Research and analysis

Life sciences competitiveness indicators 2023

Published 13 July 2023

Ministerial foreword

From:

• George Freeman, Minister of State in the Department for Science, Innovation and Technology
• Will Quince, Minister of State for Health and Secondary Care

We welcome the publication of the ninth annual life sciences competitiveness indicators (LSCIs) report, a suite of metrics demonstrating the UK’s performance in the ever more competitive life sciences sector and our position in global rankings. The data in this report predominantly provides data up to and including the years 2020 to 2022, which provides a description of the life sciences sector in the middle of the COVID-19 pandemic.

This edition of the LSCIs is being released at a crucial time given the creation of the Department for Science, Innovation and Technology (DSIT) by the Prime Minister in February 2023. The department was founded to deliver on government’s ambition to be a global science, research, and technology powerhouse for which life sciences will be a critical component. Alongside this, life sciences will be essential for delivering the Department of Health and Social Care’s goal of adopting the latest innovations to improve patient experiences in the NHS. The LSCIs will be a key document for monitoring the UK’s progress in these fields and ensuring the UK continues to be internationally competitive. This report empowers government to monitor and react to changes in the UK life sciences sector. Crucially, these metrics also allow us to monitor progress against the ambitions set out in the Life Sciences Vision – our plan to maintain and grow investment in science and research in life sciences over the next decade.

Identifying our strengths and areas for improvement through the LSCIs is crucial, as life sciences is a high growth, highly productive part of our economy, building on the UK’s collective expertise in research, academia, industry and healthcare to deliver benefits to the UK economy, health, NHS and patients. By ensuring a thriving life sciences sector we can create high-skilled jobs across the UK, help meet government R&D targets and cement the UK’s role as a science superpower. The sector is also crucial to the resilience of economies and societies, with a shift to preventative and population health against trends of ageing populations with multiple long-term conditions. This in turn will support the life sciences sector to help deliver on the Prime Minister’s key commitments of growing the economy and, through the acceleration of new innovations, reducing NHS waiting lists.

The LSCIs allow us to identify areas of strengths in life sciences and where we can harness opportunities for growth and innovation. The UK government has continuously performed highly in investing in health research and development (R&D), coming second only to the USA in budget allocations as of 2020 – demonstrating this government’s ongoing prioritisation of innovation in healthcare. The UK also continues to be one of the top countries producing high quality medical science publications showcasing the prestige and influence of our academic sector.

This report should be seen in the context of the wider clinical research landscape over the course of the COVID-19 pandemic, where the ecosystem in the UK had pivoted to delivering a range of clinical trials to evaluate vaccines and therapeutics for COVID-19. In the UK, over a million participants were recruited to COVID-19 research in the first year of the pandemic, many with considerable support from the life sciences sector, even if not formally badged as commercial trials. World-leading research into therapeutics such as dexamethasone and tocilizumab, COVID-19 vaccines, together with platform studies such as RECOVERY, REMAP-CAP and PANORAMIC have all made a significant contribution to the global understanding of COVID-19 and improvement of outcomes for patients worldwide.

The LSCIs also offer us an opportunity to examine where we would like to do better. For example, the LSCIs show that the UK has experienced a decline in ranking for the time taken to set up and approve clinical research in 2022. We are already taking action to help improve this. The government appointed Lord James O’Shaughnessy in February this year to carry out an independent review into UK commercial clinical trials. The review, published on 26 May, was commissioned to offer recommendations on how commercial clinical trials can help the life sciences sector unlock UK health, growth and investment opportunities, and how to resolve key challenges in conducting commercial clinical trials in the UK. Through our response, and as an initial first step, we have committed £121 million to make rapid progress on 5 headline commitments, with an emphasis on speed of delivery, transparency of clinical research data and easier recruitment.

To enable life sciences businesses to thrive in the UK, there needs to be an amenable, globally competitive business environment. In 2022, the UK saw a substantial drop in the estimated value of inward life sciences foreign direct investment. The LSCIs help us put this drop in context with other global business environments such as the USA, which also saw a substantial decrease in investment in 2022 compared to 2021. However, our newly announced biomanufacturing fund, which we hope will unlock further manufacturing investment in the UK, demonstrates that we are not complacent.

To continue the UK’s history as a powerful centre for science and research, the government announced a raft of measures in May 2023, backed by over £650 million in funding, to support investment, growth and innovation in the life sciences sector. As well as the decisive action on clinical trials mentioned previously, this package includes:

• publication of the ‘Pro-Innovation Regulation of Technologies Review on Life Sciences’ and the government response. This review of regulation in the life sciences sector, and the government response, commit to support skills, collaboration and data sharing between industry and regulators, and to create accelerated regulatory pathways for innovative products
• a new biomanufacturing fund to support manufacturing investments in the UK. This will particularly focus on delivering health resilience and ensuring we are better prepared for future health emergencies, supporting cutting-edge R&D and innovation
• scaling up the UK’s world-leading scientific assets through a new investment in UK Biobank. Dedicated funding will upgrade existing capabilities for this world-leading biomedical research resource
• a call for proposals under the Long-Term Investment for Technology and Science (LIFTS) initiative, providing up to £250 million to support successful proposals in mobilising institutional investment into the UK’s innovative science and technology companies
• ensuring we have the right skills to support the sector. This includes through an apprenticeship manual, securing the legacy of Cell and Gene Therapy Catapults skills pilots and funding to strengthen UK’s medicines manufacturing ecosystem to deliver the skills industry needs
• driving adoption through ‘Health Innovation Networks’ which will support our new Integrated Care Systems to get innovations and the most impactful technologies into the NHS
• demonstrating our ambition and delivering outcomes for patients through our Healthcare Missions. We will announce the Chairs and details of the Mental Health and Addiction Missions, as well as the Cancer Mission Chair
• taking steps to improve the supply of Life Sciences lab space through planning policy changes, including consulting on adding requirements to the National Planning Policy Framework
• signalling the government’s vision to continue to drive growth in the golden triangle with a route update on East West Rail (EWR). This includes the preferred route for the railway line between Bedford and Cambridge, creating opportunities for lab space and job creation, alongside opportunities for a locally-led new town at Tempsford

This wide-ranging package demonstrates that this government is committed to continue delivering on the commitments set out in the ‘Life Sciences Vision’. This report enables us to assess our progress to date, including against the   measures announced in May 2023, and we are confident that next year’s publication will continue to monitor our success.

Introduction

The life sciences competitiveness indicators (LSCIs) are a set of high-level indicators used to measure the performance of the UK’s life sciences sector by benchmarking the UK against comparator countries. The indicators are brought together from a range of different sources, including data already in the public domain, and commercially sourced data published for the first time via this report.

2023 publication updates

This is the ninth edition of the LSCIs. This year’s publication reports on the same suite of metrics as the previous 2022 report, which underwent significant changes from reports from 2021 and earlier following user consultation. The changes made to the 2022 report are summarised in the 2022 accompanying user guide.

While the list of metrics being reported on is identical to the 2022 report, there are some metrics which have not been updated in 2023 due to data availability:

• gross domestic expenditure on pharmaceutical R&D performed by business enterprises (UK only) as a percentage of GDP: this is due to the ONS Business enterprise research and development (BERD) 2021 statistics not providing an estimate for spend on pharmaceutical research and development (R&D). More details can be found on the ONS statistics page and in the relevant section on the research environment in this report
• number of people employed in manufacture of basic pharmaceuticals and pharmaceutical preparations and medical technology products: the source for the UK figures comes from a bespoke extract provided by ONS from their Business Register and Employment Survey (BRES). Due to disclosure reasons, employment figures for the relevant industries could not be published for the year 2021. More details are available in the production environment section of this report

Accompanying documents

The accompanying Life science competitiveness indicators 2023: user guide outlines the methodology behind the data used in this report. For each section of the report, it provides detail on:

• Changes to the metrics compared to previous LSCIs reports
• Data sources used for the metrics
• The methods used and what should be noted when interpreting the report

The accompanying Life science competitiveness indicators 2023: data tables provide the data used in this report in a spreadsheet format including data used in the visualisations.

The LSCIs are also accompanied by a Life sciences competitiveness indicators 2023: life sciences ecosystem, a visualisation and description of the main activities that contribute to a successful life sciences sector in the UK. This describes how these elements interact and generate value to achieve the twin goals of improving UK health outcomes and achieving economic growth. The document sets out the key actors in the sector conducting these activities and how the LSCIs measure progress against the ecosystem elements.

Other sources of UK Life Sciences data

The LSCIs form part of a suite of metrics to measure the strength of the UK Life Sciences sector in relation to comparator countries. Other data sources in this field include:

• OLS publishes the annual Bioscience and Health Technology Sector Statistics (BaHTSS) on the UK bioscience and health technology sector, providing a detailed analysis of the life sciences sector in the UK
• NICE publish an annual Innovation Scorecard. This reports the use of medicines and medical technologies in the NHS in England that have been positively appraised by NICE
• NHS England publishes the AAC Scorecard. This is an interactive dashboard that monitors the impact of AAC programmes across a wide set of measures, including the uptake of specific supported innovations. To gain access to the AAC Scorecard please contact england.irlsanalytics@nhs.net

Feedback

The Office for Life Sciences (OLS) will continue to review the publication content on an annual basis to ensure it continuously meets evolving user needs.

