Date:
Author:

The most costly places in Canada for patients to have diabetes


The Personal Health Navigator is available to all Canadian patients. Questions about your doctor, hospital or how to navigate the health care system can be sent to AskLisa@Sunnybrook.ca

The Question: What are the best and worst places to have diabetes in Canada, based on the cost of needles and other supplies?

The Answer: This question came via twitter from a patient, who rightly pointed out that health care in Canada isn’t always fully covered, especially when it comes to having a chronic condition such as diabetes.

Out-of-pocket costs for patients with Type 2 diabetes, the most common form of the disease, were lowest per year for those living in Nunavut and the Northwest Territories, where it is fully covered. In the Yukon, there is a $250 deductible, then full coverage.

The next lowest provinces are Quebec ($1,546.58) and Saskatchewan ($1,870.50). The highest costs were encountered in New Brunswick ($3,426.99), Newfoundland and Labrador ($3,396.04) and Prince Edward Island ($3036.31). Ontario ($2,073.50) was considered a middle performer. That compares to the Canadian average ($1,824.97), according to June 2011 data provided by the Canadian Diabetes Association. Those figures are based on payments made by those with an annual individual income of $30,000. In many cases, the out-of-pocket increases for those with the higher incomes of $43,000 and $75,000, save for the Yukon, New Brunswick and Newfoundland and Labrador, where the amounts are the same, no matter the income.

The amounts are based on case studies and include the cost for medications, devices, test strips for glucometers and other supplies – items that are not typically covered on public health plans.

Though the Canadian Diabetes Association’s method on tracking costs is limited – it cannot be generalized to the overall population – it is the best information currently available on cost by province.

An estimated 2.4 million Canadians were living with diabetes in 2008-2009, according to a Public Health Agency of Canada report published in 2011. Data obtained from blood samples suggest about one out of five cases of diabetes remains undiagnosed, according to that same report.

Those with type 2 diabetes have high levels of glucose in the blood. If left unmanaged, there is an increased risk of developing long-term complications such as cardiovascular and kidney disease.

Leigh Caplan, a diabetes nurse educator at Sunnybrook, often sees patients who manage with struggling with the financial burden associated with their condition. Not only do they need to make a series of lifestyle changes but also these individuals often must deal with the extra costs.

“Managing a chronic condition involving lifestyle and behavioral changes is challenging enough,” said Ms. Caplan, who sees patients with diabetes ranging in age from 20 to 90. “Adding in extra costs, just adds to the stress.”

The cost of test strips ranges from $1 to $4 per day, depending on how often an individual tests their blood sugar.

In some cases, Ms. Caplan can suggest individuals test their blood sugar less often and at varied times to help reduce the use of test strips without compromising patient care.

“There are other hidden costs as well,” said Ms. Caplan, noting that those with diabetes often have to take other medications to lower their cholesterol and blood pressure. For example, many of these medications are not covered, except by third party insurance or if a patient is aged 65 or older.

So while the out of pocket costs are higher in the east coast provinces of New Brunswick,  Newfoundland and Labrado, and Prince Edward Island, there are ways to keep expenses down.

Helpful links:

The Burden of Out of Pocket Costs for Canadians With Diabetes

Diabetes: Canada at a Tipping Point

For further background visit the Canadian Diabetes Association’s website.

Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts.  Her blog is reprinted on healthydebate.ca with the kind permission of Sunnybrook Health Sciences Centre.  Send questions to AskLisa@sunnybrook.ca.

Sunnybrook Health Sciences Centre Logo

Leave a Comment

Enter the debate: reply to an existing comment
13 comments

  1. Chris Robinson

    Your article makes the point that there is certainly lots of variability across provinces in terms of coverage for diabetes supplies. However, the above cost estimates from the CDA contain certain components which are likely not relevant for those who do not require insulin. The Canadian Agency responsible for advising provinces on issues related to drugs and technology assessment (CADTH) recently conducted a cost-effectiveness study regarding test strips for self-management of blood glucose (SMBG) among non-insulin dependent adults with diabetes (NIDDM) (http://www.cadth.ca/products/cadth-overviews/vol-1-issue-2/vol-1-issue-1-02). Since less than 10% of all diabetes cases require insulin, this NIDDM group makes up the vast majority of typical diabetes cases in Canada. CADTH’s economic review found that SMBG makes virtually no difference in improving long-term diabetes complications among NIDDM, since it has no clinically significant effect on reducing blood glucose (hemoglobin A1c was only reduced by one-quarter of one percentage point). Meanwhile, the cost of test strips remains a very large total expense for all provincial pharmacare plans. For instance, the cost of test strips alone (excluding glucometers and lancets) was $4 million in 2005/06 for Nova Scotia’s Senior Pharmacare Program, and over 60% of this cost was incurred by diabetic seniors who were not using insulin (NIDDM). This equates with over $2.4 million in potentially ineffective diabetes-related spending that could perhaps be redirected to another more effective purpose (e.g. dilated eye tests to detect early treatable retinopathy).

  2. Chris Robinson

    For reference, CADTH calculated the cost of test strips as follows:

    –> average number of test strips used per day (NIDDM person) = 1.29
    –> cost per test strip = $0.73 (plus $7 dispensing fee per 100 strips)

    over an entire year…this equals 471 test strips, or a cost of $376.68 per person

    (This excludes any related costs for glucometers and lancets)

  3. James Elliott

    Chris, you are confused this point.

    “Since less than 10% of all diabetes cases require insulin” – Incorrect.

