The document discusses how data from British Columbia and Canada can be used to improve health outcomes and system sustainability. It provides examples of using BC data to study diabetes control, asthma management, and developing a new approach to prevent prostate cancer metastasis. BC data sources like Medical Services Plan, PharmaNet, hospital discharge records, and vital statistics registries allow analyzing patterns in conditions like diabetes, asthma, and prostate cancer. Analyses of BC data have found opportunities to optimize diabetes and asthma treatment regimens to reduce healthcare use and costs. There is also potential to use drug data to study if calcium channel blockers can prevent prostate cancer metastasis.

1. Using
BC
and
Canadian
Data
to
Improve
Health
and
Healthcare
What
are
the
best
ways
to
improve
health
outcomes
and
system
sustainability?
Dr.
Bruce
Carleton
University
of
Bri<sh
Columbia
Child
&
Family
Research
Ins<tute
BC
Children’s
Hospital

2.
BC
Data
and
Diabetes

3. Diabetes
Control
• Major
test
used
to
monitor
control
is
hemoglobin
A1C
–
measures
glucose
control
over
4
months
by
analyzing
the
amount
of
glucose
on
the
red
blood
cell
• CDA
recommends
tes<ng
every
3
months;
Test
at
6-­‐month
intervals
when
glycemic
targets
are
consistently
achieved
• No
evidence
to
suggest
tes<ng
more
oPen
than
every
4
months
is
necessary

4. Annual
cost
of
A1C
tests
performed
in
BC
2005-­‐2011

5. Annual
number
of
A1C
tests
performed
in
VCHA

6. Annual
cost
of
A1C
tests
performed
in
VCHA

7. Annual
number
of
A1C
tests
performed
in
FHA

8. Annual
cost
of
A1C
tests
performed
in
FHA

9. One-­‐third
of
all
A1C
tests
are
repeated
within
3
months

10.
BC
Data
and
Asthma

11. Improving Asthma Management
3
million
Canadians
live
with
asthma
Asthma
is
the
#1
chronic
condi<on
in
children
6
out
of
10
people
living
with
asthma
do
not
have
it
under
control
250
people
die
each
year
in
Canada
from
asthma
(and
most
are
preventable)

12. The
Opportunity:
Bri<sh
Columbia’s
Data
Medical
Service
Plan
PharmaNet
Discharge
Abstracts
Database
Vital
Sta<s<cs

13.
Asthma
Regimen
Op<mality
Classifica<on
(Pa<ent
Ages
5-­‐11
Years)
Inhaled Corticosteroid Use
(Beclomethasone Equivalents)
Inhaled
Short-­‐ac<ng
Bronchodilator
Use
(Salbutamol
Equivalents)
0
µg/day
>
250
&
≤
500
µg/day
≤ 1
inhaler
/
year
>0
&
≤
250
µg/day
1
-­‐
2
inhalers
/
year
2
-­‐
4
inhalers
/
year
>
4
inhalers
/
year
Green
=
Op<mal
regimen,
n=6,155
(67%)
Yellow
=
Unclassified
regimen,
n=2,162
(23%)
Red
=
Subop<mal
regimen,
n=913
(10%)
>
500
µg/day

14. Emergency
Department
Visits
Suboptimal regimen
use
Optimal regimen use

15. Hospital
Admissions
Suboptimal regimen
use
Optimal regimen
use

16. Family
Prac<<oner
Visits
60
–
80
90
–
100
100
–
120
120
–
130
>
130
Children 0 -18 years/ Asthma related visits/ 2009
Per
100
pa<ents

17. Emergency
Department
Visits
1
-­‐
5
5
-­‐
10
10
-­‐
15
15
-­‐
20
20
-­‐
25
Children
0
-­‐18
years/
Asthma
related
visits/
2009
Per
100
pa<ents

18. Hospital
Admissions
0
–
0.4
0.4
–
0.8
0.8
–
1.2
1.2
–
1.6
Children
0
-­‐18
years/
Asthma
related
visits/
2009
1.6
-­‐
2
Per
100
pa<ents