We welcome user feedback on this report, including suggestions for changes you would like to see in future. Please provide any comments you may have by emailing analysis@officeforlifesciences.gov.uk.

Summary of the UK’s performance in the LSCIs

Table 1: overview of the UK’s ranking in the LSCI metrics in 2023

Notes:

• the latest data point for each metric varies and is identified in the column ‘Latest year of data for the UK’
• all rankings are based on unrounded values
• difference in ranking does not necessarily indicate a statistically significant difference in performance for any given metric

Ecosystem element: research environment

Metric	UK (or constituent country) rank	Latest year of data for the UK	Position relative to previous period
Government budget allocations for health R&D as a percentage of GDP	2 out of 15	2020	up from 3
Gross domestic expenditure on R&D performed by the private non-profit sector as a percentage of GDP	7 out of 10	2019	no change
Gross domestic expenditure on R&D performed by the private non-profit sector as a percentage of GDP	4 out of 10	2019	up from 5
Gross domestic expenditure on medical and health sciences R&D performed by government as a percentage of GDP	6 out of 10	2019	no change
Gross domestic expenditure on pharmaceutical R&D performed by business enterprises (UK only) as a percentage of GDP	not available	2020	not available
Percentage share of patients recruited to a subset of commercial global studies	5 out of 10	2021	up from 6
Median time from clinical trial application to a regulatory authority and the first patient receiving a first dose for a subset of commercial trials	9 out of 10	2021	down from 7
Share of medical sciences academic citations	3 out of 12	2022	no change
Proportion of each country’s medical sciences publications which are amongst the most highly cited (top 1%) globally	1 out of 12	2022	no change
Life sciences patent applications per thousand population	4 out of 13	2020	up from 6

Ecosystem element: domestic market

Metric	UK (or constituent country) rank	Latest year of data for the UK	Position relative to previous period
Percentage of new medicines made available	England: 6 out of 13 Scotland: 7 out of 13	2018 to 2021	England: no change Scotland: up from 10
Median time to availability for new medicines	England: 6 out of 13 Scotland: 7 out of 13	2018 to 2021	England: no change Scotland: up from 9
Per capita uptake of new medicines – NICE approved (relative uptake against average comparator uptake 5 years after launch)	not applicable	2017 to 2021	not applicable
Number of CT scanners, MRI units and PET scanners per million population	16 out 16	2021	no change
Number of CT, MRI and PET exams per thousand population	not available	2021	not available

Ecosystem element: production environment

Metric	UK (or constituent country) rank	Latest year of data for the UK	Position relative to previous period
Number of people employed in manufacture of basic pharmaceuticals and pharmaceutical preparations	not applicable	2019	not applicable
Number of people employed in manufacture of medical technology products	not applicable	2020	not applicable
Gross value added for pharmaceutical manufacturing	5 out of 12	2020	no change

Ecosystem element: international collaboration

Metric	UK (or constituent country) rank	Latest year of data for the UK	Position relative to previous period
Global exports of pharmaceutical products	10 out of 20	2021	down from 9
Global exports of medical technology products	10 out of 20	2021	no change
Global imports of pharmaceutical products	10 out of 20	2021	no change
Global imports of medical technology products	7 out of 20	2021	no change

Ecosystem element: investment environment

Metric	UK (or constituent country) rank	Latest year of data for the UK	Position relative to previous period
Life sciences inward foreign direct investment – projects	5 out of 18	2022	down from 3
Life sciences inward foreign direct investment – estimated capital expenditure	9 out of 18	2022	down from 2
Share of global life sciences Initial Public Offerings	7 out of 27	2022	down from 6 out of 24
Amount raised in global life sciences Initial Public Offerings (where known)	10 out of 27	2022	down from 5 out of 24
Equity finance raised by life sciences companies	4 out of 20	2020	down from 3 out of 15

Ecosystem element: access to skilled labour

Metric	UK (or constituent country) rank	Latest year of data for the UK	Position relative to previous period
Percentage of graduates from tertiary education graduating from Natural Sciences, mathematics, and Statistics programmes, both sexes	2 out of 14	no change	2020

Main points on the UK’s performance in the LSCIs

Research environment

• while the UK government has a high budget allocation for health research & development (R&D), coming behind only the USA, the UK generally places around the centre of the rankings for R&D performed by government, higher education and private non-profit sectors
• the UK saw a decline in its global share of patients recruited to commercial trials in 2021 to 2.2% compared to 3.0% in 2020. The UK has also seen a continuous increase in the length of time taken to approve and set-up commercial clinical trials between 2018 and 2021 with the median time reaching 271 days in 2021, up from 222 days in 2018. Due to these increases, the UK now ranks ninth out of 10 comparators in set-up and approval times, a decline from seventh in 2020
• share of patients in commercial trials and the time taken to approve and set-up these trials up have been heavily influenced by the COVID-19 pandemic in the years 2020 and 2021. Many other comparators have seen decreases in these along with the UK
• amongst comparator countries, the UK, Italy and France were the leaders in terms of producing high quality research in medical sciences publications in 2022, with 2.0% of medical science publications being highly cited
• whilst the UK has seen a declining trend in the number of life sciences patents filed per 1,000 population between 2016 and 2020, the UK has risen to fourth up from sixth compared to other comparators due to a similar declining trend seen in other similar countries

Domestic market

• 66% and 64% of new medicines receiving marketing authorisation between 2018 and 2021 were made available to patients in England and Scotland, respectively. Whilst England has seen a minor decline in the proportion of medicines made available compared to the previous period, Scotland has seen a substantial increase from the previous period. For the period 2018 to 2021, England’s ranking remained at sixth since the previous period, 2017 to 2020, whilst Scotland’s ranking rose to seventh, up from tenth out of 13 comparator countries
• the median length of time for medicines approved between 2018 and 2021 to be made available to patients was 297 days in England and 336 days in Scotland. Whilst England’s time to availability has remained consistent over the previous 3 time periods, Scotland’s time to availability has improved compared to the previous period. For the period 2018 to 2021, England’s ranking remains at sixth since the previous period, 2017 to 2020, while Scotland’s has risen to seventh out of 13 comparator countries
• median uptake of medicines launched between 2017 and 2021 in the UK continues to be lower than the average of competitors between 1 year after launch through to 5 years after launch. The uptake ratio was 0.74 1 year after launch for this period, meaning average uptake was only around three-quarters of the average uptake of comparator countries
• in 2020, the UK continued to have fewer MRI units, CT and PET scanners than most comparator countries. Despite this, the number of these scanners increased over the same period by 4%, continuing the year-on-year increase since 2012. The number of exams performed in 2020 dropped by 14% in 2020 compared to 2019 but this was heavily influenced by the pausing of non-essential procedures during the COVID-19 pandemic.

Production environment

• pharmaceutical manufacturing GVA in the UK was $17.1 billion in 2020. The UK’s GVA was broadly similar between 2017 and 2019 but then saw a substantial increase from $14.4 billion to $17.1 billion between 2019 and 2020. Despite this increase, the UK’s ranking amongst comparators has remained consistent at fifth

International collaboration

• the UK’s export values for pharmaceutical products and medical technology products have increased by 6% and 16% respectively in 2021 compared to 2020 but are both still lower than the 9 comparator countries with the highest value of imports in 2021
• the value of the UK’s pharmaceutical imports is lower than all 9 comparator countries however the value increased slightly in 2021 after declining each year from 2018 to 2020
• in 2021 the UK’s value of medical technology imports reduced for the first time since 2016. Out of the 9 comparator countries, all saw an increase in their value of medical technology imports between 2020 and 2021

Investment environment

• the UK saw a substantial drop in the estimated value of inward life sciences foreign direct investment in 2022 compared to 2021, falling to £1 billion from £1.9 billion, a drop of 47%. This drop resulted in the UK falling to ninth out of 18 comparator countries in 2021, down from second in 2021. The USA similarly saw a substantial decrease between 2021 and 2022 but remained the country with the highest value of estimated inward FDI. Other countries such as Ireland, India and Switzerland saw substantial increases over the same period
• the UK saw a substantial drop in equity finance raised in 2022 to £3.3 billion down from £7.2 billion in 2021. The UK also saw a substantial drop in both the number of initial public offerings (IPOs), a type of equity finance, and associated amount raised. In 2022, the UK had £7.1 million raised through 3 IPOs compared to £751.5 million over 11 IPOs in 2021
• sharp declines were similarly seen across most comparators in equity finance and IPOs between 2021 and 2022 due to changes in the life sciences investment environment following the COVID-19 pandemic and because of broader economic factors

Access to skilled labour

• in 2020, 9.2% of UK graduates from tertiary education graduated from natural sciences, mathematics, and statistics programmes – this was the second highest proportion amongst comparator countries, behind only India
• whilst the UK maintained a ranking of second in 2020, the percentage of graduates completing these degrees substantially declined from 13.4% in 2019

Section 1: research environment

Research and development (R&D)

R&D can be measured by the expenditure on R&D performed by an organisation, or the amount of R&D funded by the organisation. Funding received to perform R&D can come from the organisation itself, organisations within the same sector or a separate sector of the economy.

