Health Committee on April 16th, 2007

[The Vice-Chair, Bloc, Christiane Gagnon]

Your time is up, but there will be a third round. We will have plenty of time before the end of the meeting.

I am now going to give myself the floor, so to speak. I have not been able to ask my questions yet.

By way of comparison, you mentioned France, where access to medicines is much greater and where they are approved in greater numbers. Their evaluation process is probably different from ours. Can you give us an idea of how they evaluate drugs?

Here, we have three separate evaluations: by Health Canada, by the CDR and by the provinces. Four provinces are exceptions, I think. They don't do evaluations, so they can rely on those done by the CDR. Maybe the French model is a goal to aspire to, but we also have New Zealand's. Half the number of registered products are available to the public, and the cost is four times less. No one seems to be saying that patients are disadvantaged in New Zealand. I don't know if you know anything about the evaluation process in that country.

Why would it not be an acceptable model for all of Canada and for Quebec?

[Russell Williams]

As you have already mentioned, it's a very complex question. In our study of other countries, we concentrated on the first aspect of the question, choice. European countries do offer more choice. They make more positive recommendations than the CDR.

As regards access, forget all the debate, the list of duplications and so on. We are here to find a way to make sure that medicines are available to patients. The way this is done varies from country to country. It always seems difficult to make an exact comparison of the system in one country with the system in another. According to my information, the New Zealand system makes fewer products available.

[The Vice-Chair, Bloc, Christiane Gagnon]

True: we are talking about 2,500 products, that's half the number in Quebec where there are 5,000.

[Russell Williams]

So there is less choice.

[The Vice-Chair, Bloc, Christiane Gagnon]

They consider a number of criteria, including effectiveness and cost. They also consider that, in a number of cases, changing one molecule in a new drug is not going to improve the patient's quality of life. In those cases, they stick with the drug that they already have. The so-called cross deals affect the cost of drugs too. It's quite interesting. We can talk about access to medicines, but the impact of their cost on the entire health care system is an issue too. When we talk about the health care portfolio, we know that a large part of the funding goes to pharmacare and hospitals. They have decided to put less pressure on the entire health care area.

[Russell Williams]

I think that we have to be very careful with evaluations of drugs intended for everyone. Our studies show that a drug is very effective for some patients, but less so for others. If the authorities decide that they are not going to make the drug available for that reason, the patients for whom it would be very effective will not have access to it. So we have to be very careful with evaluations that affect everyone rather than target groups.

[Mark Ferdinand]

I would add one thing. Again, this is a question of choice, and when we compare all the countries in the world that offer a greater choice, we see that in some that does not necessarily imply an increase in the health care budget. We may ask why, and maybe a future study will give us the answer. In some cases, we may see that it is caused by optimal drug use programs or other measures that let those countries limit their costs at the same time as they offer a greater choice to doctors and their patients.

[The Vice-Chair, Bloc, Christiane Gagnon]

Thank you.

Ms. Priddy.

[Penny Priddy, NDP, Surrey North, BC]

Thank you.

We haven't touched on this, but there was some discussion in the beginning about transparency and the public input into the CDR, and I would like somebody to briefly tell me how they would see that happening in an objective way. For instance, if you fill the room with a public that wants drug A, what you have is public input, but it's really a roomful of people who are there for a particular drug.

Could you just give me a sense of how you might see that public input happening in a way that is reasonably objective and helpful?

[Peter Brenders]

I'd like to offer a suggestion. I think there are a number of ways to deal with that. We see this approach in place in other jurisdictions. A good example is right next door to us, the U.S. FDA. The FDA, before licensing any product, does an open-panel review hearing that allows for citizen engagement. It allows for the companies to sit there and answer questions as well, to be questioned by the committee and the panel in a full public environment. We see public hearings as well.

Our hope is to allow—because remember, at the end of the day, cost effectiveness—Everyone talks about the science of health technology assessment. It's not science. At the end of the day, it's still opinion, and it's opinion of a very select few people in terms of what value is. Our question on that one is to do that in public, have a public meeting. Yes, there may be a big crowd out there, but let the crowd hear what the view is, hear what the debates are, the positives and negatives, and allow for perhaps selected input into that discussion, into that framework.

At the end of the day, it's going to be those people who are most affected, whether they be physicians, pharmacists, patients, or even the manufacturers that have done the research and development to bring it there to be able to inform a group. We find it's particularly important, especially when you're dealing with unmet needs and rare diseases, where there is no 30- to 40-year history in terms of the disease treatment cycle—

[Penny Priddy, NDP, Surrey North, BC]

I realize that. There are a number I'm aware of like that.

Okay, thank you.

Also I want to say happy birthday to the chair. I don't know if this is how you planned to spend your birthday, chairing a health committee meeting, but I suppose we don't always get to choose. We're thrilled that you're here to do that.

As a cancer survivor from British Columbia, I appreciate the comments around our oncology program.

I have one more, if I might. Certainly, the party I belong to—and I think there are others—is talking about a national catastrophic drug plan. Can you see that happening independently of the common drug review? Is there a way for that to move on without going through the common drug review? Would you want to comment on that?

[Russell Williams]

I think if we want to build something that actually responds to all Canadians' needs and make sure they have access to innovative medicines in a national program, we definitely have to move it through without the common drug review.

As Mr. Brenders talked about, it's a different philosophy, and I think what we have to do is sit down and build together with each of the provinces the method that responds to those priorities.

[Peter Brenders]

Just to echo Mr. Williams' point on that one, the philosophy—We have to remember that drugs today, as much as they represent a piece of the spending—it's somewhere between 4% to 8% of total public spending. There's still another 92% that's spent on other parts of the health system.

We have a philosophy in the rest of the health system, the trial of life, when we're dealing with severe needs, which is that you will put a patient in an ICU and give him the chance to see if it works. We don't do that with drugs.

Especially with new technologies that are coming out, with unmet needs that are out there where there is nothing else, what we do is we throw them into a CDR review and say let's take a look at it for a few months before we give the patients that choice and that option.

So we're saying if it's catastrophic in terms of life and the needs, then give them the chance.

[Penny Priddy, NDP, Surrey North, BC]

Thank you.

[The Vice-Chair, Bloc, Christiane Gagnon]

Madam Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, Madam Chair. I wish you happy birthday as well.

Thanks very much to our presenters. I'm new to this discussion, so I don't have a lot of background information on it.

I have some questions regarding some of the statements you made, Mr. Williams. You talked about the agency overseeing CDR already deciding to expand. Could you elaborate on that? Is that along the same lines as the communiqué that was issued two business days ago?

[Russell Williams]

Yes.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Could you expand on that first, please?

[Russell Williams]

I could table it if you like, but it's a public document. The common view is to be expanded to new indications for old drugs. It was a communiqué that came over the wires on April 12. It was a statement that the CADTH believes that the CDR has met its objectives and is moving forward with an expansion. That's why I made that statement.

I found the timing inappropriate at the very best, coming two days before a hearing. It's a public communiqué, so I could certainly table it if that's appropriate.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

The CDR was started at the request of the provincial health ministers. Is that correct? It is a branch of the larger group that has two or three different branches to it, and 30% of the CDR's funding is federal and 70% is provincial.

[Russell Williams]

Yes.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Now what about the overall group? Is it funded federally at 30%, or is it a different percentage?

[Russell Williams]

My understanding is it's 80% for the overall group.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Are there distinct divisions within that overall group?

[Russell Williams]

There are distinct divisions, but in terms of the way the federal money is allocated, it's my understanding that we have not been able to determine how the federal money is allocated, particularly on the CDR.