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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