US volume growth rebound - temporary swine flu effect?
• Q2 ’09 marked a turning point in US market TRx growth. In 2008 US
market volumes grew only 0.3%, an 18 year low. This slow growth
continued in Q1 ’09, with growth of 0.7%. Q2 ’09 marked a turning point
with growth accelerating up to 3.3%, and this faster pace has continued
into Q3 ’09, with growth of 2.9%.
• In our view the rebound in growth was at least in part a result of
swine flu concerns leading to increased physician visits, which in turn led
to greater prescribing of anti-infective and respiratory therapies.
• From the start of Q2 Physician visits for influenza-like-illness (ILI)
jumped to more than double the level seen in previous years, (Figure 1).
• The acceleration in growth between Q1 and Q3 has been mainly
driven by two categories, Systemic Anti-infectives and Respiratory.
• Systemic Anti-infectives (which includes anti-virals and antibiotics)
showed the largest acceleration in growth, increasing 16.8 percentage
points (pp), from -7.5% in Q1 ’09, to +9.3% in Q3 ’09. This category
accounted for 22% of total market growth in Q3 ’09.
• Respiratory showed the second largest acceleration, increasing 14pp to
+6.4% in Q3, contributing 15% of the total market growth in Q3 ’09. We
believe the acceleration is partly because Asthmatics use more preventer/
reliever doses when suffering from cold / influenza symptoms. We note
the category also includes cough medicines.
• Excluding these two therapy classes, the remainder of the market
slightly decelerated from Q1 to Q3, slowing 0.4pp to +2.1% in Q3,
though ex Anti-infectives and Respiratory the market did tick up 0.5pp
from Q1 to Q2 ’09, possibly from increased ILI physician visits leading to
more frequent re-fills for general primary care classes like statins. For full
details of growth rates by category see Table 1 on page 4.
• Bottom-line: Recent acceleration has largely been a temporary swine
flu effect, 2010 growth could be only +1% if the pandemic subsides.
From Q2 ’10 volumes will annualise against pandemic inflated ’09 figures.
If 2010 sees continuation of the current ILI level, we expect annualisation
to lead to growth of around +2%. If there is no pandemic ILI, volume
growth could decelerate further to around +1%.