Abstract
Objectives
Several strategies have been proposed to manage the utilization of blood glucose test strips (BGTS) in Canada; however their potential impacts on utilization and costs of publically funded test strips are unknown.
Methods
We investigated the impact of three potential policies that would restrict the number of test strips reimbursed by the public drug plans in Ontario and British Columbia (BC), and incorporated negotiated price reductions. These policies were based on recommendations from the Canadian Agency for Drugs and Technologies in Health, a briefing document by the Canadian Diabetes Association, and a new policy introduced by the Ontario Ministry of Health and Long-Term Care. BGTS utilization rates were assessed in two cross-sectional analyses among adults aged 18 years or older in BC and 65 or older in Ontario who received publicly-funded BGTS between January 2004 and December 2012. We modeled the 5-year utilization and cost implications of the three policies using time-series analysis.
Results
In 2012, there were 31 7,1 30 test strip recipients in Ontario and 1 36,659 recipients in BC, at a cost of $104.4 million and $22.6 million respectively. Under the scenarios of reduced BGTS quantities, 5-year cost savings ranged between $98.8 million (18.2% reduction) and $224.1 million (41.4% reduction) in Ontario and between $23.1 million (19.2% reduction) and $51.1 million (42.4% reduction) in BC. Price reductions of 15% resulted in annual savings of $14.4 million (1 3.7% reduction) in Ontario and $3.4 million (14.1% reduction) in BC.
Conclusions
Policies that align with evidence and expert guidance could impart substantial cost savings in multiple jurisdictions despite different public drug plans.
Key words: Self-monitoring, self-testing, blood glucose, diabetes, utilization
Résumé
Objectifs
Plusieurs stratégies ont été proposées pour gérer l’utilisation des bandelettes de test glycémique (BTG) au Canada, mais on ignore leurs effets potentiels sur l’utilisation et le coût des bandelettes de test glycémique financées par les deniers publics.
Méthodes
Nous avons étudié l’effet de trois politiques possibles qui limiteraient le nombre de bandelettes de test remboursées par les régimes d’assurance médicament en Ontario et en Colombie-Britannique (C.-B.), et avons incorporé des réductions de prix négociées. Ces politiques étaient fondées sur des recommandations de l’Agence canadienne des médicaments et des technologies de la santé, sur un document préparatoire de l’Association canadienne du diabète et sur une nouvelle politique introduite par le ministère de la Santé et des Soins de longue durée de l’Ontario. On a évalué le taux d’utilisation des BTG dans deux analyses croisées chez des adultes âgés de 18 ans et plus en C.-B. et de 65 ans et plus en Ontario qui recevaient des BTG financées par les fonds publics entre janvier 2004 et décembre 2012. Nous avons établi le modèle d’une utilisation sur 5 ans et des conséquences financières de ces trois politiques selon une analyse des séries chronologiques.
Résultats
En 2012, il y avait 31 7 1 30 receveurs de bandelettes en Ontario et 1 36 659 en C.-B., pour un coût de 104,4 millions $ et de 22,6 millions $ respectivement. Selon les scénarios des quantités réduites de BTG, les économies sur 5 ans étaient entre 98,8 millions $ (réduction de 18,2 %) et 224,1 millions $ (réduction de 41,4 %) en Ontario et entre 23,1 millions $ (réduction de 19,2 %) et 51,1 millions $ (réduction de 42,4 %) en C.-B. Une réduction de prix de 15 % entraînait des économies annuelles de 14,4 millions $ (réduction de 13,7 %) en Ontario et de 3,4 millions $ (réduction de 14,1 %) en C.-B.
Conclusions
Les politiques qui correspondent aux faits et aux conseils des experts pourraient permettre des économies importantes dans plusieurs compétences malgré les régimes publics d’assurance médicament différents.
Mots Clés: autosurveillance, autodiagnostic, glycémie, diabète, utilisation
Footnotes
Conflict of Interest: Dr. Muhammad Mamdani has received honoraria from Boehringer Ingelheim, Pfizer, Sanofi, Bristol-Myers Squibb, Astra-Zeneca, ClaxoSmithKline, Novo-Nordisk, Eli Lilly, Merck, and Bayer. Michael Law has consulted for Health Canada on unrelated pharmaceutical policy research. All other authors report no conflicts of interest.
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