
have therefore been counted more than once (pack size or dose).
2
O ver the counter.
50 51
Growing number of reimbursable medicines Reimbursable medicines by dispensing category

Total reimbursable medicines 2015: 9,649 packs1 (100%)

In Switzerland, only medicines included in the so-called Specialties
List (SL) drawn up by the Federal Office of Public Health (FOPH)
are reimbursed through the mandatory health insurance. The
n List A: 2,382 (24.7%)
FOPH decides on inclusion in the SL based on the recommenda-
n List B: 6,581 (68.2%)
tions of the Federal Medicines Committee and stipulates the
n List C: 191 (2.0%)
maximum price for reimbursement. The defining criteria for this are
n List D: 482 (5.0%)
the efficacy, suitability and cost-effectiveness of the medicine
concerned.

The cost-efficiency is determined based on a comparison with

prices abroad. A therapeutic cross-comparison is also made with

© Interpharma
medicines in the same indication or with a similar mechanism of
action. If an innovation premium is claimed, this must be justified
by evidence of increased efficacy or a better risk profile (fewer side Source: Federal Office of Public Health, 2016, as at 1.12.2015.

effects). It is explicitly laid down in the ordinance to the Health 1

13 packs (0.1%) could not be assigned to a list. These comprised pens,
Insurance Act, because Switzerland has an interest in offering a Diskhalers and baby food.

research-friendly environment.
Medicines in the Specialties List (SL)
The scope of the SL has increased in the last few years, partly also
because there are more and more generics and generics produc- 1995 2012 2013 2014 2015

© Interpharma
ers are required to offer all the pack sizes offered with the original Number of products 2,255 2,844 2,871 2,898 2,922
product. At the end of 2015, the SL included a total of 2,922 prod- Number of packs 5,383 9,378 9,563 9,725 9,649
ucts in 9,649 packs. Nearly 93% of these were prescription only Source: Federal Office of Public Health, 2016, as at 1.12.2015.

(categories A and B), and the remaining 7% were available without

prescription (categories C and D). These non-prescription medi-
cines are only reimbursed if they have been prescribed by a doctor.
In 2015, around 41% of all SL packs were generics, as were around
59% of the packs newly included in the SL in 2015.

52 53
The price of a medicine is not a market price Composition of the price of a medicine

In Switzerland, the price to the public of a reimbursable medicine Pharmaceutical benefits according to LAMal

(maximum price that is reimbursed by the social health insurance) Value-added tax (2.5%)
is not determined on the free market, but is set by the state. It is Retail price Production costs
made up of the sales and marketing portion of the overall cost, the (according (logistics, infra-
to Specialties Sales and structure, personnel)
ex-factory price, the sales tax and the value-added tax. The ex-fac- List, SL) 1 distribution costs
tory price is established on the basis of a therapeutic reference Capital costs

pricing system and an international reference pricing system. In the Ex-factory price Sales tax
case of the former, the cost of the product is compared with that Foreign price
of medicines already approved in a similar indication or with the comparison (AT, BE,
DE, DK, FI, FR, NL,
same mode of action. The international reference pricing system SE, GB) based on
looks at the prices in countries with economically comparable ex-factory prices
structures in the pharmaceutical sector. In June 2015, Belgium,

© Interpharma
Therapeutic
Finland and Sweden were added to the basket of countries used cross-comparison
for this reference pricing since 2010 (Austria, Denmark, France,
Germany, Great Britain and the Netherlands). Source: Federal Office of Public Health.
1
The relation between retail price and ex-factory price can be found
The Swiss Agency for Therapeutic Products (Swissmedic) levies a at www.spezialitaetenliste.ch

sales tax. This is payable for every pack sold and is dependent on
the ex-factory price. It amounts to 5 Swiss francs per pack at most
and accounts for more than 50% of the income of Swissmedic.
For every medicine, a sales and marketing surcharge is imposed
by law. For prescription-only medicines up to an ex-factory price of
880 francs a surcharge of 12% is imposed, and for more expensive
medicines the surcharge is 7%. In addition, a price-related sur-
Marketing surcharges (categories A and B, without LOA1)
Ex-factory price + price-related  + surcharge
(in CHF) surcharge per pack (in CHF)
0.05 – 4.99 12% 4.00
5.00 –10.99 12% 8.00
11.00 –14.99 12% 12.00
15.00 – 879.99 12% 16.00

