“Medicine increases life expectancy”

The Swiss population is taking more and more medication. According to the latest Swiss Health Survey, the percentage of people who had taken medicine over a seven-day period during the past year has risen from 38% to 55% in the past thirty years. The use of painkillers in particular has more than doubled since 1992. In this interview, Niklaus Meier, health economist at BFH’s School of Health Professions, explains the reasons for the increase.

The consumption of medicines in Switzerland has been rising for 30 years. Have we become a sick society?

No, the opposite is true. All in all, people’s health is very good and has improved significantly over the past 30 years. The simplest indicator of this is life expectancy, which has risen steadily over the decades, only experiencing a slight dip during the Covid pandemic. On average, we are getting healthier, not sicker.

What are the reasons for the rising consumption of medication?

We are getting older and older and there are better, more effective drugs available today to treat diseases. As people get older, they develop more illnesses, above all those of a chronic nature. New drugs have made the treatments for these illnesses more effective, which means that patients live longer and so have to take medication for longer.

This can be illustrated with a few numbers: in 2002, around 500,000 people in Switzerland were aged 75 and over. Of these, 11% were taking medication for cholesterol and 40% for high blood pressure. In 2022, the population aged 75 and over numbered around 800,000. Of these, 33% were taking medication for cholesterol and 55% for high blood pressure. The ageing of society, coupled with the increasing use of drugs to treat chronic diseases, is having a multiplicative effect.

Over one sixth more women than men regularly take medication. Why is that?

Women still live longer than men – nearly four years on average. And because the amount of medication consumed increases in old age, this fact is reflected in the statistics. It is interesting to note that there is hardly any difference in the consumption of medication between women and men aged 55 and over. Among 15- to 54-year-olds, on the other hand, more women take medication, especially painkillers. The reasons for this are no doubt complex.

Painkillers are particularly common: one in four people take pain medication. What is behind this?

For the most part, the reasons are the same as for high blood pressure, for example: more older people are taking more medication, especially for chronic illnesses. However, we note that the prescription of opioids has almost doubled since the turn of the millennium. This is not unproblematic due to the risk of addiction posed by these drugs. In the USA, we have seen that the over-prescribing of opioids has triggered a massive increase in addiction. That is worrying. As a society, we should keep a close watch on the use of opioids.

The Swiss population assesses its health as good. At the same time, more and more medication is being consumed. Isn’t there a contradiction here?

No, because medications are a major factor for a higher quality of life and life expectancy. Studies have shown that around one-third of the increase in life expectancy between 1990 and 2015 can be attributed to medication. The death rate from cancer and heart disease has fallen massively, thanks in large part to medication. However, this does not mean that the result is equally positive for all medicines.

So will the trend towards more medication continue?

I would assume so. We are getting ever older and research is ongoing. The authorisation of new drugs is likely to continue.

Medication is also a cost factor. To what extent do they make the healthcare system more expensive?

Medicines don’t particularly make the healthcare system more expensive. Their consumption is rising, as are healthcare costs as a whole. In recent years, medicines have consistently accounted for 10 to 11% of total costs. They have neither aggravated nor alleviated the cost problem.

There are ever more drugs for rare diseases. A disease is considered rare if less than five people per 10,000 are affected by it. Such medicines are often expensive. Are they a prime factor in the rising cost of healthcare?

Medications for rare diseases are not often prescribed, simply because the diseases don’t occur very frequently. This means that the cost of research and development has to be recouped from a smaller quantity of medications, which makes them expensive. But overall, these medications only account for a small proportion of healthcare costs.

However, this group of drugs is highly dynamic. Around half of new authorisations in recent years have been for drugs for rare diseases. Not that the patients are a marginal group: between 7,000 and 10,000 diseases are classed as rare, affecting just under half a million patients in Switzerland. From the patients’ point of view, every new therapy is good news. As a society, however, we have to ask ourselves how much the treatment of an illness should cost. We are faced with a dilemma that needs to be discussed from the conflicting angles of politics, medicine, economics and ethics.

Are there ways to curb the consumption of medications?

It would be tricky to call for the consumption of medicines to be reduced by a certain amount, as a linear reduction could have consequences for the health of the population. However, a review would certainly be appropriate for individual types of medication. Antibiotics, for example, are prescribed too often, sometimes even for viral infections against which they are no use at all. In oncology, treatments are sometimes continued even when it is already clear that they are unlikely to prolong the patient’s life and that it may not be in their best interests to continue the therapy.

At the level of the overall system, I see two main opportunities for making savings: in increasing the proportion of generics further, and in the pricing of medicines. Generics have a market share of 17% in Switzerland, while in Germany, for example, they account for 80% of the total volume. But it is also true that drug prices in Switzerland are in some cases significantly higher than those in neighbouring countries. So there is a good deal of potential savings to be made there.