Category: Access For All

JDRF commissions cost effectiveness study to demonstrate real quality of life value of diabetes technologies

JDRF’s #AccessForAll advocacy campaign aims to make type 1 diabetes (T1D) technology affordable and accessible for all Canadians living with the disease. With support from the T1D community, JDRF seeks to increase public and private coverage technologies such as continuous glucose monitors (CGM) and flash glucose monitors (Flash GM). The goal is to reduce the out-of-pocket costs for these technologies and improve access for Canadians with T1D. 

To support our advocacy for expanded public coverage, JDRF commissioned a study to examine glucose monitoring systems (flash glucose monitoring, continuous glucose monitoring and self-monitoring of blood glucose) and their population level impact on diabetes related complications, mortality, and cost effectiveness of each of techniques in adults with type 1 diabetes (T1D) in Canada.

An estimated 300,000 people in Canada live with T1D. Living with T1D means managing the disease through frequent checking of blood glucose levels, regular infusions of insulin, either by injection or through an insulin pump, and carefully adjusting each dose to balance against carbohydrate consumption and activity levels.

For years, the only way to measure blood glucose was through frequent and often painful finger-prick tests, and insulin needed to be administered through multiple daily injections. More recently, however, diabetes devices like advanced glucose monitors, like CGMs and Flash GM along with insulin pumps have offered more options for managing diabetes and more accurate readings.

Recently, JDRF commissioned a study to examine the population level impact on diabetes related complications, mortality and cost effectiveness of each of these three glucose monitoring techniques in adults with T1D in Canada. The study used a Markov cost-effectiveness model (a probability-based model that models the probability or chance of transitioning between states and their associated costs) and Canadian epidemiologic and economic data for adults aged 18-64 years with T1D.

The study found the following: 

Self-Monitoring of Blood Glucose (SMBG) is an approach whereby an individual pricks their finger, measuring their blood glucose manually using a glucose meter.

Average annual per person costs: $2,019

After 20 years, if all 180,000 Canadians aged 18-64 living with T1D use the traditional finger-prick method, an estimated 11,200 people would remain free of complications and there would be an estimated 89,400 deaths, at a total cost of $12.2 Billion.

A continuous glucose monitor (CGM) works through a tiny sensor inserted under the skin. The sensor measures the glucose level and provides a continuous reading.

Average annual per person costs: $3,930

Universal coverage of CGM would increase the number of people living free of complications by an estimated 7,400 and decrease mortality by an estimated 11,500.

A Flash glucose monitor (Flash GM) measures the glucose level through sensors and provides a blood glucose reading when the user scans the device over the sensor.

Average annual per person costs: $2,540

Universal coverage of Flash GM would allow an estimated 3,400 more people to live without chronic complications of T1D and prevent approximately 4,600 deaths.

Universal use of CGM and/or Flash GM in Canada for the T1D population would reduce complications and death at a cost-effectiveness threshold of $50,000/ Quality adjusted life-years (QALY). QALY is a generic measure of disease burden, including both the quality and the quantity of life lived. It is commonly used in health economic evaluations to measure the cost-effectiveness of medical interventions and is the standard measure of quality of life in cost-effectiveness models.  A value of 1 corresponds to one person living one year in perfect health; and a value of 0 is assigned when a person has died.

Quality Adjusted Life-Years (QALY):

Use of CGM and/or Flash GM over SMBG for the T1D population:
  • Leads to fewer complications such as:
Severe Hypoglycemia
Diabetic Ketoacidosis
Micro- or Macrovascular complications
  • Reduces long-term costs associated with hospitalization
  • Leads to improved mortality rates
  • Are at a much lower cost-effectiveness threshold than the acceptable threshold of $50,000/QALY ($35,017 QALY and $17,488 QALY respectively)

The study demonstrates that universal adoption of CGM and Flash devices would be anticipated to lead to a significant reduction in risk of developing severe hypoglycemia (a severe event where a person often loses consciousness due to low blood glucose), diabetic ketoacidosis (a severe event where a person has high levels of blood glucose and ketones in their blood.  These often require hospitalization) and micro- or macrovascular complications (chronic complications that affect the smaller blood vessels such as retinopathy, nephropathy, and neuropathy.  They can also lead to other severe complications like kidney disease, blindness, etc.) Macrovascular complications affect more major blood vessels which includes heart attack, coronary artery disease, etc.

