title: Self-Monitoring of Blood Glucose: Impact of Quantity Limits in Public Drug Formularies on Provincial Costs Across Canada.
abstract: OBJECTIVE
  For most patients with diabetes, routine use of blood glucose test strips (BGTS) has not been shown to be beneficial, yet the economic implications of broad publicly funded reimbursement for BGTS are substantial. We assessed the potential impact of BGTS quantity limits on utilization and costs for 6 publicly funded drug plans across Canada.
  
  
  METHODS
  A cross-sectional analysis was conducted in 6 provinces (Alberta, Saskatchewan, Manitoba, Nova Scotia, Newfoundland and Labrador and Prince Edward Island) for patients who received at least 1 prescription for BGTS in 2014 through the public drug program. We determined the number of BGTS that would have exceeded the quantity limits and the associated costs to the provincial drug program.
  
  
  RESULTS
  A total of $38,051,026 was spent on BGTS reimbursed through public drug programs among the 6 provinces. In provinces where BGTS use is largely restricted to patients using insulin, the potential annual savings were minimal, ranging from 0.4% to 2.3%, whereas in provinces with more liberal listings, potential savings ranged from 12.4% to 19.8%. Combining these results with data from a previous analysis in Ontario and British Columbia, the cost savings associated with BGTS quantity limits for 8 provinces across Canada (capturing approximately three-quarters of the Canadian population) is estimated to be $30.3 million annually.
  
  
  CONCLUSIONS
  The national implementation of a quantity limit policy for BGTS that aligns with evidence of efficacy, optimal prescribing and patient safety can lead to considerable savings for most public drug plans across Canada.
authors.affiliation: Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada; Department of Medicine and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Knowles
authors.affiliation: Canadian Institute for Health Information, Toronto, Ontario, Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lee
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; The Sunnybrook Research Institute and the Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine Health Policy, Management, and Evaluation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.affiliation: Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada; Department of Medicine and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine Health Policy, Management, and Evaluation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; The Sunnybrook Research Institute and the Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine Health Policy, Management, and Evaluation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.affiliation: Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada; Department of Medicine and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: GomesT@smh.ca.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
mesh_terms: D001786:Blood Glucose; D015190:Blood Glucose Self-Monitoring / Q000191:economics* / Q000706:statistics & numerical data; D002170:Canada; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D009313:National Health Programs / Q000191:economics*
chemical_list: D001786:Blood Glucose
keywords: Canada; auto-surveillance; blood glucose; diabetes; diabète; glycémie; self-monitoring; self-testing; utilisation; utilization; uto-mesure