Canadian Blood Services is seeking $855-million over seven years to significantly boost the amount of plasma it collects from unpaid donors to make medications, according to a confidential document that summarizes the full cost of the effort.
The national blood authority sent the provincial, territorial and federal governments a business plan in January that advocated for the opening of 40 new plasma-collection centres so that Canada could become less reliant on paid American donors for its supply of immune globulin, a plasma-derived drug for which demand is skyrocketing. Right now, Canadian Blood Services (CBS) only collects enough plasma to fill 17 per cent of Canada's need for immune globulin. CBS wants to up that to 50 per cent.
But CBS, which oversees the blood supply in every province but Quebec, refused to make the business plan or its total price public.
According to a seven-page CBS letter sent in March that was obtained by The Globe and Mail, the start-up and operating costs of the plan are expected to rise from $5-million this year to $247-million in 2023-24, after which the agency hopes to offset some of that with savings elsewhere in its plasma budget.
"Based on these assumptions," the letter says, "it is estimated therefore that the annual premium for domestic security of [immune globulin] supply is approximately $140-million."
That works out to a 13-per-cent increase to CBS's current budget of about $1.1-billion, the cost of which is shared by the provincial and territorial governments.
Revelations about the cost of CBS's plan come at a pivotal moment for plasma policy in Canada.
Not only is CBS trying to shore up the country's supply of plasma-derived medications, it is also trying to thwart the rise of a paid-plasma industry that it fears could undermine Canada's voluntary blood-donation system.
The latter effort is about to get a boost from British Columbia's new NDP government: It is moving to ban payments for blood and blood products. Health Minister Adrian Dix in an e-mail said he opposes paid plasma collection and is "currently reviewing policy options to prohibit pay for plasma in B.C." Alberta, Ontario and Quebec already forbid such payments.
All the other provinces allow them, including Saskatchewan and New Brunswick, home to two new paid-plasma clinics operated by Canadian Plasma Resources (CPR), a company that is hoping to open a total of 10 locations across the country.
In fact, the CBS letter obtained by The Globe was a response to an open letter from CPR, which had accused CBS of publicly low-balling the cost of its plasma business plan. The CBS letter, dated March 23, was addressed to Manitoba's Health Minister, Kelvin Goertzen, and copied to his counterparts in other provinces, the territories and the federal government.
Graham Sher, CBS's chief executive officer, told an open meeting of the agency's board last December that the plan would cost about $100-million over seven years, something he confirmed to The Globe in an interview in January. As the letter explains, that figure covered the capital costs of setting up the new centres, not operating them.
Canada is self-sufficient in fresh plasma from altruistic donors, but it leans heavily on paid donors in the U.S. to supply the raw material to make albumin, clotting factors and immune globulin, three categories of plasma-derived medications that are usually given to patients intravenously.
CBS now spends more on buying drugs made from plasma than it does on its entire fresh-blood program. The blood authority doled out just over $623-million for the drugs in 2016, up from about $459-million two years earlier.
Much of that increase is being driven by demand for immune globulin. It's a drug that treats: primary immune deficiencies, usually caused by congenital conditions; secondary immune deficiencies, which are among the side effects of blood cancers and stem-cell transplants; and some neurological conditions.
Last month, the federal government appointed an expert panel to examine the security and sustainability of Canada's immune globulin supply. The panel will submit their report by the end of March, 2018.
Lois Shepherd, the director of transfusion medicine at Kingston Health Sciences Centre, said demand for immune globulin is rising in part because of the aging population.
"Older people actually lose some of their immune function," she said. "So in an aging population there may be more people being diagnosed with secondary immune deficiencies related to the aging phenomenon. And primary immune deficiency is being more and more frequently recognized."
A quirk of Canada's health-care system plays a part, too. Although funded out of the public purse, plasma medications are provided free to patients in hospital, just like blood.
"It may be that people preferentially use [immune globulin] when there are other alternatives that maybe other jurisdictions would choose to use," Dr. Shepherd said.
The question now for the expert panel, and for the government officials reviewing CBS's proposal, is whether Canada should spend scarce health-care dollars to collect more plasma from unpaid donors at home, or keep relying on the U.S. market for the majority of its immune globulin when that supply is not guaranteed.
Dr. Sher was not available for an interview, but a spokesperson for CBS referred The Globe back to the confidential letter for an answer.
"This 50-per-cent sufficiency target was … determined through extensive consultation and third-party expertise," the letter reads.
"This included medical and scientific expert input into the internationally recognized risk-based decision-making framework. Canadian Blood Services also conducted robust stakeholder consultations to ensure vital voices were heard, especially those who most depend on reliable access to lifesaving [immune globulin]."