The Honourable Leona Aglukkaq, P.C., M.P.
Health Canada
Brooke Claxton Building, Tunney's Pasture
Postal Locator: 0906C
Ottawa, Ontario K1A 0K9

Re: Expansion of private healthcare services offered in Canada: The use of Capsule Endoscopy as a patient purchased diagnostic test for evaluation of gastrointestinal problems

Dear Ms. Aglukkaq:

I would like to propose a change in the manner in which specialized gastrointestinal diagnostic services are offered in the public Canadian healthcare system. Gastroenterology and evaluation of digestive disease/problems is one of the most heavily utilized sectors in the healthcare system. It is critical to improve patient care by minimizing patient waiting times and to reduce the burden on physicians to provide timely and accurate patient diagnosis and care. As Canada is expanding the offering of some privately offered health services such as ct scans, mris and x-ray studies in terms of diagnostic procedures used to diagnose gastrointestinal problems1, I would like to propose that Capsule Endoscopy be made available as a privately purchased outpatient diagnostic procedure.

Currently, this extremely valuable but expensive diagnostic test is only available to a narrowly selected group of patients seeking care from a gastroenterology specialist1. This test has the ability to be used as a timely, accurate, low risk and easily administered diagnostic tool for patients presenting with several different types of gastrointestinal dysfunctions. Utilizing this diagnostic tool may decrease the load on the healthcare system and physicians by allowing gastrointestinal problems to be identified more quickly and it may reduce or eliminate the need for more time consuming and patient invasive diagnostic examinations such as colonoscopy, enteroscopy, endoscopy or barium studies2.

Capsule endoscopy is a diagnostic method of imaging the gastrointestinal tract using a wireless capsule that transmits images to a data recorder while the device traverses the small intestine.-3 The capsule is simply swallowed by the patient and images are transmitted to a data recorder worn on the patients abdomen. The images are then reviewed by a physician. The indications to utilize this procedure are numerous, including evaluation of gastrointestinal bleeding, screening for intestinal polyps, abdominal pain study, anemia, investigation of known or suspected inflammatory bowel disease and abnormal radiological findings.3

Patients are currently facing unacceptable and perhaps unnecessary waitlist times to either see a gastrointestinal specialist or have a diagnostic procedure. It is unfair to patients to withhold the availability of this valuable diagnostic tool to be purchased as a private test when it has the potential to provide so much benefit to both patient and physician. Capsule endoscopy also known as Pillcam does come at a purchase cost of approximately $900.00 per capsule and must be analyzed by a gastrointestinal specialist. The price of this exam is not significantly different from the price of other diagnostic imaging procedures being offered at private facilities and is predicted to be a very sought after diagnostic exam if it was made available for private purchase.4

Patients have expressed that they would preferentially choose a diagnostic imaging procedure such as capsule endoscopy based on the facts that it is a less invasive procedure than most other gastrointestinal diagnostic exams, it can be carried out without significant interruption to their daily activities, it is very safe to use, it can be administered at a private care facility, it has wide use application and it yields valuable results.4 This procedure could eliminate the need for patients to undergo multiple diagnostic exams that require in hospital administration and supervision in order to gain a diagnosis. The use of capsule endoscopy is superior to other exams in the diagnosis of some gastrointestinal problems simply because the camera can examine areas of the gastrointestinal tract that other testing procedures cannot and without the need for surgical measures for investigation.5

I recommend the capsule endoscopy be made available for private purchase at diagnostic imaging centers such as Canada Diagnostic Centre at a regulated price. Patients who have the financial capability to purchase this test should be allowed to and have this information presented to their healthcare provider. This application of usage would be carried out in a manner similar to the way in which other private diagnostic procedures are administered or offered. The patient would obtain a referral form from their doctor or preferably from their gastrointestinal specialist and would be able to book directly through the private facility. Patients who are not able to finance this exam would be placed on a wait list according to the severity of their need for medical assessment.

In this memo I have presented the need for improvement in healthcare for patients seeking help from a gastrointestinal specialist; and I have identified a potential action that could be implemented to do so. I propose that the Capsule Endoscopy diagnostic test be made available not only in the public health sector but that it also be made available for private purchase by individual patients. Thank you for considering the details that have been presented in this memo and the creation of a healthcare policy to address this issue.

Sincerely,

Jaime Thomas
Canadian Healthcare Policy Analyst

References

1 Enns R., Go K., Chang H., Pluta K. Capsule Endoscopy: a single-centre experience with the first 226 capsules. Canadian Journal of Gastroenterology 2004. Sept; 18(9):555-8.

2.Steinbrook R. Private Healthcare in Canada. The New England Journal of Medicine 2006; 354(16):1661-1664.

3Iddan G, Meron G, Glukhovsky A, et al. Wireless capsule endoscopy. Nature.2000;405:417

4.Triester SL, Leighton JA, Leontiadis GL, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol, 2006; 101: 954-964.

5.N Esmail, D Wrona - Studies in Health Care Policy. Medical Technology in Canada. Fraser Institute, 2008 - fraserinstitute.org