Global Health Outcomes & Strategic Pricing (GHOSP) Carole Dembek

Confidential November 10-11, 2008 Global Health Outcomes  Establish and communicate the economic value of Mozobil to global markets  Support value-based pricing & market adoption through outcomes research studies, economic models and value dossiers  Collaborate with US and global colleagues to adapt economic models to specific markets or customers to support product adoption

Confidential November 10-11, 2008 Identifying Value Drivers Reduced cost of remobilization More patients reach 2m cells -fewer failed mobilizers Patients mobilize more cells for transplant More cells transplanted associated with less resource use & cost Fewer apheresis procedures Lower apheresis costs Mozobil is well - tolerated with few side effects Eliminates cost of treating side effects of mobilizing with chemotherapy Clinical Data*Economic Value * Data from Phase III trials 3101 & 3102

Confidential November 10-11, 2008 Value Pre- and Post- Transplant Pre-transplant Period (Mobilization & Apheresis) Post-transplant Period Economic Value: Cost savings from fewer side effects of chemomobilization Cost savings from fewer apheresis procedures Potential for less use of G-CSF compared to chemomobilization Fewer failed mobilizers will result in less remobilization cost More predictability in scheduling apheresis Economic Value: More CD34+ cells may result in less supportive care, hospital days and lower cost More CD34+ cells may be associated with better survival Transplant

Confidential November 10-11, 2008 Economic Value Messages  Compared to mobilization with G-CSF alone:  Mozobil may reduce cost by reducing apheresis days  Mozobil may reduce the cost of post-transplant care by enabling patients to be transplanted with more cells  Mozobil may reduce cost by reducing the number of patients who require remobilization  Compared to mobilization with G-CSF + chemo  Mozobil may reduce cost by eliminating side effects of chemomobilization and reducing the amount of G-CSF required for mobilization  Mozobil may improve the predictability of scheduling apheresis & provide greater efficiency in the apheresis unit

Confidential November 10-11, 2008 Evidence to Support Value Messages  Mozobil clinical data  Good data comparing Mozobil to G-CSF mobilization  No data comparing Mozobil to G-CSF + chemotherapy  No economic data collected in Mozobil trials  Published literature – not specific to Mozobil  20+ publications  Cost data – cost of apheresis day avoided  Limitations – old data, small sample sizes, not MM or NHL  Outcomes studies  Partner with physicians to generate new economic data

Confidential November 10-11, 2008 Supporting Evidence More CD34+ cells = Less resource use AuthorJournalYearCountry KlausEur J of Haematology2007Germany ScheidBM Transplantation1999Germany LimatEur J of Cancer2000France KettererBlood1998France OlivieriHaematologica1998Italy SchulmanJ of Clinical Oncol1999USA SolaHematology1999Spain

Confidential November 10-11, 2008 Supporting Evidence Side effects of Chemomobilization AuthorJournalYearCountry CorsoHaematologica2002Italy JantunenBM Transplantation2003Finland FitoussiBM Transplantation2001France DesikanJ of Clinical Oncology1998USA PetrucciActa Haematologica2003Italy AlegreBM Transplantation1997Spain MiloneLeuk & Lymphoma2007Italy GojoBM Transplantation2004USA

Confidential November 10-11, 2008 Outcomes Research Studies Pr. Michallet – France 200 MM pts Comparison of resource use and cost of patients transplanted with >4m vs. <4m CD34+ cells Status – Preliminary data expected Q4 Pr. Einsele – Germany 200 MM & NHL pts Resource use and CD34+ cell dose Treatment of chemomobilization side effects Status – Data collection underway for cell dose study Pr. Apperley – UK 150 MM & NHL Outcomes of mobilizing with chemotherapy - % febrile neutropenia, cost, failure rate Status – Preliminary data received; ASH abstract accepted Dr. Gertz – US (Mayo) MM & lymphoma pts Comparison of resource use in patients mobilized with G-CSF alone vs. G-CSF + 3g Cytoxan (no cost data) Status – Preliminary data expected Q4

Confidential November 10-11, 2008 Pharmetrics Private Payer Data Study #1 – Cost of ASCT Objectives  Determine total cost of ASCT  Determine proportion of cost associated with mobilization & apheresis  Findings  Total cost = $150,000  Mobilization/apheresis = 26%  Abstract accepted for poster presentation at ASH Study #2 – Cost comparison of chemo + G vs. G alone Objectives  Determine cost of mobilization with chemo vs. G-CSF alone  Findings  Cost of mobilization with chemo was 27% higher than G- CSF  More inpatient hospital days & drug use in chemo pts  Excluding Rituxan & G-CSF, cost difference in drugs was $1,600 per patient  Abstract submitted for Tandem

Confidential November 10-11, 2008 Tools to Support Economic Value Cost-effectiveness Model Model will support global health technology appraisals & reimbursement submissions  Preliminary model for frontline use completed  Rescue model under development  Validating with KOLs  Models to be finalized in Q4  GHOSP will work with affiliates to adapt models for specific country needs Budget Impact Model Model will demonstrate the budgetary impact of adopting Mozobil  Can be used for hospitals, payers, HTA organizations, local, regional and national health systems  Model to be completed in Q4  Adapt to specific hospitals, payers or countries Value Dossier will be used to communicate the clinical & economic value story to global decision makers  Dossier to be completed end of 2008  Dossier will be updated as new data become available through clinical trials, outcomes studies and published literature Value Dossier

Confidential November 10-11, 2008 Next Steps  Complete economic models & value dossier by end of 2008  Collaborate with country affiliates to adapt for local reimbursement submissions & HTA reviews  Adapt models to support formulary adoption by transplant centers  Complete outcomes studies, present & publish data  ASH  Tandem  EBMT  Training on economic messages, models, value dossier