Evidence of meeting #55 for Health in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was cdr.
A recording is available from Parliament.
Spokesperson, Hit the slope for hope
It was to do with accessibility. Dr. Pressnail just said it had been taking a really long time but that he had his fingers crossed. So I think it was like the waiting game.
Liberal
Bonnie Brown Liberal Oakville, ON
A very long time compared with what? Did he know how long it takes every new drug?
Chair, Hit the slope for hope
He probably would. I'm not sure. We can get all that information and let you know, though.
Liberal
Director, Li Ka Shing Knowledge Institute and former Chair of the Canadian Expert Drug Advisory Committee, St. Michael's Hospital
Tarceva came before the CDR when I was the CEDAC chair, and to the best of my recollection, it was dealt with in the five months' time process, and to the best of my recollection it was recommended for funding under certain criteria.
I don't know whether those criteria were the ones your mom would have had, but certainly, to my knowledge, it wasn't delayed.
Is one allowed to make a comment?
I think the question raises one of the issues I talk about, which is the lack of integration within the whole system. I think for drugs that are truly advances, one would like to have CDR starting to review the drug at the same time as Health Canada is reviewing it, so that they don't have to wait all that time and then start all over again.
My understanding is that the CDR has started to have a few pilot tries at looking at the information that's provided to Health Canada. That can only happen, obviously, with the drug company's approval. That would be another example of the lack of integration, which does lead to a longer time than it probably should take.
Liberal
Bonnie Brown Liberal Oakville, ON
Thank you, Dr. Laupacis. We've had that suggestion from other witnesses as well. As you say, I think there are some pilot projects.
But I want essentially to let the Calvert sisters know that this wasn't a particularly slow thing for this drug, which it might have felt like from their end. It was the usual process, and Dr. Laupacis is here to witness to that. Your lack of access was more to do with the newness of the drug than anything else, not the CDR.
Spokesperson, Hit the slope for hope
Okay. I'm just wondering.... It is a family friend to whom we referred; he had access to the drug almost 10 years ago. Granted, it was a study, but it was effective for him.
Liberal
Bonnie Brown Liberal Oakville, ON
It was in clinical trials then. That's a totally different kettle of fish.
Liberal
Bonnie Brown Liberal Oakville, ON
Dr. Laupacis, I'm very interested in your statement that the main barrier to access for most people is the skyrocketing cost of drugs. You gave good examples from about 10 years ago rather than from today. I don't know whether you'd want to comment on this, but you will know that the big pharmaceutical companies claim that these huge costs are what it takes them to develop a new drug.
Do you think the costs of developing a new drug have accelerated by the same factor as the prices of new drugs today?
Director, Li Ka Shing Knowledge Institute and former Chair of the Canadian Expert Drug Advisory Committee, St. Michael's Hospital
I honestly don't know how the industry spends its funds, in terms of the proportion that goes into advertising versus basic science research, etc. I think things are changing markedly with the emergence of biotech drugs, etc.
What I would say is that eight or nine years ago industry reported that it cost them $300 million to produce one drug. Understandably, there are many failures along the way. Now that figure is up to $800 million per new drug. I'm in no way disputing that those figures are correct; I'm just saying, when does that increase end? We were perhaps under the impression that the genetic revolution would make the discovery of drugs more efficient. It sure doesn't look like that's the case.
As for what goes into those increased costs, you should ask the pharmaceutical industry. I don't know.
Liberal
Bonnie Brown Liberal Oakville, ON
You also made a comment about the seven or so countries that guide the decision-making of the Patented Medicine Prices Review Board. Do you think those are the right countries, in the sense that they're all countries for which the export of pharmaceuticals is one of their industrial strengths? One has to wonder about the prices they allow in their home country, knowing that the export of those drugs to other countries improves their balance of trade situation.
Director, Li Ka Shing Knowledge Institute and former Chair of the Canadian Expert Drug Advisory Committee, St. Michael's Hospital
This isn't an area I'm an expert in, but I would make two comments.
First, as best as I understand it--and certainly I don't have any problem with those seven countries, although I can't rhyme them off to you--the legislation says the price in Canada can't be higher than the median price of those seven countries. So I guess my first question would be how the prices in those other countries are set. It seems to be what the market will bear, not much relation to what the benefits of the drug are.
