epi slides
TRANSCRIPT
Epi slides
November 16, 2021
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Solid Tumor Oncology
2
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NSCLCMetastatic
(inc. EGFR/ALK)
106.0
43.0
139.0
54.5
0
70
140
210
280
1L Treated 2L+ Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
*Figures only contain incident patients and do not include patients who recur
Source: Decision Resources Group; BMS Internal Analysis; AJCC 8th Edition Staging
Early Stage* (Treatable population)
33.0
10.05.0 8.0
22.5
13.5
3.0
14.5
8.0
5.0
8.5
29.0
19.5
4.5
0
15
30
45
60
Stage IA Stage IB Stage IIA Stage IIB Stage IIIA Stage IIIB Stage IIIC
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
• EGFR/ALK: 15-20%
Treatment rates:
• Stage IB-II : 35% - 45%
• Stage III : 55% - 60%
Resection rates
• Stage I-II resected: ~60%
• Stage IIIA resected: ~40%
• Stage IIIB resected: ~15%
• Stage IIIC resected: ~ 2%
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SCCHN
Metastatic
19.011.0
21.0
12.0
0
15
30
45
60
1L Treated 2L Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Early Stage
25.0
32.0
0
15
30
45
60
LAD Treatable
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Source: Decision Resources Group
• LAD txt rate: 60% - 85%
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Melanoma
Metastatic Early Stage Disease
Source: Decision Resources Group, BMS Internal Analysis
Early stage txt rate: 60 – 80%
10.0
9.0
0
10
20
30
40
1L Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
17.5
16.5
0
10
20
30
40
Adjuvant Treatable
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
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RCC
Metastatic
18.5
15.0
0
10
20
30
40
1L Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Early Stage
54.5
47.0
0
30
60
90
120
Stage I-III Incidence
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
• Break out by IMDC risk category (metastatic):
• Intermediate/Poor Risk: 75%
• Favorable: 25%
• Early stage txt rate: 10-15%
• Break out by IMDC risk category (early stage):
• Intermediate Risk: 25%
• High Risk: 20%
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Bladder
Early Stage DiseaseMetastatic
Source: Decision Resources Group; BMS Internal Analysis
Cystectomy rates in MIBC are ~50%
Early stage treatment rates
MIBC txt rate: 70% - 85%
18.5
32.0
0
15
30
45
60
1L Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
17.5
37.5
0
15
30
45
60
MIBC Treatable
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
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Prostate
Metastatic
Source: Decision Resources Group
28.5
26.5
0
15
30
45
60
1L Castrate-Resistant Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
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HCC
Early Stage DiseaseMetastatic
Source: Decision Resources Group; BMS Internal Analysis
High risk ablated or resected: 10 – 20% of Early Stage
Early stage txt rate: 30-60%
14.0
14.5
0
10
20
30
40
1L Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
20.0
17.5
0
10
20
30
40
Early & Intermediate Incidence
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
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Gastric*
*Data represents adenocarcinoma only and includes GEJC
Early Stage DiseaseMetastatic
Source: Decision Resources Group
Cardia incident: 12% - 32% (avg. 25%) Stage II and III GEJC: ~20-24%
Treatment rates
Localized & resectable locally advanced txt rate: 60% - 70%
Unresectable locally advanced txt rate: 70% - 80%
13.5
25.0
0
10
20
30
40
1L Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
10.0
19.5
0
10
20
30
40
Non-metastatic Incidence (Stage IB-IIIC)
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
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Esophageal*
Early Stage DiseaseMetastatic
*Data represents adenocarcinoma and squamous only
Source: Decision Resources Group; BMS Internal Analysis
Eso stage II, stage III and stage IVA Resectable patients: ~70%
Treatment Rates:
Localized & resectable locally advanced txt rate: 60% - 75%
Unresectable locally advanced txt rate: 65% - 75%
11.0
14.5
0
10
20
30
40
1L Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
11.5
15.5
0
10
20
30
40
Non-metastatic Incidence
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
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GBM
Metastatic
13.5
10.5
0
10
20
30
40
1L Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Source: Decision Resources Group
