Kevin B. Young - Gilead Sciences, Inc.
Management
Hi, Michael. Two great questions. Let me try to deal with those in the order. So the first the U.S. If you look at our slide, actually the percentage of F0s to F2s has increased over time. It was sort of 50% a little while ago, and now it's up to 60%. So, clearly, a fitter patient, they're less sick, are being treated. And of course, that's as a result of coverage. But I want to say that the patient journey, I think, is becoming longer in the U.S. now. If you think about it, patients really are starting further back because they are healthier. We are continuing to see approximately 30,000 patients coming into specialist care, so in other words, 90,000 patients a quarter. 60,000 of those are coming out of the other side and are being treated and cured. That's probably not a bad ratio in itself. Not every patient is treated and not every patient is immediately treated. Now, we shouldn't forget that sometimes patients drift in and out of specialist care. Some patients have compounding factors that complicate the start of therapy, most notably, drug use or alcohol use. And the patients who are just less sick have less motivation themselves and the physician has less motivation to really push those sort of therapy. And lastly, the paperwork and the administrative process for authorization is still there, like it is with any specialist product. So I think those are mostly the dynamics and it's mostly around the patient being less time in the physician's practice. They're not patients that have been held for a long time. They're not patients that failed one or two prior therapies and a great urgency by the physician. In terms of Europe, as I said, we did see a down tick in the patients treated in the Southern European markets, primarily Italy and Spain. And I think that's because they are working through the sicker patients and becoming more like France and Germany. There still are more patients in the Southern European markets, but I do think they are clearing the most obvious patients to treat and cure. And I want to emphasize that market share has stayed very, very solid in those markets. And whilst there's not an obvious mechanism through advertising, television advertising, in the European markets, we are doing a lot of partnership with KOLs, with societies, with patient groups, to again try to encourage the right screening practices and the right transfer of patients into specialist care.