Transcript Cancer Advocacy Coalition

Cancer Advocacy Coalition
of Canada
2007 Report Card on
Cancer in Canada™
Media Conference
Toronto, February 12, 2008
Introduction and Overview
Dr. James Gowing
Our Findings
• Current Canadian system of managing cancer
from research to treatment and supportive care is
outdated
• As a consequence, cancer management is:
• Inconsistent
• Ineffective
• Unfair to Canadians
Overview
•
•
•
•
•
•
•
Cancer research funding – any change?
Clinical research – need for a paradigm shift?
Cancer in young adults – are they the forgotten generation?
PET scanning – why is Ontario so far behind?
Supportive Care – are nurses nursing patients?
Access to cancer drugs – is it getting worse?
Who pays for cancer drugs – do we have two-tier
medicine?
The Way Forward
• Greater collaboration between government and all
other stakeholders
• Modernize our infrastructure for both research and
access to care
• Motivate Canadians to demand better and equitable
access to cancer care
If we choose, we can have access to the
best quality cancer care.
Cancer Drug Access in Canada
Part III
Dr. Kong Khoo
Rosemary Colucci, William Hryniuk,
Joseph Ragaz, Sandeep Sehdev and Colleen Savage
Cancer Drug Access in Canada – Part III
• New wave of cancer drugs
• Report on 24 previous treatments plus 18 new
therapies
Status of Public Funding:
24 Previously Studied Cancer Drugs by Province, 2007
30
25
20
15
10
5
0
BC
AB
SK
MB
ON
Approved and Funded
Recommended but not funded
QC
NB
PEI
Limited access/funding
Not approved or funded
NS
NL
Status of Public Funding, 18 New Cancer
Drugs/Indications by Province, 2007
20
18
16
14
12
10
8
6
4
2
0
BC
AB
SK
MB
ON
Approved and Funded
Recommended but not funded
QC
NB
PEI
Limited access/funding
Not approved or funded
NS
NL
Summary of Findings
• Only a minority of the 18 new cancer drugs are
widely available
• Access to cancer drugs remains highly variable
across the country – “postal code lottery”
The Cost of Cancer Drugs in
Canada
Dr. Kong Khoo
Rosemary Colucci, William Hryniuk,
Robert Kamino, Tania Redina and Colleen Savage
The Payer Landscape for Cancer Drugs
• Public payers through provincial cancer agency
or cancer centre/hospital budgets
• Public payer through provincial “pharmacare”
plans
• Private insurers/ insurance
• Patient self-pay
• Pharmaceutical company compassionate access,
and assistance and expanded access programs
• Charitable/donated funds
• Clinical trials
Drug Costs: Who is Paying?
• Last year we detected a trend to increased
private funding for cancer drugs in Central and
Atlantic Canada
• This year we investigated public vs. private
payouts for new cancer drugs in each province
on the Brogan Inc. public & private database
• Does variable payout for new cancer drugs
correlate with the differences in cancer mortality
from west to east?
Brogan Inc. Public & Private Drug Database
• Private Drug Plan Database
• Drug benefit claims paid by most major private
insurers in Canada
• No data for PEI
• Provincial Drug Plan Database
• Represents provincial “pharmacare” programs
mainly for oral, take home cancer drugs
• No data for PEI
• There is little data for BC, AB, SK because most
cancer drugs are provided through provincial cancer
agency drug budgets including oral take-home drugs
Drug Costs – Who’s Paying?
Both public and private insurance payers
are paying more across Canada.
Drug Costs: Who is Paying More?
Manitoba
Manitoba Public Versus Private Pay 2002 - 2006
$7,000,000
$5,866,510
$6,155,968
$6,000,000
$5,019,427
$5,000,000
$4,000,000
Public Pay
Private Pay
$3,416,742
$3,000,000
$2,168,178
$2,000,000
$792,309
$1,000,000
$644,101
$173,155
$194,499
$358,801
$0
2002
2003
2004
2005
2006
Drug Costs: Who is Paying More?
Ontario
Ontario Public vs Private Pay 2002 - 2006
$ 50, 000, 000
$ 47, 577, 435
$ 45, 000, 000
$ 40, 000, 000
$ 37, 071, 888
$ 35, 000, 000
$ 31, 546, 729
$ 29, 476, 693
Ontario
Public
$ 30, 000, 000
$ 23, 931, 176
$ 25, 000, 000
$ 21, 513, 287
Ontario
Private
$ 18, 554, 513
$ 20, 000, 000
$ 15, 682, 044
$ 15, 000, 000
$ 10, 891, 114
$ 10, 000, 000
$ 7, 189, 772
$ 5, 000, 000
$0
2002
2003
2004
2005
2006
Drug Costs: Who is Paying More?
Quebec
Quebec Public Versus Private Pay 2002 - 2006
$ 40, 000, 000
$ 36, 081, 890
$ 35, 000, 000
$ 29, 066, 487
$ 30, 000, 000
$ 24, 161, 718
$ 25, 000, 000
$ 22, 997, 008
$ 19, 063, 183
Quebec P ubl i c
$ 20, 000, 000
$ 17, 257, 802
Quebec P r i vat e
$ 13, 404, 792
$ 15, 000, 000
$ 11, 569, 921
$ 8, 587, 851
$ 10, 000, 000
$ 4, 456, 338
$ 5, 000, 000
$0
2002
2003
2004
2005
2006
Drug Costs: Who is Paying More?