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Ovarian Cancer
Early Stage DiseaseMetastatic
Source: Decision Resources Group
16.5
19.0
0
10
20
30
40
1L Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
4.0
4.5
0
10
Early Stage Drug Treatable
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
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Autoimmune Disease
14
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Rheumatoid Arthritis (RA)
2.301.80
1.30
2.00
1.56
1.10
0.0
1.5
3.0
4.5
6.0
Diagnosed Prevalent Cases Diagnosed Mod-Severe Prevalent Cases Drug-Treated Mod-Severe Prevalent Cases
2020 P
ati
ent
Est
imate
s (i
n M
illions)
US EU5
• We define total prevalent cases of RA according to the 1987 ACR criteria, which requires fulfillment of at least four of seven criteria: ▪ 1. Morning stiffness. 2. Arthritis of three or more joint areas. 3. Arthritis of hand joints. 4. Symmetric arthritis. 5. Rheumatoid nodules. 6. Serum rheumatoid factor. 7. Radiographic
changes
• Alternatively, a patient's symptoms are considered to be satisfying the ACR definition if they include at least criteria 2 and 3, 2 and 6, 2 and 7, 4 and 6, or 3 and 6
• We limit our analysis to persons aged 15 or older because RA that occurs prior to this age is designated as JIA, JCA, or JRA and is diagnosed according to different criteria than
are used in the ACR 1987 classification system
25-30% treated with
targeted therapies
(biologics / orals)
Source: Decision Resources Group, BMS Internal Analysis
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Psoriasis
6.00
1.70 1.24
5.30
1.501.23
0.0
3.0
6.0
9.0
12.0
Diagnosed Prevalent Cases Diagnosed Mod-Severe Prevalent Cases Drug-Treated Mod-Severe Prevalent Cases
2020 P
ati
ent
Est
imate
s (i
n M
illions)
US EU5
• We define diagnosed prevalent cases of psoriasis based on physical examination performed by physicians. Although psoriatic lesions often exhibit a typical appearance, there
are no standardized criteria in the clinical setting. Thus, we estimate only those cases of psoriasis that are physician-diagnosed, even those that may not be exhibiting
symptoms at the time data were collected and are therefore in remission
• Excludes asymptomatic patients. Includes comorbid psoriatic arthritic patients. Severity is based on physician's subjective assessment
25-30% are treated with
systemic therapies
(biologics / orals)
Note: Severity defined
based on physician
subjective assessment,
not by %BSA
Source: Decision Resources Group, DataMonitor, Global Data, Adelphi patient chart audits, SHS Claims data, BMS Internal Analysis
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Psoriatic Arthritis
1.00
0.50
0.90
0.45
0.0
0.5
1.0
1.5
2.0
Diagnosed Prevalent Cases Drug-Treated Prevalent Cases
2020 P
ati
ent
Est
imate
s (i
n M
illions)
US EU5
• We used published studies and opinions of thought leaders throughout the major markets to derive the proportion of patients diagnosed and treated
• Patients included have confirmed psoriasis diagnosis. Unlike psoriasis, labels of branded therapies for psoriatic arthritis are not restricted to patients based on disease severity
Source: Decision Resources Group; BMS Internal Analysis
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Ulcerative Colitis Patient Dynamics
0.94
0.56 0.48
0.70
0.400.34
0.0
0.5
1.0
1.5
2.0
Diagnosed Prevalent Cases Diagnosed Mod-Severe Prevalent Cases Drug-Treated Mod-Severe Prevalent Cases
2020 P
ati
ent
Est
imate
s (i
n M
illions)
US EU5
• We base our estimates of diagnosed prevalence of UC on studies that confirmed diagnosis of the condition at initial examination or within two to six months of initial
examination based on clinical history and either (1) endoscopic examination of the colonic mucosa indicating continuous diffuse granular or friable mucosa or (2) radiological
barium studies indicating continuous mucosal involvement. (Prevalence rates are based on Shivashankar et al., 2017 and Kappleman et al., 2013
• Other companies appear to be using Kappleman et al., 2013 only, resulting in lower prevalence rates)
• Treatment rate includes all conventional, targeted oral, and biologic treatments
Note: 50-60% of Patients
are Moderate-to-Severe
Source: Decision Resources Group; BMS Internal Analysis
~80% of Mod-Sev pts are
treated, of which 35-60%
gets novel therapies
(biologics/JAKs)
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Crohn’s Disease Patient Dynamics
0.810.57 0.51