© Interpharma
charge is levied for every pack. For reimbursable OTC medicines a 880.00 – 2,569.99 7% 60.00
surcharge of 80% is imposed without a surcharge per pack. In the from 2,570.00 0% 240.00
case of non-reimbursable medicines, pricing is determined by Source: Federal Office of Public Health.

competition. 1
Service-based remuneration.

54 55
Prices of medicines have fallen further Comparison of drug prices Switzerland vs other countries

Top 200 original products 9-countries basket (exchange rate CHF / EUR: 1.20)
In September 2015, at an exchange rate of CHF 1.20 to the euro,
the prices of the 200 or so biggest-selling patent-protected original 120

medicines were 10% higher in Switzerland than the average of the 100
nine reference countries. This emerges from the seventh joint com-

102
100

99
80

94

92
parison of international prices by santésuisse and Interpharma. The

90

88

88

83

82

80
price difference is primarily due both to the appreciation of the franc 60
after the minimum threshold for the exchange rate of the franc 40
against the euro was lifted by the Swiss National Bank (SNB) in
20
January 2015 and to the widening of the basket of reference coun-
0

© Interpharma
tries (BE, FI and SE were added).
CH 9-countries DE DK AT SE BE FI GB NL FR
basket
After the SNB decision, the costs of Switzerland as a pharmaceutical
centre that is of huge importance for the national economy increased Source: Joint foreign-price comparison by santésuisse and Interpharma, December 2015.

around 20% owing to the strength of the franc, after the franc had
Harmonized Consumer Price Index
already become massively overvalued in the years before and Swit-
zerland had become an expensive location for business. At the same Pharmaceutical products (index, 2005 = 100)
time, the difference in prices compared with other countries will 128.5
120 122.5
increase further purely as a result of currency exchange rates.
114.7
110
104.6
The price review by the Federal Office of Public Health (FOPH) is 100 103.5
99.4
carried out every three years and also when the indications for a 90 98.0
95.9
product are widened. However, only downward price adjustments 80 91.7
87.0
are possible. Therefore the price differences versus other countries
70
will be reduced further. 68.2
60
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
The consumer price index of Eurostat measures price trends over a

© Interpharma
prolonged period. It shows that the prices of medicines in Switzer-   DE   AT   GB   DK   SE  
Average of 9
land have fallen substantially in the last few years. By contrast, the  NL  FR  BE   FI   CH reference countries

prices of medicines in other reference countries have increase or Source: Eurostat, 2016.

not fallen as sharply as in Switzerland.

56 57
Price comparison with other countries Price comparisons of European states

An essential component when the prices of reimbursable medi-

cines are set is the price comparison with other countries. Between
2010 and May 2015, the basket of countries was made up of AT
Austria, Denmark, France, Germany, Great Britain and the Neth- GB BE
erlands. Since June 2015, Swiss prices have also been compared SE
with those in Belgium, Finland and Sweden. The international ref- ES DK
erence pricing system is brought to bear both when a price is set
for the first time as part of the process of inclusion in the specialties NO
list (SL) and also when all medicines that have already been includ-
PT FI
ed in the SL undergo a price review every three years. Since June
CH
2015, therapeutic reference pricing has been considered in the
case of the latter (the three-year price review). Before this, it was
primarily only the international reference pricing system that was NL FR
applied as from 2012. However, the 5% tolerance margin has been
dropped. The costs of research and development continue to be
taken into account during the patent life. IT DE

In the three-year price reviews, prices can only be reduced, but IE GR

not increased. If for example the franc, which is strong at the
moment, were to weaken and Swiss prices were lower than the Official price comparison Unofficial price comparison
with all EU states with selected EU states
average of the basket of countries, the prices in Switzerland would Official price comparison Unofficial price comparison
not be automatically increased. Applications for price increases with selected EU states with all EU states
are possible. No price comparison

Switzerland

© Interpharma
Official

Source: IMS Health; EFPIA.

