title: Self-Monitoring of Blood Glucose Levels: Evaluating the Impact of a Policy of Quantity Limits on Test-Strip Use and Costs.
abstract: OBJECTIVE
  To evaluate the impact of new quantity limits for blood glucose test strips (BGTS) in August 2013 on utilization patterns and costs in the elderly population of Ontario, Canada.
  
  
  METHODS
  We conducted a population-based, cross-sectional time series analysis of all individuals 65 years of age and older who received publically funded BGTSs between August 1, 2010, and July 31, 2015, in Ontario, Canada. The number of BGTSs dispensed and the associated costs were measured for 4 diabetes therapy subgroups-insulin, hypoglycemia-inducing oral agents, non-hypoglycemia-inducing oral agents, and no drug therapy-each month during the study period. We used interventional autoregressive integrated moving average (ARIMA) models to assess the impact of Ontario's policy change on test strip use and costs.
  
  
  RESULTS
  In the course of the study period, 657,338,177 test strips were dispensed to elderly patients in Ontario, at a total cost of CAN$482.3 million. Introduction of quantity limits was associated with significant reductions in the number of monthly strips dispensed and the associated costs (p<0.0001). In the year following the policy's implementation, test strip use decreased by 22.2% compared with the prior year (from 145,232,024 test strips to 113,007,795 test strips, a net decrease of 32,224,229 strips), resulting in a 22.5% reduction in costs (from $106.5 million to $82.6 million, a net cost reduction of approximately $24 million).
  
  
  CONCLUSIONS
  The introduction of quantity limits, aligned with guidance from the Canadian Diabetes Association, led to immediate significant reductions in BGTS dispensing and costs. More research is needed to assess the impact of this policy on patient outcomes.
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: GomesT@smh.ca.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Diana
authors.initials: D
authors.lastname: Martins
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mina
authors.initials: M
authors.lastname: Tadrous
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; Centre for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Samantha
authors.initials: S
authors.lastname: Singh
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D015190:Blood Glucose Self-Monitoring / Q000191:economics* / Q000295:instrumentation / Q000639:trends; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000191:economics*; D006291:Health Policy; D006801:Humans; D009864:Ontario
chemical_list: D001786:Blood Glucose
keywords: automesure; autosurveillance; blood glucose; diabetes; diabète; glycémie; self-monitoring; self-testing; utilisation; utilization