Your Lungs, Your Life. Insights and Solutions to Lung Health in Ontario

Transcription

1 Your Lungs, Your Life Insights and Solutions to Lung Health in Ontario

2 Our Mission To be the recognized leader, voice and primary resource in lung health to enable all people to breathe with ease. ACKNOWLEDGEMENTS The Ontario Lung Association and its health professional societies, the Ontario Respiratory Care Society and the Ontario Thoracic Society, would like to thank the following individuals and organizations: Dina Brooks, PhD, MSc, BScPT Peter Dixon, MB, BS, FRCPC Margaret Fitch, MScN, PhD Roger Goldstein, MBCHB, FRCP(C), FRCP (UK) John Granton, MD, FRCPC Eric Holowaty, MD, MSc, FRCPC Tom Kovesi, MD, FRCPC Diane Lougheed, MD, MSc, FRCPC M. Reza Maleki-Yazdi, MD, FRCPC, FCCP Mika Nonoyama, RRT, PhD Andrew Pipe, CM, BA, MD, LLD Helen Ramsdale, MA, BM, MRCP(UK), FRCPC Peter Selby, MBBS, CCFP Matthew Stanbrook, MD, PhD, FRCPC David Stieb, MD, MSc, FRCPC Padmaja Subbarao, MD, MSc, FRCPC Itamar E. Tamari, MD, CCFP, FCFP Brenda Cunningham Bruce Eyre Lynn Pike Jane Wallingford Association of Family Health Teams of Ontario Asthma Society of Canada AstraZeneca Canada COPD Canada GlaxoSmithKline Lung Cancer Canada Merck Canada The National Lung Health Framework Nycomed Canada Ontario Campaign for Action on Tobacco Ontario Chronic Disease Prevention Alliance Ontario Clean Air Alliance Ontario College of Family Physicians Ontario Pharmacists Association Ontario Public Health Association Ophea Pfizer Canada Primary Care Asthma Program Registered Nurses Association of Ontario Your Lungs, Your Life: Insights and Solutions to Lung Health in Ontario has been produced by the Ontario Lung Association, based on data from: Smetanin, P., Stiff, D., Briante, C., Ahmad, S., Ler, A., Wong, L. Life and Economic Burden of Lung Disease in Ontario: 2011 to RiskAnalytica, on behalf of the Ontario Lung Association, Ontario Lung Association, Ontario Lung Association

3 Your Lungs, Your Life Insights and Solutions to Lung Health In Ontario A message from the Ontario Lung Association Lung health affects us all. Whether through personal experience or economic impact, lung disease touches millions of men, women and children. According to the World Health Organization, lung diseases will soon be the third leading cause of death in the world. Today more than 2.4 million people in Ontario are living with a serious lung disease and this number is expected to grow by 50 per cent, to an alarming 3.6 million in the next 30 years. The good news is it doesn t have to be this way. But change needs to begin now. Your Lungs, Your Life is based on a life and economic burden report undertaken by the Ontario Lung Association to gain a better understanding of the current and future state of lung health in Ontario. It paints a picture of lung disease today and into the future, by outlining the extent and scope of three significant diseases: lung cancer, chronic obstructive pulmonary disease (COPD), and asthma. Your Lungs, Your Life is a delicate balance that examines the maximum impact lung disease could have on our provincial healthcare system and economy without neglecting the unforgettable face of the disease. It offers keen insights and realistic solutions by asking questions. What if there were interventions we could do right now, right here that could prevent or delay the progression of lung disease, improve treatment and care, and ultimately save lives? In this report we have done just that. We have explored a number of What if? scenarios that predict healthier outcomes for individuals and our economic foundation, and present a convincing case for immediate action. We also examined the current state of public drug coverage in Ontario as compared to other provinces and found some alarming gaps. If we are serious about change, we need an Ontario Lung Health Action Plan that will fill these gaps and ensure Ontarians benefit from cleaner air, more prevention measures, better screening, earlier diagnosis and treatment, and proven care models. But lung disease isn t just about facts and figures. It s up close and personal and affects real people every day. It may be you, or a family member, or a friend or colleague. Lung disease affects people like you and me, and those who have selflessly allowed us to tell their stories in this report to share their day-to-day struggles so that we may all have a better understanding of the human impact of lung disease. We at the Ontario Lung Association cannot effect change on our own. Throughout this project we have been fortunate to work with a large number of experienced and committed individuals who feel as passionately about improving the lives of Ontarians as we do. Our challenge now is to remain vocal and continue to put the spotlight on lung health. Please add your voice to ours and help millions of men, women and children breathe easier in Ontario by asking the question: What if? Our scenarios present a convincing case for immediate action. George Habib President & CEO Ontario Lung Association This research study was funded through educational grants from: AstraZeneca Canada; GlaxoSmithKline; Merck Canada; Nycomed Canada; Pfizer Canada and Rx&D. Your Lungs, Your Life 3