Therefore, funding these devices is more cost-effective compared to traditional finger-prick methods, and while the cost of funding CGM and Flash GMs are higher in the near-term, they generate significant long-term cost savings due to lower costs of complications, potential hospitalization, and additional medical interventions.

Moreover, access to these devices brings users greater peace of mind and provides more accurate blood glucose measurements. T1D self-management is facilitated by these technologies through real-time readings that help to improve overall blood glucose (HbA1C) and time in target range (TIR). Better self-management and glucose control also help to relieve some of the anxiety that surrounds the disease. It allows people with T1D to better plan exercise, meals, and rest and greatly improves overall quality of life.

CGM and Flash GM devices are extremely cost-effective compared to traditional finger-prick methods. To learn more about Access for All and how to advocate in your community, please visit https://jdrf.ca/advocacy/access-for-all/

Access for All moves out east

Since the #AccessforAll campaign launched in 2019, we have seen considerable success with five provinces and one territory introducing new coverage for Continuous Glucose Monitors (CGM) and Flash Glucose Monitors (Flash GM). As a result, thousands of Canadians living with type 1 diabetes (T1D) have been able to access this diabetes technology, reducing individual out-of-pocket costs considerably.

For 2022, the campaign is focusing on persuading the Atlantic provinces to also begin providing this much-needed coverage. Armed with additional data from a new cost-effectiveness study, as well as successful models from other Canadian jurisdictions, we are confident that we’ll be able to welcome more good news in 2022.

We began the year with a productive meeting with the Minister of Health in Nova Scotia, The Hon. Michelle Thompson. We discussed the benefits of offering coverage for Nova Scotians living with T1D, and potentially expanding the insulin pump program to those older than 25.

Mother and daughter, and JDRF advocates Amanda and Aaliyah Williams spoke to the Minister about how important patient choice is for those living with T1D. Aaliyah, who is 14 years old, shared how she initially started using a different advanced glucose monitoring device, and soon realized that it wasn’t working for her. Luckily, because she is covered by private insurance, she was able to make the switch to the device that helps her live a healthier and safe life. She has never been happier, but not everyone is as fortunate to have private coverage, and this is why we are urging the government to step up and fill those gaps.

Leah Sutherland, a mother of a young adult living with T1D worries for her daughter who will age out of pump coverage next year. Leah’s daughter is at a critical point in her life, starting her career and not in a position to take on the cost of a pump and supplies, as they cost thousands of dollars per year. T1D does not end at 25, so Leah has been advocating tirelessly on behalf of her daughter, collecting signatures for a petition that will be presented in the legislature in the coming months.

We were also encouraged by PEI’s commitment to diabetes funding in their 2021 provincial budget. We, presented to Minister of Finance The Hon. Darlene Compton to make the case for CGM/Flash GM funding, and made a similar appeal to the Minister of Health in Newfoundland, The Hon. John Haggie.

We look forward to working with the Atlantic provinces to ensure that the T1D community is supported in their efforts to increase public coverage for insulin pumps and advanced glucose monitors (CGM and Flash GM). To support the campaign, please take a few minutes to send a message to your representative. You will be voicing important concerns in response to a new era of healthcare. 

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JDRF ambassador Sébastien Sasseville rides a bicycle across Canada in support of Access For All

On June 28th, 2021 endurance athlete and JDRF ambassador Sébastien Sasseville took on his greatest challenge yet. A commitment to ride a bicycle across Canada in support of universal access to diabetes devices for all Canadians living with the disease.