More information on the flows between R&D funded and performed in the UK can be found in the Office for National Statistics publication on Gross Domestic Expenditure on R&D, covering R&D across all industries in the UK.

The LSCIs measure the amount of R&D relevant to life sciences performed by government, higher education, private non-profit, and business sectors. However, it should be noted that the R&D figures presented here are not comprehensive of all life sciences R&D due to data availability. Government budget allocations are also included, as this has less of a time lag and can provide early insight into R&D performance for sectors highly reliant on government funding, such as higher education.

An update to gross domestic expenditure on pharmaceutical R&D performed by business enterprises (UK only) as a percentage of GDP is not available for this report due to the ONS Business enterprise research and development, UK: 2021 statistics not publishing an updated figure relating to pharmaceutical R&D performed in 2021. This is due to further validation being needed on breakdowns below the UK level due to methodological changes in their BERD survey. More information can be found on the ONS BERD statistics page.

The UK government budget for health R&D has increased in 2020 after being broadly consistent between 2015 and 2019

Figure 1: government budget allocations for health R&D as a percentage of GDP

Note:

• data from figure 1 can be found in table 1 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• UK data for 2021 is unavailable

In 2020, the UK government’s budget for health R&D was £3.2 billion, which equated to 0.15% as a percentage of GDP. This ranked the UK second out of all comparator countries for the most recent data available (2021 for all countries except the UK and Canada), in terms of the proportion of GDP, behind only the USA.

Please note that no data for 2021 is available for the UK and the 2020 data has been revised upwards from the previous LSCIs publication. The previous edition reported that the budget allocation for health R&D was 0.12% of GDP, but that has been revised to 0.15%. This was due to additional data being submitted after data was extracted for the LSCI 2022 report.

The USA’s budget has consistently been the highest as a proportion of GDP of all comparator countries and has been increasing each year since 2015, however in 2021 the USA saw its first reduction in budgets for health R&D, as a proportion of GDP, from 0.23% to 0.19%.

South Korea has replaced Japan as the country with the third highest budget allocation as a percentage of GDP. South Korea’s budget has increased slightly from 0.10% in 2020 to 0.11% in 2021 whilst Japan’s budget decreased from 0.12% to 0.09% in the same period. The UK government’s budget for health R&D as a percentage of GDP has remained broadly similar between 2014 and 2020.

The UK generally places around the centre of the rankings for R&D performed by government, higher education and private non-profit sectors

Figure 2: gross domestic expenditure on medical and health sciences R&D performed by government and higher education sectors and all R&D for the private non-profit sector, as a percentage of GDP for 2019 or latest year available

Notes:

• data from figure 2 can be found in tables 2-4 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• figures for government and the higher education sectors relate to medical and health science R&D. For the private non-profit sector this relates to all R&D performed.
• the data labels in the chart are rounded to 2 decimal places but the bars represent their unrounded value
• figures where R&D as a percentage of GDP rounds to 0 at 2 decimal places are not included in the visualisation

In 2019:

• UK government institutions performed £267 million of medical and health sciences R&D, amounting to 0.01% of GDP. This is lower than most comparators, with countries such as Spain and Germany spending the equivalent of 0.07% and 0.04% of their GDP respectively on medical and health sciences R&D in 2019
• the amount of R&D performed by the UK private non-profit sector was £899 million, or 0.04% as a percentage of GDP, which placed the UK in the middle of the ranking of comparators. This measure includes all R&D by the private non-profit sector. In the UK, the private non-profit sector largely consists of registered charities and trusts that specialise mainly in health and medical research, but this is not necessarily the case in other countries, where private non-profit sector R&D figures may include a higher proportion of non-life sciences R&D
• the UK higher education sector performed £2.2 billion of medical and health sciences R&D, amounting to 0.10% of GDP. This puts the UK in the middle of the rankings with a lower percentage than countries such as the Netherlands and Germany but higher than countries such as Spain and Italy

R&D as a share of GDP performed by these sectors remained broadly consistent in the UK between 2014 and 2019. More details of which organisations are included in these sectors for the UK can be found in the accompanying Life sciences competitiveness indicators 2023: user guide in the section on Research and Development.

Previous LSCI reports have also reported on the amount of pharmaceutical R&D performed in the business enterprise sector for the UK only. Due to the changes described at the beginning of this section to the ONS BERD statistics, an update for this metric for data relating to 2021, is not available. The previous time series is still available below for reference but please note that revisions may occur in future releases of the ONS BERD statistics. The LSCIs will continue to report on these figures when they become available again from ONS with accompanying notes on any revisions that occur to past figures. OLS are also continuing to seek a source to allow international comparisons of business R&D spend for future LSCI reports.

Pharmaceutical R&D performed by industry has consistently accounted for around one fifth of all industry R&D performed between 2014 and 2020

Figure 3: pharmaceutical R&D and all other R&D performed by the business enterprise sector in the UK, current prices, up to 2020 only

Note: data from figure 3 can be found in table 5 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’.

The business sector in the UK performed £5.0 billion of pharmaceutical R&D in 2020, and this has mostly followed an upward trend since 2014, in current prices. Similarly, R&D performed on all other areas by the business sector has increased each year. As a result, pharmaceutical R&D was 30% higher in 2020 compared to 2014, and similarly R&D on all other areas was 36% higher.

As a result, pharmaceutical R&D has consistently accounted for around one fifth of R&D performed by industry between 2014 and 2020.

Pharmaceutical R&D performed by the business sector accounted for 0.23% of GDP in 2020 which is a modest increase from 0.21% in 2019.

This data is only presented for the UK whilst a suitable data source is found to allow appropriate international comparisons.

Clinical trials

Data on the following metrics is extracted from the Centre for Medicines Research (CMR) Global Clinical Performances Metrics, Clarivate:

• percentage of patients recruited to a subset of commercial global studies (all trial phases)
• median time between clinical trial application to a regulatory authority and the first patient receiving a first dose for commercial trials (all trial phases)

This includes data from 25 pharmaceutical companies that participated in data collection activities. As a result, this metric only includes commercially sponsored trials. This data also only considers interventional trials, where a medicine is tested in participants, and trials for novel medicines (newly launched medicines or recently launched for a new indication). The data considers all phases of trials. More details are available in the accompanying Life sciences competitiveness indicators 2023: user guide in the section on clinical trials.

The UK and most European comparators’ share of patients recruited to commercial trials has fluctuated with the USA continuously accounting for a substantially higher share

Figure 4: percentage share of patients recruited to a subset of commercial global studies for novel medicines (all trial phases)

Notes:

• figure 4 contains a chart for all comparator countries on top then a chart beneath with the USA excluded to allow trends in other countries to be visualised
• data from figure 4 can be found in table 6 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’

In 2021 the UK’s share of patients for a subset of commercial clinical trials for novel medicines was 2.2% (4,855 out of 225,613 patients), which is a decrease from 2020, when the UK accounted for a share of 3.0% of patients recruited to these trials. Whilst the UK’s share of patients has declined, this trend has also occurred in most other comparator countries. This puts the UK fifth out of 10 comparator countries, compared to sixth in 2020. The exception to this trend is the USA which saw a substantial increase from a share of 25.5% in 2020 to 34.2% in 2021.

In 2015, the UK saw its highest share in the period 2012 to 2021 at 4.2% but this then decreased each year until 2018 to a low of 1.9%. 2019 and 2020 saw a reversal of this trend and the UK’s share rose to 3.0% in 2020 before declining again in 2021.

All comparator countries outside of the USA accounted for less than a 5% of commercial clinical trial patients but Spain accounted for the highest share out of European comparators at 4.1%.

Most countries share has fluctuated year-on-year between 2012 and 2021 and data for 2020 and 2021 will have been substantially influenced by the COVID-19 pandemic. Many countries paused non-essential research and moved focus towards COVID-19 research which in the UK and other comparators was frequently non-commercially funded, which are not included in these statistics.

This metric only presents a subset of commercial trials to allow a standardised comparison between countries. For the UK this data relates to 106 clinical trials in 2021, the number of studies included for other countries and for past years is available in the accompanying data tables.

Data in table 2 from the National Institute of Health Research’s (NIHR) Clinical Research Network (CRN) shows how many patients were recruited to commercial interventional trials in the UK. The NIHR data does not include early phase trials in healthy volunteers.

Table 2: Number of interventional studies and number of patients recruited by commercial status in the UK

	2019/20	2020/21	2021/22	2022/23
Number of patients recruited	201,821	166,780	467,851	342,390
Commercial studies	14,807	28,114	18,124	19,984
Non-commercial studies	187,014	138,666	449,727	322,406
Number of interventional studies	3,091	2,613	3,171	3,262
Commercial studies	1,291	1,091	1,393	1,449
Non-commercial studies	1,800	1,522	1,778	1,813

The majority of patients recruited to interventional trials in the UK are recruited to non-commercial studies with 94% of patients in 2022/23 on non-commercial trials.