4 Introduction and Scope According to the World Health Organization (WHO), lung disease will soon be the third leading cause of death in the world. Lung diseases have a major effect on millions of people living in Ontario and affect all ages from birth to the end of life. Despite progress achieved over the years in both prevention and treatment, lung diseases continue to have a devastating impact on both the physical and economic health of Ontarians, taking a huge toll in lost lives, lost economic productivity, and costs to our healthcare system. But perhaps the most significant impact is on the quality of life for individuals and families who face a life-long battle with lung disease. Everyone living in Ontario is at some level of risk for lung disease, making lung health everybody s business. Lung diseases include: asthma, chronic obstructive pulmonary disease (COPD), lung cancer, tuberculosis, sleep disordered breathing (sleep apnea), pulmonary fibrosis, pneumonia, cystic fibrosis, pulmonary arterial hypertension, and many others. Asthma, COPD and lung cancer are among the leading causes of disability, suffering and use of healthcare services in our province today. It is for this reason the scope of this study has been limited to these three specific diseases, all of which have a significant impact on both the current and future health and economics of Ontario. While there are many risk factors associated with lung disease, the two most important factors are tobacco smoke (through personal smoking and exposure to second-hand smoke) and air quality (indoor and outdoor). Today, both risk factors continue to pose a very real threat to the health and well-being of Ontarians of all ages. It is important to note that other risk factors do exist, such as occupational exposure to toxic substances, exposure to radon, and genetic factors among others. The scope of the current study has been limited to tobacco smoke and outdoor air quality. Purpose of the Study Given the significant impact of lung disease on the lives of Ontarians both physically and financially the Ontario Lung Association commissioned a study to estimate the life and economic burden of asthma, COPD and lung cancer in Ontario now and annually over the next 30 years. Through a series of interventions, or What if? scenarios, the study demonstrates how specific, evidence-based actions could have both an immediate and long-term impact on the extent and cost of lung disease. Economic Burden Defined For the purposes of this report, the total economic burden of lung disease was calculated as the sum of direct and indirect costs. Direct costs are the costs of activities and services either within or outside of the formal healthcare system that are directly related to treating a disease, such as: prescription drug costs, physician visits, emergency room visits, hospitalization costs, and over-the-counter medications that don t require a prescription. Indirect costs are those costs generated beyond treatment they have no direct connection to the patient s treatment, but are caused because of the illness. For example, the cost to a company because of an employee s increased time away from work due to their lung illness would be considered an indirect cost. For the purpose of this study, the indirect costs of lung disease were evaluated by examining an effect on productivity. Lost productivity resulting from lung disease was estimated by comparing current or baseline levels with the level of productivity that would result if lung cancer, asthma and COPD were to be completely eliminated from society. The value is then expressed in terms of lost wages, and represents one aspect of the indirect cost of lung disease. The extent of economic burden on caregivers (such as a parent missing work because his or her child with asthma must stay home from school due to their illness), has been identified as a significant issue. However, the appropriate data were not available for inclusion in this study. Approach Using RiskAnalytica s Life at Risk simulation platform, researchers gathered incidence (number of new cases), prevalence (people living with an illness), mortality (deaths) and other relevant data related to asthma, COPD and lung cancer in Ontario. The data were used to forecast the estimated impact of lung disease on patients, as well as the province s economy, healthcare services and workplace productivity over a 30-year time frame. Please note that all forecasted dollar estimates are stated in 2011 present-value terms. 4 Ontario Lung Association

5 Throughout this study, an independent panel of recognized lung disease experts, including: epidemiologists, oncologists, smoking cessation experts, researchers, clinicians, family physicians and respirologists, was consulted to review and assess the reasonableness of model inputs, model structure, model outputs, and conclusions. A second panel comprised of representatives from patient associations, health professional associations and environmental health organizations as well as patients themselves, was also consulted in the development of this study. Lung Disease in Ontario Right now, there are more than 2.4 million men, women and children in Ontario suffering with asthma, COPD or lung cancer. This represents more than 18 per cent of the population or just slightly fewer than the number of people living in the City of Toronto. If we maintain the status quo, the life and economic impacts of these lung diseases will grow significantly in the coming years. By 2041, it is estimated that more than 3.6 million Ontarians will be living with these conditions unless we act now. Key findings show: COPD, or chronic obstructive pulmonary disease, includes chronic bronchitis and emphysema. COPD is a serious lung disease and is one of the most significant chronic health burdens in Ontario. There are currently more than 780,000 Ontarians living with COPD more people than the population of the City of Mississauga. The number of people with COPD is expected to escalate to 1.2 million in the next 30 years. A staggering 1.7 million people in Ontario are living with asthma and almost one quarter of them are children. This number continues to climb and is expected to reach more than 2.5 million in 30 years. Today, an estimated 33,000 Ontarians have lung cancer. This is expected to almost double to 63,000 people in 30 years. Over the next 30 years, approximately 310,000 individuals will be told they have lung cancer a disease that kills eight out of 10 people who have it. Lung disease has become one of the key health and economic challenges facing our province. In 2011, the direct and indirect costs for lung cancer, asthma and COPD are estimated to be more than $293.9 million, $1.8 billion and $3.9 billion respectively. With more and more people living with lung disease, the associated costs to the people and province of Ontario are only expected to increase. From a 30-year perspective, the cumulative economic burden of lung cancer, asthma and COPD will exceed $33.5 billion, $96.7 billion and $310.7 billion respectively. Total Cumulative Direct and Indirect Costs: COPD Direct $3.3 billion $43.3 billion $98.6 billion $172.3 billion Indirect $0.7 billion $33.8 billion $83.1 billion $138.4 billion Total $4 billion $77.1 billion $181.7 billion $310.7 billion Asthma Direct $1.6 billion $21 billion $46.5 billion $79.4 billion Indirect $0.2 billion $5.5 billion $11.2 billion $17.3 billion Total $1.8 billion $26.5 billion $57.7 billion $96.7 billion Lung Cancer Direct $158.6 million $2 billion $4.6 billion $8 billion Indirect $135.4 million $6 billion $15 billion $25.6 billion Total $294 million $8 billion $19.6 billion $33.6 billion Considering the extent of comorbidities among lung diseases, these costs cannot be added together to calculate a total cost of lung disease. However, a conservative estimate puts the total direct and indirect costs for lung cancer, asthma and COPD at more than $4 billion in 2011 and more than $300 billion by Your Lungs, Your Life 5

