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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.
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