Research from St. Michael’s Hospital on the merits of costly blood glucose test strips has led to a new government policy to reduce their routine use in certain cases of Type 2 diabetes. This could save Ontario’s health care system almost $100 million over the next five years.
We know three things: (1) investment in health research makes Ontario healthier, wealthier and smarter; (2) such investment sees a very healthy return; and (3) the Choosing Wisely campaign has opened our eyes to the perils of unnecessary tests, treatments and procedures that do not add value to patient care.
It’s exceptional that one example, from one hospital, provides evidence to back all three of these truisms: Research led by Dr. Muhammad Mamdani and Tara Gomes, both at St. Michael’s Hospital, has found that, in some cases of Type 2 diabetes, blood glucose test strips were not cost effective. This has spurred a new government policy to reduce routine self-monitoring of blood glucose levels, which is expected to save Ontario’s health care system almost $100 million over the next half decade.
“These are real out-of-pocket savings for the government that do not adversely affect health care or inconvenience patients, and is a great example of the return on investment that research can provide,” said Dr. Art Slutsky, Vice-President of Research at St. Michael’s.
The results of this research were published in in the esteemed Canadian Medical Association Journal (CMAJ), in January 2010.
Type 2 Diabetes Expected to Soar
Blood glucose test strips are expensive. In fact, they were the third largest cost for the Ontario Public Drug Programs in 2007-2008, accounting for $100 million or 3.3% of drug expenditures.
Looking to the future, things could get a whole lot more expensive. If use of the test strips weren’t curbed by the evidence provided in this study, the number of people using these strips could, along with the costs, soar exponentially because cases of Type 2 diabetes are on the rise in Canada.
Researchers at the University of Ottawa reported a 70% increase in Type 2 diabetes in Canada over a ten-year period, 1998-99 to 2008-2009. Currently, around 2.5 million people are affected by Type 2 diabetes, and this number is expected to grow to 3.7 million by 2018-2019, according to the University of Ottawa.
Modest Benefits Outweighed by Significant Costs of Test Strips
To determine who was using these strips and how readily the strips were being used, Gomes, a Scientist with the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, and Mamdani, Director, Applied Health Research Centre, St. Michael’s, looked at annual prescription claims for test strips between 1997 and 2008 for patients in Ontario aged 65 and older with diabetes.
From here, patients were broken into four groups, from the least to the most intensive glucose-lowering treatment received during each calendar year. Test strip use was calculated annually for each group over the study period.
The study revealed that test strip use increased by almost 250% from 1997 to 2008. However, almost half of these patients were at low risk for drug-induced hypoglycemia, which led the researchers to conclude: “The economic benefits associated with more selective testing could be redirected to more effective interventions for patients with diabetes.”
Speaking numerically, in 2008, over 117 million test strips were dispensed in Ontario; however, more focused policy scenarios could have reduced this number by between 9.5 million and 74.5 million test strips.
This paper concluded it was not cost effective for a percentage of people with Type 2 diabetes (who do not take insulin) to routinely test their blood glucose levels with test strips, nor did this practice help those individuals. The practice proved to be an ineffective use of health resources; the modest benefits of such monitoring were outweighed by the significant costs of the test strips.
Ontario Implements New Policy
Fueled by this new evidence from St. Michael’s, the Ontario government has implemented a new policy to reduce routine self-monitoring of blood glucose levels by many people with Type 2 diabetes. It effectively restricted funding for the test strips in the summer of 2013.
Additionally, to spread the word, the province launched a public education campaign, which includes a video with Dr. Gillian Booth, an endocrinologist at St. Michael’s.
Gomes, also co-principal investigator of the Ontario Drug Policy Research Network, and Mamdani say this new policy could save the Ontario health care system almost $100 million over the next five years.
Interestingly, other provinces have expressed an interest in their recommendations, according to Gomes and Mamdani.
This study was supported by the Ontario Drug Policy Research Network (ODPRN), which is funded by the Ontario Drug Innovation Fund and the Institute for Clinical Evaluative Sciences (ICES), a nonprofit research corporation sponsored by the Ontario Ministry of Health and Long-Term Care. The ODPRN was also supported by a Health System Research Fund Program Award in 2012/13.
To read St. Michael’s press release: http://bit.ly/ZCOCO3. To read the CMAJ article: http://bit.ly/1rYMIOy . To watch a video featuring Dr. Booth on the topic of monitoring blood glucose levels with test strips: http://bit.ly/1z3uxhk. To read the University of Ottawa research: http://bit.ly/1r2w69j.