6 A Lung Health Action Plan is Needed With this devastating impact on both the physical and economic health of people living in Ontario, a coordinated, comprehensive Lung Health Action Plan is needed in order to: Improve patient outcomes - Reduce emergency department visits and hospitalization for both children and adults - Reduce school absenteeism for children and missed work for adults - Improve the overall quality of life for people living with lung disease Improve healthcare provider outcomes and integrated healthcare delivery - Improve diagnostics and treatment by making the tools, resources, supports and training required widely available, in all communities across the province Lung disease is personal. The impact of lung disease goes beyond facts and figures there is a profound impact on the quality of life of people living with lung disease and their families. It s time for a comprehensive Ontario Lung Health Action Plan to help tackle this growing healthcare crisis. A Lung Health Action Plan will make a positive impact on the long-term quality of life for individuals and families who face lung disease as well as support Ontario s healthcare priorities, including improving access to care and reducing emergency wait times. Intervention Scenarios What makes this study unique is that it also explores What if? scenarios that demonstrate the benefits of putting in place certain interventions and the risks of not taking action. An intervention or What if? scenario is a program, medication, treatment or policy that, when followed, will change the health or economic forecast. In consultation with members of the study s expert panel, four What if? scenarios were identified based on the following criteria: The intervention is evidence-based (i.e., it has been scientifically proven to be effective in improving outcomes for the disease) The intervention is currently available, but not yet widely implemented The intervention represents achievable change (i.e., it can be implemented immediately on a broader scale as part of a comprehensive Ontario Lung Health Action Plan) The interventions evaluated in this study are: 1. Smoking cessation: Helping Ontarians quit smoking (to prevent COPD and lung cancer and reduce asthma problems) What if: All Ontarians who want to quit smoking have access to behavioural counselling and medications that will help them do so? 2. Comprehensive primary care model: Managing asthma and COPD with care and education What if: All Ontarians living with asthma or COPD were diagnosed and treated following a specific and focused care model that provides appropriate screening, disease management, and patient education? 3. Accurate diagnosis through spirometry: Early screening for COPD What if: All Ontarians at risk or suspected of having COPD were screened with a currently available, simple and effective test to ensure early and accurate diagnosis and the timely provision of appropriate treatment (i.e., smoking cessation)? 4. Pulmonary rehabilitation: Improving quality of life after a COPD diagnosis What if: All individuals with moderate to severe COPD were able to participate in pulmonary rehabilitation programs (including physical activity, education and support from a multidisciplinary healthcare team)? 6 Ontario Lung Association

7 These interventions represent strategic investments that build upon existing resources to make them more widely available. Our data show that these simple steps, treatments and processes will improve the quality of life of Ontarians living with lung disease and their caregivers, reduce healthcare costs and most importantly, save lives. These proposed interventions, however, are simply the beginning of an urgent process to develop an Ontario Lung Health Action Plan. Many additional scenarios, such as early detection for lung cancer and improvement in outdoor air quality may be examined as part of future research. Lung disease is on the rise. But, while numbers are important, the story is not complete without understanding how these diseases impact the quality of life of everyday Ontarians Ontarians like: Christina Halladay, mother of seven-year-old Lauren who has asthma; Don Clarke, who lives with the daily challenges of COPD; and Roz Brodsky, one of the lucky few to survive lung cancer. Christina, Don and Roz have all agreed to share their stories to help us all understand the true impact of lung disease. Your Lungs, Your Life 7

8 Current and Future Burden of Lung Disease in Ontario ASTHMA Asthma is a chronic and variable disease that can change both daily and seasonally. When not properly controlled, asthma symptoms can lead to wheezing, tightness in the chest, difficulty breathing, and cough. Approximately 1.7 million Ontarians suffer from asthma with symptoms that can be mild, moderate or severe and may vary widely from person to person. Despite effective treatment options, at its worst, asthma can be fatal. Christina Halladay talks about her daughter Lauren, 7 By the time Lauren was diagnosed with asthma at the age of two, her mother already suspected she had the disease. The signs and symptoms were clear: her daughter was struggling to breathe. At 13 months Lauren developed a cough that just never went away. It began getting worse at night and interfered with her sleep, describes Christina.! Every day an average of 222 new cases of asthma are reported in Ontario. By 2041 this number is expected to increase to 270 per day. Half of all new asthma cases occur in children under the age of 15. Watching her normally active child sit listlessly after using every ounce of her strength to breathe was heartbreaking for Christina. You can t do anything but sit and watch them try to take that deep breath. You try to calm them by rubbing their back, hoping it will help, but you know in the end it won t. No parent should ever have to watch their child struggle to breathe.! 1.7 million Ontarians live with asthma today. By 2041, this number will increase to more than 2.5 million Ontarians. Almost half a million (480,000) will be children under the age of 15. For years Christina and her husband could count on emergency room visits during the cold and flu season since every cold immediately moved into Lauren s chest and made her breathing more and more difficult. Since her diagnosis, Lauren has constantly relied on inhalers and other medications to help her breathe. Expensive monthly prescriptions are a reality for many Ontario families. Luckily, says Christina, our family has medical insurance. Others are not so lucky, and I can t imagine having to restrict Lauren s use of the puffers or having to decide if she really needed it because of the cost. Christina Halladay of Mississauga and her little ballerina, Lauren 8 Ontario Lung Association