    – Less than 10% of people living with diabetes have type 1 diabetes, 100% of whom require daily insulin injections and blood glucose testing. If they use SMBG they typically need 4-5 strips per day (morning, lunch, dinner, night time + spot checks when feeling hypo/hyperglycaemia symptoms). There is also the option of continuous blood glucose monitoring (CBGM) which is generally more expensive and, to my knowledge, not covered by any provincial system.

    – In the other 90% of people living with diabetes (type 2 or gestational) a proportion of these people will require insulin. From my reading of the literature it’s roughly 1/3, but people more knowledgeable may be able to cite a study for the Canadian context. For more information:
    http://www.diabetes.ca/documents/for-professionals/CD–SPRING_2011–FULL.pdf

    Lastly “could perhaps be redirected to another more effective purpose (e.g. dilated eye tests to detect early treatable retinopathy)”.. I would add the money could also be used for preventative foot care, or primary diabetes prevention or increased access to dieticians… Canada has a lot of work to do before we can measure up to what is the considered the norm for diabetes care in other countries.

    Cheers!

  4. Chris Robinson

    In 2005, Statistics Canada repoorted that the prevalence of diabetes among Canadians age 12 and older was 4.9%, amounting to 1.3 million persons. Among this group, only 1 in 5 (19.9%) used insulin: this 20% overall proportion includes both type 1 (i..e 5-8% prevalence) and insulin-using type 2 persons (12-15%) ( http://www.statcan.gc.ca/pub/82-003-x/2008003/article/10663-eng.pdf). Therefore I stand corrected, and only 80% of Canadian diabetics (not 90%) require regular insulin. But that was not my point.

    To reinterate, the key issue is that leading the Canadian authority responsible for advising provincial health ministries has indicated that self-monitoring of blood glucost (SMBG) — AMONG TYPE 2 ADULTS WHO ARE NOT USING INSULIN — is neither clinically effective, nor good value-for money. In the Nova Scotia example over 60% of diabetic seniors who were reimbursed for SMBG test strips were NOT using insulin. Therefore, if this $2.4 million is roughly what is being spent on such ineffective, low value activity — then it represents a real opportunity cost in economic terms. Those same diabetes resources could then be redirected to some other higher value use which could actually save lives or reduce diabetic complications.

    • Beth

      Um, john, that is because people with type 1 diabetes like myself require insulin to stay alive. There is no diet in the world that will change that. It may perhaps help people with type 2, but there is still a lot of stigma and stereotype attached to that particular disease as well. You can be thin, youngish and still get type 2 due to genetic factors. Type 1 diabetics can eat a normal healthy diet and balance this with the insulin their pancreas cannot provide. It is an autoimmune disease.

  5. Tricia Thomson

    Type I and Type II diabetes are two fundamentally different diseases. A grave disservice is done to both by lumping them together in discussions, decisions, et cetera. Costs – out comes – causes – all are different. Type II may lead to the same drug as Type I requires but even then it is used differently.

    STOP lumping them together and consider the two diseases separately. Cholera is not the same as Typhus. We recognize the difference. The same must be done with Type I and Type II. The result of playing with insulin dosages and going without in Type I is fatal and permanently destructive. This is not to say that Type II is not a serious disease – but it’s manifestation, causes and dangers are not the same in more ways than people are being led to believe. It’s irresponsible not to distinguish between the two to a much greater extent than the media – including the medical media – does. It’s one of the main reasons drug companies are getting away with the obscene price-gouging that is going on with insulin. But that gouging affects Type I diabetics more seriously and immediately. If this doesn’t stop we’ll be competing with the third world to deny life to the poor. They need two different names to begin with. Penicillin is used to treat different diseases – we don’t lump those diseases together. It’s time to stop doing that in the case of diabetes.

  6. Sheryl Campbell

    I have been type 1 diabetic for 45 years and I HAVE to test my blood between six and eight times a day. I have absolutely no complications but I do eat a low carbohydrate diet that helps immensely. But I must take insulin every single day and I also MUST test my blood sugar to be sure I am not too high or too low. It is so terribly expensive I think they are just trying to get rid of type one diabetics to reduce the burden on the health care system. Here is Alberta we get $600 per year for blood testing and insulin supplies and because I am unemployed right now, I am very low on strips. Wish me luck!

  7. Sheryl Campbell

    This is not a thorough assessment of the costs associated with being either a Type 1 or Type 2 diabetic. The longer you are a type 1 diabetic, the more you need to test your blood. If I cannot afford blood testing strips, then I test less and less. After 45 years of being type 1 diabetic one’s ability to recognize symptoms of both low and high blood sugar decreases. And it is not a choice – I must test my blood six to eight times a day. The result of testing that much? A hemoglobin A1C of 6.2 – which almost virtually guarantees minimal complications as I get older and older.

    • Brian Cowie

      Hi Sheryl, I was wondering what the annual costs for a Type 1 diabetic are in Alberta as I’m interested in moving to Calgary in the near future but at the age of 50 and having being diagnosed as type 1 diabetic 38 years ago I wanted to consider this first as I know that I won’t receive any medical support which is understandable and I also test around 8 times per day and inject 5 times with a round 60 units of insulin. Thanks Brian

  8. Roger Clinton

    We have health minister that has said she is going to lower high medical cost (2nd highest in the world ) but she is all talk no action. But she is all BS

  9. peter loveridge

    problem with the CDA, it is financed and influenced by drug companies, it is not a reliable source of information

Submit a comment