Evidence of meeting #113 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was costs.
A recording is available from Parliament.
Director, Federal Affairs, Government Relations and Public Policy, Diabetes Canada
An insulin pump costs about $8,000 to buy and then about another $3,000 a year to run.
Conservative
Len Webber Conservative Calgary Confederation, AB
Is the supply of insulin around the world a concern? Are there shortages of insulin?
Director, Federal Affairs, Government Relations and Public Policy, Diabetes Canada
There are no shortages of insulin. There are a lot of news stories in the United States right now about people not having access to it due to costs. That's for a variety of complicated reasons we're fortunate not to be experiencing in Canada to the same degree.
No, there's no shortage. There are sometimes issues with access to certain newer kinds of insulin. Some provinces are reluctant to add newer kinds of insulin that can improve people's glycemic management quickly. That's another thing we want to ensure as we work through the strategy. As new medications become available, and they are shown to be improving patient outcomes, we need to ensure that they are made available more quickly.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you, Chair, and thank you all for coming.
I have the disadvantage of being further down the list, so much of what I was going to ask has already been asked.
I particularly appreciated the comments about the incidents that occur when people get sick go to emergency departments. I'm a recovering ER doctor with about 20 years' experience. Much of my career was in a hospital in one of the poorest area codes in Canada, so we saw a lot of non-compliance with all sorts of diseases but particularly in problems with insulin.
In regard to the costs of diabetes, particularly to the cost of non-compliance, I have lost count of the number of times I treated DKA. We could actually write out the initial orders before seeing the patient because we saw it so often. We knew that if they ended up in the intensive care unit, it would cost tens of thousands of dollars. If they ended up needing coronary bypass surgery, for example, it would be about $60,000. One shocking number that came up is that when someone ends up on dialysis, it costs $70,000 a year per patient.
We've been trying to look for these numbers, which I've been using to defend whether we can afford pharmacare. I've always been of the mind that we can't afford not to.
In respect of cost-related non-compliance for all diseases, there are various estimates. It might be about $5 billion a year nationally. Do we have any estimates of cost-related non-compliance for diabetes alone? Are there any numbers out there to show what we might save the health care system in costs due to cost-related non-compliance if we supplied only the costs for diabetes?
Director, Federal Affairs, Government Relations and Public Policy, Diabetes Canada
I can give you a partial answer to your question partly because we lack the central data that would be necessary in order to properly answer your question, and that must be remedied.
What we know is that just through identifying people with prediabetes and offering them a proven coaching program to help them manage their weight and physical activity and thereby reduce the risk of developing diabetes, we can prevent nearly 60% of them from going on to develop type 2 diabetes. That would amount to, in Canada, about 110,000 people a year, or a million-plus people over the next decade. If we prevented them from developing diabetes, we could prevent, according to studies, at least 5,000 lower limb amputations every year and at least 35,000 hospitalizations every year in Canada. That would save us about $18 billion over the next 10 years in health care costs associated with treating people presenting with type 2 diabetes, by treating those amputations and the ongoing rehabilitation, and the cost of those hospitalizations.
I should say that's using an average cost per hospitalization of $6,000, which is very low for what most people with acute diabetic ketoacidosis or on dialysis would require.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you. That's an extremely useful number.
From what I understand from the brief as well is that we talk about type 1 diabetes, but actually type 2 diabetes now is actually much more prevalent. Would that be a fair assessment?
Director, Federal Affairs, Government Relations and Public Policy, Diabetes Canada
Yes, between 90% to 95% of people with diabetes have type 2.
Liberal
Executive Director, Diabetes Action Canada
May I just add one other comment?
Executive Director, Diabetes Action Canada
I am a recovering nephrologist. So for this issue of people with diabetes and early signs of kidney disease, their treatment is predominantly medication. It's treatment for high blood pressure, high cholesterol, and specific treatment for diabetic kidney disease. Those drugs are quite expensive. If you can prevent the onset of end-stage kidney disease requiring dialysis, you will save $70,000 per year per patient, and that's quite doable. The problem is early intervention and compliance with medication. It comes back to the fact that those at greatest risk—lower socio-economic—may not be able to afford those medications. So if you want a link to pharmacare, it's those cardiovascular and renal risks that are particularly important.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
All right. I believe that's my time.
