Medicines - achieving value and sustainability in prescribing: guidance

Blood Glucose Monitoring Strips and Insulin Pen Needles

Blood glucose monitoring strips (costing more than £10 for 50 strips)

Recommendation:

• do not initiate strips that cost over £10 for 50 strips.
• deprescribe or change in individuals currently prescribed.
• prescribe only if no other item or intervention is clinically appropriate or available.

Exceptions:

• these recommendations do not apply to blood glucose monitoring strips that cost less than £10 for 50 strips.

Background and rationale for recommendation:

• there are currently over 40 different types of blood glucose testing strips available in the UK. They range in price from £5.45 to £16.40 per 50 strips. Rationalising use ensures that the most cost-effective options are used first line.
• the inclusion of BGM strips in this guideline is not to discourage prescribing it is to encourage health boards and prescribers to consider more cost-effective alternatives and to ensure blood glucose monitoring is only prescribed when appropriate. Individuals with Type 1 diabetes should always be prescribed BGM.
• self-management by regular blood glucose monitoring is not routinely recommended for individuals with Type 2 diabetes as it does not significantly improve glycaemic control, health-related quality of life, or hypoglycaemia rates.
• however, self-monitoring of blood glucose is recommended for those who:

• are on insulin
• have had prior hypoglycaemic episodes
• drive or operate machinery and use oral medications, such as sulfonylureas, that increase their risk of hypoglycaemia (see DVLA guidance)
• are pregnant, or planning to become pregnant, or
• those undergoing significant changes in pharmacotherapy, e.g. on high dose oral steroids or oral hypoglycaemic agents such as sulfonylureas that require dose adjustment.

Category:

• Items which are clinically effective but more cost-effective products are available, including products which have been subject to excessive price inflation.

Insulin pen needles (costing more than £5 per 100 needles)

Recommendation:

• do not initiate needles that cost more than £5 per 100 needles.
• deprescribe or change in individuals currently prescribed.
• prescribe only if no other item or intervention is clinically appropriate or available.

Exceptions:

• these recommendations do not apply to insulin pen needles that cost less than £5 per 100 needles.

Background and rationale for recommendation:

• there are a large variety of insulin pen needles available costing from £3.95 to £30.08 for 100.
• the Forum for Injection Technique (FIT) UK considers the 4mm needle to be the safest pen needle for adults and children regardless of age, gender, and Body Mass Index (BMI). As using shorter length needles help to prevent intramuscular injection of insulin.

Category:

• Items which are clinically effective but more cost-effective products are available, including products that have been subject to excessive price inflation.