Homie Razavi. CDA Foundation Polaris Observatory. From Economic Analysis to Financial Dialogue

Transcription

1 Homie Razavi CDA Foundation Polaris Observatory From Economic Analysis to Financial Dialogue

2 The CDA Foundation Accelerate hepatitis B and C elimination through verified data, modeling, intervention strategies, expanded access, and knowledgesharing. Study Model Mission Statement: Provide data, tools, training and decision analytics to support elimination of hepatitis B and C, globally, by 2030 Eliminate Mission Statement: Provide access to low cost, quality medicines and diagnostics through pooled procurement

3 Countries/regions that have used our analyses to shape their hepatitis national strategy Australia Brazil Colombia Egypt Iceland Mongolia Morocco New Zealand Philippines Saudi Arabia Viet Nam Influenced Belgium British Columbia France Ireland Japan Kyrgyzstan Luxembourg Mexico Influenced Pakistan Qatar Russia Switzerland Taiwan United States (+ states) Uzbekistan

4 Cost per DALY (USD) Cost per DALY (USD) Annual Cost (USD Millions) Annual Cost (USD Millions) HCV elimination has a positive return on investment in every country we have analyzed Low Income High Income Cumulative Direct Costs (Cameroon) Cumulative Direct Costs (Australia) 700 4, ,000 3,500 3,000 2,500 2,000 1,500 1, We work with national experts to collect diagnostic, healthcare & treatment costs Status Quo WHO Target Status Quo WHO Target 6,000 5,000 Cost per DALY Averted (Cameroon) 180, , ,000 Cost per DALY Averted (Australia) Economic analyses have been conducted for 25 countries 4, ,000 3, ,000 80,000 2,000 60,000 1,000 40,000 20,000 WHO Target 1x GDP 3x GDP WHO Target 1x GDP 3X GDP

5 Annual Spending ($ million) Annual Spending ($ million) The obstacle to HCV elimination is the upfront investment Total Infected Cases (Viremic) Cameroon Liver Related Deaths Cameroon HCC Cameroon 180, , , , ,000 80,000 60,000 40,000 20,000 1,200 1, , Status Quo WHO Target Status Quo WHO Target Status Quo WHO Target Total Expenditure Total Expenditure Cameroon will spend more up front, but after 15 years, HCV healthcare costs will be minimal There has been a lot of focus on reducing drug prices, but we also need to address the screening costs & the number of tests needed. Status Quo WHO Target Healthcare Costs Screening Costs Tx & Lab Costs

6 Annual Spending ($ million) There are multiple options for financing hepatitis elimination Self Funded Appropriate for countries with a strong Public health system The public health system covers the cost of screening & treatment Patient CoPay Appropriate for countries with a limited healthcare budget Pooled Procurement Loan / Bonds Appropriate for all countries Fund Total Expenditure Products Fixed Payments over 10 yrs CoPay Public Health System Public Health System Healthcare Costs Screening Costs Tx & Lab Costs Patient Patient

7 The decision to pursue an elimination strategy and buying a house are very similar Buy a House Do nothing continue to pay rent, with rent increases year after year Take Action Purchase a house Cost Upfront down payment and monthly mortgage payments Financing Take on a loan Outcome own the house after loan payment Elimination of HCV Do nothing HCC, cirrhosis, liver related deaths and liver transplantation will continue to increase as the population ages Take Action Pursue an elimination strategy with increased screening & treatment Cost Upfront cost for screening, treatment & harm reduction Financing Takeon low/no interest loan Issue a bond Outcome minimize disease burden & eliminate HCV

8 DAA Prices (USD) DAA Prices (USD) With lower price, countries can fund the elimination strategy using their existing budget Drug prices have been dropping globally Reason: Competition Volume Based Pricing Generic Access 60,000 1,800 50,000 40,000 1,600 1,400 1,200 30,000 20,000 10, ,