58 59
International impact of Swiss pharmaceutical regulation Switzerland as reference country

Both in industrialized countries and in emerging nations, the ­prices

of Swiss medicines form part of the reference basket that is used
to determine prices in those countries. The way in which prices are BE
set using prices from reference markets varies from country to TW PO
country. In some cases, the lowest price is used, and in other
cases an average or median price is used. On the basis of inter- FI
national price referencing, any change in Swiss prices of medicines KR RU
has a global impact. HU SK

A 10% reduction in price would lead to a global decline of almost

BR
1,108 million Swiss francs in sales for the industry. Of this, around CH
515 million francs would be lost in Switzerland, more than 470 OM
TR
million in industrialized countries and over 122 million in emerging
nations. In other words, international price referencing has the
effect of doubling the global impact of any price reduction in Swit- BH
zerland. Apart from the impact on prices, this can also influence TU SA LB
company decisions on the launch of innovative medicines and lead
to delays in the introduction of products on the Swiss market. With
a substantial price reduction in Switzerland, it is possible that the JO
EG
market launch in Switzerland would be considerably delayed. IR CA

DZ

© Interpharma
Average of basket prices Lowest basket prices
Other basket prices (e.g. median)

Source: The international impact of Swiss drug regulation, Charles River Associates,
study on behalf of Interpharma and Novartis, March 2013, Interpharma, 2015.

60 61
Economic Impact Export of pharmaceutical products

Export volume 2015: CHF 70.3 billion (100%)

Pharmaceutical sector as driver of the export industry
=^ 34.7% of all Swiss exports

Despite the continuing crisis in the eurozone in 2015, the pharma-

n EU52.1% n Non-EU47.9%
ceutical industry managed to maintain its position as the export
n DE14.2% n Rest of Europe
driver of the Swiss economy. But although exports fell 0.6% com- n GB7.0% 2.9%
pared with the previous year, partly due to the strength of the n IT6.7% n US18.0%
Swiss franc, they still ran to 70 billion francs. They thus accounted n FR4.6% n JP3.6%
for more than a third of Switzerland’s export volume. The trade n ES4.3% n BR, RU, IN,
surplus for pharmaceutical products increased compared with the n Rest of EU CN, MX, TR, KR
15.3% 9.5%
previous year (+5.7%), because imports were down. It amounted
n Other countries

© Interpharma
to more than 42 billion francs. The most important export market 13.9%
for pharmaceutical products remains Europe.

Source: Foreign Trade Statistics, Federal Customs Administration, 2016.

Development of pharmaceutical trade balance Import of pharmaceutical products

Pharmaceutical trade balance (in CHF billions) Import volume 2015: CHF 27.8 billion (100%)
70.3
=^ 16.7% of all Swiss imports
70

60
n EU77.7% n Non-EU22.3%
50 n DE19.6% n Rest of Europe
40
42.5 n IT10.4% 0.6%
n ES5.8% n US13.9%
30 27.8
n GB4.6% n JP1.7%
20 n FR2.8% n BR, RU, IN,
n Rest of EU CN, MX, TR, KR
10
34.5%  3.7%
0
© Interpharma

n Other countries

© Interpharma
1990 1995 2000 2005 2010 2015 2.4%
Export Surplus Import
Source: Foreign Trade Statistics, Federal Customs Administration, 2016. Source: Foreign Trade Statistics, Federal Customs Administration, 2016.

