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. 2019 Dec 12;19(8):1–108.

Table 15:

Budget Impact of Adopting Flash Glucose Monitoring, Scenario Analyses

Scenario Budget Impact, $a
Year 1 Year 2 Year 3 Year 4 Year 5
Scenario 1: All patients who require intensive insulin therapy, with or without ODB coverageb
SMBG, T1D 8,295,983 11,432,270 14,753,703 18,257,632 21,945,841
Flash, T1D 21,823,186 30,075,733 38,812,217 48,032,490 57,732,074
Net budget impact, T1D 13,527,203 18,643,463 24,058,514 29,774,859 35,786,232
SMBG, T2D 12,071,111 16,635,654 21,469,886 26,569,317 31,933,949
Flash, T2D 42,198,312 58,154,224 75,051,879 92,879,113 111,631,298
Net budget impact, T2D 30,127,201 41,518,570 53,581,993 66,309,795 79,697,349
Net budget impact, T1D and T2D 43,654,405 60,162,033 77,640,507 96,084,654 115,483,581
Scenario 2: Assumes that target population uses 3,000 strips per year (8 per day) in SMBG groupc
SMBG, T1D 10,467,045 14,423,055 18,613,785 23,034,345 27,687,180
Net budget impact, T1D 75,934 104,634 135,036 167,105 200,859
SMBG, T2D 22,467,105 30,963,480 39,961,080 49,452,570 59,437,950
Net budget impact, T2D 162,990 224,628 289,902 358,759 431,199
Net budget impact, T1D and T2D 238,924 329,261 424,937 525,864 632,058
Scenario 3: Assumes that target population uses 730 strips per year (2 per day) in SMBG groupc
SMBG, T1D 2,546,981 3,509,610 4,529,354 5,605,024 6,737,214
Net budget impact, T1D 7,995,998 11,018,078 14,219,466 17,596,426 21,150,826
SMBG, T2D 5,466,996 7,534,447 9,723,863 12,033,459 14,463,235
Net budget impact, T2D 17,163,099 23,653,661 30,527,119 37,777,870 45,405,914
Net budget impact, T1D and T2D 25,159,098 34,671,739 44,746,585 55,374,296 66,556,740
Scenario 4: All patients with type 2 diabetes who require any type of insulin therapy (including, but not limited to, intensive insulin therapy)b,d
SMBG, T2D 21,867,982 30,137,787 38,895,451 48,133,835 57,852,938
Flash, T2D 45,260,190 62,376,215 80,501,963 99,622,657 119,738,297
Net budget impact, T2D 23,392,208 32,238,428 41,606,512 51,488,823 61,885,359
Net budget impact, T1D and T2D 26,294,244 36,237,287 46,767,270 57,875,201 69,561,757
Scenario 5: Adults with diabetes (type 1 and type 2) who require intensive insulin therapyb
SMBG, T1D 4,472,834 6,163,087 7,955,076 9,845,233 11,831,771
Flash, T1D 6,171,620 8,503,833 10,976,421 13,584,460 16,325,487
Net budget impact, T1D 1,698,786 2,340,746 3,021,345 3,739,227 4,493,716
SMBG, T2D 10,830,470 14,924,916 19,260,911 23,837,267 28,650,412
Flash, T2D 22,415,837 30,890,116 39,864,332 49,336,020 59,297,794
Net budget impact, T2D 11,585,367 15,965,201 20,603,421 25,498,754 30,647,381
Net budget impact, T1D and T2D 13,284,153 18,305,946 23,624,765 29,237,981 35,141,098
Scenario 6: Includes patients at high risk of glycemic variabilityb
SMBG, T1D 8,817,159 12,149,474 15,678,122 19,401,320 23,320,850
Flash, T1D 12,165,923 16,763,854 21,632,686 26,769,957 32,178,128
Net budget impact, T1D 3,348,764 4,614,380 5,954,564 7,368,637 8,857,278
SMBG, T2D 12,301,186 16,952,505 21,878,691 27,074,985 32,542,575
Flash, T2D 25,459,780 35,086,621 45,282,354 56,037,129 67,353,408
Net budget impact, T2D 13,158,594 18,134,116 23,403,663 28,962,144 34,810,833
Net budget impact, T1D and T2D 16,507,358 22,748,496 29,358,227 36,330,782 43,668,111
Scenario 7: Funding is capped at 4 flash sensors per patient per yeare
Flash, T1D 8,087,410 11,144,039 14,382,026 17,797,592 21,392,626
Net budget impact, T1D 446,467 615,209 793,963 982,520 1,180,984
