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

Ademola Joshua Itiola; Lucy Cheng; Wei Zhang; Tara Gomes; Baiju R Shah; Michael R Law

doi:10.1016/j.jcjd.2023.08.005

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

Can J Diabetes. 2023 Aug 21;S1499-2671(23)00193-4. doi: 10.1016/j.jcjd.2023.08.005. Online ahead of print.

Authors

Ademola Joshua Itiola¹, Lucy Cheng¹, Wei Zhang², Tara Gomes³, Baiju R Shah⁴, Michael R Law⁵

Affiliations

¹ Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
² School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada.
³ Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁴ Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
⁵ Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: michael.law@ubc.ca.

PMID: 37611660
DOI: 10.1016/j.jcjd.2023.08.005

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: autosurveillance de la glycémie; bandelettes d’analyse de la glycémie; blood glucose test strips; conséquences de la politique; cost savings; diabetes; diabète; limites de remboursement; policy impact; reimbursement limits; self-monitoring of blood glucose; économies.