Time from application to first dose to first patient has been increasing in the UK and most comparator countries between 2018 and 2021

Figure 5: median number of days from clinical trial application to a regulatory authority and the first patient receiving a first dose for a subset of commercial trials for novel medicines (all trial phases)

Notes:

• the y-axis does not begin at 0
• data from figure 5 can be found in table 7 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• higher values equate to a longer time from application to first dose to first patient. Countries with lower values have a higher rank

The time from clinical trial application to first patient first dose includes the time taken for:

• regulatory approval
• set-up including recruiting patients

In 2021, the median time in the UK between a clinical trial application being submitted to a regulator and the first dose to first patient was 271 days for a subset of commercial trials. The median time has continued to increase year-on-year from 222 days in 2018. The USA continues to have the shortest turnaround time in 2021 with 159 days followed by Spain at 205 days.

The UK’s increase in median time to approve and set-up clinical trials resulted in it placing ninth in the rankings out of 10 comparators in 2021. This is a drop from seventh in 2020.

The median times in 2020 and 2021 were likely impacted by the COVID-19 pandemic, when many countries pivoted research efforts to COVID-19 research from other indications.

Every comparator country is now taking longer to approve and set-up clinical trials in 2021 compared to 2018 with other comparators such as Australia, Canada and Switzerland seeing particularly notable increases. Other countries such as the USA and Spain have also seen increases but to a lesser extent relative to comparators.

For the UK this data relates to 110 clinical trials in 2021, the number of studies included for other countries and for past years is available in the accompanying data tables.

The above data refers to the period up to the end of 2021, since then the Research Reset programme launched by the Department of Health and Social Care (DHSC) aims to restore research that has been impacted by the pandemic. The latest figures show that 73% of trials (both commercial and non-commercial) are now recruiting to time and target in May 2023 compared to only 23% in May 2022.

The number of studies in set-up, as a proportion of the overall portfolio, is now 20% as of May 2023, which is near pre-pandemic levels. However, a disproportionately high number of commercial studies are in set-up. 53% of the total number in set-up are commercial contract studies, whereas 31% of the whole portfolio (including open, suspended and in set-up) is commercial. Data on the Research Reset programme can be found at NIHR’s Research Reset webpage.

For the UK, clinical trials need to be approved by both the Medicines and Healthcare products Regulatory Agency (MHRA) and the Research Ethics Service (RES) supported by the Health Research Authority (HRA). As of 2022, all trial applications in the UK are subject to combined review from MHRA and HRA, however this will not be entirely reflected in the figures presented due to the data covering only the period to the end of 2021. Before 2022, applications could be initially submitted to either body, with the timelines for approval not necessarily being sequential or through the combined review process. The starting point for the UK takes the date for which body the applicant submitted to first if the trial was not reviewed through combined review.

Table 3 provides timelines for clinical trial approval from MHRA and HRA in the UK, and indicates the extent to which the median turnaround time can be attributed to regulatory approval, as opposed to the set-up of a clinical trial, including recruitment of patients. Data in table 3 is not directly comparable to the metric used for making international comparisons above (time from first application to first patient receiving a first dose). This is because table 3 includes all commercial Clinical Trials of an Investigational Medicinal Product (CTIMP) whereas data extracted from CMR only includes a subset of commercial trials for novel medicines.

Figures in table 3 are also not directly comparable to the length of time from first clinical trial application to a regulatory authority to first patient receiving a first dose and cannot be used to derive how much time is taken for approval compared to clinical trial set up and recruitment in the UK.

Table 3: median number of days for commercial clinical trial approval in the UK by whether they were reviewed through combined review

Year	2019	2020	2021	2022
Standard CTIMPs not reviewed through combined review	108	92	90	n/a
Standard CTIMPs reviewed through combined review	59	63	63	78

Table 4: number of commercial clinical trial applications reviewed through combined review

Year	2019	2020	2021	2022
Number of HRA Approval applications for CTIMPs that were reviewed through combined review	50	94	196	443

Notes:

• from 2022 onwards, all trials are now reviewed through combined review
• for standard CTIMPs the timeline is from first regulatory application to last regulatory approval. For combined review there is one application and one approval
• Health Research Authority (HRA) approval includes approval from Research Ethics Committees (REC) and Administration of Radioactive Substances Advisory Committee (ARSAC)

The figures in table 3 show that combined review results in shorter median approval times for commercial trials in the UK. Despite this, the median length of time to approve trials through combined review has increased to 78 days in 2022 compared to 63 in 2021. These figures are not directly comparable due to the increase in trials reviewed through combined review since all trials are now being reviewed through this method from 2022, as seen in table 4.

All clinical trial data in this section refers to all trial phases combined. Further comparisons for the UK by trial phase are available through data reported by the Association of British Pharmaceutical Industry (ABPI) on their facts, figures and industry data on clinical trials.

Citations

Citations data tends to take about 3 years after the publication to stabilise, so it should be noted that citation data presented here for more recent years, particularly for 2022, should be interpreted with caution and may be retrospectively backdated in future editions of the LSCIs.

The UK’s share of medical science citations has declined since 2017

Figure 6: percentage share of global medical sciences academic citations

Note: data from figure 6 can be found in table 8 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’.

This metric shows the share of global medical sciences academic citations held by the UK and its comparator countries (other G7 countries as well as Brazil, China, India, Russia, and Republic of Korea). Citation counts can be used to indicate the total citation impact of a country’s medical sciences publications.

In 2022, the UK’s share of global medical sciences academic citation counts was 11.7%, declining from 12.7% in 2020, which ranked it third amongst comparator countries behind the USA (30.8%) and China (22.8%).

The UK’s ranking fell from second to third in 2017 due to China’s share markedly increasing and the UK’s share declining slightly year-on-year. Whilst the USA has continuously accounted for the highest share of citations relative to comparators, there has been a declining trend in the USA’s share since 2011.

The UK has maintained the highest proportion of highly cited publications but this percentage has declined since 2020

Figure 7: proportion of medical science publications that are amongst the most cited (top 1%) globally

Note: data from figure 7 can be found in table 9 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’.

This metric indicates the proportion of each country’s publication which are among the most-cited globally within the field of medical sciences. This is calculated by taking the number of medical sciences publications for each country which are amongst the top 1% most cited globally as a proportion of that country’s total scholarly output (total publication count).

The share of global citation count indicates the volume of citations each country’s publications receive; this metric is a useful indication of how influential each country’s medical sciences publications are.

In 2022, 2.0% of the UK’s medical sciences publications were in the top 1% of the most-cited medical sciences publications globally. The UK’s percentage was the highest amongst comparator countries, with France and Italy seeing a similar percentage at 1.9%.

The UK has seen a decline in the proportion of the UK’s medical science publications that were highly cited from 2.8% in 2020 but the data shows similar declines for most comparator countries

Patents

The UK’s count of life sciences patent applications has declined slightly between 2016 and 2020

Figure 8: number of patent applications per thousand population

Notes:

• data from figure 8 can be found in table 10 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• it is known that substantial data is missing for China, and therefore the country’s figure is an underestimate

This metric shows the number of life sciences patent applications (adjusted for population) made from each country in each year. Applications are assigned to the country in which the applicant (either a company, a university, or an individual) is registered or based.

Although this metric is generally a good proxy of where and when innovative life sciences activity took place, it is important to note that the applicant address may be the address of a company’s head office, or the inventor’s home address, rather than the actual location of where the invention took place. This means that, in some circumstances, patents may originate from research and development that took place in a different country to the ‘applicant country’.

In 2020, the UK had 0.14 life sciences patent applications per thousand population, continuing the slight declining trend seen since 2016, when there were 0.2 applications per thousand population. Despite a slight decline in the applications per thousand population since 2016, the UK has risen in the rankings of comparator countries in 2020 to fourth up from sixth in 2019.

Several other comparator countries such as Switzerland, the USA and Germany have similarly seen this downward trend. Despite this, Switzerland has remained top of the rankings in between 2011 and 2020, with over triple the number of life sciences patent applications per thousand population in 2020 than any of the other countries included in this metric.

When measuring patenting activity, the Relative Specialisation Index (RSI) value can show the volume of patents filed in a given country in a specific field relative to overall patenting levels in that country.

An RSI value greater than zero indicates that a country has a higher share of a particular technology relative to its overall share of patent families. In 2020, the UK’s RSI value for life sciences patents was -0.30, indicating that disproportionately few life sciences patents are filed in the UK compared to other fields. Most comparators similarly had a negative RSI value for life sciences, but countries such as Canada and Brazil had a positive RSI of 0.47 and 0.42 respectively meaning more life sciences patents are filed there compared to other fields. The methodology for the RSI has changed since the publication of the LSCI 2022 report. More details on this change can be found in the accompanying LSCI 2023 user guide. The time series in this report has been backdated with the new methodology.

