Rich (wo)man's illness???

[Mmm pondering or confused]

I'm type 1. In recent hospital appointments with consultants I have been advised I can 'self fund' CGM or buy Freestyle Libre....
Question: are clinical outcomes dependent on the patient's income rather than anything else?

 

[everydayupsanddowns]

One of the reasons why CGM is not currently funded is that the clinical studies that were last scrutinised did not generally provide strong evidence of sufficient improvement to outcomes to justify their price tag.

This comes as something of a surprise to many people who choose to self fund (full or part time) and see significant results for themselves. Something to do with 'getting money's worth' perhaps?

And even among clinicians who are able to secure funding for some people - the results seem to be mixed. As does the ability for people to commit to using the technology.

It is something of a conundrum!

 

[mikeyB]

Interesting question. I think clinical outcomes in diabetes depend much more on the motivation of the patient rather than the precise monitoring kit. That said, I do use the Libre all the time because I can easily afford it. But, along with similar CGM kit, there are limitations that don't completely free you from finger pricks, because of the delay in their measuring system compared to blood tests. It's about 15-20 minutes, so when correcting a hypo, it gives the impression that nothing is happening. Only finger prick tests can do that. The Libre is brilliant at showing trends and predicting hypos.

Has this lead to better control? I think so. Is that dependent on my income? Yes. But it's not the only way of doing that.

 

[Robin]

Part of the problem is that the Libre hasn't been out very long, and therefore doesn't yet have NICE approval. Some hospitals are trialling it, and several members of this forum have been given them by their hospital clinics on a short term basis. Whether it gets approval, and whether it is then prescribed for all or just for 'special cases' remains to be seen.

 

[mikeyB]

It's been out a fair while - when I joined this forum around a year ago, I'd been using the Libre for a few months. I don't think it will ever be approved by NICE. It tends to be used by those who are well motivated in their self care. They would be so motivated if the Libre didn't exist. The only reason hospital clinics are trialling it is because Abbott supply the trial packs free. I don't think it will be possible to show a measurable benefit in short term use. It would take a hell of a lot more than "people love it" to convince the gatekeepers at NICE.

 

[everydayupsanddowns]

The only reason hospital clinics are trialling it is because Abbott supply the trial packs free. I don't think it will be possible to show a measurable benefit in short term use. It would take a hell of a lot more than "people love it" to convince the gatekeepers at NICE.

Interesting thoughts Mike. And I agree that trial evidence is the only way that Libre will more towards being recommended/offered on the NHS.

The Libre launched with studies that focused around safety I thik, but in the intervening years Abbott have invested in a number of large trials which they hoped would demonstrate positive outcomes. These things take a long time to complete, but my understanding is that there is now significantly more and better evidence that Libre has something to offer. Whether or not it is enough remains to be seen, but I know that Diabetes UK are doing some work to showcase the personal experiences of users as I've had some phone calls about it.

 

[mikeyB]

I hope that the evidence is enough to convince NICE Mike. I just don't think it's right that only better off folk can take full advantage from the system. Even people on relatively high income can ill afford nearly £100 per month. It almost comes to a family decision, which is an odd way to manage diabetes.

 

[Northerner]

I have to say that, once my confidence in the accuracy and consistency of a sensor has been affirmed I am doing significantly fewer finger prick tests and I am gaining good information to help me with my control. I hope that NICE take into account the fact that costs of Libre will probably be partly offset by savings on strips 🙂 I imagine also that it can provide information much more cheaply than CGMs where a clinic decides the extra data would be useful in helping patients on an occasional basis.