9 ! In 2011, asthma was estimated to cost the Ontario healthcare system $1.6 billion (direct costs). Within 30 years, the cumulative direct cost to the healthcare system will exceed $79.4 billion. The annual wage-based productivity impact (indirect costs) is estimated at $246.3 million. By 2041, the cumulative impact is expected to exceed $17.2 billion. Total economic burden of asthma in Ontario over 30 years: $96.7 billion. Current and Future Prevalence of Asthma in Ontario by Sex and Year, Adults and Children: 2011 to % Prevalence of Asthma by Sex When your child is diagnosed with asthma, there is a notion that they can t and won t be able to do anything physical. But Lauren is doing great. She is the perfect poster child for living with asthma she s so active you sometimes forget that she has it. Christina concludes, No child or adult should ever have to struggle for breath. That s why we urgently need an Ontario Lung Health Action Plan today. Percentage of the Population (%) 16% 15% 14% 13% 12% 11% 10% Males Females Total Year The graph above shows the projected prevalence of asthma by sex. A higher proportion of females are expected to be living with asthma compared to males, with an average ratio of approximately 1.20 throughout the simulation period. Your Lungs, Your Life 9

10 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) COPD is sometimes referred to as emphysema or chronic bronchitis and is primarily caused by smoking, however, some patients have the disease due to other factors. For people with COPD, flare-ups or exacerbations can be brought on by something as simple as a common cold, change in weather, or poor air quality. Often, these flare-ups can result in emergency room visits, longer-term hospital stays and, in serious cases, death. Don Clarke, 84, from Ottawa, benefits from his exercise maintenance program. Don Clarke talks about living with COPD Don Clarke started smoking 69 years ago at the age of 15 when he joined the Canadian army, and he didn t stop until long after his military career was over. Like most people who took up smoking in the 1940s, 50s, 60s, and even into the 70s, Don knew nothing of the addictive properties of nicotine, and even less about the devastating poisons and cancer-causing materials that go into each and every cigarette produced. Don survived his 35 years of military service unscathed, but unfortunately, he didn t have the same luck with smoking. Eight years ago, Don was diagnosed with COPD, a disease that affects more than 780,000 Ontarians. When I quit smoking, my family told me it was the finest gift I ever gave them a chance to be as healthy and fit as I can, for as long as I can, says Don. I m still here, but my lungs only work at a 47 per cent capacity, and you d be surprised at all the little things my lack of breath doesn t let me do.! Every day, an average of 150 new cases of COPD are reported in Ontario. By 2041 this number is expected to increase to 215 per day. Don has to think about every task he performs from walking up the 12 steps from his basement to putting on his shoes. Some days it is so bad that even bending over to put on my socks can be a struggle because my lungs compress and I can t catch my breath. It can be really frightening.! In 2011, 36,000 people will die with COPD as a contributing factor. By 2041, this number is expected to grow to more than 57,000 people or 157 deaths per day. Don participates in a unique exercise maintenance program offered by the Ontario Lung Association. He believes the program has kept him out of the hospital a common result for many people living with COPD. Unfortunately, it has not kept him from chronic health problems. 10 Ontario Lung Association

11 ! Today, more than 780,000 Ontarians are living with COPD, or 5.9 per cent of the population. Almost half of all cases are severe or very severe. By 2041, this number will increase to 1.2 million Ontarians, accounting for 6.9 per cent of the population. Almost 200,000 of these people will be living with very severe COPD and will be at risk of respiratory failure or needing daily oxygen. For the last three months I have been on six different medications to help fight a lung infection. When it gets this severe it impacts my immune system and makes me more susceptible to other infections. Those who suffer most from COPD are senior citizens. What if all of us got worse and needed long-term care? Can you imagine the cost?! COPD is estimated to cost the Ontario healthcare system $3.3 billion in 2011 (direct costs). Within a generation, the cumulative direct cost to the healthcare system will exceed $172.3 billion. Currently, one in 27 employed Ontarians suffer from moderate or severe COPD. This translates to an annual wage-based productivity impact (indirect costs) of $664.5 million. By 2041, one in 11 in the workforce older than 55 will have COPD and the cumulative impact on productivity will exceed $138.4 billion. The total economic burden of COPD in Ontario over the next 30 years is expected to be $310.7 billion. Don believes investment is the number one way to help fight the impact COPD has on patients, their families and the healthcare system. We need real funding that would allow for more research, more rehab programs in more communities, and efforts to help more doctors understand what COPD is and how to diagnose it at an earlier stage. We need to make people understand the risk factors for COPD and its severity. Percentage of the Population (%) Current and Future Prevalence of COPD in Ontario by Sex and Year, Total Population: 2011 to 2041 Prevalence of COPD in Ontario by Sex 2011 to % 6.8% 6.6% 6.4% 6.2% 6.0% 5.8% 5.6% Males Females Year Total The graph above shows the projected prevalence of COPD by sex. There is a comparable increasing trend among males and females throughout the entire simulation period. In 2011 there were estimated to be 786,686 individuals living with COPD. This number is expected to increase by 39.8% to 1.1 million over the next 20 years and 53.4% to 1.2 million over the next 30 years. Your Lungs, Your Life 11

