New and modern devices for monitoring blood glucose levels, distributed in an increasingly widespread manner throughout the territory, through the network of pharmacies and at the service of diabetic patients in Lombardy.
This is the goal Lombardy is working on, Italian region with the highest absolute number of people with diabetes in Italy: one in seven diabetics, in fact, he lives in the Lombardy region, where about 570 thousand of the estimated 4 million diabetics in our country. Of these, one out of 3 lives in the city of Milan. According to data processed by the ATS Metropolitan City of Milan, in fact, in the Lombard capital there are over 180,000 people with known and diagnosed diabetes and about 60,000 people who do not know they have it.
Healthcare expenditure per capita amounts to around 3,000 euros each year, amounting to over 1.5 billion euros in total to be paid by the SSR.
An amount, however, which could be significantly reduced, thanks to the widespread dissemination of new medical devices for continuous blood glucose monitoring (Continuous Glucose Monitoring – CGM) as confirmed during a Forum held in Milan in the presence of pharmacoeconomics experts, clinicians, representatives of institutions and patient associations
The meeting, entitled “Fight against diabetes – Possible innovation and new models of health governance in the Lombardy Region”, organized by Italian Health Policy Brief with the unconditional contribution of Abbott, was an opportunity to take stock of the disease in the Region and following the unanimous approval, by the Regional Council, of motion 808/2022 concerning measures dedicated to diabetic patients to improve access to medical devices for continuous glucose monitoring (Continuous Glucose Monitoring – CGM).
The motion, in detail, commits the Council to:
- evaluate the possibility for diabetic patients to collect CGM devices also from alternative facilities, such as pharmacies and community homes;
- evaluate the possibility of providing for a supply that lasts one year, or at least every six months;
- evaluate to foresee, within the scope of the temporal supply, the possibility of implementing the number of single CGM devices and insulin infusers supplied to make up for all those critical situations, therefore needs, which may arise;
- evaluate the possibility of developing training courses and immediate and systemic information for general practitioners on the benefits that the use of these innovative devices procure for patients’ quality of life.
Among the most important results of the project, a significant improvement in the living conditions of patients, a reduction in hospitalizations and savings, in terms of management costs, which could reach around 33 million a year for the SSR.
THE DEVICES – They are currently available Two types of blood glucose monitoring systems: il Real-time CGMs (real time Continuous Glucose Monitoring, rt-CGM) e intermittent glucose monitoring systems (intermittently scanned Continuous Glucose Monitoring is-CGM) also called flash glucose monitoring. These latest devices, the isCGM systems, are now available and already used by a large part of the diabetic population in Italy, both type 1 and type 2 patients, thanks to the significant clinical benefits shown together with the sustainability for the NHS with acquisition costs more sustainable.
As underlined during the Forum by Stefano Genovese, Head of the Diabetes, Endocrinology and Metabolic Diseases Unit, IRCCS, Cardiologico Monzino, the clinical evidence can be found both on glycated and on glucose metrics. Studies carried out on tens of thousands of patients show, in fact, that already three to six months after using the devices on an ongoing basis, there is a significant reduction in glycated haemoglobin as well as a reduction in hospitalizations due to acute complications of the disease. These findings are found not only in the population in multi-injection insulin therapy, but also in treatment with basal insulin alone.
What happens, with innovative monitoring systems, it is therefore a 360° optimization in disease management and an improvement, from the clinical side, in patient care with the possibility to stratify the patient himself on the basis of risk. Objectives that go in the direction of the guidelines of the Lombardy Region recalled by the councilor Marco Bestetti, of the Permanent Commission on Health, of “moving towards taking care of patients increasingly up to expectations”.
USE AND CRITICAL ISSUES – At the moment, as recalled by Dr. Emirena Garrafa, Councilor of the Diabetic Association of the province of Brescia, unfortunately these are tools that are still little used at national and regional level, as reported by the ARNO data, where there is a total expenditure for diabetes, in this type of device, substantially stable, going from 4% in 2019 to 6% in 2022.
Among the reasons that underlie a use that is still so limited the costthe fact that these are devices that make the patient and the need for adequate training for the patient and his caregiver for correct use.
Everyone however negligible aspects compared to the benefits for patients’ health, and which must be overcome, as mentioned by Garrafa himself, with increasingly targeted awareness-raising and training operations on the technology, and perhaps by pursuing concessions for those who use it, such as, for example, a reduction in the number of mandatory check-ups and examinations .
ECONOMIC IMPACT – As underlined by Davide Croce, director of the Center on Economics and Management in Health and Social Care (CREMS), in the Lombardy Region around 100,000 diabetic patients are eligible to use the new devices. Today there are 25,000 diabetic patients who use it, but it is expected that in 2 years, thanks also to a widespread diffusion of distribution throughout the territory, they can almost double, reaching 45,000 considering a linear trend. Going to evaluate the current cost of procurement and dispensing borne by the SSR, the model returns a scenario in which the savings in terms of management costs could reach up to around 33 million per year for the SSR.
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