title: Promoting health and reducing costs: a role for reform of self-monitoring of blood glucose provision within the National Health Service.
abstract: OBJECTIVE
  To determine the cost-effectiveness of all options for the self-monitoring of blood glucose funded by the National Health Service, providing guidance for disinvestment and testing the hypothesis that advanced meter features may justify higher prices.
  
  
  METHODS
  Using data from the Health and Social Care Information Centre concerning all 8 340 700 self-monitoring of blood glucose-related prescriptions during 2013/2014, we conducted a cost-minimization analysis, considering both strip and lancet costs, including all clinically equivalent technologies for self-monitoring of blood glucose, as determined by the ability to meet ISO-15197:2013 guidelines for meter accuracy.
  
  
  RESULTS
  A total of 56 glucose monitor, test strip and lancet combinations were identified, of which 38 met the required accuracy standards. Of these, the mean (range) net ingredient costs for test strips and lancets were £0.27 (£0.14-£0.32) and £0.04 (£0.02-£0.05), respectively, resulting in a weighted average of £0.28 (£0.18-£0.37) per test. Systems providing four or more advanced features were priced equal to those providing just one feature. A total of £12 m was invested in providing 42 million self-monitoring of blood glucose tests with systems that fail to meet acceptable accuracy standards, and efficiency savings of £23.2 m per annum are achievable if the National Health Service were to disinvest from technologies providing lesser functionality than available alternatives, but at a much higher price.
  
  
  CONCLUSIONS
  The study uncovered considerable variation in the price paid by the National Health Service for self-monitoring of blood glucose, which could not be explained by the availability of advanced meter features. A standardized approach to self-monitoring of blood glucose prescribing could achieve significant efficiency savings for the National Health Service, whilst increasing overall utilisation and improving safety for those currently using systems that fail to meet acceptable standards for measurement accuracy.
authors.affiliation: Lifecode® Solutions, Liverpool, UK.|Liverpool Health Economics, University of Liverpool, Liverpool, UK.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-6843-6447
authors.initials: S
authors.lastname: Leigh
authors.affiliation: Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK.
authors.forename: I
authors.initials: I
authors.lastname: Idris
authors.affiliation: Liverpool Health Economics, University of Liverpool, Liverpool, UK.|Public Health, Wirral Council, Wirral, UK.
authors.forename: B
authors.initials: B
authors.lastname: Collins
authors.affiliation: Lifecode® Solutions, Liverpool, UK.|Liverpool Health Economics, University of Liverpool, Liverpool, UK.
authors.forename: P
authors.initials: P
authors.lastname: Granby
authors.affiliation: Lifecode® Solutions, Liverpool, UK.
authors.forename: M
authors.initials: M
authors.lastname: Noble
authors.affiliation: Lifecode® Solutions, Liverpool, UK.
authors.forename: M
authors.initials: M
authors.lastname: Parker
mesh_terms: D015190:Blood Glucose Self-Monitoring / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000639:trends; D003131:Combined Modality Therapy / Q000191:economics / Q000295:instrumentation / Q000639:trends; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000097:blood* / Q000191:economics / Q000628:therapy; D017048:Health Care Costs; D018166:Health Care Reform / Q000191:economics; D006293:Health Promotion / Q000191:economics; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D007003:Hypoglycemia / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D018803:Models, Economic; D017410:Practice Guidelines as Topic; D055656:Prescriptions; D058996:Quality Improvement / Q000191:economics; D011787:Quality of Health Care; D011934:Reagent Strips / Q000191:economics; D015203:Reproducibility of Results; D013222:State Medicine; D006113:United Kingdom
chemical_list: D011934:Reagent Strips