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Pump cost comparison for private funding

Discussion in 'Insulin Pump Forum' started by tim2000s, Jul 1, 2015.

  1. Spiker

    Spiker Type 1 · Well-Known Member

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    Oh interesting. I thought the data was for no significant reduction in hba1c but a reduction in hypos at constant hba1c. That is what they told us on the pump course at GSTT in fact. Thanks for checking!
     
  2. Spiker

    Spiker Type 1 · Well-Known Member

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    In those studies did they control for longevity of effect and vs other interventions because it is known that *any* intervention will produce an improvement, short term at least, presumably due to "attention effects" (trying harder / optimism) by the patients.
     
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  3. tim2000s

    tim2000s Type 1 · Moderator
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    Those were all observational studies, so as you say, observational bias is very likely to be present.When RCTs are taken into account, the comment is:

    In summary, there is little evidence from the RCTs of a significant difference between CSII and MDI therapy in terms of a decrease in HbA1c levels or in the rate of severe hypoglycaemic episodes in people with diabetes mellitus. Observational studies show a much greater improvement (decrease) in HbA1c levels with CSII therapy, as well as statistically significant decreases in the rate of severe hypoglycaemia episodes. There is no clear evidence of any greater benefit of CSII over MDI therapy in pregnancy.

    So it almost comes back to anecdotal evidence is what drives decisions about pump funding in the UK. And it also means that the comment on the pump course was in fact incorrect...

    Or in other words, your first supposition is correct - there is no significant RCT evidence of either improvement in Hba1C or hypo reduction when using a pump. Given the costs, CGM would probably be better. There may, however, be lifestyle improvements that can be gained.
     
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  4. tim2000s

    tim2000s Type 1 · Moderator
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  5. donnellysdogs

    donnellysdogs Type 1 · Master

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    I just wish their trials were then followed up byntrue costs of set failures with real users etc for pumps.
     
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  6. tim2000s

    tim2000s Type 1 · Moderator
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    As someone on a Facebook group commented - her trust hand out pumps like sweets to idiots who haven't a clue and won't bother to try and have a clue. How does that fit with the cost model that NICE have derived?
     
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  7. donnellysdogs

    donnellysdogs Type 1 · Master

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    CCGs need to look at patients and contact them really to find out if their hospitals are prescribing correctly.
    CQC inspections only really look at cleanliness in hospitals and procedures for ops etc.

    Something is going wrong somewhere if some hospitals can give out willy nilly and others can't or won't.

    We state on here the commitment that is needed for a pump but perhaps that is another failure within our NHS system?

    Perhaps they should only be setting up a loan system to patients for 6 months?? If people don't prove themselves that they go back to MDI?
     
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  8. tim2000s

    tim2000s Type 1 · Moderator
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    I don't think this is a bad idea at all. I think that if you can prove your capability/desire by at least showing how much work you've done under MDI, that should qualify you to start a pump.

    NICE's own data shows that in randomised control trials, pumps are no better than MDI for control, so how they are distributed would make a critical difference.
     
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  9. donnellysdogs

    donnellysdogs Type 1 · Master

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    Trouble is

    A) I have pump upstairs packed away because it was no longer able to function well without my lack of fat!! I would love to give it back for someone else to use.. They can't for some reason.. Its not as if it is contaminated!!!

    So although they can give loan pumps out in some hospitals, they don't actually appear to be anle to re use a pump given to a patient....
     
  10. donnellysdogs

    donnellysdogs Type 1 · Master

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  11. iHs

    iHs · Well-Known Member

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    Pumps are not exactly given out willy nilly.... there is usually specific reasons. Young people sometimes get them through non compliance over multi injections and find themselves being admitted to ICU facing serious DKA. Of course there is no need reallyfor MDI to be used in the first place as twice daily insulin is still available and if only those young diabetics featured in the channel 4 programme 'The Hospital' had been using twice daily instead of MDI, their health and mental well being would hopefully been ok. Getting back to pumps again.......its better to give a young person a pump than watch themselves slowly kill themselves through non compliance over MDI.

    Regarding the passing on of out of warranty pumps to other diabetics. There is a lot of red tape involved as CCGS will only fund the consumables for pumps that are brand new and not second hand. Also, if a pump was passed on to someone who didn't use it wisely and found themselves in ICU fighting for their life, then legal action could taken against the person supplying the pump and there would be questions asked. So, that's why it's not wise to pass on a used pump.........there's a lot of legal red tape involved so everyone who wants a pump needs to go through a hospital consultant, with the back up of a DSN trained in pump use and an agreement set up with pump company and then a CCG will fund using a consultants recommendation.
     
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  12. Spiker

    Spiker Type 1 · Well-Known Member

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    That is very depressing if "litigation culture" makes it impossible to re-use pumps. What a shocking and pointless waste. :-(
     
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  13. donnellysdogs

    donnellysdogs Type 1 · Master

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    So totally agree. They could easily clean up external bits of a pump and give new sets etc for a trial.

    Intersting @Spiker that my consultant said that she had people come off pumps and never had one person go back on them... I can't see that I will go back on it.
     
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    #33 donnellysdogs, Jul 26, 2015 at 6:47 PM
    Last edited by a moderator: Jul 26, 2015
  14. tim2000s

    tim2000s Type 1 · Moderator
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    Given there is an ongoing warranty, it couldn't be that hard to return a used pump to the manufacturer and they certify it as good or replace under warranty...
     
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  15. Spiker

    Spiker Type 1 · Well-Known Member

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    Exactly. A manufacturer certification / refurbishment programme would be many times cheaper than a new pump. And the NHS has the purchasing power to force all pump manufacturers to do that if they want to play in the UK.
     
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  16. Rivieralady

    Rivieralady · Member

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    Hi Tim, Many thanks, is interesting to see. I have wanted a Dana R for a few years, my Accu Check combo went swimming in Spain and died (just as the Insight is finally available) so I am hoping this is an opportunity to claim on house insurance and change to Dana, having seen this I can assess what costs might be if I cant. Thanks
     
  17. justbe

    justbe Type 1 · Well-Known Member

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    And then you have Northern Ireland, where only one Hospital even HAS pumps, refuses to give them out even to computer programmers like me (a natural fit, I'd say), claiming that there's a two year waiting list, and is then found out to have cupboards full of the things, not given out to anyone :/ It's obscene.
     
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    #37 justbe, Jul 30, 2015 at 11:44 PM
    Last edited by a moderator: Jul 31, 2015
  18. justbe

    justbe Type 1 · Well-Known Member

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    Uggh. In NI, they're really against pumps, for no logical reason -- so much so, that I'm considering relocation. But that's a long way off, and I don't want my health to suffer in the mean time.

    Is there no way you can just buy one? I was all excited when I realised that the omnipod could be filled with my existing novorapid cartridges :/
     
  19. Angusc

    Angusc Type 1 · Active Member

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    if you want a pump argue it on cost terms e.g. a ambulance callout is £400+, a day in hospital is £600+so say you have 2 callouts that involve 3-5 days in hospital it works out at £4800+ per year so a pump may well be cheaper that was the argument that got me my pump + sensor funding plus the better control was secondary effect which is not the way it's supposed to work
     
  20. justbe

    justbe Type 1 · Well-Known Member

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    Not funding it is... sad. Getting in the way of people who've worked their butts off to be able to privately fund is downright harmful.
     
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