19. Costs
per
Pa<ent
(by
region)
ED Service
Use
*ED
Costs
are
based
on
BCCH
Data,
Physician
Visits
Costs
from
MSP
All
Costs
based
on
2009
Data/Dollars

20. Urban
vs.
Rural
Bubble Size: Estimated number of physicians in the area

21. Cost
per
pa*ent
according
to
op*mality
of
asthma
drug
regimens
(2009)
1200
1,067.23
Cost per patient
1000
800
600
Pts with optimal regimens
471.98
Pts with suboptimal regimens
400
180.28
200
47.59
0
ED visits
Hospital admissions
Health Services
The costs of ED services was 2.3X higher for patients with a suboptimal regimen
when compared to those treated with an optimal regimen
The costs of hospital admission was 4X higher for patients with a suboptimal regimen
when compared to those treated with an optimal regimen

22. Daily
vs.
Intermikent
(Seasonal)
Use
of
Inhaled
An<-­‐
inflammatory
Asthma
Drugs
1. Intermikent
users
of
ICS
are
28%
more
likely
to
have
hospital
admissions
than
regular
users.
2. Intermikent
users
of
ICS
are
19%
more
likely
to
have
ED
visits
than
regular
users.

23.
BC
Data
and
Prostate
Cancer

24. Using BC Data to Develop a New
Approach to Prevent Prostate Cancer
Metastasis
Prostate
Cancer
is
the
most
commonly-­‐diagnosed
cancer
among
Canadian
men
23,600
Canadian
men
will
be
diagnosed
with
prostate
cancer
this
year
In
2013,
3,900
Canadians
will
die
from
Prostate
Cancer

25. Prostate
Cancer
Mortality
• Most
of
the
<me,
prostate
cancer
is
a
chronic
disease
with
low
mortality
• Unfortunately,
when
the
disease
became
metasta<c,
it
has
a
high
mortality
rate
• There
is
evidence
to
suggest
that
blocking
a
specific
type
of
calcium
channel
can
prevent
metastases

26. The
opportunity:
Bri<sh
Columbia’s
Data
BC
Cancer
Registry
BC
Cancer
Agency
Pharmacy
Data
PharmaNet
Medical
Services
Plan

27. Relevance
If
blockade
of
specific
calcium
channels
decreases
metastases,
then
men
who
take
these
drugs
for
heart
disease
should
have
lower
rates
of
prostate
cancer
metastases
than
men
who
do
not.
If
an
associa9on
is
found
between
this
par9cular
class
of
calcium
channel
blocker
use
and
survival
or
metastases,
then
calcium
channel
blockers
could
poten9ally
be
prescribed
to
either
prevent
prostate
cancer
metastases
or
prolong
survival.

28.
BC
and
Canadian
Data
and
Hepa<<s
C

29. Standard
HCV
Drug
Therapy
• Recommended
treatment:
•
PEG-­‐IFN-­‐α
+
Ribavirin
(48-­‐week
course)
Significant Variability
in Response
40-50%
clear virus
50-60% do not
clear virus
Significant ancestry related differences in response
rates (European > African response rates)
Treatment often poorly tolerated because of ADRs

30. New
drugs
available
and
on
pipeline
Direct
Ac*ng
An*virals

31.
New Therapeutic Options for
HCV Drug Therapy
• High
Rates
of
ADRs
• Boceprevir/telaprevir
decreased
hemoglobin
(9-­‐52%)
• Telaprevir/boceprevir
neutropenia
and
thrombocytopenia
• Telaprevir-­‐induced
skin
reac<ons
(56%;
1%
severe)
• Psychiatric
symptoms
from
boceprevir
Telaprevir
(2012:
4
safety
warnings)
Bocepravir
(2012-­‐13:
5
safety
warnings)

32. Can we determine the
op*mal
HCV
treatment
prior
to therapy?
Pa*ent
IL28B
Genotype
&
Clinical
Factors
PEG-­‐IFN-­‐RBV
PEG-­‐IFN-­‐RBV
+
Prot.
Inhib.
+
$20,000-­‐40,000

