Reducing ‘unnecessary’ blood glucose test strip use
Blood glucose test strips are the third most expensive cost for the Ontario Public Drug Program.
A study released in 2009 suggests that the Ontario government is unnecessarily spending between $19 and $42 million per year on glucose test strips.
However, no changes have yet been made to reduce the use of blood glucose test strips.
Researchers have suggested that the Ontario Ministry of Health and Long-Term Care (MOHLTC) is unnecessarily spending tens of millions of dollars per year on blood glucose test strips that don’t benefit patients. The studies were published in 2009, yet the government continues to pay for the strips. What’s the story?
What are blood glucose testing strips, and why do we measure blood sugar levels in persons with diabetes?
People with diabetes have high blood sugar (also known as blood glucose) levels. Lowering the blood glucose close to normal can decrease the chances of developing serious long-term complications of diabetes such as blindness and requiring dialysis, and is an important part of good diabetes care.
Many people with diabetes can control their blood glucose levels with diet and exercise, some need to take pills, and others require insulin.
Insulin can lower the blood sugar rapidly and dramatically. Therefore, people on insulin –everyone with type 1 diabetes and a small proportion of those with type 2 diabetes are on insulin – must check their blood glucose levels many times a day to ensure that their levels are neither too high nor too low. The blood glucose level is measured by pricking a fingertip with a tiny stylet, putting a drop of blood on a small plastic blood glucose strip, and inserting the strip into a machine the size of a cell phone called a glucometer. The glucometer automatically produces a reading that indicates what the blood glucose level is. Glucometers are often provided free of charge to persons with diabetes. However, the strips cost between $0.44 and $0.77 per strip in 2008, and they are not re-usable.
People with diabetes who are not on insulin need to monitor their blood sugars so glucose-lowering medications can be started or adjusted when needed. However, most do not need to measure their blood glucose levels on a daily basis, because oral medications are adjusted every few weeks or months (not every day as can be the case with insulin), and pills rarely cause the blood glucose levels to drop to dangerous levels.
What the Ontario government spends on glucose test strips
The MOHLTC pays for glucose test strips in the same manner that it pays for many prescription drugs – in other words, Ontarians 65 years of age and older and younger people who are on disability support or welfare pay very close to nothing for the test strips. Because diabetes is extremely common (there are about 1.2 million Ontarians with diabetes), the government expenditure on test strips is extremely high – around $85 Million in 2008. This makes it the 3rd highest “drug” expenditure in the Ontario Drug Benefit Plan.
However, a significant chunk of the expenditure on test strips in Ontario is for people who are either on no glucose-lowering drugs at all (who use about 13 million test strips per year), or on pills that do not cause a dangerously low blood glucose level (who use about 25 million test strips per year).
Why do physicians order, and patients use, glucose test strips if they are highly unlikely to provide benefit?
A recent study found that the MOHLTC could save between $19 million and $42 million per year by not paying for test strips used by persons with diabetes who are highly unlikely to derive any benefit by regular self-monitoring of blood glucose.
Some persons with diabetes probably like the security of constantly knowing that their blood glucose is under control, and immediately knowing if it gets too high. If their physicians recommend regular testing, many patients are unlikely to question the value for money of regular testing, especially because they do not have to pay for the glucose strips themselves.
Physicians who order blood glucose monitoring in patients highly unlikely to benefit likely do so for a combination of reasons that include patient request and a feeling that it is good for patients to monitor their diabetes as closely as possible. They, like their patients, may not think much about the costs because the costs are covered by the government and many may not know that the total cost is so high.
Why does the Ontario government continue to pay for glucose test strips in people unlikely to benefit?
With the Ontario government dealing with a significant deficit, saving millions of dollars annually by reducing spending on unnecessary blood glucose test strips may seem like a “no brainer”. Why does the government continue to pay for the strips?
Withdrawing a service that it is already providing can be politically risky for governments. In this case, some persons with diabetes and their physicians may accuse the government of abandoning them. The manufacturers of glucose strips will certainly be unhappy and will almost certainly vigorously criticize any attempt to decrease expenditures on glucose test strips.
On the other hand, restricting public funding may seem sensible to many Ontarians: the millions saved by not paying for these test strips can be used elsewhere in the health care system to greater effect, and the government will continue to pay for test strips in persons with diabetes who benefit from them (those on insulin and taking pills that can dangerously decrease blood glucose levels). Also, if the government doesn’t pay for the strips, many persons with diabetes can afford to pay for the strips themselves if they want to test their own blood sugars.