Section 2: domestic market

Access to pharmaceuticals

This report takes the analysis from the European Federation of Pharmaceutical Industries and Associations’ (EFPIA) W.A.I.T Indicators. A medicine being available in this analysis in England and Scotland is defined as when the National Institute of Health and Care Excellence (NICE) and the Scottish Medicine Consortium (SMC), respectively, have issued a positive recommendation as part of their technology appraisal processes. If the medicine was not evaluated by NICE or SMC, IQVIA sales data was analysed to determine if the medicine is available. Of the constituent countries of the United Kingdom, only England and Scotland are included in these figures due to data availability.

The time to availability takes the median length of time from central marketing authorisation in Europe to the below milestones for England and Scotland for the period 2018 - 2021:

• England: for medicines with a positive NICE recommendation, the accessibility date is the date of published final draft guidance (cancer medicines) or date of published guidance + 90 days (non-cancer medicines). Cancer medicines benefit from earlier funding. For the remaining medicines, the IQVIA sales data is analysed to determine month of routine availability.
• Scotland: for medicines with a positive SMC recommendation, the accessibility date is the date of published final guidance. For remaining medicines, IQVIA sales data is analysed to determine month of routine availability.

For the periods prior to 2018 to 2021, the below milestones were used:

• England: for medicines with a positive NICE recommendation, the accessibility date is the date of published final guidance (cancer medicines) or date of published guidance + 90 days (non-cancer medicines). Cancer medicines benefit from earlier funding. For the remaining medicines, the IQVIA sales data is analysed to determine month of routine availability.
• Scotland: for medicines with a positive SMC recommendation, the accessibility date is the date of published final guidance + 90 days. For remaining medicines, IQVIA sales data is analysed to determine month of routine availability.

These changes reflect cancer medicines in England having earlier access to funding from the date of published final draft guidance via the cancer drugs fund (CDF). Non-cancer medicines in England must be funded by the NHS within 90 days of a positive NICE recommendation. The removal of the 90 days for non-cancer medicines in Scotland reflects the ability for Health Boards in Scotland to fund medicines as soon as SMC Guidance is published. Due to this change comparisons between 2018 – 2021 and past periods should be made with caution.

The analysis is based on new medicines that received central marketing authorisation from the European Medicines Agency (EMA) within the associated time periods. Following the UK’s exit from the EU, from 2021 onwards, the MHRA are the sole regulator to approve medicines for marketing authorisation in the UK. The latest W.A.I.T indicator publication covers medicines approved by the EMA between 2018 and 2021 and will cover a period where the UK no longer uses EMA regulatory processes. The analysis for this period still uses the time from the EMA marketing authorisation date as opposed to the MHRA marketing authorisation date. Internal analysis has been carried out to check the impact of this and was found to only have minor changes on the median time to availability for both England and Scotland and would not change their rankings relative to European comparators.

The National Institute for Health and Care Excellence (NICE) adapted its priorities during the COVID-19 pandemic and paused appraisals of some new active substances. The rate of availability for England in the 2018 - 2021 period may therefore be understated and trends over time should be treated with caution. Other countries included in the report may have faced similar impacts.

For more information please see the access section of the accompanying Life sciences competitiveness indicators 2023: user guide.

The rate of availability for new medicines has declined slightly in England but risen in Scotland

Figure 9: percentage of new medicines that received central marketing authorisation between 2015 and 2021

Note:

• data from figure 9 can be found in table 11 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• note the y axis does not begin at 0

There were 168 new medicines in the analysis that received central marketing authorisation from the European Medicines Agency (EMA) between 2018 and 2021, 66% of these medicines were made available to patients in England. This proportion has declined in each period since 2016 to 2019, when 72% of medicines were made available. Despite this decline, England continues to rank sixth out of 13 comparators in the period 2018 to 2021, the same position as for medicines approved between 2017 to 2020.

63% of medicines with marketing authorisation received between 2018 and 2021 were made available to patients in Scotland. In contrast to England, this proportion has risen from 54% in the period from 2016 to 2019. This increase has resulted in Scotland ranking seventh out of 13 comparators, rising from tenth in the period from 2017 to 2020. As outlined at the beginning of this section, there has been a methodological change in the way the median time has been calculated for Scotland for the 2018 to 2021 cohort which may have influenced part of this increase.

Across European comparators, there is high variation in the proportion of medicines made available, with 88% of medicines available in Germany compared to only 39% in Ireland in the period 2018 to 2021.

More information on the differences between how medicines are reimbursed across Europe can be found in the World Health Organisation’s (WHO) report on Medicines reimbursement policy in Europe.

Time to availability for new medicines varies substantially across Europe with both England and Scotland placing around the centre of the rankings against comparator countries

Figure 10: median number of days between marketing authorisation and medicines being made available for medicines that received central marketing authorisation between 2018 and 2021

Notes:

• a higher median number of days indicates new medicines take longer to be available to patients in the respective country
• the marketing authorisation (MA) date is based on the EMA central marketing authorisation date except for Switzerland where local authorisation dates are used
• data from figure 10 can be found in table 12 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’

For medicines that received central marketing authorisation in Europe between 2018 and 2021, the median time from the marketing authorisation date to availability, referred to as the time to availability, was 297 days in England. The median time has remained consistent over the previous 3 time periods and England continues to rank sixth out of 13 comparators for the period 2018 to 2021.

For Scotland, the median time to availability for medicines approved between 2018 and 2021 was 336 days, compared to 384 days for medicines approved between 2017 and 2020. Due to this change, Scotland was ranked seventh out of 13 comparators in 2018 to 2021 compared to ninth in the previous period.

There have been changes in the way time to availability is calculated for England and Scotland for the period 2018 to 2021 compared to past time periods so comparisons should be treated with caution. These changes are summarised at the beginning of the access to pharmaceuticals section and the LSCI 2023 accompanying user guide.

Similarly to the proportion of medicines made available, there is high variation in the median time to availability, with a median time of 47 days in Germany in the period 2018 to 2021 compared to 438 in Ireland over the same period. In Germany, medicines are in principle available immediately after marketing authorisation with a health technology assessment running in parallel which can later restrict access.

More details on the definition for the length of time for medicines to become available is in the accompanying Life sciences competitiveness indicators 2023: user guide.

The Cancer Drugs Fund (CDF) was introduced in 2011 (and reformed in 2016) in England to provide earlier access to patients for innovative treatments. In 2022, the Innovative Medicines Fund was launched to provide a similar early access option for non-cancer medicines, but this will not yet be reflected in the data presented here as only medicines receiving marketing authorisation up to the end of 2021 have been considered.

Uptake of medicines

The uptake ratio measures the relative adoption of new medicines in the UK in contrast to other countries. The uptake ratio is a measure of relative uptake in terms of days of therapy (DOT) per capita for new medicines recommended by NICE and first launched between 2014 and 2020. A ratio of the UK DOT per capita to the average DOT per capita for comparator countries is calculated for each medicine, and then the median of these ratios is taken to summarise how uptake in the UK compares to other countries – this value is hereafter referred to as the uptake ratio.

An uptake ratio of 1 means the median UK per capita consumption (referred to in this report as ‘uptake’) is equivalent to the average uptake per capita in the comparator countries.

An uptake ratio of less than 1 means the median UK per capita consumption is lower than the average uptake per capita in the comparator countries. Conversely, an uptake ratio of greater than 1 means the median UK per capita consumption is greater than the average uptake per capita in the comparator countries.

The uptake ratio accounts for individual country population size, but not for need (number of cases and HTA authorities’ recommended coverage), standard clinical practice or total medicine spend in each country. It also does not adjust for the impact of different marketing or launch strategies in different countries. These factors are likely to have a substantial impact on uptake figures.

In many cases there is no consensus as to what the ideal level of uptake should be. As such, high or low usage should not be interpreted as good or bad performance in itself. Nonetheless, the uptake ratio with respect to an international benchmark may be used to understand how UK adoption of innovative products changes in the years following their introduction.

Uptake in the UK continues to be below the average of comparators

Figure 11: UK uptake (days of therapy) of new medicines, per capita, as a ratio of comparator countries average

Notes:

• the figures only include medicines with a positive NICE recommendation
• each line refers to the cohort of medicines with a launch date in the labelled years. The x-axis refers to the number of years after launch for each medicine in the cohort
• the figures are adjusted for population size between countries but not for other factors (such as disease prevalence and HTA authorities’ recommended coverage) which may influence differences in uptake

Data from figure 11 can be found in table 13 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’.

The comparator countries used to derive the uptake ratio are Australia, Austria, Belgium, Canada, Finland, France, Germany, Ireland, Italy, Japan, Netherlands, Spain, Switzerland, Sweden, USA.

For medicines launched between 2017 and 2021, the uptake ratio 1 year after launch was 0.74, meaning that the average uptake of new medicines per capita in the UK was lower than for comparator countries. This has fallen compared to the previous 2 cohorts, when this ratio was 0.81.

For medicines launched between 2017 and 2021, the uptake ratio fluctuates each year between 1 year after launch through to 5 years after launch. The uptake ratio increases to 0.82 2 years after launch before declining again in years 3 and 4. By 5 years after launch the uptake ratio has reached 0.97 but this figure should be interpreted with caution since only 5 medicines are used in the calculation. This is because very few medicines receiving HTA approval between 2017 and 2021 have had sufficient time to accumulate a full 5 years of data. Table 4 shows the uptake ratio values alongside the number of medicines in the calculations for each period.

