“Disinvestment: What Does it Mean in the Canadian Context?”

Public Payor Perspective

CADTH Symposium

April 2016

Chad Mitchell, MSc. PharmA/Executive Director, Pharmaceuticals and Supplementary Health Benefits

Alberta Health

CURRENT STATE“Creating Headroom”

Projected deficit in Alberta

High-cost, precision drugs

Anticipated increase in drug spend

High-yield generic drug savings

CREATING HEADROOM“I’m disinvesting and I didn’t know it!” OR “Disinvestment and it’s 43 related terms”1

Figure from: Parkinson, Serment, Clement et al., Disinvestment and Value-Based Purchasing Strategiesfor Pharmaceuticals: An International Review. PharmacoEconomics. Published Online 06JUN2015 1: Adapted from Gnijidic & Elshaug. De-adoption and its 43 related terms: harmonizing low-value care terminology. BMC Medicine (2015) 13:273

Brand PLA / Generics Savings

Appropriate Prescribing

Treatment Restriction

Alberta’s ROBS Policy

CREATING HEADROOM“Breaking up is hard to do” OR “Why disinvestment is harder than investment”1

PAYER

PHARMA

TECHNOLOGY

LAB / Device

PATIENT

JURISDICTIONAL

Media / Public

PROVIDER

RETAIL HEALTH

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SUPPORT TOOLS/ GUIDELINES

EVIDENCE REVIEW

POLICY CYCLE

THE ANSWER IS 17“Now what is the question?”

• It is frequently stated that it takes an average of 17 years for research evidence to reach clinical practice.1

• With countries trialling new strategies, evaluation is critical, as is knowledge sharing to support continual effective reform.3

The challenges associated with disinvestment bring additional challenges for the standards applied to investment

decisions.2

Figure 1 Morris et al., The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med 2011: 104: 510–520.2 Haas et al., Breaking up is hard to do: why disinvestment in medicaltechnology is harder than investment. . Australian Health Review, 2012, 36, 148–1523 Parkinson, Serment, Clement et al., Disinvestment and Value-Based Purchasing Strategiesfor Pharmaceuticals: An International Review. PharmacoEconomics. Published Online 06JUN2015

REINVESTMENT “What do you think are the next steps?”

Those standing to loose the technology have a stronger incentive to lobby for the continuation of the status quo, than gainers do for effecting the

change.1

•Role of Government could be to support at the:– Stakeholder Level:

• Resistance/Time to changing prescribing behaviors• Articulating Opportunity Costs

– Policy Level:

1) Adapted from: Haas et al., Breaking up is hard to do: why disinvestment in medicaltechnology is harder than investment. . Australian Health Review, 2012, 36, 148–1522) Adapted from: Parkinson, Serment, Clement et al., Disinvestment and Value-Based Purchasing Strategiesfor Pharmaceuticals: An International Review. PharmacoEconomics. Published Online 06JUN2015

• Increasing focus towards ‘active disinvestment’ with metrics for dis(re)investments identified a-priori.2