This article is more than 5 years old. Information may no longer be current.
‘Expanded global vision’ needed to deliver care to limited resource areas
Click Here to Manage Email Alerts
ORLANDO — In his address to the World Congress of Gastroenterology at ACG 2017, World Gastroenterology Organization President David J. Bjorkman, MD, MSPH, FACG, called for global collaboration to address future challenges in gastroenterology, and to deliver quality care to developing countries with limited resources.
“Together we can do a lot more than any of us can do alone,” he said during his presentation. “It’s my plea that all of us will have a global vision for health care ... and that we will be able to address the challenges in health care, not just in terms of new diseases and new therapies, but the biggest challenge, which is: ‘How do we deliver health care throughout the world in the best way [that recognizes] the limited resources in many areas of the world.’”
The problem of limited global resources is far-reaching. In fact, Bjorkman said global resources are limited in “the vast majority of the world,” and even high-resource countries are struggling to control health care costs.
Based on figures from the U.N., “75% of the countries in the world are considered to be challenged economically,” and face unique challenges, including physician shortages, limited infrastructure, and lack of access to advanced drugs and technology, he said.
Increasing burden, costs
Bjorkman emphasized that these resource limitations are increasingly challenging given the rising global burden of GI diseases.
Viral hepatitis has become the seventh leading cause of death worldwide, IBD incidence is “dramatically increasing” in developing countries, and colorectal cancer has become the third most common cancer in the world, with almost 1.4 million new cases in 2012, and again, increasing incidence in developing countries.
“This is something that ... seems to be changing with economic development in different countries, but the resources haven’t changed with it,” he said.
While recent advances like new antivirals, biologics and better colorectal cancer screening strategies have improved the diagnosis and treatment of these diseases, he said the costs of these interventions remain a challenge, especially in low resource areas.
“The big challenge that we have in developing optimal health care on a global basis is, how do we deliver the best health care, which is often the most expensive health care,” he said.
For example, the cost of hepatitis C treatment is “substantial,” ranging between $50,000 and $90,000 for a treatment course.
“That’s a pretty hard bill to take if you’re living in a country where the average income is less than $1,000 a year,” he said.
He noted that while some countries have addressed this by providing less costly antivirals — for example, a generic treatment course costs about $550 in India — these drugs remain prohibitively expensive in other low-resource countries. He noted that in Vietnam, less than 10% of patients with HCV can afford treatment.
Anti-TNF infusions for IBD are also “a big-ticket item,” and while the arrival of biosimilars may provide cost savings, “some countries don’t even have the facilities to provide infusions,” and therapeutic drug monitoring is not available or affordable in many areas, he said. “Even in this country, [drug monitoring is] sometimes difficult ... because the insurance companies claim [it is] experimental and therefore won’t pay.”
Similarly, the average colonoscopy cost exceeds $3,000 in the U.S., and screening programs require a sophisticated infrastructure. Fecal immunochemical testing may be less expensive, but positive FIT requires colonoscopy and surveillance, he noted.
“In many countries of the world, colonoscopy is a test that’s just not available,” he said.
Global, regional, individual efforts
Gastroenterologists can help meet these challenges by participating in organizations like the WGO, Bjorkman said.
The WGO’s efforts include training a larger health care workforce with the Train the Trainers (TTT) program, establishing 23 WGO Training centers, and developing global and regional courses.
The WGO also works to identify acceptable treatment approaches for low resource areas, and based its guidelines on “cascades” that tailor optimal care strategies to a region’s available resources.
While participating in these organizations is important, Bjorkman noted that gastroenterologists also have individual opportunities to make an impact. He called for physicians to participate in international activities led by the ACG; to join WGO committees; attend, teach or host a TTT event; participate in training centers; or join a WGO guidelines group.
“What is the prerequisite for participation on an individual basis? Basically, it’s motivation,” Bjorkman said. “WGO activities are successful through the joint efforts of our regional organizations, our national organizations like the ACG, and committed individuals like yourselves.” – by Adam Leitenberger
Reference:
Bjorkman DJ, et al. WGO Presidential Address. Presented at: World Congress of Gastroenterology at American College of Gastroenterology Annual Scientific Meeting; Oct. 13-18, 2017; Orlando, FL.
Disclosures: Bjorkman reports no relevant financial disclosures.