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Self blood glucose monitoring in type 2 diabetes. A financial impact analysis based on UK primary care

Authors


  • Disclosures JB and TD are directors of JB Medical Ltd, a medical education consultancy. JB Medical Ltd has been paid by Merck Sharp & Dohme Ltd to write educational programmes and clinical papers in the area of diabetes. JB Medical Ltd has received a grant from Merck Sharp & Dohme Ltd for their participation in the writing of this paper. JP is an NHS general practitioner and hospital practitioner. JP has spoken and advised at numerous pharmaceutical meetings and advisory boards, including those held by Merck Sharp & Dohme Ltd. SR is a director of Soar Beyond Ltd, a healthcare consultancy. SR has received funding for consultancy, advisory board attendance and speaker fees from several pharmaceutical companies, including Merck Sharp & Dohme Ltd. HU was an employee of Merck Sharp & Dohme Ltd until April 2007. KJ is an employee of Merck Sharp & Dohme Ltd and holds stock in the company.

JD Belsey,
JB Medical Ltd, Chapel Lane, Little Cornard, Sudbury, Suffolk, CO10 0PB, UK
Tel.: + 01787 882 900
Fax: + 01787 882 901
Email: jbelsey@jbmedical.com

Summary

Background:  UK consensus guidelines recommend limited use of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes using diet and exercise, metformin and/or a glitazone. This analysis quantifies the usage of and costs associated with SMBG in type 2 diabetes according to treatment regimen.

Methods:  Prevalence data for diabetes were assessed using UK Quality and Outcomes Framework returns for 2006/2007. Data on current SMBG prescribing expenditure were extracted from UK Prescription Pricing Agency Data for 2007. Prescribing data were extracted from the records of 40,651 patients with diabetes on the IMS Disease Analyzer (MediPlus) database. These were combined to arrive at mean usage and expenditure data per patient, broken down by treatment type. The analysis assumes that it is appropriate to use patients’ treatment regimen alone to compare the frequency of SMBG in clinical practice with the frequency recommended in treatment guidelines; it does not take into account other valid reasons for SMBG.

Results:  Mean national expenditure on SMBG was £73.64 per patient per year. Estimated mean weekly test strip usage by treatment was 2.5 (diet), 2.6 (glitazone monotherapy), 3.1 (metformin monotherapy) and 3.5 (sulphonylurea monotherapy). Combination oral therapy ranged from 3.3 to 4.1. Mean annual expenditure in patients with an identified treatment type was £62.06 per patient, ranging from £9.83 for diet-treated patients to £37.87 for those on triple therapy, with insulin-treated patients incurring costs 3–5 times higher.

Conclusions:  Based on the assumptions that the treatment regimen is the sole factor in determining the appropriate level of SMBG frequency, this study demonstrates that the use of SMBG exceeds current guidelines in certain treatment groups. The study estimates that the potential savings of up to £17 million could be made each year if guidelines were followed more closely. There is a need for further research into SMBG use in patients with type 2 diabetes.

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