Opportunity to Save €4.2 million per year
This month (April) marks four years since the launch of the HSE’s Freestyle Libre Reimbursement Scheme. I’ve published posts on this issue previously including this one which came about when an elected representative reached out to me online and we began messaging back and forth, discussing access to the Freestyle Libre and how we could do something to fix it or that might help.
In February 2021, I suggested that we find out how many people were using all the different sensors and they submitted Parliamentary Questions PQ to that effect. In February 2022, I requested asked another elected representative to submit a PQ to request numbers for 2021.
I created the attached report as a result of this new data, which reviews HSE funded Glucose Sensor uptake from 2018 to November 2021, with the help of Phil Miesle’s spreadsheet and chart creating specialities. I would also like to express my special thanks to Councillor John Maher and Deputy Cathal Crowe for their assistance in submitting PQs and for answering my never-ending emails and messages.
A Review of Continuous and Flash Glucose Sensors Uptake from 2018 to November 2021 in Ireland
The following Review of Continuous and Flash Glucose Sensors Uptake from 2018 to November 2021 in People with Type 1 Diabetes in Ireland is the result of this. This report details how the restricted access to Flash (Freestyle Libre) glucose monitoring in people over the age of 21 years cost €2.4 million more in Continuous Glucose Monitoring in 2021 alone! And that over the next three years as uptake of glucose sensors in this age group continues will cost €4.2 million each year for the next three years.
Background
Glucose Sensor technology has been available in Ireland since 2014, but it wasn’t until 2016 that people became more aware of these devices. However, the real uptake of the glucose sensor story begins in 2018 with the launch of the HSE’s reimbursement scheme for a new Flash glucose monitor called the Freestyle Libre. This document does not include how many people are funding their own sensors as those figures are owned by the respective companies.
Key points of interest
56% of people with type 1 diabetes are using glucose sensors
The latest figures from the HSE provided through Parliamentary Questions have revealed that over half of people with type 1 diabetes are using Flash and Continuous Glucose Monitoring devices as of the end of November 2021, (figures include Dexcom, Freestyle Libre and Medtronic Guardian sensors).
The uptake of glucose sensors has grown rapidly since 2018, increasing from 14% to 56% by November 2021. However, when the numbers are examined by age groups; Under 21 years and Over 21 years, there is a very revealing story told.
Under 21 Years
83% of Under 21’s are using HSE funded sensors
Of the 11,212 people using HSE funded sensor 4,581 are aged 21 years or younger (Under 21), based on the estimated population as per Kate Gajewska’s 2020 paper on the epidemiology of type 1 diabetes in Ireland.
55% of those Under 21’s are using the Freestyle Libre device, 33% are using Dexcom and 12% are using Medtronic Guardian.
This high percentage suggests that all those within this group, who have requested sensors, have received them once they meet the eligibility criteria.
Over 21 Years
46% of those Over 21’s are using HSE funded sensors
Of the 11,212 people using HSE funded sensor 6,631 are aged 21 years or older (Over 21), based on the estimated population as per Kate Gajewska’s 2020 paper on the epidemiology of type 1 diabetes in Ireland.
77% of the Over 21’s are using the more expensive Dexcom and Medtronic CGMs, while 23% are approved for the Freestyle Libre through exceptional circumstances.
The uptake of sensors in the Over 21’s has doubled each year since 2018
The uptake of glucose sensors has grown rapidly since 2018, however, the increase in uptake in the Under 21’s remained the same since the end of 2018 suggesting it has reached maximum capacity of this group. While uptake in the Over 21’s has doubled each of the four years and we have no reason to believe that this will not continue.
Conclusion
Rapid growth set to continue in Over 21’s
The rapid growth in uptake is set to continue in the Over 21 population, especially as many, if not most, of the remaining sensor-less, will qualify for a sensor and have yet to apply. However, with most of the group restricted to only two of the available three sensors in the Under 21 group this will have serious cost implications.
Opportunity to reduce the cost by €4.2 million per year
What if the 3,000 new people Over 21 who were approved for sensors in 2021 had the choice of the Freestyle Libre, and if uptake was distributed similarly to the Under 21’s across the three devices (55% Libre, 33% Dexcom, 12% Medtronic G), the total cost of funding sensors would have been reduced by €2.4 million for that year alone!!!
With almost half of those Over 21’s who qualify for a sensor yet to apply, and as long as the Libre is not included as a choice for this cohort, this will cost €4.2 million more per year going forward.
Therefore, the sooner the HSE removes the age restriction from the Libre reimbursement scheme the more will be saved.
Read the full report here