Freestyle Libre petition

[DeusXM]

Who do you think will be the next manufacturer to make this type of thing ?

I suspect all the big manufacturers have something in their R&D labs and while I'm excited about the Abbott device, I think it's these companies we need to be really watching.

The Libre has been really obviously priced to keep it at the top end of costs that are likely to be paid for by national health care services and in the States, private insurance. The financial argument for the Libre is actually more solid than test strips at the moment because it removes the issue of patient compliance. Docs can be skeptical about unlimited test strips because often they're not convinced people use the information to any real benefit. But if the Libre collates all the information, that can then be given to the care team and it cuts out all the usual "oh, I forgot to test" or "oh, yes, all my reading has been fine" shenanigans doctors often face from patients. It basically removes anecdote from the entire equation. It also partially removes the need for an A1c - who needs a three month average based on an imperfect result when you can see everything.

That means, assuming the Libre performs as it's supposed to (and that's a big assumption), I would be very surprised if it doesn't make it through the NICE approval process.

That's where things get interesting, because it means the mass market for test strips dies in the UK (and likely the US and EU as well), except for the minor calibration/double-check tests. That means if other pharmaceutical companies want to compete, they HAVE to develop their own Libre equivalent. The Libre is what you could probably call a first generation device of its type. It's the first iPhone. As a general rule, the first generation of anything is generally a bit flaky. The second generation one will be a vast improvement, and it'll be the other manufacturers who'll bring the next generation along AND they'll be obliged to price it to compete with the Libre. That means the Libre will then come down in cost and you'll see a price war with the manufacturers. All of this means that by 2020 you'll probably have versions of the Libre that are priced effectively to secure NHS funding and will likely not require calibration. They'll also probably have smaller sensors too.

 

[m1dnc]

Speaking as a retired patent attorney with many years experience of the pharma world, I bet most of the other manufacturers have their patent people combing through Abbott's patent portfolio to find a way to bring out competing products. If they're not successful, Abbott could have market exclusivity for many years to come. But from my experience, I'll put good money that they will find a way.

 

[graj0]

Signed by me. I get the impression that no matter how worthy the cause, the NHS is skint. So, where's the petition to encourage HMG to increase the basic rate of tax to pay for anything not presently available. I'd like to think that I'm being reasonable, there's more money coming out than going in, simple arithmetic.

 

[everydayupsanddowns]

That means, assuming the Libre performs as it's supposed to (and that's a big assumption), I would be very surprised if it doesn't make it through the NICE approval process.

My guess (and it's a reasonably educated one with what I know about the NICE process) is that the tipping point for NICE to consider the Libre as a valid form of therapy for general use will revolve around two main things:

1. Whether the Libre is shown in Randomised Control Trials to reduce HbA1c and/or Severe Hypoglycaemia
2. Cost

Potentially you could add 'patient satisfaction' to that, but it would not have anything like the weight.

If they can get RCT data that shows a decent average A1c reduction (0.7% or 1% perhaps) alongside a reduction in mild and severe hypoglycaemia then it's an easy call for them to make.

If it just helps people 'feel better' but there are no data to show A1c reduction, then the economic model of 'amount of money potentially saved by avoiding future complications' just doesn't balance out with the upfront cost.

It's a shame - but there it is. More expensive options need to be more robustly defended by trial data to make the cut.

 

[Northerner]

Signed by me. I get the impression that no matter how worthy the cause, the NHS is skint. So, where's the petition to encourage HMG to increase the basic rate of tax to pay for anything not presently available. I'd like to think that I'm being reasonable, there's more money coming out than going in, simple arithmetic.

If only governments could take a longer term view. Better equipment, support and education for people with diabetes (and the healthcare professionals who support and treat them) would slash the billions currently spent on the largely avoidable complications suffered by so many. It won't eradicate them, because you'll always get non-compliant or unlucky patients and bad HCPs, but they could make a big dent in the £10bn spent on diabetes, and that money could be used to enhance peoples' quality of life. Where is the £2.5bn in fines to the banks for the forex rigging going to go? Can you think of a better target for that money than the NHS?

 

[trophywench]

I don't think you could dump your meter at all.