Sébastien was diagnosed with Type 1 diabetes in 2002. He vowed that T1D would never keep him from living life to the fullest, and today his story is a testament to how challenges can be turned into opportunities. These opportunities have included running across Canada, climbing Mt Everest and participating in a number of the world’s hardest endurance races.

This journey was for a cause extremely close to Sebastien’s heart.

“I’ve been using an insulin pump and CGM system for years and it’s had a tremendous impact on my life and diabetes management – these devices are life changing, nothing short of that. They enable me to do what I do,” says Sébastien.

“When I think about not everyone with diabetes having access to the device of their choice, it’s heartbreaking and really – it’s not fair – nobody chooses T1D. These tools that I use today were the things I was dreaming about when I first diagnosed. A closed loop hybrid was like something out of a sci fi movie 20 years ago, I couldn’t even imagine it – and now it’s here today, and I use it. And I want to help JDRF with their advocacy work to ensure that everyone with T1D who could benefit from this technology can have access to them.”

The provincial governments of Quebec, Saskatchewan and British Columbia recently announced they will join Yukon in offering public coverage of CGM systems under provincial or territorial health plans. In addition, Prince Edward Island and Manitoba have also recently announced plans for funding based on their 2021 budget platforms.

“These are significant announcements impacting the more than 300,000 children and adults living with type 1 diabetes in Canada, but the coverage for both insulin pumps and for advanced glucose monitoring systems varies greatly depending on where you live in Canada, and even by age,” said Dave Prowten, President and CEO of JDRF Canada.

“We applaud Sébastien’s desire to bring attention for the need for equitable access to life-changing technology for all Canadians living with type 1 diabetes, and we encourage people to support Access For All by sending a letter to their provincial or territorial representative at jdrf.ca/accessforall.

Sébastien also wanted to highlight how hard diabetes management is even with these devices. That it makes life easier, but not easy. Even with advanced technology, there is still a lot of work involved with day-to-day management. He worries that people may see the athletic endurance feats he accomplishes without realizing how much effort is involved in managing his T1D.

I truly am not a natural athlete – my journey is not about winning medals. I’ve never won anything or even been on the podium. My message is really about ‘hey, this is not easy, there are great tools available, and they should be available to all’ – and then figuring out what works for you to make tomorrow a little bit better than today. My diabetes management is not perfect – I have highs and lows like everyone. I manage as well as I can with the exercise – I am proud that I can say I can keep it under control with years of experience and experimentation. But it’s not any easier for me. It’s not easy for anyone and that’s why it’s so important that everyone has access to the best tools for their own management.”

“This one was so much harder. I’ve never suffered this much. Including Everest. This was by far the toughest thing I’ve ever done, because of the intention of going fast. The real story was can this be done in under two weeks. What happens when you ride 400 km a day with no days off and almost no recovery time. From a diabetes management perspective, everything was new. It was trial and error, as the training doesn’t always translate to real life. The high temps (45 degrees Celsius), the difficult conditions; these were things I did not expect.”

Sébastien finished his journey in just over two weeks and was followed by a documentary crew who will be putting together a video to be released later in the summer.

“I feel I learned through the challenges, and it’s made me even more resolute to continue to use my platform to help others living with diabetes,” he says.

As for raising awareness for Access For All, Sebastien says, “I think I helped, but credit to the employees and advocates – just everyone at JDRF who has been advocating for years. These campaigns are successful over years by making sustained noise over time to get into the ears of the right people. I know we made a lot of noise on social media. I hope I helped this cause.”

Sebastien without a doubt contributed and we could not be more grateful. JDRF thanks Sebastien, his team and his sponsors Dexcom Canada and Tandem Diabetes Care for his incredible efforts and achievement and commitment to ensuring access to diabetes devices to any Canadian who could benefit from it.

Follow his journeys at: instagram.com/sebinspires

Consider joining us as we advocate for Access For All

There has been some great progress made recently towards greater access to diabetes devices and federal commitments to funding and incorporating a national diabetes strategy. These have only been achieved through collaboration with partners and other diabetes organizations and on the strength of our volunteers.