Atlantic
Atlantic Provinces Public Versus Private Payer 2002 - 2006
$7,000,000
$6,540,167
$6,000,000
$5,154,610
$5,000,000
$4,724,712
$3,809,348
$4,000,000
$3,524,504
Public Pay
Private Pay
$3,000,000
$2,782,125
$2,583,278
$2,203,397
$2,000,000
$1,857,050
$1,692,015
$1,000,000
$0
2002
2003
2004
2005
2006
Who Pays? Private Insurance
Cost Per Incident Cancer Case
By Private Insurance 2006
$800.00
$721.63
$684.40
$700.00
$600.44
$600.00
$551.52
$500.00
$456.46
$383.62
$400.00
$300.00
$200.00
$134.29
$100.00
$81.07
$87.98
$33.00
$0.00
BC
AB
SK
MB
ON
QC
NB
NS
PEI
NL
Est i m a t e d N e w C a nc e r C a se s by M a j or C a nc e r S i t e ( Ta bl e 3 , C a na di a n C a nc e r S t a t i st i c s, 2 0 0 6 , pa ge 2 4 )
The Cost of Drugs – Who Pays?
Summary
• The cost is rising rapidly for both public and
private payers for cancer drugs
• Private insurers and patients in different parts of
the country bear very different burdens for the
cost of cancer drugs
• If you have cancer, depending on your postal
code:
• A new cancer drug might be provided to you by
government
• You may have to rely on your private insurance
• You may have to pay for the drug yourself
Additional Highlights
Dr. William Hryniuk
Summary of the Other Key Articles
Inconsistent
Ineffective
Unfair
Drug Access
X
X
X
Drug Payments
X
X
X
Cancer Research
Funding
X
Clinical Research
X
Cancer Treatment
in Young Adults
X
X
PET Scan
X
X
X
Supportive Care
X
X
X
Cancer Research Funding in Canada
• Epidemic diseases historically controlled by prevention
• Present grant system focused on the cancer cell not the
cause
• Using strict definitions of research, have found few changes
since 2004 Report Card
• Government sponsored research agencies continue to
emphasize basic research of the cancer cell not the cause
• Non-government organizations such as CCS and NCIC
making important, strategic shift to more treatment and
prevention research
• Need to rethink research objectives and focus on societal
priorities, not researchers’ priorities
Cancer Treatment Research
Paradigm Shift Needed
• The present infrastructure of clinical trials is
becoming obsolete for the present era
• Based on 1970’s approaches
• Major bottleneck  new curative agents backed up
waiting in queue to be tested.
• Delays of introducing new curative agents into
practice
• Inability to materialize their survival gains
• Major loss of opportunity to avoid cancer deaths!
Cancer Treatment Research
Paradigm Shift Needed
• Reforms proposed for breast cancer
• Five-point proposal package to reducing overinvestigation of these new curative agents presented
to an international meeting
• If implemented, package has potential to save
thousands of lives, and millions of dollars
Young Adults With Cancer:
The Forgotten Generation
• Young adults with cancer:
• Have the same chance of surviving cancer today as they did
in the 1970’s
• Represent 28% of the potential life lost due to cancer
• Deal with unique and challenging emotional issues as a
result of their stage of life
• The Canadian healthcare system:
• Allocated less than 0.1% of new research funding to young
adult cancer issues in 2006
• Delivers only four support groups for young adults in the
whole country
• They are a generation that warrant a significant
investment of resources to help them be the
contributors and leaders they were destined to be
PET Scanning
Why is Ontario So Far Behind?
• An innovation for diagnosis and management
for cancer; ironically originated in Canada
• Ontario continues to lag far behind other
provinces and the world in recognizing its utility
• Ontario requires unattainable standards of
evidence for the utility of PET in clinical cancer
medicine
• Ontario cancer patients suffer the consequences
Supportive Care
The Role of Nurses
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•
•
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Why supportive care?
Nurses ideally suited for providing supportive care
Historic evolution of nurses’ role
Nurses in major cancer centres only partially providing
supportive care
• 32% of nursing hours spent on non-nursing duties
• Redeployment of these hours would allow navigation of
cancer patients through the silos of the healthcare
system and enhance primary care nursing
The Future “Re-thinking Cancer”
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Cancer research funding…greater focus on prevention
Clinical research…streamline to get results quicker
Cancer in young adults…invest now for high return
PET scanning…embrace modern technology
Supportive care…empower nurses to nurse
Access to cancer drugs…equal access to quality treatment
Cancer drug payment…redesign public/private payment
system
The Future
• End the postal code lottery
• Develop a national vision for cancer care in
Canada
• Usher in a new era of collaboration
• Act with urgency
The 2007 Report Card on
TM
Cancer in Canada
Thank You
www.canceradvocacy.ca