The article, “Cost-Effectiveness of Self-Monitoring of Blood Glucose in Patients with Type 2 Diabetes Mellitus Managed Without Insulin,” suggests that the modest clinical benefits associated with self-monitoring by non–insulin-treated patients with type 2 diabetes are outweighed by the significant cost of the test strips. In 2006, Canadian publicly and privately funded drug plans spent more than $330 million on test strips. It is estimated that more than 50% of all the money spent on test strips is for patients with type 2 diabetes who are not using insulin.

“Nevertheless, self-monitoring of blood glucose is routinely recommended for patients who are not using insulin. This results in major investments in this technology by patients and payers,” writes Chris Cameron, Health Economist at CADTH and co-author of the article.

An article from the Institute for Clinical Evaluative Sciences entitled “Blood glucose test strips: options to reduce usage” is also published in the same issue of CMAJ/JAMC. This article examines how even modest changes in the frequency of self-monitoring of blood glucose among selected patients with type 2 diabetes, achieved through focused policy decisions, could substantially reduce test strip use.

CADTH's CMAJ article is based on extensive research on the practice of self-monitoring of blood glucose by people living with diabetes. Following a detailed analysis of the benefits, harms, and cost-effectiveness of self-monitoring, CADTH released Optimal Therapy Recommendations for the Prescribing and Use of Blood Glucose Test Strips in July 2009. The recommendations were developed by an expert committee that includes leading diabetes specialists, family physicians, pharmacists, health economists, and members of the public.

To access these recommendations and the supporting evidence, visit www.cadth.ca/smbg. In January 2010, a variety of user-friendly tools will also be posted on the website. These tools are designed to help consumers, health care professionals, and policy decision-makers put evidence about self-monitoring of blood glucose into practice.

About CADTH

The Canadian Agency for Drugs and Technologies in Health (CADTH) is an independent, not-for-profit agency funded by Canadian federal, provincial, and territorial governments to provide credible, impartial advice and evidence-based information about the effectiveness of drugs and other health technologies to Canadian health care decision-makers.

Media Contact:

Janet Crain
A/Manager, Knowledge Exchange
613-226-4969, extension 1487
Cell: 613-294-2897
janetc@cadth.ca

What is a therapeutic review?

A therapeutic review is a review of the most recent evidence available in the public domain regarding a single drug, a drug class, or a drug category. Generally, these are drugs, drug classes, or drug categories that have been available in the marketplace for some time. The scope and depth of the reviews will be determined by the jurisdictions and CADTH. The final outputs of the CADTH therapeutic reviews will include either recommendations, advice, or a report and conclusions.

Why is CADTH undertaking a therapeutic review pilot project?

The need for therapeutic reviews at the time that formulary decisions are being made has been identified as a need by participating drug plans and expert advisory committees for some time. Therapeutic reviews are seen as an important tool in the overall recommendation and policy decision-making process. In addition to making listing decisions based on efficacy, safety, and cost-effectiveness analyses of available information, drug plans also consider the existing coverage policies of therapeutically related drugs. To this end, a working group comprising members from the Advisory Committee on Pharmaceuticals, the COMPUS Advisory Committee, and CADTH staff has developed a framework for therapeutic reviews conducted concurrently with formulary submissions. The purpose of the pilot project is to test and to make enhancements to the framework. 

Will affected manufacturers have a role in the therapeutic review pilot project?

Manufacturers that have products included in the therapeutic review pilot project will be apprised directly and will be invited to provide input and comments during specific phases of the therapeutic review process.

What are the next steps in the therapeutic review pilot project? 

• A more detailed description of the therapeutic review pilot project will be posted in the near future.
• On completion, the therapeutic review pilot project will be evaluated. The findings from the evaluation will be used to make changes and improvements to the requirements and process for conducting therapeutic reviews.

• The revised process for conducting therapeutic reviews will be posted for stakeholder feedback (after the pilot project is completed), and relevant feedback will be used to further enhance the process.

We can be contacted at cadthfeedback@cadth.ca. 

The course was developed by MDcme.ca using CADTH’s series of Optimal Therapy Reports on proton pump inhibitors (PPIs), including clinical and cost-effectiveness evidence and recommendations for optimal prescribing and use. The launch of this course is the latest example of how CADTH provides stakeholders with credible, evidence-based information that supports patient care and the effective use of health care resources.

The aim of the course is to increase awareness among physicians and other health care practitioners of the optimal use of PPIs in the management of upper gastrointestinal conditions. The course is available free of charge to registered users of MDcme.ca and has been accredited for MainPro M1 for up to 1.5 credit hours.

Following completion of the course, learners should be able to:

• Understand the role of double-dose PPI therapy and compare various PPIs and their effects on clinically important outcomes.

• Recognize clinical scenarios where PPIs may be inappropriately utilized and re-assess the medication therapy.

• Define the role of PPI therapy in the treatment of asthma and laryngeal symptoms.

• Understand the complications of long-term PPI use.

Visit the PPI section of CADTH’s website for complete information about the PPI topic, including scientific reports and tools to help decision-makers put evidence into practice.