For the previous 2 cohorts, the uptake ratio 5 years after launch was 0.79 and 0.85 for medicines launched between 2015 to 2019 and 2016 to 2020 respectively.

A median value for uptake is taken across all medicines for each country, to show broadly how UK uptake compares to other countries. It should be noted however that there is substantial variation between medicines for the average uptake in the UK compared to other countries. Each medicine is weighted equally in the analysis but the eligible patient population varies substantially for different medicines and between different countries.

Table 5: uptake ratios for the UK and number of medicines included in the ratio calculation

Measure	Launch year	Year 1	Year 2	Year 3	Year 4	Year 5
Uptake ratio	2015-19	0.81	0.72	0.72	0.68	0.79
Uptake ratio	2016-20	0.81	0.81	0.74	0.72	0.85
Uptake ratio	2017-21	0.74	0.82	0.74	0.69	0.97
Number of medicines in the analysis	2015-19	74	56	49	36	23
Number of medicines in the analysis	2016-20	72	52	39	26	14
Number of medicines in the analysis	2017-21	67	43	28	15	5

This report does not rank countries by their uptake of medicines due to the uncertainty around the ideal level of uptake for each individual medicine. This measure does not make inferences on what the UK’s ratio should ideally be but exists to provide information on how the UK is utilising new medicines compared to peers and how that is changing over time.

Availability and utilisation of diagnostic technologies

The UK continues to have lowest number of MRI units, CT and PET scanners per million population amongst comparator countries

Figure 12: Number of MRI units, CT and PET scanners per million population

Notes:

• data from figure 12 can be found in table 14 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• the chart visualises the 10 comparator countries with the highest number of scanners for the most recent year of data in addition to the UK, which has the lowest number of scanners out of 16 comparators
• for Australia this only includes equipment eligible for public reimbursement
• for Sweden scanners outside of hospitals are excluded
• for Switzerland scanners outside of hospitals are excluded for CT and PET scanners
• for the UK, scanners outside of hospitals are excluded for data relating to 2019 and onwards

This metric gives an indication of the differing levels of availability in the UK and comparator countries for 3 diagnostic technologies: computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET).

Whilst these technologies have an important function in medical diagnosis, it is important to note that there is no general international benchmark for the ideal number of CT scanners, MRI units or PET scanners.

The UK’s count of diagnostic technologies per million population have been presented alongside data for 15 comparator countries (the same 15 as used in the ‘uptake of medicines’ metric, see the section on uptake). Comparisons are drawn between countries based on their 2021 data (or nearest year, if 2021 data is not available).

For the combined number of CT scanners, MRI units and PET scanners in 2021, the UK had the lowest number per million population at 19.1 compared to all comparators. The UK has however seen an increase from 17.2 per million population in 2020, an increase of 11% which is the largest relative increase out of the 7 comparator countries which have data for 2020 and 2021.

The UK has also seen an overall upward trend between 2010 and 2020, although data for 2019 and after is not comparable to earlier data points as scanners outside of hospitals are excluded. PET scans are also not included in the total for data relating to 2010 to 2014 but these make up a small proportion of the total of scanners (3% in 2021). Japan has a substantially higher combined number relative to all comparators at 177.8 per million population as of 2020, an increase of 4% since 2017 .

Amongst comparator countries, Japan had by far the highest number of CT scanners and MRI units per million population in 2020 (115.7 and 57.4 per million population respectively). Meanwhile for PET scanners the USA ranked first with 5.8 per million population in 2020.

The UK had the lowest number of CT scanners (10.0), MRI units (8.6), and PET scanners (0.5) per million population in 2021 amongst comparator countries. Despite this, the UK has seen an increase of 12%, 10% and 25% in the number per million population for CT scanners, MRI units and PET scanners, respectively, compared to 2020.

Data for the UK only includes diagnostic equipment and scans performed in hospitals. The NHS is expanding the number of Community Diagnostic Centres (CDCs) to transform the way care is provided and delivery more convenient access to diagnostic procedures. There are ambitions to increase the number of CDCs up to 160 by March 2025 from 106 as of June 2023. These are expected to delivery more tests and capacity for diagnostic tests. As a result, the figures for the UK should be interpreted with caution against other countries as equipment in CDCs will not necessarily be captured in these statistics.

The UK performed a comparatively low number of diagnostic exams to comparators with most countries seeing a decline in 2020 due to COVID-19

Figure 13: number of diagnostic exams per 1,000 population

Notes:

• data from figure 13 can be found in table 15 of the accompanying ‘Life sciences competitiveness indicator 2023: data tables’
• for Switzerland and the UK exams conducted outside of hospitals are not included
• for Australia exams conducted on public patients are not included
• for the Netherlands privately funded exams are not included

This metric demonstrates the varying levels of diagnostic technology utilisation in the UK and comparator countries. Please note that the latest data for this metric relates to 2020, when the COVID-19 pandemic broke out and many countries paused non-essential procedures including diagnostic exams. This means the data reported for 2020 is not comparable to previous time periods and should be used with caution. Rankings have not been presented for this year due to the varying impact COVID-19 would have on each country’s diagnostic exams.

The UK’s count of diagnostic exams per 1,000 population is presented alongside that of 12 comparator countries – this is a subset of the 15 countries used for the international comparison of diagnostic technology equipment availability, as data for Japan, Sweden and Ireland was not available. Updated rankings for 2020 are not provided due to the lack of comparable data to past years due to the COVID-19 pandemic.

The UK performed 148.4 CT, MRI and PET exams combined per 1,000 population in 2020, a substantial decline of 15% compared to 2019. The decline in the UK will have been influenced by the pausing of non-essential exams during the pandemic. Several comparator countries saw a decline over the same time period, including the USA which previously performed the highest number of exams in 2019 by a substantial margin.

Prior to 2020, the number of exams performed in the UK had seen an upward trend since 2012 with a year-on-year increase up until 2019 with 62% more exams performed in 2019 compared to 2012. Despite this, the UK still performed a lower number of exams than all comparators over this period.

In 2020, 64% of the exams performed in the UK were CT scans, 34% were MRI scans and 2% were PET scans. CT scans similarly make up the largest share of diagnostic exams for all comparator countries, followed by MRI exams and then PET exams.

Section 3: production environment

An update to the metrics for employment in pharmaceutical and medical technology manufacturing is not available in this edition of the LSCIs. This is due to the inability to publish a figure for the UK from the underlying source, the ONS Business Register and Employment Survey (BRES), for disclosure reasons. The BRES survey was impacted by a low response rate in 2021 due to COVID-19. Future LSCI reports will update this metric when ONS are able to publish estimates for the relevant industries used in this report.

Manufacturing employment

Whilst no update is available for this metric since the 2022 LSCI publication, the commentary from past years has been reused for this report for reference on the latest figures available.

UK employment in pharmaceutical manufacturing has been increasing, up to 2019, but remains lower than several comparators

Figure 14: number of people employed in manufacture of basic pharmaceutical products and pharmaceutical preparations

Notes:

• no update has been provided to these figures since the 2022 LSCI report due to disclosure reasons outlined above
• data from figure 14 can be found in table 16 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’

The UK saw an increase in pharmaceutical manufacturing employment between 2016 and 2019 with employment of 32,200 in 2016 compared to 56,500 in 2019, a relative increase of 76%. This has resulted in the UK overtaking Spain and Switzerland to have the fourth highest employment in both 2018 and 2019.

Germany, France and Italy all have higher employment than the UK for the most recent data available (2020 for Germany and Italy, 2019 for the UK and 2017 for France). Germany has a substantially higher level of pharmaceutical manufacturing employment than comparator countries, with their 2019 employment figure being over 3 times that of the UK.

Figures presented only include employment in enterprises whose economic activity is classed as manufacture of basic pharmaceuticals and pharmaceutical products and will not consider all persons working in pharmaceutical manufacturing. Please see the accompanying Life sciences competitiveness indicators 2023: user guide for more details.

Whilst no update is available for this metric since the 2022 LSCI publication, the commentary from past years has been reused for this report for reference on the latest figures available.

Employment in medical technology has been stable in the UK up to 2020

Figure 15: number of people employed in manufacture of medical technology products

Notes:

• no update has been provided to these figures since the 2022 LSCI report due to disclosure reasons outlined above
• data from figure 15 can be found in table 17 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’

Employment in medical technology in the UK was 43,000 in 2020 with employment fluctuating between 2015 and 2020 with no clear trend. The UK has consistently ranked fourth amongst 12 comparators since 2010. Employment in 2020 in the UK was 14% lower compared to the peak seen of 49,700 in 2008. Similar to pharmaceutical manufacturing, Germany, France and Italy all continue to have substantially higher employment than the UK. Germany has substantially higher employment than all other comparators with employment being nearly 3 times higher than the next nearest comparator, Italy.

Figures presented only include employment in enterprises whose economic activity is classed as manufacture of irradiation, electromedical and electrotherapeutic equipment and manufacture of medical and dental instruments and supplies.