Flash, T2D 12,733,392 17,548,773 22,648,227 28,027,596 33,686,881
Net budget impact, T2D 1,799,401 2,479,879 3,200,501 3,960,679 4,760,412
Net budget impact, T1D and T2D 2,245,868 3,095,088 3,994,464 4,943,198 5,941,397
Scenario 8: Funding is capped at 8 flash sensors per patient per yeare
Flash, T1D 8,533,877 11,759,248 15,175,988 18,780,111 22,573,610
Net budget impact, T1D 892,934 1,230,418 1,587,925 1,965,039 2,361,969
Flash, T2D 14,532,792 20,028,652 25,848,727 31,988,275 38,447,294
Net budget impact, T2D 3,598,801 4,959,758 6,401,002 7,921,357 9,520,825
Net budget impact, T1D and T2D 4,491,735 6,190,176 7,988,927 9,886,397 11,882,793
Scenario 9: Includes all costs associated with monitoring blood glucose (i.e., beyond those reimbursed)
SMBG, T1D 7,875,328 10,851,800 14,004,875 17,330,872 20,831,630
Flash, T1D 10,562,511 14,554,603 18,783,555 23,244,433 27,939,705
Net budget impact, T1D 2,687,184 3,702,802 4,778,680 5,913,562 7,108,075
SMBG, T2D 11,269,390 15,531,130 20,044,282 24,805,166 29,813,784
Flash, T2D 22,672,020 31,245,887 40,325,551 49,903,610 59,980,063
Net budget impact, T2D 11,402,630 15,714,758 20,281,270 25,098,443 30,166,279
Net budget impact, T1D and T2D 14,089,814 19,417,560 25,059,950 31,012,005 37,274,354
Scenario 10: Assumes a lower price of flash sensors ($70 vs. $89 in the reference case)
Flash, T1D 8,428,165 11,613,583 14,987,999 18,547,476 22,293,983
Net budget impact, T1D 787,222 1,084,752 1,399,936 1,732,404 2,082,342
Flash, T2D 18,090,729 24,932,092 32,177,046 39,819,685 47,860,009
Net budget impact, T2D 7,156,738 9,863,198 12,729,320 15,752,767 18,933,540
Net budget impact, T1D and T2D 7,943,960 10,947,950 14,129,256 17,485,171 21,015,882
Scenario 11: Assumes a higher uptake rate, at 50% in year 1 to 70% in year 5b
SMBG, T1D 25,468,025 28,953,837 32,609,210 36,434,143 40,421,498
Flash, T1D 35,140,801 39,950,528 44,994,214 50,271,861 55,773,616
Net budget impact, T1D 9,672,777 10,996,691 12,385,005 13,837,718 15,352,118
SMBG, T2D 36,449,017 41,440,647 46,672,638 52,144,988 57,854,128
Flash, T2D 75,438,575 85,769,759 96,598,416 107,924,545 119,740,760
Net budget impact, T2D 38,989,558 44,329,112 49,925,778 55,779,558 61,886,632
Net budget impact, T1D and T2D 48,662,335 55,325,803 62,310,783 69,617,275 77,238,750
Scenario 12: Uses lower-priced strips, $0.4 per strip
SMBG, T1D 4,453,310 6,136,435 7,919,423 9,800,195 11,779,791
Flash, T1D 10,277,343 14,161,656 18,276,434 22,616,877 27,185,385
Net budget impact, T1D 5,824,033 8,025,221 10,357,011 12,816,682 15,405,594
SMBG, T2D 6,372,572 8,782,484 11,334,564 14,026,731 16,858,985
Flash, T2D 22,059,917 30,402,307 39,236,837 48,556,305 58,360,713
Net budget impact, T2D 15,687,346 21,619,823 27,902,273 34,529,574 41,501,728
Net budget impact, T1D and T2D 21,511,379 29,645,043 38,259,283 47,346,256 56,907,322

Abbreviations: ODB, Ontario Drug Benefit; SMBG, self-monitoring of blood glucose; T1D, type 1 diabetes; T2D, type 2 diabetes.

a

Numbers might be inexact because of rounding.

b

Estimation of target population in Appendix 5.

c

Cost in flash group was same as cost in the reference case.

d

Budget impact for type 1 diabetes was same as for reference case.

e

Flash group combined use of flash glucose monitoring for a given duration and use of self-monitoring of blood glucose for the remaining time. Total cost of self-monitoring of blood glucose was the same as total cost in the reference case.