9 Most countries don t realize that the cost of screening could surpass the cost of treatment % diagnosed in NZ AntiHCV prevalence in NZ Viremic rate in NZ AntiHCV RNA Cost Per Test $10 $ % 0.42% $2,476 $ % Already Dxed % 0.42% 1.1% RNA+ Screening Cost/ New ly Dxed 2.6 Status Quo $3, % 0.26% AntiHCV % 98.9%

10 Screening in high risk populations will reduce the antihcv screening costs significantly % diagnosed in NZ Viremic rate in NZ AntiHCV RNA Cost Per Test $10 $231 HCV prevalence is higher in highrisk populations 50.0% 1.90% $545 $ % Already Dxed % 1.90% 5.0% RNA+ Screening Cost/ New ly Dxed 2.6 Status Quo $3, % 1.20% SQ High Risk $1,153 AntiHCV % 95.0%

11 Without a national registry or a voucher system, the cost of screening will increase exponentially by 2025 % undiagnosed will decrease Percent viremic will decrease as more are treated & cured AntiHCV RNA Cost Per Test $10 $231 AntiHCV prevalence will stay the same 15.0% 0.033% $31,364 $7, % Already Dxed % 0.19% 1.1% RNA+ Screening Cost/ New ly Dxed 33 Status Quo $3, % 0.88% SQ High Risk $1,153 Status Quo 2025 $39,064 AntiHCV+ 3, % 98.9%

12 A registry or a voucher system can reduce screening costs significantly by 2025 In the undiagnosed /untreated population, viremic rate will stay the same With a registry, only those not diagnosed are tested AntiHCV RNA Cost Per Test $10 $231 AntiHCV prevalence will stay the same 100.0% 0.84% $1,238 $ % Already Dxed % 0.0% 1.1% RNA+ Screening Cost/ New ly Dxed 1.3 Status Quo $3, % 0.26% SQ High Risk $1,153 Status Quo 2025 $39,064 AntiHCV+ SQ 2025 w Surveillance $1, % 98.9%

13 Conclusions National financing for hepatitis elimination can be supported through: Self funding (stand alone budget or part of the existing budget) Copays that diminishes with price reduction (always less than catastrophic expenditure) Bonds / Loans Prices will go down with volume but a global procurement mechanism is needed to support countries with small orders Without a national screening strategy, the cost of screening will surpass the cost of treatment The same financing issues will be faced by all future curative therapies as well (e.g. HBV)

14 Appendix

15 Price Price Drug & diagnostic prices will drop with volume High Income Price Elasticity Curve Private Market Price Elasticity Curve Public Market Middle Income Low Income Public markets are not price sensitive once the prices drop below threshold Manufacturing Cost Manufacturing Cost Volume Volume There is a misconception that manufacturers make the same profit along the price elasticity curve. However, dropping prices without an increase in volume will lead to substantial losses. They are willing to lower prices for guaranteed volume & payment.

16 Price However, for countries with low volume orders, the national tendering process will not result in reduction in prices Country orders are too small to get discounted pricing Global procurement can provide a mechanism for lower drug and diagnostic prices. This will result in significant reduction in the cost of elimination Pooled procurement negotiates prices at the international level However, current tendering process does not allow countries to participate in global procurement mechanisms. Manufacturing Cost

17 The current medicine approval process is complex & can take 3 yrs for access Private Health System Country Public Health System International Agencies Registration Out of Pocket Insurance 1 2 years 1 3 years Registration Essential Medicine List Reimbursement Approval Tender Process 100% Coverage CoPay Out of Pocket Insurance WHO Essential Medicine List PreQualification FDA Approval Patient Access International Aid 100% Coverage 2 3 years

18 The current diagnostics approval process is complex & can take 2 yrs for access Private Health System Country Public Health System International Agencies Registration Out of Pocket Insurance 1 2 years 6m 1 year Registration Reimbursement Approval Tender Process 100% Coverage CoPay Out of Pocket Insurance WHO PreQualification FDA Approval Patient Access International Aid 100% Coverage 1 2 years