62 63
High export surplus Pharmaceutical trade balance compared with
other countries
In 2014, Switzerland posted an export surplus of around 38 billion
In CHF millions, according to SITC 541, 2014
Swiss francs for pharmaceutical products. This has steadily grown
in the last few years. Comparison with the rest of Europe shows
40,000
that Switzerland occupied a leading position with this result not 38,350

only relatively, but also in absolute terms. The neighbouring coun- 30,000
27,040
20,000 21,628
tries, for example, showed much lower export surpluses. Great
Britain, the USA and Japan also show a negative trade balance. 10,000 9,526 8,622
3,030 2,329 1,701 1,481
0
–247
Switzerland’s positive trade balance demonstrates the high degree –10,000
of competitiveness of its pharmaceutical industry. Switzerland is –20,000
–16,106
the country with the largest export surplus of pharmaceutical –30,000
–25,600
products not only in Europe, but also worldwide. Yet it is not only

© Interpharma
–40,000
an important production centre, but also a major research hub. CH DE IE BE NL FR DK IT AT GB JP US

Source: UN Comtrade database, 2016; conversion to CHF by Interpharma.

¹ The Standard International Trade Classification (SITC) is a classification of

goods used to classify the exports and imports of a country.

64 65
High workplace productivity and major employer Workplace productivity
pharmaceutical industry / overall economy
The pharmaceutical industry is the most productive sector in Swit-
In CHF per employee (full-time equivalent)
zerland. Workplace productivity increased almost every year
between 1980 and 2008, after which it fell again until 2012. In 800,000
2014, it stood at around 627,000 francs per employee, which was 627 233
much higher than in the early years of the last decade. The pro- 600,000
ductivity of the pharmaceutical industry is more than four times
400,000
higher than that of industry as a whole. This has likewise increased
almost every year since 1980, with the exception of a few years,
200,000 157 964
but the increase has been much less marked than in the pharma- 103 952

ceutical sector. Workplace productivity is defined as the nominal 0 63 783

© Interpharma
gross value added in francs per employee. 1980 1990 2000 2014

  Pharmaceutical industry   Overall economy

The pharmaceutical sector is a major employer in Switzerland.
Source: BAK Basel Economics, Polynomics, 2015.
Thus in 2014, a total of around 41,800 people were directly
employed in pharmaceutical companies, which corresponds to
Number of employees
1% of all Swiss employees. Indirectly, another 182,000 or so peo-
pharmaceutical industry / overall economy
ple are employed in the supply sector providing services to the
pharmaceutical industry. The number of those directly employed Growth in the number of employees in the pharmaceutical industry and
in the industry has nearly doubled since 1995. the overall economy (in 1,000)
6,000 45
41.8

4,000 5 056.2 30
3 530.1

22.8
2,000 15

0 0

© Interpharma
1980 1990 2000 2010 2014

  Overall economy (left axis)   Pharmaceutical industry (right axis)

Source: BAK Basel Economics, Polynomics, 2015.

66 67
High level of research investments in Switzerland Interpharma companies in Switzerland

Pharmaceuticals Switzerland, 20151, in CHF millions

In 2015, the 24 Interpharma companies spent more than 6.9 billion
francs in research and development (R&D). That is more than
7,000
twice as much as they achieved in sales in Switzerland. This high
6,000 6,968
level of financial investment in underlines the importance of Swit-
5,000
zerland as a research centre and testifies to the driving power of
4,000
innovation within these companies. In the research and develop- 3,000
ment process, the research-based pharmaceutical companies 2,000 3,104
shoulder the full risk of research themselves. Particularly the 1,000
companies with headquarters in Switzerland (Actelion, Novartis 0
1,365

© Interpharma
and Roche) invested a lot in R&D, but major R&D investments were
also made by Merck, Janssen-Cilag and Vifor. n  Sales2  n  R&D  n  PP&E Investments

Source: Interpharma, 2016.

