Diabetes is a complex condition that can require management across the entire spectrum of healthcare delivery, including self-management support as well as care delivered through general practice, community specialist care and hospital inpatient specialist care.
The HSE has statutory responsibility for pricing and reimbursement decisions under the community drug schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. In making a relevant reimbursement decision, the HSE is required under the Act to have regard to a number of criteria including clinical efficacy, the health needs of the public, cost effectiveness and potential or actual budget impact.
The National Centre for Pharmacoeconomics (NCPE) are involved in the pharmacoeconomic evaluation of products being considered for addition to the HSE reimbursement list. The NCPE are not involved in reimbursement decision making. The HSE Executive Management Team has the decision-making authority in respect of reimbursement decisions.
To ensure that the Health Information and Quality Authority (HIQA) carry out Health Technology Assessments (HTAs) which are of the maximum benefit to the healthcare system, a prioritisation process is used to select HTA topics. Within the prioritisation process, HIQA gathers high-level information on four areas of impact: clinical, economic, policy and organisational. Topics are then ranked on the basis of the four areas of impact. An advisory group comprising key stakeholders, including the Department of Health and the HSE, is then involved in selecting the most relevant topics.
Continuous glucose monitoring (CGM) systems provide an alternative approach to using blood glucose test strips for self-monitoring of blood glucose, by measuring glucose levels in the interstitial fluid (a thin layer of fluid around the cells). These systems comprise of sensors (self-administered subcutaneously, typically in the upper arm and replaced every 7 to 14 days depending on the system), transmitters (or combined sensors and transmitters), and a mechanism to display the results (readers/receivers or smart device application).
HIQA published a HTA of CGM in adults with type 1 diabetes on 29th September 2023. This is available at: www.hiqa.ie/reports-and-publications/health-technology-assessment/rapid-health-technology-assessment-continuous.
In line with the advice from HIQA, and due to the budget impact associated with CGM sensors, the HSE established a single reimbursement application system from 1 December 2023 for all CGM sensors on the reimbursement list.
Reimbursement support for CGM sensors under the community drug schemes is for people with type 1 diabetes regardless of age. An application for reimbursement support of CGM sensors can be submitted for any patient, and each application is reviewed by the HSE-Medicines Management Programme (MMP) on a case-by-case basis.
To date, a Health Technology Assessment of CGM sensors for people with type 2 diabetes has not been undertaken, and as a result there is limited information available to support the extension of reimbursement support for CGM sensors to those with type 2 diabetes.
However, there has been significant service development and investment by Government in supporting people with type 2 diabetes. There has been a significant shift in the quality and delivery of diabetes care in recent years, with more patients being provided with care in the community and at an earlier stage.
The inclusion of diabetes as one of four chronic diseases in respect of which adults who hold a medical or a GP visit card receive ongoing, planned care from their GP through the Chronic Disease Management Programme also represents a major step forward in assisting those living with diabetes to manage their condition.
Significant resources have been allocated under the Enhanced Community Care Programme to establish Specialist Diabetes teams within community hubs to better support GPs to manage people with complicated Type 2 diabetes.
Where necessary, GPs can refer these patients into ECC Chronic Disease teams, where further specialist services are provided, such as podiatry, dietary advice, and if necessary, access to consultant-level care in the community.
Research into the Chronic Disease Management Programme has shown that over 90% of patients with chronic diseases, including diabetes, are now successfully managing their conditions in community settings.
