PID clinic network Réseau québécois de cliniques d immunodéficience
Quebec PID network Structure Goals Achievements
McGill University Montreal Children s Hospital Dr. Christine McCusker Dr. Francisco Noya, Dr. Christine Lejtenyi Dr Reza Alizadehfar Dr. Marie Noel Primeau Dr. Bruce Mazer Dr. Nada Jabado, Hematologie-Oncologie Montreal General Hospital Dr. Christos Tsoukas, Dr. Reza Alizadehfar, Laval University (Quebec) Dr Jacques Hébert Dre louise Coté Dr Pierre-Michel Bédard Dre Hélène Senay Dr Aubert Lavoie Dr Rémi Gagnon University of Montreal Dr. Devi Banerjee, Dr. Joseph Shuster Dr. Phil Gold, Dr. Ann Clarke Ste-Justine Dr Elie Haddad Dr Françoise LeDeist Dr Anne Desroches Dr Michel Duval Dr Georges Rivard Notre-Dame Dr Sophie Laberge Dr Benoit Laramée
Quebec PID network Structure Goals Achievements
1. Diagnosis and treatment of PID patients 2. Développement of new therapeutic options: home therapy for antibody deficient and HAE patients 3. Development of protocols for therapies and follow-ups 4. National register 5. Teaching
Quebec PID network Structure Goals Achievements Home therapy for PID Home therapy for HAE
Home therapy for PID To convince the health authorities to move ahead Economical arguments mostly= less expensive To establish the teaching and supervision program To enroll the regional blood banks to provide better services for patients from remote areas
Home therapy Comparison of Advantages Subcutaneous No venous access required Intravenous Convenient and well tolerated by most patients Slow administration and gradual absorption reduces severe headaches and other adverse events Ability to give large volumes per infusion allows intermittent dosing (every 21-28 days) Maintains more consistent IgG levels; eliminates low troughs Clinical efficacy recognized: annual rate as expected Excellent safety profile Facilitates self or home infusion, increasing patient autonomy may improve patient s selfimage and sense of control Less expensive for society and patient Berger M. Clin Immunol. 2004;112:1-7.
Comparaison: IV (hosp) SC (home) IVIG hospital based SCIG home based Garduf et al 14,124 4,636. US$ 1993 Hogy direct and indirect 31,027 14,893 Euro 2003 Liu 18,600 11,760 Euro 2005 Haddad 14,304 18,216 Euro
Economical Impact Government perspective CADTH report Economy of 9 millions CDN$ / Year if 75% of patients on IVIg are switched to SCIg Economy of 700$ / patient (Tubing and pumps included) Ho C. Et al Overview of subcutaneous vs IV for PID: systematic Review and Economic Analysis Canadian Agency for Drug and Technologies in Health 2008
Methods of administration PUMP Method: an ambulatory infusion pump or syringe driver is used to infuse the dose as described in the product monograph Frequency: Weekly dose Weekly Dose: ¼ monthly IVIg dose Patient can be ambulatory during administration PUSH Method: pushing the product using small doses regularly has been used in some US and Canadian centres Frequency: every day, every 2-3 days, 5 days/wk, etc Daily Dose: weekly dose divided in vial sizes or number of treatment days required Input from patients should be considered when choosing a regimen Once patient has learned how to self-administer, nursing services may not be needed
Economical Impact Government perspective CADTH report Economy of 9 millions CDN$ / Year if 75% of patients on IVIg are switched to SCIg Economy of 700$ / patient (Tubing and pumps included) Much better with the PUSH technique no pump and minimal tubing Ho C. Et al Overview of subcutaneous vs IV for PID: systematic Review and Economic Analysis Canadian Agency for Drug and Technologies in Health 2008
Economical advantage of the PUSH method over the PUMP method Pump Method Push method Pump $2000 $0 Ancillary products (Tubing + syringes) Training (nursing time) $800 $325 3-5 sessions 2-3 sessions
Situation in Québec: Nov 2009 CANADA - Québec 160 pts
Clinique d immunodéficience PID clinic du CHUL Founded in1982 >150 patients 60 treated at CHUL >60 on home therapy
Home therapy for PID To convince the health authorities to move ahead To establish the teaching and supervision program To enroll the regional blood banks to provide better services for patients from remote areas
Administration of Vivaglobin - home therapy with a seringe driver
home therapy with a seringe driver Indications Patient preference Advantages Simple: one infusion /wk in multiple sites with the same pump Faster and less expensive than using multiple pumps Once a week Disadvantages Higher costs: tubes, pumps (not paid by Health System) Take more time at each infusion Reliability of pumps In Montreal, patients from children hospitals are on pump method
Administration of Vivaglobin home therapy with a seringe (PUSH)
- home therapy with a seringe (PUSH) Advantages Decreased costs compared to PUMP No dependance to pump Faster and more convenient for adults Préparation Infusion Disadvantages 4-7 infusions per week (Infusions of 10ml (1.6gr)X 6 for average adult (9.6gr)
Home therapy for PID To convince the health authorities to move ahead To establish the teaching and supervision program To enroll the regional blood banks to provide better services for patients from remote areas
Satellites Blood Banks Rimouski Chicoutimi Maria Trois-Rivières Teaching Distribution of products
Quebec PID network Structure Goals Achievements Home therapy for PID Home therapy for HAE
Home therapy for HAE
Clinique d immunodéficience HAE clinic du CHUL >25 patients from the province 5 on home therapy IV 1 to come Moncton (NB)
Home therapy for HAE Target population Symptomatic patients Side effects with available medication Age
Home therapy for HAE Teaching
Home therapy for HAE The only home therapy program in Québec 1000 units 1-3 times per week 5 patients 1-2 to come The home therapy on demand to begin in January
Home therapy for HAE Teaching Backups with local facilities Supervision
Let be prepared for the future Thank you Jacques Hébert CHUQ/CHUL Centre de recherche en allergie de Québec