Libre sensors

[Michael Cullis]

As Abbott are now selling their sensors to the NHS for £35 why are they still selling them to patients at £35?

 

[mikeyB]

I assume you mean not selling them to patients at £35. Simple. It’s to bring the NHS price closer to, or in the same ball park, as some of the more expensive test strips. It makes the whole system more prescribable without terrifying the money men of the NHS. It’s a loss leader. Once the system is widely prescribed, the price to the NHS will slip up gradually. Big Pharma has been playing this game for years.

 

[Vince_UK]

I have to agree, Loss leader to gain market penetration and market share and gain a competitive edge over rivals.
Well tried proven marketing methodology. As soon as the target market levels are achieved then the prices will steadily rise in the belief that customers will stay loyal to the brand and not change. Prices will rise slowly so as not to alert existing and potential customers but rise they will.
Not only pharma been doing this, it is a common business marketing strategy.
We have two optons, ignore it or take a short term advantage of it.

 

[Northerner]

The NHS has considerably more bargaining power than any individual and can therefore negotiate a better price. Companies will cut their margins in order to considerably increase their market share and sales. 🙂

 

[SadhbhFiadh]

So then when people walk around saying people get paracetamol on prescription, but could buy it for less than the health board pays for it - is that a load of nonsense? I never understood that.

 

[Northerner]

So then when people walk around saying people get paracetamol on prescription, but could buy it for less than the health board pays for it - is that a load of nonsense? I never understood that.

Some medications have become 'generic' so pharma companies can no longer set the high prices as many companies can manufacture them. In the case of a prescription item like paracetamol there would be costs to the NHS involved in actually filling the prescription, and a higher cost to the patient if they don't get free prescriptions as they could get it for less than the price of a prescription item if they just bought it over the counter 🙂

 

[Michael Cullis]

I assume you mean not selling them to patients at £35. Simple. It’s to bring the NHS price closer to, or in the same ball park, as some of the more expensive test strips. It makes the whole system more prescribable without terrifying the money men of the NHS. It’s a loss leader. Once the system is widely prescribed, the price to the NHS will slip up gradually. Big Pharma has been playing this game for years.

Thanks guys for your replies.
Yes a slip of the fingers, or brain, it should read £59 to non NHS . Less haste more speed.
I understood it to be a marketing ploy, but doesn't that apply to everybody? Surely if they want to encourage people to buy the sensors that would apply to patients who cannot get them on prescription. I will be glad when other companies come into the market with them and sets up some competition.

 

[Northerner]

Thanks guys for your replies.
Yes a slip of the fingers, or brain, it should read £59 to non NHS . Less haste more speed.
I understood it to be a marketing ploy, but doesn't that apply to everybody? Surely if they want to encourage people to buy the sensors that would apply to patients who cannot get them on prescription. I will be glad when other companies come into the market with them and sets up some competition.

Something I find especially cynical about the Libre sensor marketing is that they only last 10 days in the US, when clearly they can work for 14 days here! 😱 In the UK they are £49 to the individual as you don't pay the VAT if you have diabetes 🙂

 

[Davein]

I was looking at self financing one of these but apart from the cost putting my off slightly is it correct that DVLA will not accept readings from these so when I drive I have to go back to usual finger prick testing?

 

[grovesy]

I was looking at self financing one of these but apart from the cost putting my off slightly is it correct that DVLA will not accept readings from these so when I drive I have to go back to usual finger prick testing?

At the moment yes but I believe it is under review.

 

[Michael Cullis]

That's correct the DVLA has not accepted the readings from the sensors, so you still have to finger prick. I think it is because it is not a true blood reading as it is the interstitial reading it is sensing. I would like to buy them but at over a £100 a month it is too expensive for me.

 

[mikeyB]

The DVLA doesn’t understand what the Libre can tell you. Someone may think that 5.9 is fine for driving. A Libre user will see the 5.9 with a level arrow, or an upward arrrow and feel fine to drive. With a downward, or worse, a vertically downward arrow and they would know something needed to be done, whereas the strip user would carry on regardless.

 

[everydayupsanddowns]

As I understand it the DVLA discussions have gone well, and proceeded as far as they can, but to change the current situation involves a change/update to the law, and legislative changes are notoriously complex to get through at any speed.

Hopefully it will happen at some point, though I'm not quite sure where you would stand if one technology said one thing and another said something else - especially if you were experiencing ongoing deviation between sensor glucose and BG, which can heppen occasionally with all sensing technologies.

As for the £35, I'm pretty sure that was negotiated to allow for decent uptake - it is very close to the NHS cost of 8x test strips a day which is supported by NICE guidelines, and Abbott's data shows that average 'real world' users in the early years of Libre have scanned 16x a day.

 

[Davein]

As I understand it the DVLA discussions have gone well, and proceeded as far as they can, but to change the current situation involves a change/update to the law, and legislative changes are notoriously complex to get through at any speed.

Hopefully it will happen at some point, though I'm not quite sure where you would stand if one technology said one thing and another said something else - especially if you were experiencing ongoing deviation between sensor glucose and BG, which can heppen occasionally with all sensing technologies.