0.60
0.330.30
0.0
0.5
1.0
1.5
2.0
Diagnosed Prevalent Cases Diagnosed Mod-Severe Prevalent Cases Drug-Treated Mod-Severe Prevalent Cases
2020 P
ati
ent
Est
imate
s (i
n M
illions)
US EU5
• We define a diagnosed prevalent case of CD based on a physician diagnosis of clinical symptoms (abdominal pain, weight loss, malaise, diarrhea, and/or rectal bleeding) and
histological, endoscopic, radiological, and/or surgical findings. (Prevalence rates are based on Shivashankar et al., 2017 and Kappleman et al., 2013
• Other companies appear to be using Kappleman et al., 2013 only, resulting in lower prevalence rates)
• Treatment rate includes all conventional, targeted oral, and biologic treatments
~90% of Mod-Sev pts are
treated, of which 40-60%
gets novel therapies
(biologics)
Note: 55-70% of Patients
are Moderate-to-Severe
Source: Decision Resources Group; BMS Internal Analysis
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Multiple Sclerosis
RRMS
363255
416
275
0
200
400
600
800
1,000
Diagnosed Prevalent Cases Drug-Treated Prevalent Cases
2020 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
SPMS
82
40
93
28
0
50
100
150
200
250
Diagnosed Prevalent Cases Drug-Treated Prevalent Cases
2020 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
• We define MS based on the McDonald criteria (McDonald WI, 2001; Milo R, 2014) and MS diagnostic codes recorded in nationally representative health insurance, research, and long-term
disability databases. In our definition, we also include cases of CIS. When using data that include diagnoses made prior to 2001, we additionally use the Poser criteria to define MS, and include
clinically definite, probable, and possible MS cases in our definition. The possible cases include cases of CIS and/or suspected MS cases. We restrict our analyses to individuals aged ten or older,
because MS is rarely diagnosed in children. We define subtypes of prevalent MS cases based on physician diagnosis: RR-MS, CP-MS, which is further categorized into PP-MS and SP-MS, and CIS ,
i.e. cases that have not yet progressed to MS at the time of diagnosis. The drug-treated estimates include patients in 2020 who were treated with DMTs—excluding corticosteroids for acute
relapses. Drug-treatment rates in our model continue to be lowest in the United Kingdom owing to long-standing barriers in access to specialty MS care in that country.
Source: Decision Resources Group; BMS Internal Analysis
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Systemic Lupus Erythematosus (Includes Lupus Nephritis)
330264
165
132
0
250
500
750
Diagnosed Prevalent Cases Drug-Treated Prevalent Cases
2020 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
• Definition of SLE is important. These numbers are based on criteria used by clinicians to diagnose SLE: the presence of four or more ACR criteria or three ACR criteria along
with an SLE diagnosis by a rheumatologist, a biopsy-confirmed diagnosis of LN, or a diagnosis of SLE-related ESRD. In addition, we categorize SLE cases identified from national
administrative databases under clinically defined SLE. These prevalence numbers represent patients with any organ affected. LN patients represent ~30% of all SLE cases
Source: Decision Resources Group; BMS Internal Analysis
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Eosiniphilic Esophagitis (EoE)
EoE Diagnosed Prevalence
354
313
0
200
400
600
800
Diagnosed Prevalence
2020 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
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Atopic Dermatitis
10.9
6.1
10.5
6.1
0
5
10
15
20
Diagnosed Prevalent Cases Drug-Treated Prevalent Cases
2020 P
ATIE
NT E
STIM
ATES (
IN M
ILLIO
NS)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
• Diagnosed Prevalent Cases includes all ages population with mild, moderate & severe AD. We categorized AD by severity in people aged 15 or older in all countries under study
using the severity distribution from a population-based study conducted in the United States (Silverberg JI, 2018). To categorize pediatric patients by severity, we applied the
ratio between the severity distributions in 12-month total prevalent cases (Silverberg JI, 2018) and diagnosed prevalent cases (Barbarot S, 2018) in adults to the severity
distribution of diagnosed prevalence cases in children younger than nine in each of the countries under study (Barbarot S, 2018; Ben-Gashir M, 2004; Silverberg JI, 2018;
Willemsen M, 2009).
