In the Journals

Quantity limits for blood glucose test strips reduce costs

Implementing a quantity limit policy for blood glucose test strips reduced costs without worsening short-term outcomes or causing patient harm, according to findings published in JAMA Internal Medicine.

“Despite the demonstrable cost savings associated with quantity limit policies for blood glucose test strips, these policies have been the subject of considerable debate,” Tara Gomes, MHSc, from St. Michael’s Hospital, Toronto, and colleagues wrote. “Some have argued that limiting patients’ ability to monitor blood glucose would lead to poor glycemic control and worsening clinical outcomes, while others suggest that these quantity limits are an opportunity to help prevent overuse of a costly intervention offering limited clinical benefit. Given the growing adoption of quantity limit policies for [blood glucose test strips] across North America, evidence is needed regarding their impact on patient outcomes.”

From April 2008 to March 2015, Gomes and colleagues performed a cross-sectional time series analysis to investigate whether clinical outcomes were affected by the introduction of quantity limits for blood glucose test strips in August 2013. Patients with diabetes aged 19 years and older from Ontario, Canada who were eligible for public drug coverage were included in the study. The researchers also performed a sensitivity analysis in which they restricted evaluation to a cohort of patients who, prior to the implementation of quantity limits, were given a large amount of blood glucose test strips and thus were most likely to be affected. The study included 834,309 Ontario drug benefit-eligible patients who were stratified into groups based on their diabetes therapy: insulin, hypoglycemia-inducing oral diabetes agents, nonhypoglycemia-inducing oral diabetes agents and no drug therapy.

Results indicated that throughout the study duration of 7 years, the hypoglycemia rate declined from 4.9 to 3 visits per 1,000 patients and the hyperglycemia rate declined from 4.2 to 3.6 visits per 1,000 patients among those aged younger than 65 years. There was no significant association between the decline in hypoglycemia and hyperglycemia rates and the introduction of quantity limits. Similarly, there was a reduction in hypoglycemia (from 2.9 to 1.3 visits per 1,000 eligible patients) and hyperglycemia (from 0.8 to 0.5 visits per 1,000 eligible patients) rates throughout the study duration among patients aged 65 years and older. There was also no significant association between the introduction of quantity limits and the reduction of hypoglycemia and hyperglycemia rates.

In addition, mean hemoglobin A1c (HbA1c) levels were not significantly impacted by blood glucose test strip quantity limits. The sensitivity analysis showed that these results were consistent with high-volume users.

“In this large, population-based policy evaluation, we found no indication of short-term worsening in rates of hypoglycemia, hyperglycemia, or changes in mean HbA1c levels after implementation of a quantity limit policy for [blood glucose test strips] that focused restrictions on noninsulin-treated patients,” Gomes and colleagues concluded. “This suggests that these quantity limits represent an important opportunity for policy makers to achieve considerable cost savings without introducing patient harm.” – by Alaina Tedesco

Disclosure: The authors report funding by a grant from the Ontario Ministry of Health and Long-Term Care Health System Research Fund. Please see full study for complete list of relevant financial disclosures.

Implementing a quantity limit policy for blood glucose test strips reduced costs without worsening short-term outcomes or causing patient harm, according to findings published in JAMA Internal Medicine.

“Despite the demonstrable cost savings associated with quantity limit policies for blood glucose test strips, these policies have been the subject of considerable debate,” Tara Gomes, MHSc, from St. Michael’s Hospital, Toronto, and colleagues wrote. “Some have argued that limiting patients’ ability to monitor blood glucose would lead to poor glycemic control and worsening clinical outcomes, while others suggest that these quantity limits are an opportunity to help prevent overuse of a costly intervention offering limited clinical benefit. Given the growing adoption of quantity limit policies for [blood glucose test strips] across North America, evidence is needed regarding their impact on patient outcomes.”

From April 2008 to March 2015, Gomes and colleagues performed a cross-sectional time series analysis to investigate whether clinical outcomes were affected by the introduction of quantity limits for blood glucose test strips in August 2013. Patients with diabetes aged 19 years and older from Ontario, Canada who were eligible for public drug coverage were included in the study. The researchers also performed a sensitivity analysis in which they restricted evaluation to a cohort of patients who, prior to the implementation of quantity limits, were given a large amount of blood glucose test strips and thus were most likely to be affected. The study included 834,309 Ontario drug benefit-eligible patients who were stratified into groups based on their diabetes therapy: insulin, hypoglycemia-inducing oral diabetes agents, nonhypoglycemia-inducing oral diabetes agents and no drug therapy.

Results indicated that throughout the study duration of 7 years, the hypoglycemia rate declined from 4.9 to 3 visits per 1,000 patients and the hyperglycemia rate declined from 4.2 to 3.6 visits per 1,000 patients among those aged younger than 65 years. There was no significant association between the decline in hypoglycemia and hyperglycemia rates and the introduction of quantity limits. Similarly, there was a reduction in hypoglycemia (from 2.9 to 1.3 visits per 1,000 eligible patients) and hyperglycemia (from 0.8 to 0.5 visits per 1,000 eligible patients) rates throughout the study duration among patients aged 65 years and older. There was also no significant association between the introduction of quantity limits and the reduction of hypoglycemia and hyperglycemia rates.

In addition, mean hemoglobin A1c (HbA1c) levels were not significantly impacted by blood glucose test strip quantity limits. The sensitivity analysis showed that these results were consistent with high-volume users.

“In this large, population-based policy evaluation, we found no indication of short-term worsening in rates of hypoglycemia, hyperglycemia, or changes in mean HbA1c levels after implementation of a quantity limit policy for [blood glucose test strips] that focused restrictions on noninsulin-treated patients,” Gomes and colleagues concluded. “This suggests that these quantity limits represent an important opportunity for policy makers to achieve considerable cost savings without introducing patient harm.” – by Alaina Tedesco

Disclosure: The authors report funding by a grant from the Ontario Ministry of Health and Long-Term Care Health System Research Fund. Please see full study for complete list of relevant financial disclosures.