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 accessOne-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 CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Familial hypercholesterolemia/autosomal dominant hypercholesterolemia: molecular defects, the LDL-C continuum, and gradients of phenotypic severity.J Clin Lipidol. 2016; 10: 970-986
- Systematic review of low-density lipoprotein cholesterol apheresis for the treatment of familial hypercholesterolemia.J Am Heart Assoc. 2016; 5: e003294
- Integrated guidance on the care of familial hypercholesterolaemia from the International FH Foundation.Eur J Prev Cardiol. 2015; 22: 849-854
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.
- Severe hypercholesterolaemia: therapeutic goals and eligibility criteria for LDL apheresis in Europe.Curr Opin Lipidol. 2010; 21: 492-498
Article Info
Publication History
Published online: January 21, 2017
Accepted:
January 14,
2017
Received:
November 14,
2016
Footnotes
See page 411 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
