Advancing Access to Newer Treatments for Atrial Fibrillation

8/6/2019 Advancing Access to Newer Treatments for Atrial Fibrillation

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Canadian Cardiovascular Society Congress

October 24, 2010

Montreal, Canada

AdvancingAccess to Newer

Treatments for

Atrial Fibrillation


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Canadian Cardiovascular Society Congress

October 24, 2010

Montreal, Canada

The CanadianConundrum

D. Wayne Taylor, PhD, F.CIM

The Cameron Institute


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Value for money

Who here pays taxes?

Who here likes paying taxes?


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Economic Drivers vs. Riders

Myth: Number #1 driver of costs is drugs

Drugs are an expense or a rider

FACT: Number one driver of costs is our own ill

health


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Another fact


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And another

Source, CIHI, Health Care In Canada, 2009


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Two tier pharmacare


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And 40% of private is O-O-P!

G7 countryG7 country Govt pharmaGovt pharma

spendspend

Private pharmaPrivate pharma

shareshare

OutOut--ofof--pocketpocket

pharma sharepharma shareUnited StatesUnited States 40%40% 40%40% 20%20%

CanadaCanada 45%45% 35%35% 20%20%

FranceFrance 70%70% -- 30%30%

ItalyItaly 70%70% 5%5% 25%25%GermanyGermany 80%80% 10%10% 10%10%

Japan*Japan* 70%70% 10%10% 20%20%

UKUK 90%90% 5%5% 5%5%


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Comparative health systems

(no US)

#23


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Comparative health systems contd

#30


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Government creates financial

barrier to care

p.35


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Inequity in the system

Private drug insurance coverage

75% policies are open

Out-of country coverage common today

Public drug plans are restricted (seniors,lower income patients)

INCLUDING

hospital formularies (all patients!!!)


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Common Drug Review

First institutionalized barrier to access

Decision-based evidence-making

Thus, drugs being denied to some Canadians(contrary to CHA)

E.g. Orphan drugs

$6-50m*/$20B spent, or 0.25 of 1%!

vs. the $10B to be saved on generics if tendered 95% Canadians favour access to orphan drugs for rare

diseases; 87% favour government funding**

* Robarts Research Institute, 2005

** Pollara, September 2007 for BIOTECanada


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Common Drug Review contd

Rx&D Report, 2008

1/3 Canadians rely on public drug plans for Tx of Ca,

CVD, diabetes, osteoporosis, mental health,HIV/AIDS etc.

#17/18 re public spend on Rx

#16/18 re public access (only Aust. & NZ worse)

46% YES (78 HC approvals) vs. 91% in EU and 88% inthe US

Longest approval wait times


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Common Drug Review contd


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Comparative Drug Utilization

CDR

Medicare Part D


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Implicit Policy Decision?

Canada has chosen static efficiencyover dynamic efficiency in its

healthcare rationing decisions Static efficiency: lowest pricefor existing

products and services

Dynamic efficiency: incentives for

innovationi.e. research, development,commercialization and diffusion of newproducts and services


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Intentions vs. Outcomes

Health economics and health technologyassessment (HTA) have become tools for cost

containment NOT relative cost-effectiveness i.e. takes away choice rather than informs

choice

Medicare/CHA was always about healthfinancing (wealth=health) NOT costcontainment (healthcare=cost)


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Canadian Cardiovascular Congress

October 24, 2010

Montreal, Canada

Advancing the

Patient Voice inEnsuring Access toNewer Treatmentsfor Atrial Fibrillation

Siobhan Cavanaugh,Ward Health Strategies


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Why Advance Public Education forDetection/Treatment of Atrial Fibrillation

Medical and financial costs significant burden on patients andthe health system:

Approximately 250,000 patients with AF in Canada

Approximately 43,000 hospitalizations/year

Hospital costs are about $5,160/per event

Costs of in patient care alone $225 million

AF affects primarily patients over age 45, so economic burdenwill only increase with aging population

Quality of life-chronic fatigue, sleep apnea, affecting overallproductivity

Co-morbid conditions: diabetes, hypertension, CHF, increaserisk of stroke adding to burden of care


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Comprehensive Strategy to Raise

Awareness of Need to Treat AF Identify cardiac and co-morbid conditions medical associations and

advocacy groups

Establish public awareness campaign to reach affected patients

Facilitate communication between doctors and patients

Facilitate communication between patients affected by AF

Provide information on effective tools for detecting and treating AF


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Benchmarking Awareness of AF

In order to build a comprehensive strategy, we need to understandcurrent constituent outreach activities and then identify gaps. Wehave undertaken the following process:

Identified and prioritized stakeholder advocacy organizations whoseconstituents are affected by atrial fibrillation

Held preliminary interviews with those groups to benchmark level ofpublic outreach in support of AF

The Cameron Institute will host consensus conference (Oct.27/28)withthese leaders to identify issues, barriers, and opportunities to improvedetection and access to innovative treatments for patients affectedby AF.


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Prioritized Groups

Canadian Cardiovascular Society

Canadian Stroke Network

Canadian Diabetes Association

Ontario Lung Association

Stroke Survivors Association

Canadian Hypertension Society


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Advocacy in Other Jurisdictions

United States:

StopAfib.org ( developed for patients by patients)

Heart Rhythm Society (for health professionals andpatients)

September AF Awareness month

Europe/Global: AF AWARE comprised of four leading patient and

medical association to highlight and issues thatcontribute to the growing burden of AF.


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Improving Outcomes for

Canadian Patients with AF Mitigating the economic and social burden of AF in Canada:

More public education and awareness of AF symptoms, detectionand treatment

Creation of effective partnerships/ alliances and actively engageorganizations whose patients have co-morbid conditionsdiabetes,hypertension

Advocate for access to innovative AF treatments to improvepopulation health outcomes

Advocate for innovative disease management strategies to evaluatethe effectiveness of innovative treatments and support ongoingquality improvements in the care of patients affected by AF.

Documents

Advancing Access to Newer Treatments for Atrial Fibrillation