The Impact of Blood Glucose Test Strips Reimbursement Limits on Utilization, Costs, and Health-care Utilization in British Columbia

• Published in: Canadian journal of diabetes 2024-02, Vol.48 (1), p.10-17.e5
• Main Authors: Itiola, Ademola Joshua, Cheng, Lucy, Zhang, Wei, Gomes, Tara, Shah, Baiju R., Law, Michael R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; autosurveillance de la glycémie; bandelettes d’analyse de la glycémie; Blood Glucose - analysis; Blood Glucose Self-Monitoring; blood glucose test strips; British Columbia - epidemiology; conséquences de la politique; Cost Savings; diabetes; Diabetes Mellitus - epidemiology; Diabetes Mellitus - therapy; diabète; Humans; limites de remboursement; Patient Acceptance of Health Care; policy impact; reimbursement limits; self-monitoring of blood glucose; économies
• ISSN: 1499-2671; 2352-3840
• DOI: 10.1016/j.jcjd.2023.08.005

People living with diabetes and not using insulin may not derive clinically significant benefit from routine glucose self-monitoring. As a result, in 2015, British Columbia (BC) introduced quantity restrictions for blood glucose test strips (BGTS) coverage in public plans. We studied the impact of this policy on utilization, costs, and health-care utilization. We identified a cohort of adults (≥18 years old) with diabetes between 2013 and 2019. Using BC’s administrative data, we studied utilization and costs among individuals with at least one PharmaCare-eligible BGTS claim. Using interrupted time-series analysis, we studied cost savings and determined the level of policy adherence. In addition, we investigated longitudinal changes in all-cause and diabetes-specific physician visits, all-cause hospitalizations, and health-care spending in the 3 to 5 years after policy implementation. Over the study period, 279.7 million BGTS were eligible for PharmaCare coverage, on which the government spent $124.3 million. After policy implementation, we observed an immediate decline in average utilization and PharmaCare expenditure on BGTS, leading to an estimated $44.6 million in savings between 2015 and 2019 (95% confidence interval $16.9 to $72.3 million). We found no association between the policy’s implementation and health services utilization or overall health-care spending over the long term. Restricting reimbursement for BGTS in BC resulted in significant cost savings without any attendant increase in health services utilization over the subsequent 5 years. This disinvestment freed up resources that could be channeled toward other interventions. Les personnes vivant avec le diabète qui n’utilisent pas l’insuline ne retirent pas d’avantages significatifs sur le plan clinique de l’autosurveillance systématique de la glycémie. Par conséquent, en 2015, la Colombie-Britannique (C.-B.) a instauré des limites quantitatives sur la couverture des bandelettes d’analyse de la glycémie (BAG) dans les régimes publics. Nous avons étudié les conséquences de cette politique sur l’utilisation, les coûts et le recours aux soins de santé. Nous avons constitué une cohorte d’adultes (≥ 18 ans) diabétiques entre 2013 et 2019. À partir des données administratives de la C.-B., nous avons étudié l’utilisation et les coûts chez les individus qui avaient au moins une demande de BAG admissible à PharmaCare. À l’aide de l’analyse des séries chronologiques interrompues, nous avons étudié le