Article: OHS vs TAVR in BC, Canada

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shanwow1

Active member
Joined
Apr 10, 2013
Messages
40
Location
Vancouver, BC, Canada
This article on the front page of The Province (newspaper here in Vancouver, BC) caught my eye as I was leaving a restaurant last night. I have posted the text below in case the link doesn't work. I think there a some facts missing from this article, but the underlying argument about Universal Healthcare is an interesting one. Call me a socialist but I'd personally take the Canadian system over the US system any day. Also, the last line is particularly interesting. Thoughts/Opinions?

http://www.theprovince.com/news/declared+healthy+alternative+open+heart+surgery/9409840/story.html

B.C. man declared too healthy for alternative to open-heart surgery
By Susan Lazaruk, The Province January 21, 2014

A Nelson man in need of heart surgery says it’s unfair that he has to undergo an “aggressive” open-heart operation instead of a newer, costlier, less-invasive procedure because he’s young and healthy.

Dan Sammartino, 51, needs a new heart valve because of a defect he was born with, but is being denied the more modern method because he’s a good candidate for open-heart surgery.

The St. Paul’s Hospital doctor who pioneered the newer procedure, in which the heart is accessed remotely through a leg artery, is reserved for patients too frail or elderly to survive open-heart surgery because “it’s more cost-effective” for them but less cost-effective for younger, healthier patients.

It’s an example of decisions that have to be made in health care and will become increasingly common with the development of expensive cutting-edge procedures that may not be essential, according to a University of B.C. medical ethicist.

Is it unethical for health-care professionals to withhold a more humane procedure in an effort to control the costs of public health, to better use those savings to help more people?

Biomedical ethicist Michael Burgess, at the School of Population and Public Health, said it depends on which side of the fence you sit.

“If it’s me, I want compassion; if it’s not me, I want justice,” he said.

Sammartino, born with aortic stenosis, or fused valves, but is otherwise healthy, said he’d prefer not to have open-heart surgery because it’s “so intense. They have to cut you right open along the breastbone, and it takes longer to heal. (With the newer procedure), after one day in the hospital, you’re good to go.”

Sammartino, a father of five, aged 20 to seven, one who’s in university and four of whom live at home, said his job managing a bowling alley for a non-profit group doesn’t provide health insurance.

“To be off work for six months (to recover), what would that do to my family?” he asked.

Doctors say the recovery time for open-heart surgery is three months.

But Sammartino fears it could last longer because he knows of a healthy 33-year-old, open-heart patient who is using a walker eight months later, and he estimated he could lose $50,000.

There isn’t enough evidence to determine whether a trans-catheter aortic-valve implantation, or TAVI, is viable over the long-term, said Dr. John Webb, whose procedure revolutionized valve replacement in 2005 and is being taught around the world.

“In the past, there have been valves that haven’t worked,” said Webb.

The average patient age for a TAVI is 84, someone who is “likely to benefit from TAVI for at least two years,” David Babiuk, head of Cardiac Services B.C., said in an email.

Tests on lower-risk patients are being done, he said.

But Sammartino is accusing the B.C. government of “dragging its feet” on those tests and said it’s an excuse to save money.

TAVI valves are $20,000 more than conventional valves. Open-heart surgery patients usually spend more time in hospital, but if they’re younger, those extra costs wouldn’t likely surpass the difference in the costs of the valves, Webb said.

Therefore, “it’s not cost-effective for those who are good candidates for open-heart surgery,” he said. “It (the cost) certainly is a consideration.”

B.C. Health Ministry spokeswoman Kristy Anderson wouldn’t comment on whether the decision on which surgery is done had financial considerations.

“The standard for fairly young, healthy patients requiring a heart-valve transplant is open-heart surgery,” she said in an emailed response.

But Burgess said costs are a factor in health-care decisions, when half of our tax dollars go to health care.

“We can’t afford to help everyone have everything they need,” citing the example of exemptions from Medicare, including glasses and non-essential and cosmetic procedures. He noted the growth of out-of-pocket expenses and costs paid by private insurance is growing apace with overall health-care costs.

But under Canada’s public health system, as with TAVI, patients aren’t always given the option of choosing a more expensive procedure if they pay for it themselves because that runs counter to universal health care.

Burgess said as a society, “we do have to make these judgments over whether the marginal benefits (of a newer procedure) justify the extra costs” to determine what’s fairer to all people.

Webb said St. Paul’s has done about a thousand TAVI procedures since 2005 and do about five a week, the most in Canada. He estimated it would be another five to 10 years for TAVI to be routine for valve replacements.

[email protected]

twitter.com/susanlazaruk
© Copyright (c) The Province
 
Where are they getting these recovery times for OHS? Three months, six months, eight months??!! Really? An otherwise healthy 51-year-old worrying about recovery? I was a 46-year-old suffering from CHF and was back to work in six weeks (could have been much sooner if I didn't have to drive) and feeling better than I have in my entire life. Also, I suppose that Mr. Sammartino does not realize that the TAVI valve will not last forever and at his age he's likely to need a re-op in a few years, this time a full OHS (sorry, you can't do a TAVI in another TAVI). I think that someone needs to take the Province to task for not doing at least minimal research to find out just what the issues involved are, instead of simply deciding on a thesis ("medical decisions are based on cost and this particular patient is being offered the inferior choice because it is cheaper") and tailoring the story to support it.

