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Prescribing Advice for GPs

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Cost-efficacy of blood glucose monitoring

The Journal of the Canadian Medical Association has published a cost-efficacy analysis of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin.

Data from the United Kingdom Prospective Diabetes Study (UKPDS) was used to forecast diabetes-related complications based upon a modest reduction of 0.25% in HbA1c that could be expected in patients using testing strips.

The analysis identified an increment cost utility ratio of Can$113,643/QALY (quality adjusted life-year). The analysis also reports the number needed to treat (NNT) to prevent specified diabetes related complications over a 40 year period. The lowest NNT reported is 266 for myocardial infarction, based on the reported cost of $0.40 per strip this intervention would cost Can$1,553,440.

The authors conclude that, "use of blood glucose test strips for frequent self-monitoring is unlikely to represent efficient use of finite health care resources". They also note that less frequent monitoring or a reduced test strip price would improve cost-effectiveness.

This study details some limitations such as the use of HbA1c as a surrogate for diabetes-related complications, the limitation of using the UKPDS data to model potential health benefits and the lack of a measure for hypoglycaemia.

Action: This study is consistent with existing analyses. Clinicians should continue to discourage regular and frequent self monitoring in patients with non-insulin treated type 2 diabetes.

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