1. Economic Impact of Eliminating HCV H. Razavi April 13, 2016

2. 2 HCV Economic impact models have been developed for 15 countries/ regions AfricaAmericasAsia/ PacificEurope EthiopiaMexicoEgyptCroatia GhanaBritish ColumbiaJapanSwitzerland NigeriaMalaysiaSpain MongoliaGreece Saudi Arabia Viet Nam

3. 3 Methodology Direct Costs »Healthcare costs (outpatient, inpatient, medical cost excluding HCV treatment) »Laboratory costs – screening, PCR, viral load, staging, genotyping, other »Current and future cost of therapies (DAAs, Peg IFN, traditional medicine) »Private vs. public »Patient co-pay Indirect Costs »Years living with disability »Years of life lost »Converted to an economic value using gross national income (GNI) per capita for ages Scenarios »WHO recommendation / elimination »Drop in generic drug prices over time »Simplifying laboratory procedures

4. 4 Ethiopia Economic Impact Analysis - Assumptions Annual Cost per Diagnosed Patient - USDPublic CostPrivate Cost Annual Follow-up Cost (F0-F3) 601857 Compensated Cirrhosis6851,028 Decompensated Cirrhosis3,4005,100 Hepatocellular Carcinoma4,9007,350 Diagnostic Costs - USDPublicPrivate Anti-HCV1320 RNA Test/ PCR120180 Genotyping70105 Staging/ Liver Biopsy/ Fibroscan250375

5. 5 Economic Impact of HCV Treatment – Direct Costs

6. 6 Economic Impact of HCV Treatment – Direct & Indirect Costs

7. 7 Breakeven analysis - Ethiopia Breakeven

8. 8 In every country we have analyzed, treatment is more cost saving than status quo Estes C, Abdel-Kareem M, Abdel-Razek W, Abdel-Sameea E, Abuzeid M, Gomaa A, et al. Economic burden of hepatitis C in Egypt: the future impact of highly effective therapies. Aliment Pharmacol Ther 2015 Jul 22. Egypt (Total Direct & Indirect Costs) Elimination Status Quo in 2014 Mongolia (Total Direct & Indirect Costs) Elimination Status Quo in 2015

9. 9 This is not limited to low & middle income countries – in high income countries the healthcare costs & cost per life year is higher Breakeven Saudi Arabia

10. 10 Negotiating drug prices is important, but the central issue facing HCV elimination is how to pay for it now & recover investment later Mongolia Current spending on Treatment of HCC & Cirrhosis & Diagnosis

11. 11 Conclusions: 60% of all HCV infected individuals can have access to generic DAAs TODAY We need good healthcare and diagnostic costs to estimate the economic burden of HCV and cost effectiveness of drugs and diagnostics The laboratory/ testing requirements for HCV treatment need to be simplified, simplified, simplified The cost of diagnostics needs to be examined closely in low income countries Central issue facing HCV elimination is how to pay for it now & recover investment later