A4 05 babiak disinvestment presentation
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Transcript of A4 05 babiak disinvestment presentation
Disinvestment – What does it mean in the Canadian Context?Industry Perspective
Lesia M. Babiak
April 11, 2016
Experience From Both Sides of the ‘Fence’
• Government– Drug plan Manager –
Associate Director of Ontario Drug Programs
• Industry– Johnson & Johnson –
Government Affairs & Policy– LifeScan – Government Affairs– Janssen – Federal Affairs,
Market Access
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3
Health Care System goals
• Enhance system efficiencies to allow improved access to care that is effective, safe and offers worthwhile benefit
• Assessment of new technologies
• Reassessment of established technologies
Optimization of use of technology involves
Disinvestment or Optimization, Modernization, Reassessment
Reassessment Objectives
• Improving health outcomes
• Facilitating the adoption of technologies & approaches offering high value
• Supporting health system sustainability
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Proton Pump Inhibitor – A Draconian Approach Focused on Cost Savings That Failed
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Background • Major spend pressures, 15-20% growth annually• Expert committee perception of misuse• Perception of inappropriate promotion by
manufacturerResults• New PPI limited use criteria introduced weeks
before an election• New limited use forms, with Ministry able to ‘audit’
prescribers• Major backlash from physicians and pharmacists• Limited use forms revised, eventually eliminated• ICES analysis subsequently demonstrated PPI
usage largely appropriate
Formulary Modernization – Focus on Optimization of Care
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• Extensive effort to address a number of suboptimal use and safety concerns
• Focus on optimization of care vs. major cost savings• Examples:− Flexeril – Muscle relaxant with little evidence to support usage− Demerol – An effective narcotic in short term, long term use concern due
to metabolite accumulation
• Manufacturers provided opportunity to input over 18 month process• Communication plan developed targeted at physicians and
pharmacists
Back-ground
• Flexeril delisted – Some backlash• Demerol restricted to two weeks maximum usage – No backlashResults
Antimicrobial Resistance – Focus on Addressing a Growing Concern
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Background • Incidence of antimicrobial resistance of concern in the 90’s
due to overuse of antibiotics and increased use of 2nd and 3rd line agents
• Extensive review undertaken with multiple opportunities for manufacturers and clinicians to input
• Multi pronged approach deployed – Public Health engaged• Extensive change management/communication plan
developed• Communication plan targeted at physicians, pharmacists
and patientsResults• Formulary hurdles introduced for 2nd and 3rd line agents• Antibiotic usage dramatically changed, antimicrobial
resistance reduced• Some backlash/resistance, no significant traction• Unintended consequence of Ontario and restrictions of
other jurisdictions – Reduced investment in antimicrobial R&D
Blood Glucose Test Strips
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Background • Provincial concerns about level of spend on blood glucose test
strips (BGTS)• CADTH launched a review, recommended disinvestment of BGTS
for Type 2 diabetes• Consultation with stakeholders perceived to be limited, major
stakeholders, including Canadian Diabetes Association (CDA) and others felt largely ignored, significant backlash
• Minor alterations applied to final recommendation• CDA launched an independent assessment, published a position
which advocated for continued access to BGTS however recommended guidelines for ‘reasonable’ levels of testing in light of cost constraints
Results• No provinces adopted the CADTH recommendations• Ontario, British Columbia and Saskatchewan introduced CDA
based BGTS quantity limits• Usage in Type 2 patients has fallen dramatically 40-50%,
overall usage decreased by over 20%• Ontario worked proactively with CDA, BC worked proactively with
CDA and numerous stakeholders • Backlash minimal
Impact of Ontario BGTS Policy: 19 Month Experience – Significant and Sustained Savings
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
Insulin Insulin & Oral Agents Oral Agents/Hypo Oral Agents Non-Hypo Lifestyle
Therapy%Change*
Insulin -2%
Insulin + Oral Agents
+15%
Oral Agents/Hypo
-44%
Oral Agents/Non Hypo
-50%
Lifestyle -46%
Total -23%
* Aug 2013-Feb 2015 vs. prior 19 monthsSource: IMS Brogan
Thousand
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Legacy Medical Devices
Minimally Invasive Hysterectomies
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Background • Hysterectomies are still the most common surgical
procedures that CDN women undergo• CDN and international publications support least
invasive procedures to minimize complications and recovery time
• Ottawa Hospital launched a series of initiatives in 2007 to address issue
Results• Ottawa Hospital results significant, MIS increased
from 40.1% (2005) to 74.2% (2012)• Decrease in mean LOS from 2.5 to 1.6 days
Reduced complications, cost savings• Despite guidelines and publications, national figures
for open hysterectomies remain high:Rate of open hysterectomies remain at 57% (National Ambulatory Care Reporting System and the Discharge Abstract Database, 2014/2015 data)
Key Learnings
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• Active engagement of stakeholders at all key stages including−Prioritization−Reassessment−Decision making− Implementation
• Support is critical from affected stakeholders for optimization of use
• Transparent and evidence based• Thoughtful and effective knowledge transfer to all
stakeholders
Key Learnings
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• What should the focus be?−Has to be worthwhile as the effort is significant
• Cost savings, maximizing value• Safety/efficacy
−Likelihood of success should be relatively high
• Unintended consequences?−Possible increase vs decrease in costs −Potential impact on R&D priorities
Key Learnings
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Reassessment of evidence is just the beginning of this journey……