12 LUNG CANCER Lung cancer claims more lives than any other type of cancer and kills eight out of 10 people who have it. Each year, more people die of lung cancer than breast, colon, and prostate cancers combined. It is more common in older adults and rare in people under age 45. While smoking is the leading cause of lung cancer, it also occurs in people who have never smoked. In fact, approximately 10 to 15 per cent of lung cancers occur in non-smokers. 12 Ontario Lung Association Roz Brodsky, lung cancer survivor Roz Brodsky talks about how she defied the odds of lung cancer Roz Brodsky is one of the lucky ones. Seven years ago she was diagnosed with lung cancer, a disease with an extremely low survival rate. Of every 10 new cases in Ontario, more than eight people will die from it.! Every day in Ontario, an average of 16 people die from lung cancer, totaling 5,800 individuals yearly. By 2041 this number will grow to 21 deaths per day, or 7,700 yearly. I thought I was a goner. The general perception is that no one survives lung cancer. It s a scary diagnosis, explains Roz. Roz credits early diagnosis and her medical team s rapid response for her survival. The moment she coughed up blood she went to see her physician. This resulted in an x-ray and a stage one diagnosis, an anomaly since most lung cancers are typically detected in stages three and four. Roz has been cancer free for six and a half years, and today she is considered cured. Despite this clean bill of health, she lives with the pain of her diagnosis every single day. The surgery to remove my tumour meant removing ribs and part of my chest wall this has left me with daily pain and a weakened right side of my body. Emotionally, I m more of a realist. After a diagnosis of cancer you never really shake the feeling of terror; you never have the same sense of security as you had before.! Every day, an average of 23 new cases of lung cancer are reported in Ontario. By 2041, this will increase to 30 per day. The lifetime prevalence of lung cancer in Ontario will exceed an estimated 33,000 individuals in By 2041, this number will increase by 92 per cent to 63,000, and more than half that number will be women. Roz s journey through the diagnosis, treatment and survival of lung cancer has opened her eyes to the realities of this disease, and she s frustrated by the lack of attention it gets. Her experience underscores the need for increased investment in lung health research, detection and early intervention, and most of all, the need for preventative measures, such as programs and promotions to prevent youth and young adults from starting to smoke, as well as programs to help smokers quit.! In 2011, lung cancer will cost the Ontario healthcare system $158.5 million. Within a generation, the cumulative direct cost is expected to exceed $7.9 billion. Approximately 35.5 per cent of these costs are for end-of-life care. Currently, the wage-based productivity impact (indirect costs) due to lung cancer is $135 million. By 2041, the cumulative impact is expected to exceed $25.6 billion. Total economic burden of lung cancer in Ontario over 30 years: $33.5 billion

13 Roz believes it is time to tackle this devastating disease head on. She s a firm supporter of the Ontario Lung Association s call for an Ontario Lung Health Action Plan. People are dying because of a lack of awareness and education. Everyone needs to know how to prevent this disease, and most of all, to recognize its signs and symptoms. For lung cancer, early diagnosis can mean the difference between life and death. Without a doubt, the current healthcare system is struggling to meet the needs of lung cancer patients and their families. We are seeing not only increased suffering, but also increased calls to physicians offices, increased visits to emergency rooms, increased admissions to the hospital, and an increased length of stay once they re there. Something needs to be done on a policy level to address these unmet needs. Margaret Fitch, MScN, PhD Director, Oncology Nursing Research Associate Scientist, Sunnybrook Health Sciences Centre Percentage of the Population (%) Current and Future Prevalence of Lung Cancer in Ontario by Sex and Year, Total Population: 2011 to % 0.38% 0.36% 0.34% 0.32% 0.30% 0.28% 0.26% 0.24% 0.22% 0.20% 2011 Prevalence of Lung Cancer by Sex Year Males Females Total The graph above shows the current and projected prevalence of lung cancer by sex in Ontario. The results project the prevalence to remain higher in females compared to males throughout the simulation period. Your Lungs, Your Life 13

14 What Can Be Achieved: Intervention Scenarios Every day I see what lung disease does to my patients and the impact it has on their families. We already have a very clear sense of how to proceed. We have the expertise across Ontario to make a tremendous impact on lung health. John Granton, MD, FRCPC Associate Professor of Medicine, University of Toronto Past Chair, Ontario Thoracic Society President, Canadian Critical Care Society The next four sections describe the potential impact of each of the What if? scenarios on the life and economic burden of asthma, COPD and lung cancer now, and over the next 30 years. This report provides estimates of the gross benefit or savings, rather than the net, since the costs of the interventions were not included in the analysis. As mentioned earlier, the four interventions were chosen because they are currently though not widely available, and because there is ample evidence of their benefits. In short, these interventions represent real, achievable change. Smoking Cessation: Helping Ontarians Quit Smoking Smoking is not simply a lifestyle choice or a habit. Smoking is a powerful addiction that many smokers don t recognize in themselves. Most began smoking as teenagers and, despite their desperate efforts to quit, will relapse several times throughout their lives. There is no silver bullet to breaking this addiction, but there are many effective tools and supports. We need to ensure that every Ontarian who wants to quit smoking has access to the tools that will help them if they are unable to quit on their own. Peter Selby, MBBS, CCFP Clinical Director, Addictions Program Head of the Nicotine Dependence Clinic Centre for Addiction and Mental Health Tobacco use is linked to approximately 13,000 avoidable premature deaths annually, and is a major cause of COPD and lung cancer, as well as many other cancers. Tobacco smoke narrows the air passages and causes chronic swelling in the lungs, making breathing a challenge and contributing to a variety of other lung conditions as it damages the sensitive tissue in the lung. Beyond the obvious human costs, the financial cost of tobacco use is simply staggering. In Ontario, tobacco-related healthcare costs and productivity losses total $7.7 billion each year 1 or, approximately $600 per person, including non-smokers! Despite the progress made to date by the Ontario Government on smoking policies, more than 2.1 million Ontarians continue to struggle with an addiction to tobacco. While support for legislation and strategies to prevent individuals from starting to smoke must continue, the first scenario addresses a current gap in Ontario the need for greater assistance for those who want to quit smoking. The What if? scenario includes access to scientifically proven prescription and over-the-counter medications, along with behavioural counselling to help smokers quit. This type of intervention could be provided in a variety of settings, for example healthcare settings where smokers can be identified and provided with immediate support. 1 Evidence to Guide Action: Comprehensive Tobacco Control in Ontario (page 14), available at: 14 Ontario Lung Association

