Critical survival factors in the pharmaceutical industry: a systematic review of methodologies and determinants from 1995 to 2024

The pharmaceutical industry is widely regarded as one of the largest and most strategically important sectors of the global economy, given its essential role in advancing public health, addressing complex diseases, and generating substantial economic returns. However, despite substantial R&D investment and increasing demand driven by factors like aging populations and chronic disease prevalence, pharmaceutical companies face significant challenges, including market exit through mergers and acquisitions. Existing literature on firm survival lacks a comprehensive synthesis specifically focused on pharmaceutical companies. This systematic review aims to identify key determinants of pharmaceutical company survival to inform policy and decision-making. A systematic review was conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD42024553565). Without applying any date restriction, four databases (PubMed, Scopus, Web of Science, ProQuest) and additional sources were searched for quantitative studies using survival analysis methods, focusing on pharmaceutical companies’ survival or exit (e.g., mergers, bankruptcy). Data extraction involved a standardized form of collecting study characteristics, methods, variables, and findings. Due to heterogeneity, a narrative synthesis was performed. The initial search yielded 35,129 records, resulting in 58 included studies published between 1995 and 2024. The majority (58.62%) were published in the last decade, predominantly from high-income countries (mainly the United States). The most common analytical methods were Cox proportional hazards models and logistic regression. Sixty-three factors influencing survival were identified, and categorized into five groups: firm-specific (e.g., size, age, financial performance, innovation), industry-specific (e.g., market competition), macroeconomic conditions, geographic conditions, and owner/manager characteristics. Firm size, firm age, market competition, innovation-related activities, and financial performance emerged as the most frequently studied determinants, with mixed findings regarding their impact on survival. This review synthesizes evidence from 58 studies on pharmaceutical company survival, revealing 63 factors influencing their longevity. While firm-specific and industry-specific factors were most commonly investigated, the impact of many determinants remains ambiguous and context-dependent. Policymakers are encouraged to implement targeted interventions—such as financial and regulatory support for small firms, incentives for high-risk R&D, streamlined approval pathways, mentorship programs, and workforce development—to enhance the resilience and long-term sustainability of pharmaceutical companies. Future research should focus on understudied regions and contextual factors.