In addition to R&D spending, the Interpharma companies in Swit-
zerland also invested more than one billion francs in plant, such as
technical apparatus, machines and the equipment of buildings
and production facilities. Both categories of investment are reflect-
ed in high staffing levels. The pharmaceutical industry is thus a
mainstay of Switzerland’s economy.
1
The figures are based on the 24 Interpharma companies that were members
of Interpharma in June 2016, even if they had not yet become members in
2015. Some companies do not break down certain key indicators by country
and for this reason the corresponding information is not reflected in these
figures. In the case of companies with several divisions, only the information
for the pharmaceuticals division was included.
² Prescription-only medicines.

Many Interpharma companies are organized as regional compa-

nies in Switzerland and are therefore unable to report certain key
figures for Switzerland, even though they invest in Switzerland.

Staff levels of Interpharma companies in Switzerland

© Interpharma

Pharmaceutical sector Switzerland, 2015¹

Headcount 29,409
Source: Interpharma, 2016.

68 69
High global spending on research and development Interpharma companies worldwide

Pharmaceuticals worldwide, 2015¹, in CHF millions

In 2015, the 24 Interpharma companies invested more than 90 billion
francs in the research and development of medicines and new treat- 400,000 447,174
ments. This corresponds to around 20% of their sales. This reinvest-
300,000
ment in research and development (R&D) is above average compared
with other industries. More than 516,000 people worldwide were 200,000
employed in the pharmaceutical divisions of companies.
100,000
90 , 838 93 ,077

© Interpharma
In the overall groups of Interpharma companies – i.e. with all other 0 10,852

divisions, such as medical technology, generics or animal health

n  Sales2  n  R&D  n  PP&E Investments   n  Operating profit
divisions – more than a million people were employed. The groups
invested more than 100 billion francs in R&D and spent around 29
billion francs on the construction of new plants. Groups (all divisions) worldwide, 2015, in CHF millions
600,000
500,000 589,520

400,000
300,000
200,000
100,000
29,283 110,902

© Interpharma
0 100,704

n  Sales   n  R&D  n  PP&E Investments   n  Operating profit

Source: Interpharma, 2016.

Staff levels of Interpharma companies and groups
1
The figures are based on the 24 Interpharma companies that were members
Worldwide, 2015
© Interpharma

of Interpharma in June 2016, even if they had not yet become members in
Headcount of Interpharma companies worldwide1 516,847 2015. Some companies do not break down certain key indicators by country
Headcount of Interpharma companies worldwide (groups) 1,175,139 and for this reason the corresponding information is not reflected in these
figures. In the case of companies with several divisions, only the information
Source: Interpharma, 2016.
for the pharmaceuticals division was included.
² Prescription-only medicines.

70 71
Major investments in Switzerland as a research hub Interpharma companies in Switzerland: sales, research
and exports
In 2015, the Interpharma companies Actelion, Novartis, Roche,
In CHF billions, 2015
Gilead, Merck and Vifor Pharma spent 6,935 million Swiss francs
on research and development (R&D) in the field of pharmaceuti- 70 70.3

cals in Switzerland. This corresponds to 34.6% of their global R&D 60

spend. In 2014 they spent more than 500 million francs less. In the 50
USA, the companies invested 9,271 million francs in R&D. The 40
high levels of investment in pharmaceutical research and develop-
30
ment in Switzerland and the USA underline the importance of
20
these two research centres.
10
7.0
3.1
0

© Interpharma
Interpharma companies: spending on R&D worldwide
Sales Research and Export
development
Global R&D expenditure of Interpharma companies , 2015:
1

CHF 20,026 million (100%)

Source: Interpharma; export trade statistics, Federal Customs Administration, 2016.

n Switzerland
34.6% =^ CHF 6,935 million
n Rest of Europe
10.7% =^ CHF 2,135 million
n USA46.3% =^ CHF 9,271 million
n Japan3.6% =^ CHF 731 million
n Others4.8% =^ CHF 954 million
© Interpharma

Source: Interpharma, 2016.