As for the £35, I'm pretty sure that was negotiated to allow for decent uptake - it is very close to the NHS cost of 8x test strips a day which is supported by NICE guidelines, and Abbott's data shows that average 'real world' users in the early years of Libre have scanned 16x a day.

If I used your final comment regarding the cost of test strips and also self financed the Libre starter pack what chance do you think I would stand of getting the sensors on the NHS assuming my health authority sanctions use of this equipment? Zero?

 

[Michael Cullis]

The DVLA doesn’t understand what the Libre can tell you. Someone may think that 5.9 is fine for driving. A Libre user will see the 5.9 with a level arrow, or an upward arrrow and feel fine to drive. With a downward, or worse, a vertically downward arrow and they would know something needed to be done, whereas the strip user would carry on regardless.

The sensor gives a reading that is on its way to the blood stream. and is, in my case, about 20mins away. Also the sensor reading, in my case, is about 2mmol lower than the blood glucose at the lower end and 3 to 4mmol lower at the higher end.

 

[Northerner]

The sensor gives a reading that is on its way to the blood stream. and is, in my case, about 20mins away. Also the sensor reading, in my case, is about 2mmol lower than the blood glucose at the lower end and 3 to 4mmol lower at the higher end.

As I understand it, the software algorithm seeks to adjust the sensor reading to be more in line with the blood glucose one. I don't know the technical ins and outs, but presume it must be using some sort of predictive technology as does the artificial pancreas - the sensor has the information about where you are heading it doesn't just display the interstitial fluid value and leave it at that. Most of my sensors have been very much in line with my BG readings, and, indeed, some meters are regularly at variance to others. Where you do have a problem is when the conditions the sensor is operating under are not ideal - for example, if you are dehydrated then the sensor cannot read accurately, also if it has not seated correctly.

 

[Michael Cullis]

I think that the algorithm would have to be very clever to do that accurately as it cannot know if you are sedentary, or exercising. I was told by one of the instructors that there would be a difference in the the two readings and it would depend on each person and their activities, or body performance status. The differences also change according to the speed and rate of change in glucose intake. If your BG changes rapidly it may also affect the readings of the sensor to BG levels.

 

[everydayupsanddowns]

The sensor gives a reading that is on its way to the blood stream. and is, in my case, about 20mins away. Also the sensor reading, in my case, is about 2mmol lower than the blood glucose at the lower end and 3 to 4mmol lower at the higher end.

Not sure how many readings you have based your calculation of 20 minutes on, and it may well be the case for you. Certainly 10-15 minutes has always been the expectation for the delay between interstitial glucose and capillary glucose.

From what I can tell Abbott's algorithm attempts to close that gap to nearer 5 minutes on average (as you suggest different people can see different performance in their individual results). Recent results and rate of change are used to attempt to close the gap with the algorithm. I have seen this in evidence particularly where BG levels are peaking and/or changing direction where an algorithmed spot check can appear outside the BG trace in the downloaded reports.

On the few times I've attempted to construct an approximate MARD of sensors I have used, I have often been surprised by how low it is for sensors that I was convinced are reading 'loads out' because my sense of their performance can be established and then confirmed by a few readings of notable difference and I quickly forget other results that are within a few decimal points which quickly take the average down even in sensors I have suspicions over.

Hope you are managing to get useful information from the sensors you are using.

 

[everydayupsanddowns]

If I used your final comment regarding the cost of test strips and also self financed the Libre starter pack what chance do you think I would stand of getting the sensors on the NHS assuming my health authority sanctions use of this equipment? Zero?

It is more likely to depend on your current strip provision and (more importantly) your local CCG/prescribing committee's evaluation of the emerging guidance on Libre use. There's lots of work being done behind the scenes I think, but the primary thrust at the moment seems to be people with T1D who are either using a lot of strips, or who benefit from Libre as opposed to (say) going on a pump. Sadly, while I believe there is some good evidence for outcomes in T2, it seems that T2s may have to wait a while yet.

While infuriating, I suppose it is understandable in some ways. I saw a 'back of envelope' calculation the other day that sensors for all UK T1Ds would cost something like £150million a year. While the entire 'extra' budget negotiated for 'diabetes transformation' recently (of all types) was more like £40-50 million.

Suffice to say that for the forseeable future sensors are going to have to be distrubuted/prescribed for those in the greated need. I just hope that those decisions begin to include people struggling with T2D very soon.

 

[Bruce Stephens]

I think that the algorithm would have to be very clever to do that accurately as it cannot know if you are sedentary, or exercising. I was told by one of the instructors that there would be a difference in the the two readings and it would depend on each person and their activities, or body performance status. The differences also change according to the speed and rate of change in glucose intake. If your BG changes rapidly it may also affect the readings of the sensor to BG levels.

I think you're assuming too much cleverness. Much more likely it's doing something like fitting a simple curve to the most recent few readings and projecting forwards a little. So (I suspect) it's not trying to judge whether you're exercising, or just about to eat, or anything like that: it's just doing something much more direct to get some estimate of what blood glucose was 5 minutes ago rather than 10 or 15 (or whatever the raw reading gives).
And when it's inaccurate, they can (reasonably) point to the various warnings: reading's not reliable when BG is changing too quickly, etc.