PID clinic network

Réseau québécois de

cliniques d’immunodéficience

Quebec PID network

• Structure

• Goals

• Achievements

McGill UniversityMontreal 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. Devi Banerjee, Dr. Joseph Shuster

Dr. Reza Alizadehfar, Dr. Phil Gold, Dr. Ann Clarke

Laval University (Quebec)Dr Jacques Hébert Dre louise Coté

Dr Pierre-Michel Bédard Dre Hélène Senay

Dr Aubert Lavoie

Dr Rémi Gagnon

University of MontrealSte-Justine

Dr Elie Haddad Dr Françoise LeDeistDr Anne Desroches Dr Michel Duval

Dr Georges RivardNotre-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

Subcutaneous Intravenous

No venous access required 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 self-

image and sense of control

Less expensive for society and patient Berger M. Clin Immunol. 2004;112:1-7.

Comparison of Advantages

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 doseWeekly 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, etcDaily 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)

$800 $325

Training(nursing time)

3-5

sessions

2-3

sessions

Situation in Québec: Nov 2009

CANADA-

Québec

160 pts

Clinique d’immunodéficience

du CHUL• PID clinic

• 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

du CHUL• HAE clinic

• >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