The Increased Mortality and the Medicare Disability Eligibility Status of the HCV Population in the US Gabriela Dieguez1, Bruce Pyenson1, Steven E Marx2, Yuri Sanchez Gonzalez2 1 Milliman Inc. 2 AbbVie Inc. November 13, 2016 AASLD

Disclosures and Conflicts of Interest Gabriela Dieguez and Bruce Pyenson are employed by Milliman, Inc., which received consulting fees from AbbVie for conducting research and analysis Steven Marx and Yuri Sanchez Gonzalez are AbbVie employees and own AbbVie stock The design, analysis, and financial support of this study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the study November 13, 2016 AASLD

Goals Assess excess mortality burden for HCV-diagnosed beneficiaries Explain how HCV-diagnosed people qualify for Medicare before age 65 through disability Compare medical costs for disabled and non-disabled Medicare HCV beneficiaries Identify 2012 costs for HCV-diagnosed beneficiaries who died Goals Source: http://redpacientes.com/wall/9833 November 13, 2016 AASLD

Medicare covers people > age 65 (“aged”) and some people <65 who are disabled Are people with HCV more likely to enter Medicare before age 65? Are people with HCV more likely to die? What are the costs associated with HCV-related deaths? Background November 13, 2016 AASLD

Methods to Assess the Burden of HCV to Medicare Identify HCV status and liver disease stage Compare mortality for HCV-diagnosed to standard mortality rates Compare rates of Medicare eligibility for HCV-diagnosed and general US population <65 Tabulate Medicare costs for HCV-diagnosed November 13, 2016 AASLD

2012 Medicare 5% database (medical claims and demographics) -Includes diagnoses, reason for eligibility, death indicator Census data (National Health and Nutrition Examination Survey) 2010 Period Life Table (US Census Bureau) Data Sources November 13, 2016 AASLD

Results: Mortality and Medicare Disability Rates in the US   HCV Stage (1) HCV Population (2) US Population* (3) = (1) / (2) HCV to US Population Annual Mortality Rates Newly Diagnosed 0.0660 0.0205 3.2 Non-Cirrhotic 0.0600 0.0146 4.1 Cirrhotic 0.0973 0.0151 6.4 ESLD 0.1861 0.0133 14.0 Transplant 0.0692 0.0125 5.5 All HCV 0.0736 0.0154 4.8 Medicare beneficiaries with HCV have almost 5 times the annual mortality of non- diagnosed beneficiaries *Age/gender adjusted to the HCV cohort No difference in rate of Medicare-eligibility through disability for HCV diagnosed and non-diagnosed   HCV Stage (1) HCV Population (2) US (3) = (1) / (2) HCV to US Population Medicare Disability** All HCV 0.0102 1.0 **”Medicare disability” defined as eligibility to Medicare benefits through disability November 13, 2016 AASLD

Results: Medicare Costs for HCV Disabled On average, HCV-diagnosed Medicare disabled are 19 years younger than Medicare aged1 beneficiaries diagnosed with HCV Average Age: 54 Average Age: 73 However, annual medical costs for Medicare disabled and aged1 with HCV are similar. HCV 1Medicare Aged defined as beneficiaries first eligible for Medicare by attaining age 65. November 13, 2016 AASLD

Results: Average Medicare Costs in the Last Year of Life Average medical expenses in last 12 months of life: $107,838, over 3 times the annualized cost for all HCV patients (2012) Average monthly cost for all HCV patients with Medicare $2,529 Notes: Assuming patients die, on average, mid-month November 13, 2016 AASLD

Study Limitations HCV status and liver disease stages were identified through diagnosis codes in administrative claims databases and are susceptible to provider coding practices. This study excludes undiagnosed individuals infected with HCV and those that are missing an HCV diagnosis code in their claims data. Medical costs, mortality rates, and Medicare disability status may not be attributable entirely to the HCV diagnosis; we did not attempt to measure the impact of comorbidities associated with HCV on these variables. Medicare eligibility through disability drops sharply as individuals reach age 65. Patients with HCV that may have qualified through disability but instead waited until age 65 to enroll in Medicare are identified as “aged” in this study. November 13, 2016 AASLD

Conclusions Medicare-covered HCV patients are associated with higher mortality rates than people of the same age and gender, but not with higher Medicare disability rates Medicare disabled patients with HCV are 19 younger than Medicare aged (non-disabled) patients with HCV, but had similar average medical costs (about $30,000 per year) Average medical costs for Medicare-covered HCV patients that died in 2012 are over $100,000 in the last year of life, and cost peaks in the last month of life at over $25,000 November 13, 2016 AASLD