If you think you're going hypo (however you found out, by how you feel/behave or you scanned and got a downwards arrow) you HAVE to use it, you need to know what your BG is right now this second, not 10 minutes ago! And the DVLA don't use interstitional fluid testing, only blood testing so at the moment, all your driving specific tests must be followed. Abbott specifically say this. They've asked DVLA and they said No. My Combo meter is the thing that works out my IOB so personally I'd not inject insulin - bolus or correction - without testing my blood.

In time, it may be agreed that it's accurate enough to save doing an A1c. However - that would actually mean not only providing every single diabetic with a Libre but also full-time sensors, and FORCING them to stick sensors in, FORCING them to scan every 8 hours at least, otherwise you'd never get a full 24hrs info - then have someone to review the Libre results, to make sure anyone's A1c wasn't more than whatever they said at the time it should be.

I think that wouldn't work anyway, would be more expensive still than at present and wouldn't happen anyway, even in a month of Sundays !

 

[HOBIE]

Speaking as a retired patent attorney with many years experience of the pharma world, I bet most of the other manufacturers have their patent people combing through Abbott's patent portfolio to find a way to bring out competing products. If they're not successful, Abbott could have market exclusivity for many years to come. But from my experience, I'll put good money that they will find a way.

That's what I think & said ! They will ALL be looking at this with great interest if they have any brains ! The more votes the more clout 😉 I have got her indoors to put it on her farsebook 😎(sorry). Keep going 😉

 

[HOBIE]

Libra has arrived. Bang on time from friendly delivery driver 😎 Ask me if I am chuffed. Kid at Xmas. Got some reading to do. Pls keep voting & make some noise. Its cheaper for Nhs 🙂

 

[Northerner]

Libra has arrived. Bang on time from friendly delivery driver 😎 Ask me if I am chuffed. Kid at Xmas. Got some reading to do. Pls keep voting & make some noise. Its cheaper for Nhs 🙂

Great news Hobie! Let us know how you get on with it 🙂

 

[HOBIE]

5757 Now its a lot but need more ! Pls ask you family members to give it ago 😎

 

[DeusXM]

If it just helps people 'feel better' but there are no data to show A1c reduction, then the economic model of 'amount of money potentially saved by avoiding future complications' just doesn't balance out with the upfront cost.

I don't disagree at all and you're also closer to this than me so your experience trumps mine. I do wonder though if convenience may play a part. My understanding is that pens and cartridges are more expensive than syringes and vials (although I could be wrong), but the NHS wouldn't dream of sending a newly dxed person home with a bag of syringes.

 

[HOBIE]

5910 Keep at it please, is going up 😎

 

[everydayupsanddowns]

I don't disagree at all and you're also closer to this than me so your experience trumps mine. I do wonder though if convenience may play a part. My understanding is that pens and cartridges are more expensive than syringes and vials (although I could be wrong), but the NHS wouldn't dream of sending a newly dxed person home with a bag of syringes.

No - you are absolutely right. Patient experience will count. But I'm just not quite convinced that on its own that would carry £1,250's worth of benefit a year to the NHS - especially since you would still need moderate fingerstick coverage (driving, double checking).

I do have high hopes that it will be approved for use in some cases - impaired awareness of hypoglycaemia... multiple severe hypos... multiple A&E visits... - but much like CGM I suspect it will be for 'special cases' rather than a blanket thing that everyone can just ask for. Would be nice though! 😛

I trialled sensors for 28 days and it made a HUGE difference to me. I will be buying more as and when I need/can afford them.

 

[HOBIE]

Over 6000 now ! Thank you all if you have got someone at work today 😎

 

[gewoff]

Signed with gusto!

Maybe I've missed this, but how much do these devices cost please?

 

[Northerner]

Signed with gusto!

Maybe I've missed this, but how much do these devices cost please?

Starter pack (reader plus two sensors) £133.29 + VAT
Then £48.29 + VAT per sensor
Having diabetes we have VAT exemption on medical items

Sensors last for 14 days 🙂

 

[gewoff]

Wow! That's a prompt reply, but an an expensive piece of kit.....

Say one starter pack and twenty five sensors a year at £48 a time, gives over £3,000 per annum - I hadn't realised that it would be so expensive......

Presumably NICE are considering this

I try to keep more aware!

 

[Northerner]

Slightly wrong with your calculation - 25x48=£1200 😉

 

[gewoff]

Slightly wrong with your calculation - 25x48=£1200 😉

Whoops! Too early in the morning.......

 

[Northerner]

Whoops! Too early in the morning.......

I had to check with a calculator! 😉