SWITCH Individual and public health benefits

1. SWITCHIndividual and public health benefits October 2015

2. The benefits of switch • Better resource utilization in health systems: • Saves time on the management of self-treatable conditions • Reduces the prescribing of products available OTC • Allows resources to be redirected to conditions not suitable for self-care • Wider availability of OTCs can reduce the problem of people self-treating with prescription drugs • Benefits for patients • Reduces the need to wait for physician appointments and time required to attend appointments* • A range of conditions can be treated from the onset of symptoms • Time critical products can be accessed and taken early • Benefits for healthcare professionals: • Doctors spend less time managing self-treatable conditions • Pharmacists can make better use of their professional skills * Likewise, it improves access to physicians for those who are most in need

3. Switch supports self-care which supports healthcare systems “Healthcare systems in all regions are under pressure and cannot cope if they continue to focus on disease rather than patients; they require the involvement of individual patients who adhere to their treatments, make behavioural changes and self-manage” International Alliance of Patients Organisations, 2007

4. Supporting what people want “ People want to have a more active role in their own healthcare, including the decisions about what medicines to take. When it comes to access to self-medication, good information and support translate into empowered patients who can benefit fully from the opportunities of self-care and who can practice it safely and effectively with informed choice.” Report of the working group on promoting good governance of nonprescription drugs in Europe, June 2013

5. Helping to empower patients Non-prescription medicines play an important role since they offer economic as well as social benefits. Self-medication empowers people to treat or prevent short term or chronic illnesses which they consider not requiring the consultation of a physician, or which may be treated by the people after an initial medical diagnosis. Source: Communication from the European Commission of 10 December 2008 “Safe, Innovative and Accessible Medicines: a Renewed Vision for the Pharmaceutical Sector”

6. Addressing global chronic diseasesthrough switch “Without action, an estimated 388 million people will die from chronic diseases in the next 10 years. Each of us has a choice: whether to continue with the status quo, or to take up the challenge and invest now in chronic disease prevention.” WHO 2005. Preventing chronic diseases, a vital investment.

7. Addressing global chronic diseasesthrough switch • Treatment of tobacco dependence with NRT Tobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung diseases, and cardiovascular diseases. Tobacco smoking causes approximately 6 million deaths per year.

8.  Treatment of tobacco dependence with NRT • WHO Framework Convention on Tobacco Control (FCTC), Article 14: “parties must implement measures for the management and treatment of tobacco dependence, including pharmaceutical products such as NRT” • Evidence: the use of NRT increases the rate of success in quitting smoking and is cost effective • Cochrane Library, 2008 (7th update): all commercially available forms of NRT can increase people’s chances of stopping smoking. • NRT now included into the 16th Model List of Essential Medicines (early 2009).

9. Addressing global chronic diseasesthrough switch  Treatment of obesity with orlistat • Being overweight or obese increases risk for hypertension, coronary heart disease, diabetes and premature death. • In most countries, weight-loss drugs were and still are limited to prescription only.

10.  Treatment of obesity with orlistat • Orlistat is available without a prescription in Australia, New-Zealand, China, the Philippines, Singapore and the USA. • Orlistat approved as the first ever centralized switch in Europe in 2009. Obesity and weight management are now in the self-medication arena

11. Some other notable switches • Chloramphenicol eye drops- acute bacterial conjunctivitis. • Azithromicin- asymptomatic chlamydia for people over 16 who have tested positive for the infection and have no symptoms, and for their sexual partners. • Ella One - emergency hormonal contraception, on the basis that the safety of the drug is well-documented and emergency contraception is an area where time matters. • Sumitriptan - treatment of migraine, where fast action can stop the migraine before it takes hold • Tamsulosin - treatment of BPH with subsequent doctor diagnosis

12. Switch economic benefit studies • A number of studies from around the world have shown economic benefits associated to switch: • Savings in doctors’ time and health system costs • Increased consumer benefit such as not needing to wait for appointments or time for visiting the doctor • Sweden (2008): Research showed that a switch to nonprescription status cut the number of medical visits by up to 15-24% and prescriptions by anything between 6 and 70%, • A 2013 economic study estimated that migraine attacks across 6 EU Member States cost €582 million annually, and having a triptan available without a prescription would achieve savings of €75 million (13% of the overall direct economic burden of migraine).

13. Switch economic benefit studies  Australian OTC Value Study (2014) • The study examined the economic and budgetary impacts of switching 11 categories of common prescription medicines to Pharmacist Only status. • Could achieve savings of $2.1 billion (AUD) including a reduction of 17 million GP appointments • It also estimated the economic impact should 8 categories of present OTC medicines only be available on prescription. • Would lead to an incremental $3.8 billion (AUD) cost in doctors’ visits • Could exceed $10 billion (AUD) if taking the indirect costs to society into account

14. Switch economic benefit studies  Cough and cold (US study, 1992) • $750 million per year saved • Doctor visits fell by 110,000 a year • 16,500 fewer consultations for colds than fifteen years before • In 2004 a further US study found that nonprescription medicines to treat common upper respiratory infections could save $4.75 billion a year

15. Switch economic benefit studies  Heartburn (US study, 2009) • In the USA, OTC heartburn treatments include: antacids, H2-blockers, proton pump inhibitors. • Reduced doctor visits • saved patients an average of $174 in office visits and medication costs each year • Saved $750 million to the U.S. healthcare system

16. Summary – Benefits of Switch • Switch supports healthcare systems • Switch supports patients • Switch supports healthcare professionals