15 Over the next 30 years, increased access to medication and counselling to help people quit smoking could not only reduce smoking prevalence to 3.2 per cent, but also save the Ontario economy more than $36 billion. The extensive benefits of this solution are clearly illustrated below. 10-year impact of intervention: Reduction in smoking prevalence rate from 9.5 per cent (as projected it would be in 2021) to 4.3 per cent Reduction in second-hand smoke exposure from 4.0 per cent (as projected it would be in 2021) to 1.9 per cent 6,500 fewer new cases of lung cancer 34,000 fewer new cases of COPD $2.8 billion gross saving to the Ontario economy: - $1.1 billion reduction in direct costs - $1.7 billion reduction in indirect costs 30-year impact of intervention: Reduction in smoking prevalence rate from 8.7 per cent (as projected it would be in 2041) to 3.2 per cent Reduction in second-hand smoke exposure from 3.5 per cent (as projected it would be in 2041) to 1.1 per cent 62,200 fewer cases of lung cancer 162,900 fewer cases of COPD $36.3 billion gross saving to the Ontario economy: - $11.7 billion reduction in direct costs - $24.5 billion reduction in indirect costs Direct Economic Impact of Cessation Program on Asthma, COPD and Lung Cancer in Ontario Total Direct Economic Burden of Asthma, COPD and Lung Cancer in 2011 Present Value Terms, Base Model vs. Smoking Cessation Intervention Total Direct Economic Burden ($ Billions) $300 $250 $200 $150 $100 $50 $ The reduction in the total direct economic burden of asthma, COPD and lung cancer produced by upper and lower bounds of smoking cessation scenario as compared to the base model (status quo) is shown in the graph above. Non-smokers have a false sense of security and current smokers just don t accept the consequences. If I knew then what I know now, I would have never taken a puff of a cigarette in my life! Roz Brodsky, lung cancer survivor 2041 Base Model Helpline Counselling + Medication Extensive Counselling + Medication Year Your Lungs, Your Life 15

16 Comprehensive Primary Care Model: Managing COPD and Asthma through Care and Education I had asthma for probably 20 years when a life changing asthma attack happened to me. Little did I know at the time that my asthma was out of control. I wasn t treating it properly, I didn t have ownership over the disease and I didn t understand it. As a result, one evening I went into an asthma attack and unfortunately my asthma medication didn t work and I got progressively worse to the point where my husband called 911. Had people not responded as quickly as they did, I don t believe I would have survived that asthma attack. 16 Ontario Lung Association Lynn Pike, asthma patient Lynn Pike and son Kyle When not properly controlled, asthma symptoms can lead to potentially life-threatening wheezing, tightness in the chest, difficulty breathing and cough. Symptoms can be mild, moderate or severe and may vary widely from person to person, changing daily and seasonally. It is imperative that all Ontarians with asthma, their caregivers and healthcare providers have access to resources and educational material that are based on the most up-to-date research and best practices available. Improved awareness and understanding of asthma and its treatment will lead to improved control, which will subsequently lead to more appropriate medication use (using the right medication at the right time), fewer emergency department visits and hospitalizations and reduced healthcare costs in Ontario. Ontario currently supports a primary care model for asthma management, known as PCAP Primary Care Asthma Program. Based on the Canadian Guidelines, the model includes five components: an asthma care map, an asthma treatment flow chart, asthma program standards, a written asthma action plan, and asthma education. The goal of this type of model is to provide: A template for disease management based on guidelines A step-by-step guide to prescribing medications A set of standards that detail program requirements A patient support tool to assess levels of asthma control in order to identify appropriate care; and Educational materials for patients and families based on patient needs. The Primary Care Asthma Program is delivered in a healthcare environment, such as clinics, family health teams, or community health centres under the leadership of a certified asthma or respiratory educator, a healthcare professional who has taken additional training in asthma or respiratory education. With so many competing priorities in a typical healthcare setting, the key to the success of this program is the specific expertise the educator brings to the practice. With a dedicated focus on asthma diagnosis, education, appropriate use of medications, and asthma management, the program promotes patient and family self-management. Madonna Ferrone, Registered Respiratory Therapist, Certified Respiratory Educator