Thank you.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
I just have one correction.
Ms. Hanson, in terms of insulin pumps, in British Columbia, the province I come from, effective July 3, the Minister of Health, Adrian Dix, announced that the province would cover the cost of insulin pumps for all British Columbians. I think prior to that there had been a restriction. They only covered it for people under 25.
Is that the only province that you're aware of in the country that covers insulin pumps for all citizens, or do other provinces do that?
Director, Federal Affairs, Government Relations and Public Policy, Diabetes Canada
No. In other provinces, it's not age limited. I'm not a deep expert on all provinces, but I know, for example, in Ontario, the assistive devices program covers insulin pumps for people of any age. There are provinces where it's provided regardless of age and then there are provinces, as I mentioned earlier, where there is currently little or no support for insulin pumps.
NDP
Don Davies NDP Vancouver Kingsway, BC
Okay, thanks.
Mr. Prowten, what challenges are specific to diagnosing and managing type 1 diabetes particularly among children and adolescents?
President and Chief Executive Officer, Juvenile Diabetes Research Foundation Canada
I think it's things like compliance which has been talked about a lot today. It's a big burden for the child, but it's a big burden for the parents as well, so it's very much a family disease at that point.
We've talked a lot about insulin pumps, but we haven't really talked a lot today about continuous glucose monitors. There's more technology that is here today. Continuous glucose monitors are not approved by any province in Canada right now. They're not being reimbursed. I was at a dinner last night with two families that have a child with type 1 diabetes. They're monitoring their child on their phone because they can check and correct the blood sugar through the continuous glucose monitor.
We have an opportunity to give people better technology right now to manage the disease, but also, in essence, to de-burden this disease. It's better for the child, but it's also better for the family. I would really encourage us to think about giving access to all of the technology that's out there right now to help families and particularly the kids have healthier lives.
NDP
Don Davies NDP Vancouver Kingsway, BC
To follow up on that, I was doing a town hall in Nanaimo this summer, and a man came up to me afterwards. He had type 1 diabetes. He told me that when he was sleeping, he had to have a particular kind of monitor because he could go into diabetic shock while he was sleeping. Is that what he was referring to, a continuous glucose monitor? Is that what people need when they're sleeping?
I realize you're a juvenile diabetes specialist, but do you have any information on that?
Director, Federal Affairs, Government Relations and Public Policy, Diabetes Canada
Dave, can I show them?
President and Chief Executive Officer, Juvenile Diabetes Research Foundation Canada
Yes, that would be great.
Director, Federal Affairs, Government Relations and Public Policy, Diabetes Canada
I wear a continuous glucose monitor. That's a readout on my phone of what my blood sugar is. It's high because I was running late due to traffic and I'm stressed out. This monitors me all the time. If I start to go low, which can happen to many people with type 1 in the night and they might not wake up, it will start alarming me audibly. If I don't respond and tell it that I'm conscious, I'm aware and I'm treating my low blood sugar, it will start pinging my husband's phone so that he'll wake up and save my life.
I cannot overstate the criticality of this for parents of children with type 1 diabetes who are being counselled now, when their child is diagnosed, that they have to get up at least once, if not two or three times in the night, just to make sure that their child is still alive. Imagine the terror they feel all the time; whereas if they had these kinds of devices, that would allow them to sleep knowing that the technology will tell them if their child is in jeopardy of going into a coma, and they can get up and act.
It is not for all five million people in Canada with diabetes. That would be maybe overkill for many, but for people with type 1, it is almost essential. I couldn't manage without it.
NDP
Director, Federal Affairs, Government Relations and Public Policy, Diabetes Canada
Extremely few have it, because this is also extraordinarily expensive to run. It would cost another $3,000 or $4,000 a year to operate this system. As Dave mentioned, there is currently no province that provides any coverage.
NDP
Don Davies NDP Vancouver Kingsway, BC
A recent study by the Canadian Federation of Nurses Unions found that cost-related non-adherence results in the deaths of 270 to 420 working-age Canadians with diabetes every year. I think it's important to note that, while we're talking about deteriorating health, this is a life-and-death matter for many people.
You just talked about people who could die in the middle of the night because they don't have access to technology that exists, because our health care system is not making it affordable. Should we be covering that for every Canadian who needs it?