Therefore, this will not consider all persons working in medical technology manufacturing. Please see the accompanying Life science competitiveness indicators 2023: user guide for more details.

GVA for pharmaceutical manufacturing

The UK’s pharmaceutical manufacturing GVA ranks fifth compared to comparators

Figure 16: GVA for pharmaceutical manufacturing in 2021 (or latest year), constant prices, base year 2015 ($ million)

Note:

• data from figure 15 can be found in table 18 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• 2021 data is unavailable for the UK, Germany and Spain so 2020 data has been used
• 2021 and 2020 data is unavailable for Switzerland so 2019 data has been used

GVA measures the contribution to the economy that an industry makes. GVA is calculated as either the value of outputs from production minus the value of the inputs used, or revenue from pharmaceuticals minus the costs of production.

The UK’s GVA for pharmaceutical manufacturing was $17.1 billion in 2020. The UK’s GVA was broadly similar between 2017 and 2019 but then saw a substantial increase from $14.4 billion to $17.1 billion between 2019 and 2020. Despite this increase, the UK’s ranking amongst comparators has remained consistent at fifth.

The increase in GVA seen in 2020 for the UK was likely influenced by the COVID-19 pandemic when there was an increase in life sciences activity due to the efforts to develop treatments for COVID-19.

The USA has a substantially higher GVA for pharmaceutical manufacturing than all comparators at $164.1 billion in 2021, with 3 times the value of the next highest comparator, Switzerland.

Section 4: international collaboration

Export and imports of pharmaceuticals and medical technology products

The value of the UK’s export of pharmaceutical products increased in 2021 following 5 years of decline

Figure 17: value ($ million) of global exports of pharmaceutical products

Notes:

• data from figure 17 can be found in table 19 of the accompanying ‘Life science competitiveness indicators 2023: data tables’
• data for Switzerland includes Liechtenstein
• data for China includes Hong Kong and Macau

In 2021, UK exports of pharmaceutical products were valued at $27.7 billion. After 5 consecutive years of decreasing pharmaceutical product exports the 2021 value represents a $1.7 billion (6%) increase compared to the previous year. However, the export value in 2021 is still 25% lower than the peak of $36.7 billion in 2015.

The UK ranked tenth amongst comparator countries for exports of pharmaceutical products in 2021. Germany and Switzerland have consistently been the top 2 exporters in recent years, with Germany in particular experiencing rapid growth with a 19% increase in 2021 compared to the previous year.

The USA and China saw the largest relative increases in the value of pharmaceutical exports in 2021 compared to 2020, with relative increases of 43% and 121% respectively. As a result, the USA overtook Ireland to occupy third place amongst the selection of comparator countries and China rose to seventh place compared to thirteenth in the previous year.

The UK had a substantially lower value of exports for medical technology products despite seeing notable increases between 2016 and 2021

Figure 18: value ($ million) of global exports of medical technology products

Notes:

• data from figure 18 can be found in table 20 of the accompanying ‘Life science competitiveness indicators 2023: data tables’
• data for Switzerland includes Liechtenstein
• data for China includes Hong Kong and Macau

The value of UK exports of medical technology products in 2021 was $5.4 billion, an increase of $0.7 billion (16%) since 2020. The UK saw a small decrease in the value of medical technology exports in 2016 and has experienced notable and consistent growth since then.

In 2021, the UK ranked tenth amongst comparator countries in terms of value of medical technology exports, which is the same position as in 2020. The USA and Germany have consistently been the top exporters of medical technology products since 2011, and after a decline in the USA’s value in 2020, the country saw the largest absolute increase in export value between 2020 and 2021, increasing from $35.1 billion to $38.0 billion. Ireland saw the largest relative growth in export value between 2020 and 2021, increasing by $1.7 billion (relative increase of 27%) from $6.3 billion to $8.0 billion.

The value of UK imports of pharmaceutical products increased slightly in 2021 compared to 2020 but was still over 20% lower than the peak in 2014

Figure 19: value ($ million) of global imports of pharmaceutical products

Notes:

• data from figure 19 can be found in table 21 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• data for Switzerland includes Liechtenstein
• data for China includes Hong Kong and Macau

In 2021, the value of UK imports of pharmaceutical products was $27.5 billion, placing the UK tenth amongst the selection of comparator countries. Despite this representing a small increase of $0.6 billion since 2020, it is a decrease of $7.3 billion, or 21%, from $34.7 billion in 2014.

Prior to 2021, the UK had seen an overall downward trend in the value of imports of pharmaceutical products between 2014 and 2020.

The UK had a pharmaceutical products trade surplus of $0.2 billion in 2021 (meaning that UK exports exceeded UK imports by $0.2 billion) and this was the first year where the UK had a trade surplus since 2015. Most other comparators have seen an upward trend since 2014 in contrast to the UK. The USA and Germany continue to have a substantially higher value for pharmaceutical imports and they were also the countries which saw the largest absolute growth in imports between 2020 and 2021, increasing by $12.3 billion and $10.6 billion respectively.

The value of UK imports of medical technology products declined in 2021 whilst the value for most other comparator countries increased

Figure 20: value ($ million) of global imports of medical technology products

Notes:

• data from figure 20 can be found in table 22 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• data for Switzerland includes Liechtenstein
• data for China includes Hong Kong and Macau

The value of UK imports of medical technology products in 2021 was $6.3 billion, a reduction of $0.6 billion (9%) since 2020. There had been a continuous increase in UK medical technology product imports between 2016 and 2020 and 2021 was the first year since 2016 where there had been a decline. Out of the 9 comparator countries with the highest value of imports in 2021, all saw an increase in their value of medical technology imports between 2020 and 2021.

In 2021, the UK ranked seventh amongst comparator countries for the value of medical technology products imports. The UK has remained in the same position in the rankings for each of the 11 years prior to 2021.

The USA has a substantially higher value for medical technology imports than all other comparators. In 2021, the USA’s imports were valued at $44.2 billion, over double that of the comparator country with the second highest value, China, whose exports were valued at $17.9 billion.

Section 5: investment environment

FDI

FDI is an investment from a foreign investor into an enterprise in a different country. The entity then becomes an affiliate enterprise, which is either a subsidiary, branch, or an affiliate company of the parent company – the foreign investor. In practical terms, a foreign company can either set up a version of itself in the country or can acquire/merge with an existing company.

The FDI data in this report however only includes situations where a foreign company has set up a new entity in the UK and doesn’t include mergers or acquisitions. The data also only includes publicly available data on FDI projects and therefore underestimates global FDI. More information can be found in the accompanying ‘Life science competitiveness indicators 2023: user guide.

This indicator is based on fDi Markets data available at the industry Cluster level definition for ‘Life Sciences’, which includes projects in pharmaceuticals, biotechnology, medical devices as well as some projects in adjacent sectors such as healthcare, software and IT, business services and various other industries where fDi Markets has tagged these projects as life sciences.

The UK’s ranking has fluctuated since 2011 but with a substantial decrease in 2022 compared to 2021

Figure 21: life sciences inward foreign direct investment – estimated capital expenditure (£ million)

Note: data from figure 21 can be found in table 24 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’

The value of FDI comes from capital expenditure collected from fDi markets data. Some projects do not have a known value for capital expenditure and this is estimated by fDi markets.

In 2022 the value of estimated inward FDI into the UK was at £1.0 billion which is a reduction of £0.9 billion compared to 2021. The UK’s ranking fell from second to ninth between 2021 and 2022. Despite a 37% decrease in inward FDI in 2022 compared to 2021, the US remains at the top of the rankings with a value of £4.3 billion in 2022. Ireland’s inward FDI more than doubled between 2021 and 2022 from £1.5 billion to £3.7 billion and as a result, it ranked second amongst comparator countries in 2022.

The FDI data has likely been impacted by the COVID-19 pandemic through the years 2020 to 2022. Investment into life sciences companies to accelerate research into COVID-19 occurred with the number of projects and associated value likely to be declining as of 2022.

This data uses the fDi markets definition of ‘life sciences’ and as a result some projects included do not necessarily align with the definition of life sciences considered in the Office for Life Sciences official statistics on Bioscience and Health Technology Sector Statistics (BaHTSS). In 2021, there was a substantial investment into the UK that would be considered healthcare and outside of the scope of the BaHTSS definition of life sciences. Despite this, the fDi data provides a consistent definition across countries to allow for international comparisons.

The value of estimated inward FDI in 2022 was generated from 47 projects in the UK which was similar to 2021 when there were 49 projects. The USA had the highest number of projects in 2022 at 164. India, Ireland and Germany all saw a higher number of projects compared to the UK in 2022 but this is highly volatile year on year.

Equity finance raised by industry

Industry investment in this report refers to the amount of equity capital raised by the issuing of new shares by life sciences companies. The amount includes equity raised by private and publicly listed companies that has been publicly disclosed (private companies do not always disclose capital raises). One type of equity financing is Initial Public Offerings (IPO) which are also reported on in the section on Initial Public Offerings.

The data for both equity finance and IPOs in this report includes companies who have previously listed on a stock exchange relisting on a different stock exchange. The relisting value will also be included in the figures in this section. More details can be found in the accompanying ‘Life science competitiveness indicators 2023: user guide’.