Second, my understanding is that Canadian prices are compared to the list price. France, for example, enters into all sorts of volume price agreements. The list price might be the price they'll pay for the first 500,000 people for the drug and they'll pay a much lower price for the next 250,000, just for an example. We're comparing our price with the list price of those drugs for those countries when in fact the actual prices that are paid might be lower.
There are others who are much more expert in international drug pricing than I am.
Liberal
Bonnie Brown Liberal Oakville, ON
I thank you for pointing that out about the list price vis-à-vis the actual price a French patient might have to pay. This is what I mean about the countries that are part of that group. They have reasons for pricing things the way they price them.
I think we're going to have some very good questions, Mr. Chair, when we get to that stage in our study. We're focusing, for a couple of meetings, on price.
Thanks very much.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Thank you, Mr. Chair.
Thank you for being with us this afternoon, ladies and gentlemen.
Mr. Upshall, I want to check that I have fully grasped your comment. Is it your position that the people in the CDR who study the drugs are so-called experts because they are not familiar with each area of expertise, especially the area of mental illness? You made it clear that this is a specific area.
I would just like to know if, in your opinion, these groups of experts should be made up of people with expertise in each illness or medical specialty so that their evaluation of the drugs is of high quality.
National Executive Director, Mood Disorders Society of Canada
Thank you.
My sense is that the expertise should be as broad as possible. I limit my comments to mental illnesses, but mental illnesses are so pervasive that I think the need for expertise is apparent to anyone, other than the people who appoint people to CEDAC.
I think the reality is that if they're going to advise appropriately, they must be experts in the field. As far as I'm concerned, they must have significant expertise. It exists in Canada, from the scientific level down to the community level, and it should be accessed. Also, I think expertise should be accessed as the drug moves through various approval phases.
Luc Malo Bloc Verchères—Les Patriotes, QC
At the moment, anywhere in the world, are there drugs that can improve the situation of people with mental illnesses or mood disorders, or studies that seem to show that certain drugs can?
National Executive Director, Mood Disorders Society of Canada
We know that in a number of countries effective medications for mental illnesses are available, and they're certainly not available in Canada. We know that throughout Canada there's no consistent policy. Quebec, as you may know, is the leader in terms of making available medications for people with mental illnesses.
There's no real understanding that I can find among the decision-makers that medications for people with mental illnesses are significantly different in the way in which they work compared to medications for cardiovascular, for instance. The broadest choice is not available to people in Canada, and it should be.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
That leads me to ask Dr. Laupacis a question.
Mr. Upshall seems to be saying that more drugs are approved and available in Quebec than in provinces that have to operate under the rules of the CDR.
Are you in a position to explain the difference?
Director, Li Ka Shing Knowledge Institute and former Chair of the Canadian Expert Drug Advisory Committee, St. Michael's Hospital
I think Quebec has traditionally always had a more liberal view about the reimbursement of drugs. I've never sat on the Quebec drug reimbursement committee, so I can't really comment.
I guess I'd make three comments about this general issue. One is that there's no question that one needs expertise in a particular disorder. Certainly, the common drug reviews always obtain the input of one or two experts in a particular disorder. I can well remember conference calls around some drugs for psychiatric illnesses where we had two experts on a teleconference with the whole committee discussing the drug.
But at the same time, I think it's important to have people who have a broad view of health care and the use of these drugs in the system. I think Mr. Upshall indicated that there were 1.5 million people with mental illness in Canada. There are not enough psychiatrists to look after those 1.5 million people. They're largely looked after by family physicians, nurse practitioners, other health care workers.
I think one of the things that CEDAC is faced with is assessing what the likely cost-effectiveness of a drug is going to be and how it's going to be used in the real world, which is considerably different sometimes from the way the academic, hospital-focused—which is me, actually—researchers see the world.
Then the final point I would make is that there's an obvious benefit to rapid access to a drug if it turns out to be clearly beneficial and non-harmful. I think we've seen some examples...Vioxx, for example, where the drug was used, in retrospect, probably more widely than it should have been, and it probably caused a few heart attacks. There have been issues around some of the new antipsychotic drugs, about their causing an increased risk of stroke and heart attack.
I think we have to balance, as best we can, rapid and appropriate access to drugs and trying to get the best possible information we can to make those decisions.