17 The PCAP model has been proven to be effective in improving patient outcomes and reducing use of expensive healthcare resources. Unfortunately, this program is only available in some Ontario communities. However, the benefits of expanding this program across the province are clear: If all children with asthma were treated with this approach, 70 per cent fewer would have to go to the emergency room because of their disease. If a similar disease management model were adapted for COPD and made available to all patients with this disease, we could reduce COPD hospitalizations and emergency department visits by about 40 per cent. The Comprehensive Primary Care Model scenario illustrates the possible impact over 10 years and 30 years of adapting the successful asthma management model for COPD patients, and making it available to all Ontarians. Over 30 years, the gross savings to Ontario s economy of this intervention scenario is estimated at $129.2 billion. 10-year impact of intervention - $28.2 billion gross savings: - $8.5 billion reduction in total cumulative direct costs - $19.7 billion reduction in total cumulative indirect costs 30-year impact of intervention - $129.2 billion gross savings: - $36.1 billion reduction in total cumulative direct costs - $93.1 billion reduction in total cumulative indirect costs Direct Economic Impact of Primary Care Model on COPD and Asthma in Ontario Total Direct Economic Burden ($ Billions) Total Direct Economic Burden of COPD and Asthma in 2011 Present Value Terms, Base Model vs. Patient Care Intervention $300 $250 $200 $150 $100 $50 $ COPD and Asthma Base Model: Total Direct Economic Burden Primary Care Scenario COPD and Asthma Total Direct Economic Burden Year The reduction in the total direct economic burden of COPD and asthma produced by implementing a Primary Care Model as compared to the base model (status quo) is shown in the graph above. Your Lungs, Your Life 17

18 Accurate Diagnosis through Spirometry: Early Screening for COPD Don Clarke s story earlier in this document describes the challenges of living with chronic obstructive pulmonary disease as only a personal story can describing how an irreversible and progressive condition such as chronic bronchitis and emphysema takes its toll on a person s life. The stages of COPD are mild (coughing, mild airflow limitation), moderate (shortness of breath during brisk activity) and severe (significant airflow limitation, risk of respiratory and heart failure). An effective way to help diagnose COPD or asthma is through spirometry. It is a simple breathing test that calculates the amount of air the patient s lungs can blow out, and the rate at which the air can be expelled. Carole Madeley, Registered Respiratory Therapist Spirometry is particularly important in diagnosing COPD in the early (mild) stage, when many people are unaware that their airflow is reduced. Unfortunately, many people have never heard of spirometry, and patients at risk of COPD such as current or former smokers are not routinely tested. Healthcare professionals need additional support, training and other resources to administer and properly read the test results. Carole Madeley, Ontario Lung Association, demonstrates a spirometry test on lung health champion Walter Gretzky. If people at risk of COPD were tested, it would be possible to detect the disease at an early stage and provide appropriate treatment. For example, early detection has been shown to motivate people to quit smoking sooner, which can reduce disease progression by about 75 per cent for former smokers as compared to current smokers. Sadly, COPD is often not diagnosed until it is in an advanced stage, when suffering can be a daily occurrence. This doesn t have to be the case. In fact, if we make spirometry testing available to all people considered at risk, we can diagnose patients faster, with more accuracy and ease their burden considerably. Henry Roberts, Member, Executive Committee COPD Canada 18 Ontario Lung Association

19 This What if? intervention scenario estimates the health outcomes if all Ontarians at risk or suspected of having COPD had access to a spirometry test, with results over a 10-year and 30-year time frame. Over 30 years, the gross savings to Ontario s economy of this intervention scenario is estimated at $19.3 billion. 10-year impact of intervention: 78,300 fewer people living with severe COPD 20,900 fewer people living with very severe COPD $2.6 billion gross saving: - $1.3 billion reduction in total cumulative direct costs - $1.2 billion reduction in total cumulative indirect costs 30-year impact of intervention: 140,600 fewer people living with severe COPD 58,700 fewer people living with very severe COPD $19.3 billion gross savings: - $10.7 billion reduction in total cumulative direct costs - $8.5 billion reduction in total cumulative indirect costs Total Direct Economic Burden ($ Billions) $0 Direct Economic Impact of Spirometry on COPD in Ontario $200 $180 $160 $140 $120 $100 $80 $60 $40 $20 Total Direct Economic Burden of COPD in 2011 Present Value Terms. Base Model vs. Spirometry Intervention COPD Base Model: Total Direct Economic Burden Spirometry Scenario COPD: Total Direct Economic Burden Year The total direct economic burden of COPD using the Accurate Diagnosis through Spirometry intervention in Ontario as compared to the base model (status quo) is shown in the graph above. Your Lungs, Your Life 19

20 Pulmonary Rehabilitation: Improving Quality of Life After a COPD Diagnosis Pulmonary rehabilitation (also called respiratory rehabilitation) makes a real difference in the lives of those living with COPD and other lung conditions by helping patients focus on improving muscle strength, learning breathing techniques to cope with their breathlessness and improving their aerobic fitness. Pulmonary rehabilitation programs also educate patients on the proper use of inhalers, good nutrition, coping skills, and how to save energy when undertaking common, day-to-day activities. The proven benefits for patients include reduced flare-ups or lung attacks and increased mobility. Pulmonary rehabilitation programs are led by multidisciplinary teams, either in the hospital or in the community.! Unfortunately, despite the positive role that pulmonary rehabilitation can play, less than two per cent of COPD patients in Ontario are currently able to take advantage of these programs. Access to pulmonary rehabilitation for all COPD patients could provide Ontario s economy with gross savings of $76.2 billion over the next 30 years. 10-year impact of intervention: $17.5 billion gross savings: - $9.6 billion reduction in total cumulative direct costs - $7.9 billion reduction in total cumulative indirect costs 30-year impact of intervention: $76.2 billion gross savings: - $40.7 billion reduction in total cumulative direct costs - $35.5 billion in total cumulative indirect costs Pulmonary rehabilitation services are also being studied for people suffering from lung cancer and other lung diseases, with promising results. Pulmonary rehabilitation improves the symptoms of COPD and results in a better quality of life. Pulmonary rehab makes a difference to what matters to individuals with COPD by making day-to-day living easier. Dina Brooks, PhD, MSc, BScPT Associate Professor, Physical Therapy; Graduate Coordinator, Graduate Department of Rehabilitation Sciences, University of Toronto By making pulmonary rehabilitation available to all people suffering with moderate to severe COPD, the number of COPD-related visits to the emergency room would be reduced by 24 per cent, the number of hospital admissions would be reduced by 22 per cent and the length of stay in hospital would shrink by 50 per cent. 20 Ontario Lung Association

