Health Committee on April 30th, 2007

[Barry Stein]

Certainly, getting this done on a regular basis, informally at this point, I think we rely on a lot of the information from the FDA, for example. I think there's unquestionably a possibility of working together with the other groups, such as the FDA, to consolidate the information. Many of these trials, of course, are done internationally in any event, so I don't think it would be a problem.

[Penny Priddy, NDP, Surrey North, BC]

All right. Thank you.

Around cost-effectiveness, and again, it's probably a debate for another day, but was there debate at the table you had in Montreal around...? I understand doing cost-effectiveness for a variety of reasons in a variety of ways. It seems to me somewhat more difficult to do cost-effectiveness either around rare disorders or around oncology drugs, because no matter what, it's going to be expensive. So it's not going to be cost-effective from a money perspective.

I don't know if at the tables you sit at cost-effectiveness has been explored in a broader way, in a more socialistic, cultural, dynamic way, as well as just the money part. Has anybody been part of that kind of discussion?

[Dr. William Hryniuk]

The answer is no, they haven't.

[Penny Priddy, NDP, Surrey North, BC]

Okay, thank you.

The JODR is separate. There's certainly a suggestion that disorders be separate. Do you think that weakens, in any way, the CDR? Do you think that's simply a compatible partnership? If you had a magic wand--not a big one, a little one--would there be ways in which CDR could make changes?

They've acknowledged there are changes they can make as well, particularly around transparency, which you spoke about as well. The transparency patients have looked for, I know, is not there, other than people are planning on printing or putting out information about why the drug wasn't approved. I don't know what you can put, other than that it wasn't safe, without breaking intellectual property if the drug is not registered.

Could you just speak quickly to the transparency one? Given that CDR is prepared to say they need to do things differently as well, is that possible?

Then I'm done--I know I am; that's why I'm not looking at the chair.

[Barry Stein]

Any panel can improve itself, there's no question about it, if they change enough.

Transparency helps, perhaps, in the carefulness of the decision and in the acceptability of the decision.

[Penny Priddy, NDP, Surrey North, BC]

So trust of the decision.

[Barry Stein]

Needless to say, transparency in and of itself is not the answer. What we're looking for, of course, is easier access. So cost-effectiveness certainly has to be taken into account; we know that from experience. However, one of the experts who was speaking at the round table conference pointed out that with all the formulas, whether it's quality or whatever, largely at the end result it's disregarded.

In any event, the levels that are set are very artificial. If you set a $50,000 quality, where did that $50,000 come from? It came from 10 years ago, and perhaps the number should be $100,000 today. So these are artificially set values in any event.

At the end of the day, what we have to look at...we have to look at ourselves in the mirror and ask if we're taking these new technologies to Canadians who will best benefit from them, or are we depriving them?

[Penny Priddy, NDP, Surrey North, BC]

I understand that.

Diana, you look like you want to say something.

I know I'm done, Mr. Chair, without looking at you.

[Diana Ermel]

I really agree with Bill and Barry about this. I guess what we can see--and you said this common drug review is too far gone to be helped. It's the process or the—

[Penny Priddy, NDP, Surrey North, BC]

Yes, Steven asked that, not me, though.

[Diana Ermel]

Yes.

What we see is that with this cost-effectiveness comparison versus how much longer you are going to live, it just doesn't give the answers to help make decisions. If the drug isn't too expensive and it's going to let you live two months, well, great, there's no problem. So it really is about how much money.

So somehow or other this system--and the way we work and the way we make these decisions in Canada--is what needs to be fixed. Somebody said drilling down and looking at the process. I put in my notes a systemic re-look at what are our values, what are we valuing, and what is the value of life. I don't know the answer to it. These people have suggested some.

Sorry, I've finished.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Ms. Priddy is very perceptive. She was actually finished a while ago, but I don't want to cut off Ms. Knox twice in a row, so I'll allow her to answer.

[Dr. Jennifer Knox]

That's okay.

Very quickly, on a much less sophisticated level, Canadians have a publicly funded health care system and they understand that the money is not endless. But I honestly think everybody is saying that if you could involve them in the decision-making and the debate, we might actually come up with something productive about what we all agree should be paid for and not.

It's the secrecy about how the decision is made. I can't even explain to my patients sometimes why that decision was made and about the way the patients weren't at the table. I think there needs to be this dialogue, and that's not happening.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Ms. Davidson, you have five minutes.

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

Thank you, Mr. Chair.

Thanks very much to all of the presenters.

I have a couple of questions, and my first one is just a brief question to Dr. Knox.

You referred to a couple of the drugs for kidney cancer treatment that were withdrawn and were not available, but they were available in many other countries.

[Dr. Jennifer Knox]

Yes.

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

Now, could these drugs have been approved by the provinces? If the CDR does not approve them for the formulary, could the provinces have approved them?

[Dr. Jennifer Knox]

Yes, they can.

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

Have they ever?

[Dr. Jennifer Knox]

British Columbia does. Correct me if I'm wrong, but so far Ontario has decided not to fund Nexavar, based on the CDR recommendation. Is that correct?

[Debbie Milliken]

Nexavar is currently under reconsideration through the Ontario process.

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

So there's no consistency then. Each province can act independently.

[Dr. Jennifer Knox]

Yes, but I think in general they don't, and that's why you see such differences. Quebec gets them. British Columbia gets them. Ontario often doesn't. The Maritimes do worse. That's upsetting.

[Barry Stein]

I think there's a general perception that if the CDR says no, then it's no, and if they say yes, then it's maybe.

[Dr. Jennifer Knox]

Yes, that is correct.