Advertisement
Canadian Journal of Cardiology

Barriers to the Implementation of Lipoprotein Apheresis in Canada

  • Guido Filler
    Correspondence
    Corresponding author: Dr Guido Filler, Department of Paediatrics, Children's Hospital, London Health Sciences Centre, University of Western Ontario, 800 Commissioner's Rd East, Rm B1-135, London, Ontario N6A 5W9, Canada. Tel.: +1-519-685-8377; fax: +1-519-685-8156.
    Affiliations
    Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada

    Department of Medicine, Division of Nephrology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
    Search for articles by this author
  • Misan Lee
    Affiliations
    Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
    Search for articles by this author
  • Robert A. Hegele
    Affiliations
    Department of Medicine, Division of Endocrinology and Metabolism, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
    Search for articles by this author
Published:January 21, 2017DOI:https://doi.org/10.1016/j.cjca.2017.01.008

      Abstract

      This article details the effectiveness of using lipoprotein apheresis (LA) rather than plasmapheresis in patients with homozygous familial hypercholesterolemia (HoFH), using results from the first HoFH pediatric patient treated with LA in Ontario. We further detail the barriers involved in adhering to international guidelines by implementing this as a first-line treatment for this condition in Ontario, and the potential savings that would be gained with treating the remaining HoFH patients in this province with LA. A primary barrier has been the division of responsibility that exists in Canada, where the delivery of medical services and the delivery of blood products are separated, artificially discounting the price of plasmapheresis and making it seem like the less expensive option. We would like to implement LA as a first-line therapy, to not only improve patient quality of life and outcomes, but to also to potentially save our federal and provincial governments' taxpayer money.

      Résumé

      À partir des résultats du premier patient pédiatrique atteint d’hypercholestérolémie familiale de type homozygote (HFHo) qui a été traité par aphérèse des lipoprotéines (AL) en Ontario, cet article explique en détail l’efficacité liée à l’utilisation de l’AL plutôt que de la plasmaphérèse chez les patients atteints de HFHo. Nous traitons plus en détail des obstacles liés au respect des lignes directrices internationales en recourant à cette technique comme traitement de première intention de cette affection en Ontario, et des économies potentielles à réaliser en traitant par AL les autres patients atteints de HFHo de cette province. L’un des principaux obstacles a été la répartition des responsabilités qui existent au Canada, là où la prestation de services médicaux et l’offre de produits sanguins sont séparées, ce qui baisse de manière artificielle le coût de la plasmaphérèse et donne l’impression qu’elle est l’option la moins coûteuse. Nous voudrions recourir à l’AL comme traitement de première intention pour ne pas seulement améliorer la qualité de vie et les résultats cliniques des patients, mais aussi pour pouvoir économiser l’argent que les contribuables paient aux instances gouvernementales fédérale et provinciale.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Foody J.M.
        • Vishwanath R.
        Familial hypercholesterolemia/autosomal dominant hypercholesterolemia: molecular defects, the LDL-C continuum, and gradients of phenotypic severity.
        J Clin Lipidol. 2016; 10: 970-986
        • Wang A.
        • Richhariya A.
        • Gandra S.R.
        • et al.
        Systematic review of low-density lipoprotein cholesterol apheresis for the treatment of familial hypercholesterolemia.
        J Am Heart Assoc. 2016; 5: e003294
        • Watts G.F.
        • Gidding S.
        • Wierzbicki A.S.
        • et al.
        Integrated guidance on the care of familial hypercholesterolaemia from the International FH Foundation.
        Eur J Prev Cardiol. 2015; 22: 849-854
      1. Medical Advisory Secretariat of the Ministry of Health and Long Term Care on behalf of the Ontario Health Technology Advisory Committee. OHTAC Recommendation. Low-Density Lipoprotein Apheresis. November 2007. Available at: http://www.hqontario.ca/english/providers/program/ohtac/tech/recommend/rec_ldl_20071122.pdf. Accessed January 29, 2017.

        • Thompson G.R.
        • Catapano A.
        • Saheb S.
        • et al.
        Severe hypercholesterolaemia: therapeutic goals and eligibility criteria for LDL apheresis in Europe.
        Curr Opin Lipidol. 2010; 21: 492-498