¹ B ased on data for R&D in pharmaceuticals from Actelion, Novartis, Roche,

Gilead, Merck and Vifor Pharma. The other Interpharma companies do not
break down their R&D investments by country and were therefore
not included.

72 73
Switzerland leads in innovation ranking Swiss innovation system in comparison with EU countries

European Innovation Index 2014

According to the European and Global Innovation Index, Switzer-
land is both European and world champion in innovation. The 0.8
particular strengths of Switzerland lie amongst other things in the

0.81
0.7

0.74

0.74
number of scientific publications in international journals and their 0.6

0.68

0.68

0.65

0.64

0.64

0.63
citability, patent applications and income based on licences and

0.62

0.62
0.5

0.59

0.59

0.56
patents abroad. High employment quotas in knowledge-intensive 0.4
activities and the high proportion of new graduates are further 0.3
particular features of Switzerland. The European innovation index 0.2
is drawn up with reference to 25 indicators, while the global index 0.1

© Interpharma
is based on 80 indicators. The data for both indexes comes pri- 0.0
marily from the years 2010 to 2014. CH SE DK DE FI NL LU GB IE BE IS AT FR EU

Source: Innovation Union Scoreboard 2015, European Union, 2015.

Despite the relatively good position of Switzerland by European
standards, recent developments give some cause for concern.
Compared with other countries, for example, Switzerland has Swiss innovation system in worldwide comparison
fallen behind in clinical research. A master plan to strengthen
Global Innovation Index 2015
biomedical research and technology, which the Federal Council
approved in December 2013, is aimed at reinforcing the global 68

68.3
competitiveness of Switzerland as a research centre and of the 66
64
Swiss pharmaceutical industry.
62

62.4

62.4
60

61.6

60.1

60.0
58

59.4

59.1

59.0
56

57.7

57.2

57.1

57.0

56.3
54
52

© Interpharma
50
CH GB SE NL US FI SG IE LU DK HK DE IS KR

Source: Global Innovation Index 2015, WIPO et al., 2015.

74 75
Research and Development Pharmaceutical patents with the European Patent Office

Patent applications with the European Patent Office or via PCT¹

Patent protection promotes medical advances
per million employees (in the economy as a whole), average 2000–2010

Patents allow exclusive commercial use of an invention during the 100

20-year period of patent protection. In return, the research and

94.5
80
development results must be made accessible to the public. Third

85.1
parties can be excluded from the commercial use of the patented 60
invention and the use can be licenced for a fee. In the case of 40

52.0
52.0
medicines the period of patent protection is reduced de facto to

43.2

37.0

33.9

33.3
15 years at the most because of the time it takes to develop the 20

© Interpharma
medicine and gain regulatory marketing approval. As a result of

16.7
0
patent protection, the investments made in research and develop- DK CH SE US DE NL GB FR IT
ment are protected and incentives created for further innovations,
Source: BAK Basel Economics, 2013; OECD REGPAT database, 2012.
because the development new medicines is time-consuming and
Patent Cooperation Treaty: international agreement that allows a patent
1 
expensive, and the pharmaceutical companies are sole bearers of
to be requested by filing a single patent application for all states that have
the risk of research. In addition, the manufacturing process of a signed up to the PCT. Duplication of counts is excluded.
medicine is relatively easy to copy. Against this background, pat-
ent law, which protects biotechnological inventions, is of utmost
importance for pharmaceutical and biotech companies in Switzer-
land. Besides protecting the actual invention, the protection of
data from preclinical and clinical trials required by the health
authorities (first-applicant protection) makes sure that no other
company can refer to and use this data during the period of pro-
tection following market approval.

Precisely for a country like Switzerland, which has no raw materi-

als at its disposal, knowledge and know-how are important capital.
In pharmaceutical research more than 85 patents per million
employees were registered from Switzerland between 2000 and
2010.

