From collaborating with authorities to tackling awareness surrounding mental illnesses, Altan Gorseval, country manager of Lundbeck Turkey, paints an accurate picture of the company’s dedication to improving mental health and patient outcomes in the country.

What have been your strategic priorities for Lundbeck Turkey over the past two years?

Our strategy in Turkey ties in tightly with the global priorities of our company – namely increasing efficiencies and improving the effectiveness of our organization as well as focusing on improving the lives of the patients with brain diseases.

Initially, we were part of the Asian sphere of Lundbeck operations and reported to the Asian regional headquarter. In 2016, we became part of the southern business area of Europe regional headquarter, which covers Greece, Bulgaria, Slovenia, Croatia, Israel, and Turkey. Turkey is one of the biggest countries in this business area. As newly appointed country manager, my major task has been to improve the efficiency in the company which includes a restructuring in the organization.

At Lundbeck Turkey, we employ a collaborative culture, the team multitasks well, and following a challenging first year after the organizational changes, we developed new competencies in tackling issues effectively. Lundbeck is a specialized company dedicated to the treatment of brain diseases always focusing on improving the lives of the patients. Lundbeck is also proud to be a company being unique with regards to respect to the balance of private and professional life for our employees. To achieve greater effectiveness with a smaller team, we empowered our employees to make decisions within their business responsibilities, by increasing their autonomy and their operational scope. Fundamentally, we must all be experts in what we do, but we cannot reach this point without thorough training and empowerment.

In 2016, upon appointment as country manager, we launched our new antidepressant Brintellix® (vortioxetine hydrobromide). We were the market leader in depression with Cipralex and Cipram before this launch, but we were also facing increasing competition. It is not easy to change patients’ and physicinas’ routines, particularly when dealing with mental-health medicines; nonetheless, our product is unique in that it is effective both in mood and cognitive symptoms of depression leading to functional recovery which is the ultimate treatment target in depression. Functionality, although a rather new concept in the market, is crucial in everybody’s life and the product is unique in improving/restoring the functionality in patients with depression. Brintellix is now an important alternative for the patients and is more and more prescribed by the physicians.

How were you successful in launching the product?

A combination of factors led to a successful launch. As Brintellix is the only product with proven efficacy both in mood and cognitive symptoms leading to functional recovery in patients with depression, we started to actively engage the stakeholders to prepare the market for the functionality concept.

In Turkey, reimbursement is challenging and can be time consuming. That said, the CNS therapeutic area is largely reimbursed in Turkey, while – in comparison – certain countries consider these products as secondary, or they only receive partial reimbursement. Obtaining reimbursement for Brintellix® (vortioxetine hydrobromide) was however particularly complex given that awareness of mental illness is still low amongst the Turkish ecosystem and the authorities. Depression is not always considered a ‘real disease’, but it is just as harmful as diabetes, hypertension, or any other significant chronic disease. In fact depression is considered as the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease by the WHO.

Consequently, we try to fight against this stigma and are obliged to explain to the authorities that our product brings additional advantages to the lives of the patients During the pre-reimbursement phase, all our employees worked collaboratively to obtain market access and to get the project over the line.

How important is the CNS therapeutic area in Turkey, particularly given that 50 percent of the population is under the age of 31?

Based on statistics, 8.3 to 8.5 percent of the population is over 55. This figure will rise to 11 percent by 2020, and 25 percent by 2080, which is a long time, but, for the UN, any country over 18 percent is considered as an older population. In Turkey, we are at a turning point from a young population to and ageing population. The afflictions of mental illnesses worsen with age, and Lundbeck works not only with depression, but also improving the lives of patients with some other important brain diseases such as Alzheimer’s, Parkinson’s, and schizophrenia. We collaborate with the authorities to underline the importance of brain diseases, but there is still a long way to go.

Ultimately, all issues revolve around the financials. Cost is always very important, but the price is not just the final figure attached to the label. We must consider other expenses, including disability and the burden of the disease. In this regard, recent studies forecast that depression will be the number one global disease burden by 2023 and heart disease will be second— and we must be prepared for this eventuality.

Turkish doctors see high numbers of patients daily. When a doctor sees 100 patients a day, on average, how realistic is effective diagnosis of a CNS disease?

Many years ago, I worked as a doctor, and I sympathize in understanding that when you see 100 patients a day, it is hard to diagnose any disease, but particularly brain diseases as you have to spend more time to communicate and hence understand the patient. Especially, depression is rather hard to quantify and to diagnose. Furthermore, depression is often mixed with other mental illnesses, and there is no simple diagnostic tool or metric from which an understanding can be drawn. A physician should spend at least 20 to 30 minutes with a patient to comprehensively get to the root of the depression and to better understand the illness of each patient. Moreover, especially for Brintellix® (vortioxetine hydrobromide), it is crucial to ask the right questions to the patients, which implies to go beyond answering fundamental but basic questions (such as ‘are you happy in your life ?’) to better comprehend how the illness affects daily life.

What objectives would you like to focus on in the next five years?

Our vision as Lundbeck is to be a global leader in brain diseases. However, being a global leader is not only about having the highest market share, it also centers on perception of the healthcare professionals and more importantly patients. Our comparative advantage is that Lundbeck is a specialized company in brain diseases, but we must have additional capabilities to reach our global vision of being the leader in this area. Training and scientific support of the medical community are among our core capabilities. Indeed, we invest significantly in educational activities not only for depression but also for several other brain diseases even not related directly to our products.

In Turkey, we intend to improve our relationship with patient organizations; however, given that Brintellix® (vortioxetine hydrobromide) is our primary product, it is still challenging for us to speak openly with patients suffering from depression. Engaging with schizophrenia patients is more straightforward, but persuading depressed patients to come together is challenging. Worse still, there are vast numbers of depressed patients, and the stigma surrounding the subject is still too high.

We are fighting against the stigmatization of mental diseases together with the healthcare professionals. People often think mental conditions are not the same as other diseases and through work with the medical community we hope to break down the stigma.

What growth do you expect from this affiliate in the next three to five years?

We expect a strong and a sustainable growth in the next two to three years largely with Brintellix® (vortioxetine hydrobromide), which represents an excellent treatment opportunity for the patients with depression. Until 2022, when the first generic should enter, we will strive to maintain our leadership in depression area with Brintellix, Cipralex and Cipram. After 2022, we expect to introduce more products to Turkey from our global pipeline.

In the meantime, we have many other products – which represent 80 percent of our turnover- that we can offer to the patients with mental diseases. Finally, we intend to maintain and further increase efficiency in the coming years.

What would be your final message to our readers?

Turkey’s population is aging. For the pharmaceutical industry, this represents a tremendous opportunity because the more we age, the more we fall ill—especially with mental illnesses. Although, we have seen off some turbulence in recent years, the system works very well, and we have a good collaboration—not only Lundbeck but the entire pharmaceutical industry and the authorities work well together. I think we have begun to understand each other better. The environment is improving for the pharmaceutical industry, and although we faced certain pricing issues, slowly but surely this will recover so that prices become more attractive.

Ultimately, Turkey is a huge, expanding market, and it only has intentions to grow. In general, the population is not only aging but growing, and our healthcare ecosystem continues to show promising signs of development.