Equity finance raised in 2022 dropped substantially in most countries compared to 2021

Figure 22: equity finance raised by life sciences companies, (£ million, currency translations at historic exchange rates)

Notes:

• data from figure 22 can be found in table 25 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• figures for China include Hong Kong

Equity finance raised by the UK life sciences industry fell to £3.3 billion in 2022, down from £7.2 billion in 2021, a decrease of 54%. A similar substantial decrease was seen in most countries globally due to high investment in life sciences companies during the COVID-19 pandemic which in 2022 returned to levels seen prior to 2020 and the impact of wider economic factors.

Despite the substantial decrease seen in equity finance raised in the UK, its place relative to other comparators fell slightly to fourth in 2022 down from third in 2021. The USA and China, whilst also seeing a similar decline between 2021 and 2022, still raised substantially more equity finance against comparators with £53.5 billion and £23.3 billion raised respectively.

The decline seen in 2022 has returned the UK to similar levels seen in 2018 for equity finance raised.

IPOs

An IPO describes the act of a company offering their stock on a public stock exchange for the first time. An IPO allows a company to raise capital from public-market investors and enables its shares to be traded after the listing. A publicly listed company is more likely to increase its activities in the country where it is listed.

The data in this report includes companies that have previously listed on one country’s stock exchange and then relisted on another country’s. Both the initial offering and the relisting are included in these figures if in the referenced time series.

The value raised in IPOs in the UK and most comparators has substantially fallen between 2021 and 2022

Figure 23: amount raised (where known) in life sciences Initial Public Offerings (IPOs) (£ million, currency translations at historic exchange rates)

Notes:

• data from figure 23 can be found in table 27 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’
• figures for China include Hong Kong

The value of an IPO is determined by the amount of money it raises, which generally reflects the valuation of the company, and its growth prospects. IPOs are also one type of equity finance so the values for IPOs are included in the equity finance figures in this report.

In 2022, UK IPOs in life sciences raised £7.1 million from 3 IPOs, a notable decline from the £751.5 million over 11 IPOs raised in 2021. As with equity finance overall, this trend has been seen in other countries globally due to the spike in investment seen in life sciences companies around 2020 and 2021 due to the COVID-19 pandemic.

The £7.1 million raised in the UK for 2022 is the lowest amount seen since 2018 but both the number of IPOs and amount raised has been highly volatile since 2010. The USA saw both the highest absolute drop in 2022 compared to 2021, with the value raised falling to £1.7 billion down from £14.6 billion in 2021, a fall of 88%. This has resulted in China overtaking the USA in 2022 to first in the rankings for the first time since 2017. South Korea had the highest relative decrease over the same period at 92%.

The UK now ranks tenth relative to comparators in 2022, down from fifth in 2021 but it should be noted that most countries only had a small number of IPOs in 2022. The USA, China and South Korea accounted for 75% of the IPOs in 2022 and 97% of the amount raised.

Section 6: access to skilled labour

The UK continued to rank second but saw a substantial decline in 2020 compared to 2019 for the proportion of graduates from life sciences fields

Figure 24: percentage of graduates from tertiary education graduating from natural sciences, mathematics, and statistics programmes, both sexes (%)

Note: data from figure 24 can be found in table 28 of the accompanying ‘Life sciences competitiveness indicators 2023: data tables’.

Tertiary education comprises undergraduate degrees (or equivalent) and above - this metric shows the percentage of graduates from tertiary education graduating from natural sciences, mathematics and statistics programmes.

UNESCO data for 2021 is not available for all countries so 2020 data has been taken as the most recent data point. Where 2020 isn’t available, rankings have been made using the most recent year of data that is available.

The UK has a high proportion of graduates completing degrees in natural sciences, mathematics and statistics against comparators, ranking second and behind only India in 2020. Whilst the UK has a high percentage compared to other countries, there was a steep decline in the percentage of graduates completing these programmes between 2019 and 2020. In 2020, 9.2% of graduates completed degrees in these fields compared to 13.4% in 2019.

In addition to the number of graduates, the number of life sciences apprenticeships started each year in the UK can be a measure of the sector’s skills base. In the financial year 2021/22, the number of life sciences apprenticeships started was 1,370, an increase of 25% compared to the previous financial year. The number of starts has broadly followed an upward trend since 2017-18, with only a small decrease seen between 2019/20 and 2020/21.

400 of the life sciences apprenticeships started in 2020/21 were level 6 or 7, approximately equivalent to a bachelor’s or master’s degree. This accounted for 29% of all starts in 2021/22, a proportion that has continuously increased since 2017/18.

The full time-series on the number of starts in life sciences apprenticeships in the UK can be found in this report’s accompanying ‘Life sciences competitiveness indicators 2023: data tables’. Details on the data source used and the selection of apprenticeship types to represent ‘life sciences’ can be found in the accompanying ‘Life sciences competitiveness indicators 2023: data tables’.

Annex A: statistics on pharmaceutical expenditure

The LSCI 2022 report undertook a review of whether a metric should be developed on pharmaceutical expenditure. The result of that review found that there were not currently any suitable data sources that would allow a global comparison for the UK.

How pharmaceutical expenditure influences the goals of improving health outcomes and economic growth (recognising that spend on pharmaceuticals may displace other healthcare provision), was also not evaluated as part of the LSCI review in 2022. Despite this, monitoring pharmaceutical expenditure can also be useful context for understanding how much value for money countries are getting for their spend. This should be looked at within the context of uptake and access to medicines.

For the LSCI 2023 report the above assessment remains the same so no indicators are present on pharmaceutical expenditure. References to some sources of expenditure are signposted below for interested users.

International sources

Various sources in the public domain attempt to quantify expenditure on pharmaceuticals at an international level, including for the UK:

• OECD’s pharmaceutical spending as a percentage of healthcare spending
• IQVIA’s report on Drug Expenditure Dynamics 1995 – 2020

The OECD statistics only include expenditure on retail pharmaceuticals (i.e. community pharmacies), including prescription and over the counter medicines. Medicines consumed in hospitals and other healthcare settings are excluded. Final expenditure on pharmaceuticals includes wholesale and retail margins and value-added tax, where applicable. Total pharmaceutical spending refers in most countries to ‘net’ spending, i.e. adjusted for possible rebates payable by manufacturers, wholesalers or pharmacies. The OECD statistics are collected from countries in accordance with the framework described in A System of Health Accounts.

IQVIA’s report includes estimated spend for pharmaceuticals in both hospitals and other health care settings in addition to retail pharmacy.

IQVIA’s data source for the UK is based on the Department of Health and Social Care (DHSC) and Association of British Pharmaceutical Industry (ABPI)’s joint Waterfall Analysis of UK medicine sales 2018-21. This analysis estimates the residual between:

• branded medicines sales at list price (IQVIA data) for medicines supplied to the NHS across the UK
• sales of branded medicines net of all discounts and distribution costs, but not including the payment made by industry through the VPAS or Statutory Scheme (SS). The net sales data comes directly from VPAS company returns or adjusted IQVIA parallel import data, and will not include VAT, centrally procured vaccine sales (which are excluded from VPAS) or distribution and supply chain elements

The ‘discount/residual’ is the difference between spend at list price and net sales revenues accruing to companies. This difference can be accounted for by distribution costs, pharmacy margins, and discounts off list price; more information is available in the Waterfall Analysis.

The IQVIA analysis takes the sales of branded medicines net of all discounts and the payments made by industry through the VPAS or Statutory Scheme (SS). IQVIA additionally add data for over-the-counter medicines to this total from their data. True net NHS spend is likely to include a proportion of the discount/residual amount, but this is not quantified in the waterfall model. These figures therefore do not account for the additional discount/residual and are likely to understate net spend by the NHS.

IQVIA’s methodology differs for other countries and is summarised in the table on page 35 of the report.

Domestic sources

In addition, the NHS Business Service Authority (NHSBSA) publish official statistics for England on the Prescribing Costs in Hospitals and the Community. Prescribing Costs in Hospitals and the Community (PCHC) shows the actual costs paid for drugs, dressing, appliances, and medical devices which have been issued and used in NHS hospitals in England. This is alongside the cost for the same classes of items that have been issued in other settings in England. This includes:

• prescriptions issued by GP practices and community prescribers in England that have been dispensed in the community in the UK (excl. Northern Ireland)
• prescriptions issued by Hospitals in England that have been dispensed in the community in the UK (excl. Northern Ireland)
• prescriptions issued by dental practitioners that have been dispensed in the community in the UK (excl. Northern Ireland)
• medicines issued in hospitals in England that have been dispensed via the hospital pharmacy, homecare companies and outsourced out-patient pharmacy partnerships

but excludes:

• prescriptions issued through Justice and Armed Services health services in England commissioned by NHSE but not dispensed in the community, this covers pharmacy, appliance, Dispensing Doctors (DD) and Personally Administered Items (PADM).
• any medicines issued in hospital in England but not managed via the hospital pharmacy service

Information on how this data is collected can be found on NHSBSA’s accompanying methodology note.