76 77
Pharmaceutical industry is crucial in national research Funding of R&D in Switzerland
and development
Total spending on R&D in 2012: CHF 18,510 million (100%)

Private industry continues to invest a great deal. In 2012, the pri-

n Private sector 60.8%
vate sector accounted for more than 60% of all investments spent.
n Federal government 15.3%
The public sector (federal government and cantons) contributed
n Cantons10.1%
25% of research and development (R&D) funding, while 2% came
n Others11.7%
from private non-profit organizations and from universities.
n Foreign country 12.1%

R&D play an important part in Switzerland’s private sector.

In-house R&D spending in 2012 amounted to 12.8 billion Swiss

© Interpharma
francs. This expenditure covers all financial and human resources
deployed for R&D within companies in Switzerland (production
sites or laboratories). At almost 3.8 billion francs, the pharmaceu-
Soure: R&D in Switzerland 2012, Federal Statistical Office, 2014.
tical industry accounted for around 30% of all in-house R&D
1
Private non-profit organizations and university funds.
spending in Switzerland, which was thus around twice as high as
the amount spent in the engineering and metal industry.
Spending on R&D in the private sector
Many corporate groups are increasingly focusing their R&D
In-house R&D spending by industry
spending on individual company units, while other divisions apply Total expenditure in 2012: CHF 12,819 million (100%)
the results of their R&D. If this is included in the analysis, the phar-
maceutical sector benefited from more than 5.7 billion francs or n Pharmaceuticals 29.6%
45% of total in-house R&D spending in 2012. n Machinery/metal 15.7%
n Research and development 14.4%
n I nformation and communications
technology 10.8%
n High-tech instruments 8.0%
n Chemistry 4.0%
n Food 0.5%

© Interpharma
n Others 17.0%

Source: Federal Statistical Office, 2013.

78 79
High awareness of Swiss research Country ranking according to recognition
of scientific publications
Despite the growing competition from countries that have invested
2009–2013
massively in research and development in the last few years (espe-
Research field 1 2 3 4 5
cially in Asia), Swiss research is held in high regard worldwide. In
terms of visibility in scientific publications between 2009 and 2013 Life sciences US GB IS CHNL

Switzerland occupies an outstanding position, as shown in the Physics, chemistry and

earth sciences US CH NL GBDK
bibliometric evaluation of research in Switzerland by the State
Agriculture, biology and
Secretariat for Education, Research and Innovation. Of the twenty

countries with the largest number of publications, Switzerland was
the most productive country at 3.9 publications a year for every
1,000 inhabitants.
© Interpharma
environmental sciences GB CH NL US DK
Technological and
engineering sciences, IT DK NL CH USGB
Source: Bibliometric evaluation of research in Switzerland 1981–2013, report of State Secretariat
for Education, Research and Innovation, 2016.

Switzerland came in the top five in almost all natural sciences. In

the period from 2007 to 2011, however, it was even better placed. Scientific impact by country
But in clinical medicine, Switzerland did not feature among the five
Top 10, 2009–2013
best countries and was ranked seventh.
120

120
115

118

117

116
In a scientific publication, other publications are usually cited. The
110
more often an article is cited, the greater its impact in the research

110

109
community. Swiss publications were cited extraordinarily often 105

108

106
between 2009 and 2013 and commanded above-average atten-

105

105
100
tion in the research community. First place in the world ranking by

100
impact was taken by the USA. Switzerland occupied third place

© Interpharma
95
with a value 17% above the global average. While Switzerland only
accounted for 1.2% of publications worldwide, these publications 90
US NL CH GB BE DK CA DE FR SE World
enjoyed high international attention.
Source: Bibliometric evaluation of research in Switzerland 1981–2013, report of State Secretariat
for Education, Research and Innovation, 2016.

