On the 24th January, it will be two years since the HSE announced its decision to include the Freestyle Libre flash glucose monitoring system in the Long Term Illness scheme, but only for approximately 3,000 of the 20,000 people with type 1 diabetes in Ireland.
The health service has been reviewing how much it would cost to expand the flash glucose scheme to more people and how much would be saved in the reduction of finger stick test strips to offset this cost since December 2019. However, the cost of the continuous glucose monitors that are available on the LTI is not being considered. This is something I do not understand! We also have a situation where people are being forced to apply for these more expensive sensors when they would be very happy to have the flash sensors.
In this post I have briefly looked at:
the cost of finger stick meter testing strips
the cost of Libre sensors
the cost of continuous glucose sensors
Questions arising from the above
** Disclosure: I am not a health economist, but I do run a household and keep a basic budget. I also decided to focus only on the immediate cost of these products as the long term savings with widening access to glucose sensors is much more difficult to estimate.
Background to Libre Access
The Freestyle Libre glucose monitoring system has been available to purchase in Ireland since November 2016. Abbott submitted an application to have the device included on the Long Term Illness Scheme in February 2017, and on the 24th January 2018, two years ago, the HSE announced that only people aged between 4 and 21 years would be allowed access to the reimbursement scheme. There’s a bit more information here.
The HSE seems to be stuck on justifying the cost of this advancement in diabetes management technology against the cost of 1980’s technology, which to me is like comparing the cost of a smart phone to a landline telephone (apples and oranges).
Forced to Choose CGM over Flash
When people ask in our community groups about getting the Libre they are usually very surprised to find out that there are two other similar devices which ARE ALREADY on the Long Term Illness scheme, and have been for a while: I’ve been using my HSE funded CGM since November 2015. These devices are the Dexcom CGM and the Medtronic Guardian CGM and access is based on clinical need. This webpage includes information where you can find out more about the clinical criteria to qualify.
Both of the CGM devices are a lot more expensive than the Freestyle Libre, so my next question is why are the HSE not considering the cost of CGMs that are currently included in the LTI scheme in comparison to the Libre. This has created a situation where people who would be so happy to have access to a flash glucose meter are forced to apply for a CGM at an increased cost to the HSE of at least €1,000 per person approved per year!!!!
Cost Comparison between Flash €4.30 and Continuous €7
The flash glucose sensor costs €60 per sensor which lasts 14 days, this is a daily equivalent cost of €4.30.
The Dexcom sensor costs €75 per sensor, lasts 10 days which is a daily equivalent of €7.50, almost twice the cost of flash and the Medtronic sensor is a daily equivalent cost of €7.
Does it not make sense to offer the Libre in addition to Dexcom and Medtronic?
Cost of Finger Stick Test Strips (€2.64 daily)
The most expensive test strip available through the LTI in Ireland costs .44c per strip, if a person with type 1 diabetes used 6 strips per day (I’m being conservative) that’s a daily cost of €2.64 in test strips. As mentioned above the Libre sensor is a daily equivalent cost of €4.30 so the yearly saving per person by the reduction in test strips needed for the Libre is less than €1,000. The sensors cost twice this at least
We are also looking at a relatively small population, the number of people with type 1 diabetes is estimated at 20,000, which means that even if Libre access was expanded to all people with type 1 diabetes the reduction on test strips would offset half the cost of the Libre. However, when you consider that a flash/continuous glucose monitor are far superior tools for diabetes management this consideration feels a lot like comparing apples with oranges. For every person who is approved for this sensor it’s a reduction of €964.66 per year. If you think about how much the total spend on test strips for all 220,000 people with diabetes in Ireland this seems like such a tiny saving.
Cost comparison between finger stick test strips, flash and continuous glucose monitoring
The Real Savings
Is anyone else confused as to why our penny-pinching public health service is spending €1,000 more per person per year for a CGM when offering the choice of a flash glucose meter would actually be a significant saving?
Has any of the “pounds and pence” people in the HSE considered asked themselves:
How many people with diabetes are being funded for Continuous Glucose Monitoring CGM sensors by the HSE's Long Term Illness scheme?
How many of these people are over the age of 21 years?
How many people were approved for CGM sensors since January 2018 when more people found out about glucose sensors?
Maybe we should be asking our TDs to ask these questions of the HSE on our behalf:
How many people with diabetes were funded for the Dexcom Continuous Glucose Monitoring CGM sensors by the HSE's Long Term Illness scheme/PCRS and how many of those people are over the age of 21 years of age for the years 2018 to 2020 in tabular form?
Why is the Dexcom CGM included in the HSE's Long Term Illness scheme at a cost of €225 per month and the Freestyle Libre Glucose Monitoring system, which costs €120 per month, a difference of €105 for a very similar product, is not included for persons with diabetes aged over 21 years?
So there you have it! These are some of the questions I have struggled to articulate this year and finally decided to just try to put them into words. I should add that I was advised not to be wary about asking these questions but in the interest of saving our country money as we head into a pandemic recession I think it is important that we do ask them.