(BTW - I just pasted this message to the comments on the article.)
 
Sammartino, born with aortic stenosis, or fused valves, but is otherwise healthy, said he’d prefer not to have open-heart surgery because it’s “so intense. They have to cut you right open along the breastbone, and it takes longer to heal. (With the newer procedure), after one day in the hospital, you’re good to go.”

Sammartino, a father of five, aged 20 to seven, one who’s in university and four of whom live at home, said his job managing a bowling alley for a non-profit group doesn’t provide health insurance.

“To be off work for six months (to recover), what would that do to my family?” he asked.

Doctors say the recovery time for open-heart surgery is three months.

But Sammartino fears it could last longer because he knows of a healthy 33-year-old, open-heart patient who is using a walker eight months later, and he estimated he could lose $50,000.

There isn’t enough evidence to determine whether a trans-catheter aortic-valve implantation, or TAVI, is viable over the long-term, said Dr. John Webb, whose procedure revolutionized valve replacement in 2005 and is being taught around the world.

“In the past, there have been valves that haven’t worked,” said Webb.

The average patient age for a TAVI is 84, someone who is “likely to benefit from TAVI for at least two years,” David Babiuk, head of Cardiac Services B.C., said in an email.

[/I]

This patient seems to be ill-informed about this surgery as indicated by his comment..... "33 yr old friend who has taken longer than eight months to recover". Modern surgical patients normally take far less time to recover. Even in 1967 I returned to work, full time, six weeks after surgery.

Perhaps his docs are saying TAVI is not cost effective in his case (age 51) since their quote is that "age 84 TAVI patients are likely to get at least two years extension of their lives"....but a 51 year old would probably need several re-ops using current TAVI technology.
 
Where are they getting these recovery times for OHS? Three months, six months, eight months??!! Really? An otherwise healthy 51-year-old worrying about recovery? I was a 46-year-old suffering from CHF and was back to work in six weeks (could have been much sooner if I didn't have to drive) and feeling better than I have in my entire life. Also, I suppose that Mr. Sammartino does not realize that the TAVI valve will not last forever and at his age he's likely to need a re-op in a few years, this time a full OHS (sorry, you can't do a TAVI in another TAVI). I think that someone needs to take the Province to task for not doing at least minimal research to find out just what the issues involved are, instead of simply deciding on a thesis ("medical decisions are based on cost and this particular patient is being offered the inferior choice because it is cheaper") and tailoring the story to support it.

(BTW - I just pasted this message to the comments on the article.)

I agree with most of what you are saying however it is NOT true that "(sorry, you can't do a TAVI in another TAVI)" for people who have a normal size valve, chances are they WILL be able to get a 2nd valve inside the first percutaneous valve.
 
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The guy in the article is uninformed and needs to do his homework before going to the press and creating alot of controversy. I know the medical system here very well and know of the delays and other issues he speaks of. But the reality is that TAVI is still relatively new and not all the surgeons are skilled at this or trained at it yet. The issue of using TAVI in more life threatening or high risk cases is not confined to BC either - this is the case in many other areas (incl. across Canada).

(my Cardiologist told me that "a TAVI inside another prosthesis is a particularly special scenario. It may be possible but there is no way to know and it has a long way to go").

T
 
"Call me a socialist but I'd personally take the Canadian system over the US system any day. Also, the last line is particularly interesting. Thoughts/Opinions?"

I think this forum is not the appropriate place to discuss health care politics. US citizens get good health care as do Canadians. Just thank your higher power that you were not born in a society where there is no health care and you would die never knowing of your heart valve problem.
 
"Call me a socialist but I'd personally take the Canadian system over the US system any day. Also, the last line is particularly interesting. Thoughts/Opinions?"

I think this forum is not the appropriate place to discuss health care politics. US citizens get good health care as do Canadians. Just thank your higher power that you were not born in a society where there is no health care and you would die never knowing of your heart valve problem.

Fair enough. It wasn't my intention to start a debate about politics. I only made the comment to express my dissent to the implied views of the man in the article. But you are right about thanking someone out there for all the things that had to go right in order for my condition to be found and (eventually) treated.

And I think that gets down to the root of my problem with this article, besides the fact that it is poorly researched, and perhaps I should have said this in my original post. These doctors are researching and pioneering a fantastic new(er) procedure and yet the front page news is a conspiracy theory that they're not doing it fast enough because it costs too much? Give me break.

Anyway, the last line of the article, that they estimate TAVI/TAVR will be routine in 5-10 years, was interesting to me. Most people seem to remain cautiously optimistic, but has anyone seen a statement of timeline like this anywhere else, or has it always been, "Oh it's coming, we're working on it"?
 
I emailed the author/reporter and corrected alot of the inaccurate facts. I told her she should not have even written it. If anyone is going to criticize the health care system here and create controversy over what is/is not funded, they should not use heart treatment as the basis for this.
T
 
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