Replies to post #170264 on Biotech Values

[ciotera]

Re: long term HCV opportunity

I'm not arguing that the numbers aren't theoretically there. They are, but they are not as readily accessible as the analysts believe them to be. Once the initial bolus is depleted and warehousing is out of the picture (which I think can happen within the first year of the IFN-free era), the market will return to its steady-state dynamics sourcing business from new diagnoses each year which are not enough to back the annual revenue numbers that are being thrown around.

Sure, there will be an effort to increase awareness and diagnosis rates, both through CDC/guidelines and by companies themselves through DTC and detailing, but that's a hard nut to crack, requires a lot of investment and takes a long time. Also, keep in mind that majority of newly diagnosed patients will have low fibrosis and technically will not need to be treated right away (especially if the treatment costs >100k and they have to pay some part of it). And if sales do get very large (which they will in the initial years), payers (even in the US) will step in and start controlling the costs (passing them more to patients, restricting treatment to F3/F4s, etc.)

So, I don't think this is an attractive commercial opportunity long-term. BMS, for instance, has far more attractive and durable opportunities in the IO space, which I think is what they have decided to focus on.

[jellybean]

The problem with that 2M number is that it is an estimate and no one really knows the prevalence. The best estimates come from the NHANES survey, and in the 2011-12 report 0.8% of the population was positive for HCV RNA which translates to 2.3M patients. the NHANES number has varied from 0.6% to 1% over the past 16 years. However, NHANES cautions that sampling is biased towards the uninsured, the lower income, and the unemployed, which is the demographically the group with the highest rates of HCV. In other words, the NHANES number is most likely skewed towards the high end.

[DewDiligence]

Re: HCV throughput

Respectfully disagree with you and ‘ciotera’ that the shortened duration of treatment (from 24 weeks with Incivek/Victrelis to 12 weeks for non-hard-to-treat patients using GILD’s or ABBV’s all-oral regimen) changes the throughput of the HCV healthcare system to an appreciable degree.

Regardless of whether treatment duration is 24 weeks or 12 weeks, the number of per-patient visits to the treating physician’s office (including initial assessment, SVR12 confirmation, and discharge) will be about the same. That the all-oral regimens will allow the same number of per-patient visits to be compressed into a shorter period does not increase the number of HCV patients a given physician can treat during a given period of time, which is the definition of throughput as discussed in the seventh paragraph of #msg-92234861.