We rely on a network of passionate volunteer advocates to help Canada’s decision-makers understand the impact and severity of type 1 diabetes (T1D) and what needs to be done to improve the lives of those living with this disease.

We have a variety of volunteering opportunities and are always open to suggestions. Please visit our website to see some of the ways our volunteers help and consider joining us too.
www.jdrf.ca/get-involved/advocate

Two wins for Continuous Glucose Monitoring (CGM) devices in Quebec and British Columbia

Access for All was launched in 2019 and has already driven major change. We are fortunate to have some of the most powerful young voices in the country advocating for our mission. These dedicated individuals have rallied communities across the country, and now several provinces and territories are in the process of revisiting their coverage and considering expanded access. 

Diabetes devices are not a luxury, they are lifesaving pieces of equipment that help people living with T1D more closely monitor their blood glucose levels, helping to prevent hypo and hyperglycemic episodes and hospital visits. 

‘Paying out of pocket is beyond what I can afford. I don’t consider my son’s CGM an ‘optional’ medical device…I’ll do whatever I need to do, and I know I’m not alone in this,’ says Nadine, parent of a child with T1D. 

JDRF is pleased to announce that two more provinces recently added coverage options for continuous glucose monitors (CGM) over the past month, a great step forward in our goal of Access For All across the country. 

On May 26, 2021, the Régie de l’Assurance Maladie du Quebec or RAMQ announced that it would start providing coverage of the Dexcom G6 CGM for people living with type 1 diabetes (T1D), age two years or older. 

This announcement marks a significant accomplishment in increasing access to life changing technology used in the management of T1D  for people in the province, as they will now also be able to order and pick up their Dexcom CGM supplies directly through their local pharmacy. 

To receive coverage for Dexcom G6 under RAMQ, an individual must meet the eligibility requirements for the Public Insurance Plan. In addition, you must be: 

  • Living with T1D  and aged 2 years or older. AND, you must have one or more of the following:  
  • Failure to achieve an appropriate glycated hemoglobin (HbA1c) value despite taking prescribed medications and testing blood sugar regularly; or 
  • Have experienced frequent episodes of hypoglycemia in the past year despite following a treatment plan; or 
  • Are not able to recognize or report symptoms of hypoglycemia. 

A local pharmacist can than provide a prescription for RAMQ approval, which initially lasts for six months and must be renewed every 12 months following. 

For more information on coverage, please visit: https://www.ramq.gouv.qc.ca/en/citizens/aid-programs/devices-compensate-a-physical-deficiency 

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In 2020, JDRF turned its attention west to British Columbia working with the community to advocate for better diabetes device coverage. This included a pre-budget submission, holding community consultations across the province, and JDRF participated alongside Diabetes Canada and Type 1 Together in public and stakeholder consultations held by BC Pharmaceutical Services in August and September. 

On June 11, 2021 British Columbia announced that it will begin covering Dexcom G6 continuous glucose monitoring (CGM) for those requiring insulin therapy aged 2+ who meet eligibility criteria. This coverage is effective as of June 11, 2021. An estimated 20,000 British Columbians are expected to qualify helping them better manage their disease. 

In BC, Dexcom G6 sensors and receivers will be fully covered for those whose family income is <$30K annually or who are on government assistance and mostly covered for everyone else. Eligibility criteria is fairly broad and the government expects some 20K people to qualify. 

British Columbia and Quebec now join Saskatchewan, Manitoba and the Yukon in covering CGM for some or all with T1D. Quebec, Ontario, Saskatchewan and the Yukon also cover Flash GM. 

JDRF is very pleased with these announcements as a step towards universal coverage of life-saving diabetes devices, but there is still work to be done for true Access For All.  

It is our hope that in the future other CGM products and the Flash GM will be covered in BC and QC – and the remaining provinces as well. Diabetes is a very individual disease that affects different patients differently. We believe in choice when it comes to treatment options, and for patients in consultation with their health care providers to decide on their best course of treatment.