Challenges in RX hemophilia-2

Download Challenges in RX hemophilia-2

Post on 11-May-2015

109 views

Category:

Health & Medicine

1 download

Embed Size (px)

TRANSCRIPT

<ul><li>1.Challenges in the treatment of hemophilia Renchi Yang, MD Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences </li></ul> <p>2. Healthcare Delivery System Developed countries Emerging countries Developing countries Undeveloped countries 3. Challenges Complications: inhibitor development, viral infections (HIV, Hepatitis, etc) hemarthropathy/pseudotumor Aging issue Affordable? Available? Compliance 4. Adherence rate toAdherence rate to secondsecondaryary prophylaxisprophylaxis among pamong patienatientsts with severe hemowith severe hemo philiaphilia AA Ono O et al., Haemophilia 2009;15:10328 100 90 80 70 60 50 40 30 20 10 0 3-5 6-12 13-18 19-29 30-39 40-49 50- yrs of age 50 75-51 90-76 90 5. Obstacles against introduction ofObstacles against introduction of thethe prophylaxis by ageprophylaxis by age Ono O et al., Haemophilia 2009;15:10328yrs of age Total score Difficulty in venous access Risk for appearance of inhibitors Mental stress on the patient Unwillingness of family members Feeling no necessity Inadequate system for guidance Problems with drug safety Poor adherence to replacement therapy Others 250 200 150 100 50 0 3 3-5 6-12 13- 6. Hemarthropathy in different age goups Zhang L, et al. Hemophilia 2003,9(6):696-702 7. Pseudotumor 8. BeijingBeijing TianjinTianjin HefeiHefei JinanJinan GuangzhouGuangzhou Hong KongHong Kong ShanghaiShanghai CHINACHINA Area: 9 600 000 KmArea: 9 600 000 Km22 Population: 1.3 billionPopulation: 1.3 billion 9. 6 initial network 17 new centres Haemophilia care situation Low diagnosis rate Lack of specialised hospitals clinical and lab expertise Complex medical insurance system Access and availbility of treatment Lack of awareness 10. Current Status of treatment Low supply of plasma derived concentrates High cost of concentrates Low coverage and reimbursement by Insurance 11. Planned care is more effective than random care 12. WFH HTCCNC Secretary: Renchi Yang Vice secretary: Xuefeng Wang Tianjin Institute of Hematology Beijing PUMC Hospital Shanghai Ruijin Hospital Guangzhou Nanfang Hospital Hefei Anhui Provincial Hospital Jinan Shandong Blood center National Hemophilia Registry Center Coagulation Testing Training Center Hemophilia Nurse Training Center Physiotherapist Training Center Chinese Society of Hematology Thrombosis and Hemostasis Committee 13. Regional Hemophilia Network Beijing Henan, Shanxi, Gansu Qinghai, Ningxia, Xinjiang Tianjin Hebei, Shaanxi, Inner Mongolia Liaoning, Jilin, Helongjiang Guangzhou Guangxi, Hainan Yunnan, Guizhou Shanghai Jiangsu, Zhejiang, Fujian Sichuan, Chongqing Anhui Jiangxi, Hunan Hubei Shandong Tibet 14. HTCCNC meeting 1st HTCCNC meeting: Jinan, 2004 2nd HTCCNC meeting: Shanghai, 2005 3rd HTCCNC meeting: Hefei, 2006 4th HTCCNC meeting: Beijing, 2007 5th HTCCNC meeting: Tianjin, 2008 6th HTCCNC meeting: Guangzhou, 2009 7th HTCCNC meeting: Jinan, 2010 8th HTCCNC meeting: Wuhan, 2012 15. Evolution of Product Availability Before 1995 Cryoprecipitates, FFP, plasma derived concentrates (non virus- inactivated) 1995 Domestic produced plasma derived concentrates (virus-inactivated) 2002 rhFVIIa NovoSeven 2007 rhFVIII Kogenate FS 2013: Adavate, Xyntha, Benefix 16. Evolution of Medical Insurance Before 2001 No national medical insurance program 2002 Some hemophilia patients covered by medical insurance 2003 FVIII concentrates / PCC covered by medical insurance in some cities (Tianjin, Beijing, Shanghai, etc.) 2005 FVIII concentrates covered by national medical insurance all over the country 2007 outpatient covered as inpatient 2008 rhFVIII concentrates covered by medical insurance in some cities (Guangzhou, Tianjin, etc.) 17. Electronic patient registry 18. 2010-Q42010-Q4 2010-3-72010-3-7 2010-4-162010-4-16 2010-1-122010-1-12 2010-4-13 News conference 2010-7-6, Provincial center workshop 19. Inhibitor rate in China 1435 hemophilia 16/3/2007-5/6/2008 1108 severe 249 moderate 78 mild. 1363 no relation. 56/1435 3.9% inhibitor 18/56 3 2.1% high titer 5BU/ml . Severe 48/1108 4.3% Moderate 6/249 2.4% Mild 2/78 2.5% Wang XF, et al. Haemophilia 2010, 16(4):632-9 20. Key players &amp; contributers l Beijing l Henan l Xinjiang l Xian l Ningxia l Lanzhou l Qinghai l Tianjin l Haerbin l Shanxi l Changchun l Dalian l Hebei l Shenyang l Guangzhou l Guiyang l Shenzhen l Hainan l Kunming l Guangxi l Shanghai l Fujian l Wenzhou l HangzhouX2 l Suzhou l Chongqing l ChengduX2 l Yangzhou l Hefei l Changsha l WuhanX2 l Jiangxi l Shandong l Beijing l Henan l Xinjiang l Xian l Ningxia l Lanzhou l Qinghai l Tianjin l Haerbin l Shanxi l Changchun l Dalian l Hebei l Shenyang l Guangzhou l Guiyang l Shenzhen l Hainan l Kunming l Guangxi l Shanghai l Fujian l Wenzhou l HangzhouX2 l Suzhou l Chongqing l ChengduX2 l Yangzhou l Hefei l Changsha l WuhanX2 l Jiangxi l Shandong Organizations National Haemophilia Study Group since 1985 Haemophilia Home of China established in 2000 Haemophilia Treatment Centre Collaborative Network of China established in 2004 Development support WFH since 2001 NNHF fellowships &amp; projects since 2006 GAP programme started in 2009 Grants by pharmaceutical companies 21. Acknowledgement Members of the HTCCNC: Dr. Xinsheng Zhang, Dr. Jing Sun, Dr. Xuefeng Wang, Dr. Jingsheng Wu, Dr. Runhui Wu, Dr. Renchi Yang and Dr. Yongqiang Zhao Consultants: Prof. Man-Chiu Poon, Calgary, CANADA, Dr. K.H. Luke, Ottawa, CANADA, Prof. Changgeng Ruan and Prof. Hongli Wang Hemophilia Patients Union of China World Federation of Hemophilia, Novo Nordisk Hemophilia Foundation Baxter, Bayer, Novo Nordisk, Pfizer Ministry of Health, PRC 22. THANKSTHANKS </p>