Following the submission of our recent report “Users Experiences of Flash Glucose Monitoring on Daily Life Experiences” to the Minister for Health and to the HSE, and the support by TDs who agree that the Freestyle Libre should be made available to all people with Type 1 diabetes, the HSE’s Primary Care Reimbursement Service responded via Parliamentary Question to say that the Health Technology Assessment (HTA) process envisaged in the coming months will allow for patient experience and societal aspects of benefit to be considered and that the Diabetes Ireland report would satisfy that criteria.
While acceptance of the Diabetes Ireland survey report is a positive step, a further parliamentary reply stated that an initial review of the reimbursement data for Freestyle Libre which will also form part of the HTA process “indicates that some persons with diabetes continue to access comparable (if not more) levels of ancillaries in their pharmacy. So, it does not appear that the innovation has achieved an overall expenditure reduction”.
Diabetes Ireland’s concern is once again that the pending HTA decision will be based more on short terms cost savings rather than other aspects mentioned above.
Over the summer months, Diabetes Ireland sought urgent clarification from the Minister for Health and the HSE as to what weighting in the HTA decision making process will be given to;
- short term cost savings,
- quality of life improvements
- improved glycaemic control; and
- the impact of flash glucose monitoring in improved health outcomes which will delay the development of medium and long term complications which in turn could lead to huge cost savings for the government.
Diabetes Ireland also asked that the reimbursement dataset on which the decision is being considered be made publicly available to ensure transparency.
The Minister’s response to our initial letter was disappointing as it did not answer the direct questions asked and in fact the content of the reply was basically the standard “line to take” provided and used by the HSE to many TDs, patients and ourselves over the past few months. In fact, it was those HSE replies that raised a concern as to what the criteria and the level of weighting which will be given to each by the HSE Review Team. On 2 September, we wrote to both the Minister and the HSE again asking the same questions. To date, we have not had a reply so it’s time for members of our community to seek the help of their TDs and ask them to submit the following PQs;
To ask the Minister for Health to set out the weighting percentages to be used as part of the upcoming HSE Freestyle Libre Review decision making process that will be given to the following criteria; short term cost savings, quality of life improvements, improved glycaemic control and the impact of flash glucose monitoring in improved health outcomes which will delay the development of medium and long term complications and if he will make a statement?
To ask the Minister for Health will the reimbursement dataset specifically cover only current HSE funded users of Freestyle Libre or will the Health Technology Assessment Review simply compare total blood glucose strip usage spend year on year?
Positive Clinical Outcomes of Freestyle Libre Usage
Although Freestyle Libre usage is still in its infancy in the Republic of Ireland there is some Irish data beginning to emerge showing positive clinical effectiveness outcomes in Libre users. A recent study of 34 young adults who attend Beaumont Hospital, Dublin showed an improvement in diabetes control. The audit showed an average reduction in HbA1c from 77.3 mmol/mol to 70.6 mmol/mol after 5.8 months usage.
In Northern Ireland, an audit of 82 people with Type 1 Diabetes with an average age of 43 years showed an average reduction in HbA1c from 68 mmol/mol to 63 mmol/mol. Many of these patients started on Freestyle Libre also reported overwhelming glycaemic control improvements and positive psychological benefits. The Northern Ireland data also included all patients of all ages with Type 1 diabetes and patients of all ages benefitted from the technology. To our knowledge, we are the only country to have introduced Flash Glucose Monitoring with an age limitation.
Together, these studies show positive clinical effectiveness outcomes in an Irish setting which will enable patients to reduce their HbA1c thus improving their glycaemic control, enhancing their quality of life and delaying/preventing the onset of costly complications.
The removal of the age restriction on the Freestyle Libre is an absolute necessity. On behalf of the diabetes community, Diabetes Ireland is once again seeking your help in removing this age restriction and making the Freestyle Libre available to all people with Type 1 diabetes.