33. 1.
Triple
therapy
IL28B
offers
modest
C/C
improvement
for
IL28B
C/C patients 70-­‐86%
SVR
but $$, ADRs
Safe
&
Effec*ve
PEG-­‐IFN+RBV
No
Effect
Adverse
Drug
Reac*on
80-­‐90%
SVR
PEG-­‐IFN+RBV
+
Prot.
Inhib.
+
$20-­‐40k
Safe
&
Effec*ve
No
Effect
Adverse
Drug
Reac*on
“An
individual
with
a
CC
genotype
could
be
spared
the
expense
and
adverse
events,
and
would
achieve
similarly
excellent
results
with
PEG-­‐IFN/
RBV
alone”
-­‐
Jenson
&
Pol,
Liver
Intl,
2012

34. 2. Triple therapy
IL28B
significantly
C/C
improves SVR in
IL28B T/T patients 70-­‐86%
SVR
with
$$,
ADRs
IL28B
T/T
25-­‐40%
SVR
Safe
&
Effec*ve
Safe
&
Effec*ve
PEG-­‐IFN+RBV
No
Effect
No
Effect
Adverse
Drug
Reac*on
80-­‐90%
SVR
PEG-­‐IFN+RBV
+
Prot.
Inhib.
+
$20-­‐40k
Adverse
Drug
Reac*on
60-­‐75%
SVR
Safe
&
Effec*ve
Safe
&
Effec*ve
No
Effect
No
Effect
Adverse
Drug
Reac*on
Adverse
Drug
Reac*on

35. The
opportunity:
Build
the
Dataset
in
Canada
Ac<ve
Surveillance
with
CPNDS
across
Canada

36. Chronic
Hepa**s
C
treatment
goal:
Biomarker
and
Stepwise
Approach
PegIFN
+
RBV
Pa<ents
with
predictors
of
good
response:
IL
28
C/C
IFN
4
Clinical
factors
PegIFN
+
RBV
+
DAA
Pa<ents
with
NO
predictors
of
good
response
Pa<ents
without
an
increased
risk
to
develop
toxicity
to
DAA
Pa<ents
with
failure
or
relapse
to
PegIFN/RBV
DAA
combina<on
(IFN
Free)
Future
treatment???
Pa<ents
at
higher
risk
to
develop
toxicity
to
Peg-­‐RBV
Pa<ents
at
higher
risk
to
develop
toxicity
to
DAA
Op<mizing
Cost:
Each
Pa<ents
receives
the
appropriate
medica<on
Op<mizing
Safety:
Clearly
iden<fied
risk-­‐benefit
profile
for
each
drug
SVR

37. HCV
Treatment
Algorithm
Patient with HCV genotype 1
No previous HCV treatment
Predicted good responder to
dual therapy
Genetic testing for
IL28B/IFNL4 gene
region variants
Predicted poor responder
to dual therapy
ITPA genetic testing for
RBV-induced anemia
risk
Low Risk
ITPA genetic testing
for RBV-induced
anemia risk
High Risk
Treat with
dual therapy:
PegIFN/RBV
Treat with dual therapy
+ early erythropoietin
+ enhanced monitoring for
anemia
Low Risk
High Risk
Treat with
triple therapy:
PegIFN/RBV +
telaprevir or boceprevir
Treat with triple therapy
+ Reduce RBV dose by 50%
(to 600mg/day)
+ enhanced monitoring for
anemia

38. Hepa<<s
C
Treatment
• The
right
treatment
for
every
pa<ent,
avoiding
unnecessary
risk
and
providing
the
best
possible
care.
• Op<mize
healthcare
expenses
for
Hepa<<s
C
treatment

39. This
is
Beau<ful,
Bri<sh
Columbia
• BC
has
the
BEST
health
data
in
North
America
• Rich
informa<on
on
collec<ve
health
experiences
• Can
help
us
find
solu<ons
to
health
and
health
system
problems
• Not
just
about
research,
but
USE
of
findings
to
increase
system
efficiencies
and
improve
care
of
pa<ents
• Preserve
health
benefits
for
Bri<sh
Columbians
in
the
next
and
future
genera<ons