• Treated population includes the percentages of all ages diagnosed population with mild, moderate & severe AD in 2018 who received drug treatment with key drug classes used
to manage the disease (e.g., TCSs, TCIs, conventional oral immunosuppressants, oral corticosteroids) in each of the seven markets under study.
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Hematology
24
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Lymphoma
DLBCL
31.2
12.1 11.0
28.0
10.07.0
0
20
40
60
80
1L Treated 2L Treated 3L+ Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
FL
11.2
3.9 5.9
10.9
3.9
5.9
0
10
20
30
40
1L Treated 2L Treated 3L+ Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
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Multiple Myeloma
Treated Population
18.3
11.2
18.5
12.29.8
12.7
14.4
15.2
8.5
5.7
0
10
20
30
40
1L SCT Eligible 1L SCT Ineligible 2L 3L 4L+
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
Not for Product Promotional Use
Leukemia
CLL+SLL
19.1
9.96.2
15.7
8.6
5.6
0
10
20
30
40
1L Treated 2L Treated 3L+ Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
AML (excluding APL*)
16.6
13.7
0
10
20
30
40
Diagnosed Incident
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Source: Decision Resources Group; BMS Internal Analysis *APL = acute promyelocytic leukemia
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MDS
Lower-Risk MDS Treated Incident Population
11
5
8
3
0
2
4
6
8
10
12
14
16
18
20
ESA Naïve (1L) ESA R/R (2L)
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
• ~40% of lower-risk patients are RS Positive
Note: ~40% RS Positive already applied to ESA R/R (2L)
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Myelofibrosis
Incident Cases
3.8
4.1
0.0
2.5
5.0
7.5
10.0
Diagnosed
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
Not for Product Promotional Use
Beta Thalassemia
Prevalent Cases
6
11
0
4
8
12
16
20
Drug-Treated
2021 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
• NTD: 35%
• TD: 65%
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Cardiovascular
31
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Secondary Stroke Prevention
Ischemic Stroke Events
0.74 0.67
0.65
0.55
0.0
0.4
0.8
1.2
1.6
Total Events Diagnosed Events
2020 P
ati
ent
Est
imate
s (i
n M
illions)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
Not for Product Promotional Use
Acute Coronary Syndrome
ACS
0.79
1.01
0.0
0.5
1.0
1.5
2.0
Diagnosed Events
2020 P
ati
ent
Est
imate
s (i
n M
illions)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
Not for Product Promotional Use
Atherosclerotic Cardiovascular Disease
CAD/PAD
15.80
5.00
11.60
5.30
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Diagnosed Prevalent Cases (CAD) Diagnosed Prevalent Cases (PAD)
2020 P
ati
ent
Est
imate
s (i
n M
illions)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
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Venous Thromboembolism
VTE Tx
0.79
5.29
0.88
5.75
0.0
3.0
6.0
9.0
12.0
Diagnosed incident Cases (first ever) Diagnosed 10-year Prevalent Cases
2020 P
ati
ent
Est
imate
s (i
n M
illions)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
Not for Product Promotional Use
Atrial Fibrillation
AF
7.35
9.42
0.0
5.0
10.0
15.0
20.0
Diagnosed Prevalence
2020 P
ati
ent
Est
imate
s (i
n M
illions)
US EU5
Source: Decision Resources Group; BMS Internal Analysis
Not for Product Promotional Use
Hypertrophic Cardiomyopathy (HCM)
HCM
Source: Decision Resources Group; Maron BJ, 1995, Maron BJ, 1999, Maron BJ, 2004 BMS Internal Analysis
660
150 90 60
635
15090
600
200
400
600
800
1000
1200
1400
Total Prevalence Diagnosed Prevalent HCM Obstructive HCM Non-Obstructive HCM
2020 P
ati
ent
Est
imate
s (i
n 0
00’s
)
US EU5
• Numbers reflect base case estimates; Total HCM prevalence assumes a (~1/500) rate based on literature sources (below); Diagnosed prevalence estimates are variable due
to HCM being a highly undiagnosed and misdiagnosed disease; Due to limited literature, it is recommended to utilize ranges vs. absolute point estimates
(100 – 200) (75 – 120) (30 – 75)
(75 – 110)
(105 – 220)
(40 – 75)
(550-750)
(550-750)