21 Direct Economic Impact of Pulmonary Rehabilitation in Ontario Total Direct Economic Burden of COPD in 2011 Present Value Terms, Base Model vs. Pulmonary Rehabilitation Intervention $200 Total Direct Economic Burden ($ Billions) $180 $160 $140 $120 $100 $80 $60 $40 $20 $ COPD Base Model: Total Direct Economic Burden Pulmonary Rehabilitation Scenario COPD Total Direct Economic Burden Year Through this research process, what has been very apparent is the commitment to collaboration and positive change from our lung health experts, our patients, and other stakeholders. As a healthcare community, we know pulmonary rehabilitation and ongoing exercise maintenance improve the quality of life for people living with COPD. The challenge now is to find ways to increase access to these recognized best practice services so that all Ontarians with COPD can benefit. Andrea Stevens Lavigne Vice President, Provincial Programs Ontario Lung Association The reduction in the total direct economic burden of COPD produced by implementing the pulmonary rehabilitation scenario as compared to the base model (status quo) is shown in the graph above. The significant cost savings, both direct and indirect, are largely driven by the reduction in hospitalizations, and the corresponding improvement in economic productivity. This highlights the multiplicative effect of keeping patients out of the hospital through proper care and rehabilitation. Your Lungs, Your Life 21

22 An Ontario Lung Health Action Plan CONCLUSION Across this province, one in five Ontarians is suffering with lung disease every day. This is simply unacceptable. Imagine a time in which every child, woman and man in Ontario had access to the programs, supports and medications they needed when they needed them to prevent and better manage lung disease. How many lives would be impacted? How many lives would be saved? The time is now to put Ontarians first and to work towards this goal a goal that is well within our reach. The Ontario Lung Association, along with more than 40 healthcare experts and stakeholders, is eager to assist the government of Ontario in the development of a Lung Health Action Plan. We know we can have a tremendous, positive impact on the incidence, prevalence and severity of asthma, COPD and lung cancer in this province. Successful work in the area of lung health is already happening. We have a very clear sense of how to proceed. We have the expertise and the infrastructure to make a difference for patients who struggle every day with lung disease. This report provides a foundation for achieving a healthier Ontario by building a provincial Lung Health Action Plan. It can provide guidance to the government regarding which areas will have the most impact both from a health and economic perspective. The Ontario Lung Association s primary goal is to improve lung health and prevent lung disease among Ontarians through the development of an Ontario Lung Health Action Plan. This plan should: Protect the lung health of Ontarians Prevent lung disease Ensure lung health research is well funded Give Ontarians a fighting chance by detecting and treating lung disease as early as possible Make Ontario, indoors and out, a safe place to breathe; and Ensure that Ontarians have fair and equitable access to existing and promising new medications and supports that will help them to succeed in taking care of their own lung health. What we need now is to come together with the provincial government and our partners, as passionate advocates who believe and know we can make life better for those affected by lung disease, and to clearly articulate and act on our vision. As Ontarians committed to the life and breath of our children, families and friends, we will accept nothing less than the government s commitment to an Ontario Lung Health Action Plan. Because when you can t breathe, nothing else matters. TM The Ontario Lung Association is calling for our provincial government to commit to an Ontario Lung Health Action Plan. We ask everyone who is affected by lung disease and all of their parents, brothers, sisters, families, friends and caregivers to join us in this effort. Let your voice be heard. Millions of lives depend on it. Team COPD Ambassador Bruce Eyre of Sudbury shows his support by signing the pledge for a Lung Health Action Plan George Habib, President & CEO, Ontario Lung Association To sign the Ontario Lung Association s pledge for an Ontario Lung Health Action Plan, visit on.lung.ca/actionplan 22 Ontario Lung Association

23 IN MEMORY Don Clarke 1927 to 2011 We are deeply saddened by the passing of Team COPD Ambassador Don Clarke since the first printed edition of Your Lungs Your Life. Don passed away in October, Our most sincere condolences go out to his family, his friends, and his caregivers. Don will be missed by many of us at the Ontario Lung Association, and his absence is deeply felt by the staff and participants at the Ontario Lung Association s COPD Exercise Maintenance program in Ottawa. L to R - Bruce Cooke, Ontario Lung Association Board member; Libby Groff, Chair, Ontario Respiratory Care Society; George Habib, President & CEO, Team COPD Ambassador Margaret McDougall; Kelly Muñoz, Board Chair; Team COPD Ambassadors Brenda Cunningham and Bruce Eyre. Your Lungs, Your Life 23