80 81
No biomedical research without animal experiments Laboratory animals in Switzerland

Laboratory animals used in animal experiments requiring a permit

Even the most state-of-the-art technology is not yet able to pro-
vide an adequate picture of living organisms and the interplay
2,000,000 1,992,794
between organs. For this reason, animal experiments will also
remain necessary for the foreseeable future. In 2010, research- 1,600,000
based pharmaceutical companies in Switzerland signed up to a
1,200,000
charter committing themselves to compliance with the highest
standards of animal welfare both in law and in ethical terms. This 800,000
606,505
also includes efforts relating to the 3Rs in research1. The 3R
400,000
Research Foundation Switzerland2 has been supported by the

© Interpharma
research-based pharmaceutical industry for more than 25 years. 0
1983 1990 2000 2010 2014

In Switzerland, all procedures and actions involving animals for

Source: Animal experiment statistics 2014, Federal Food Safety and Veterinary Office, 2015.
experimental purposes have to be approved by the responsible
authorities. Every animal experiment is evaluated by an independ-
Laboratory animals by species
ent committee, which also includes members of animal welfare
organizations. Rats and mice were the most frequently used ani- Total demand in 2014: 606,505 (100%)
mals in 2014 and together with birds (incl. poultry) accounted for
about 88% of procedures. Since 1983, the total number of animals n Mice64.3%
used has been reduced by more than two-thirds from almost n Rats13.7%
n Birds (incl. poultry) 10.3%
2 million to 606,505 in 2014. Compared with the previous year, the
n Fish6.6%
number of animals increased by 2.8%. Around 30% of all labora-
n Cattle, sheep, goats, pigs,
tory animals were used in industry, 54% in universities and hospi- horses, donkeys,
tals. Compared with the previous year, 5,915 fewer animals (−3.1%) diverse mammals 2.3%
were used in industry in 2014. n A mphibians, reptiles,
invertebrates1.3%
n R abbits, dogs, cats 0.8%
n G uinea pigs, hamsters,

© Interpharma
other rodents 0.6%
¹ The research principle of the 3Rs is aimed achieving a reduction, n Primates0.04%
a refinement and the replacement of animal experiments.
Source: Animal experiment statistics 2014, Federal Food Safety and Veterinary Office, 2015.
2
www.forschung3r.ch

82 83
Fewer clinical trials Clinical studies in Switzerland

To study the efficacy, safety and quality of new medicines, pharma- Clinical trials definitively approved by Swissmedic for medicines

ceutical companies have to carry out clinical trials before products 400
363
are allowed onto the market. In these trials, studies are first carried 350
out in healthy volunteers (Phase I), then in a small number of 300
patients (Phase II) and finally in a larger number of patients (Phase 250
III). Only after this can an application for marketing authorization be 200 207
129
submitted to the medicines regulatory authority Swissmedic. Once 150 117
market approval has been granted, the new medicine must be 100 86
monitored in practice (Phase IV). 50 95 78
22 29
0 6

© Interpharma
Every clinical trial has to be approved by the responsible ethics 05 06 07 08 09 10 11 12 13 14 15
committee and definitively released by Swissmedic. The number of n  Total   n  Phase I   n  Phase II   n  Phase III   n  Phase IV
1

studies carried out is an indicator of the attractiveness of a research

Source: Swissmedic, 2016.
centre. In the last ten years, there has been a marked decrease in
1
T he total may differ from the sum of Phase I–IV trials because Phase 0
clinical research in Switzerland. Since 2005 the number of clinical
studies and observational studies have also been included in view of their
trials has declined substantially. This trend can be seen in all clinical small number.
trial phases, but it is especially marked in Phase I (–75%).

The master plan approved by the Federal Council in December

2013 with a view to strengthening biomedical research and tech-
nology provides for measures to counter this downward trend.
Amongst other things, the quality of training for doctors in clinical
research at universities and hospitals is to be improved. The Human
Research Act, which came into force at the beginning of 2014, aims
at speeding up the approval procedure for clinical trials in the ethics
committees.

84 85
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