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Libre on NHS, what's happening about Dexcom

Discussion in 'Type 1 Diabetes' started by MoonSpirit, Sep 15, 2017.

  1. MoonSpirit

    MoonSpirit Type 1 · Well-Known Member

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    At last something approved on NHS, the Libre,
    But Libre while usefull is not a proper continious meter, it can't alarm when your high or low.
    It would quite happily sit on my arm and let me die in my sleep,
    Unlike Dexcom which would be bleeping away, waking me up telling me to save my own life.

    When can we expect a proper life saving meter like Dexcom, rather than a half way house, to be approved?
    Or maybe there is a V2 Libre that includes alarms in the soon to be relieved pipeline?

    How much longer are we likely to be waiting?
     
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  2. pinewood

    pinewood Type 1 · Well-Known Member

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    I prefer, and will continue to use, the Dexcom G5.

    I suppose all we can hope for is that we will receive a contribution towards the cost of Dexcom equal to what the NHS would have spent on us for the Libre. In reality, I can't think how this would work practically and expect it is very unlikely that they would offer this.

    I doubt there is a new Libre system being developed that will offer the alarms; Abbott have built and advertised it solely as a "half-way-house" between finger pricking and CGM by calling it "flash glucose monitoring".

    I'd be interested to know how hard (if at all) Dexcom have been pushing to get their products on the NHS. It's clear that Abbott invested a lot of time and resources into securing NHS coverage; it seems like Dexcom couldn't care less.
     
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  3. tim2000s

    tim2000s Type 1 · Expert
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    @MoonSpirit - there is already guidance within the NICE guidelines for Dexcom, and if you are someone for whom Dexcom is truly lifesaving, then that's what should be used to make a case for it via your clinic and GP. As it stands at the moment, the cost model for Dexcom (based on sensor changes every 7 days, which is what they must base it on) doesn't stack up in the NHS QALYS method for all users. It works out at around £3,400 per year, vs £960 for the Libre.

    In context, a Hypo call out for an ambulance is around £250 and one night's stay in a hospital about £700 so calling an ambulance is more cost effective than Dexcom unless you do it more than 12 times a year. It's a horrible way of looking at it, but unfortunately it's the kind of equation the NHS and CCGs use.

    The key thing to do is think laterally. Given that CCGs currently approve "one sensor a month" for certain patients wanting CGM (usually kids), there is precedent. Once the Libre is available and provided by the CCGs, there's nothing to stop us putting together a case that instead of Libre, we'd like Dexcom or Enlite sensors. Using the £35 cost to the NHS of Libre annually, it should be possible to argue the case for support in Dexcom, which works out to 16 sensors a year.

    Now the CCG can only condone that use in a similar way to the "one a month model" I mentioned earlier, but if you extend the Dexcom sensors as most do, then you can start to recover some of the costs. Once people start doing that, it's an easier step to move reimbursement for Dexcom or Enlite onto the Drug Tariff.

    In addition, the next gen Dex sensors are supposed to be cheaper and last for two weeks, so if they can be provided at parity with Libre or better, that would open the door to getting them on prescription. They aren't due till late 2018 though.
     
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  4. catapillar

    catapillar Type 1 · Well-Known Member

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    My dexcom is currently nhs funded. But that's because I meet the criteria for NHS funding in that I'm completely hypo unaware, and I have had multiple ambulance call outs for severe hypos (although I can't see I'd allow myself to be admitted, I barely let the paramedic stay until I'm euglycaemic, seriously once I'm conscious you can leave me alone and for god sake stop trying to feed me, I'll be in double figure all day). So I don't especially recommend meeting the funding criteria, but it is possible. I've also had enlite sensors funded for a brief period to link up with the 640 pump with low suspend. There are also nice guidelines on sensor augmented pump therapy.
     
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  5. MoonSpirit

    MoonSpirit Type 1 · Well-Known Member

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    Hi Tim
    Yes I think I understand, Dexcom too expensive in comparison to Libre based on 7 day sensor use.
    I'm currently self funding Dexcom and getting 20 day average use out of each sensor (second week always more accurate than week one but third week the figures are getting dodgy, but still usefull reading)
    To complicate things I live in Jersey which is outside the NHS, but our Jersey health department usually falls into step with whatever NHS is providing within a month or so. Now Libre is getting funding, I'm getting more hopeful that were closer to getting some sort of funding, even a small contribution towards the CGM costs would be great.

    I'm struggling with the ongoing costs of funding Dexcom myself,
    If it's going to be a long wait for Dexcom to come out with the next hopefully more cost effective version to be launched and maybe get NHS support, I will need to take a huge step back wards and move from Dexcom to Libre
     
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    #5 MoonSpirit, Sep 15, 2017 at 1:19 PM
    Last edited: Sep 15, 2017
  6. Shannon27

    Shannon27 Type 1 · Well-Known Member

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    I'm using the Libre at the moment and would swear by it - I got 2 free sensors from my local hospital and am using the second, with 9 more days on it. Until this morning when I woke up and it told me I was 2.9, which I checked with a blood test. I am considering self funding for the Libre until I can get it on NHS, but unsure if I can afford the £35 per sensor which only lasts 2 weeks. I'd love to go on the Dexcom which would help me so much in regaining control, especially with the alarms, I normally wake up once I go below 4 so this mornings reading has really shocked me.
    How much is the dexcom (per sensor) and is it worth the cost compared to the Libre?
    I'm not a pumper so the function that lets it "talk" to the pump wouldn't be needed.
     
  7. katmcd

    katmcd Type 1 · Well-Known Member

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    Dexcom sensor is £51 each and G5 transmitter (the grey bit that clips on) is £250 and lasts 3 months officially (the software switches it off after this). Compatible phones mean you can use mobile Bluetooth for readings instead of buying the official receiving device.

    You don't have to change the sensor every week, you can restart it until it eventually falls off which can reduce costs. Using the xdrip+ app keeps the battery going past 3 months until it runs out.

    I keep my sensors on between 22 and 30 days. By using xdrip+, my transmitter is on day 169.

    I self fund and the alarms, especially during exercise, I find invaluable. Wouldn't be without dex if I can at all help it.
     
  8. Shannon27

    Shannon27 Type 1 · Well-Known Member

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    So you need to get the sensor and transmitter separately? And for the receiver you can just use your phone?
     
  9. tim2000s

    tim2000s Type 1 · Expert
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    Yes, although the transmitter seems to have come down by about £50 as the last one I bought was £200.
     
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  10. Shannon27

    Shannon27 Type 1 · Well-Known Member

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    I've worked it out and based roughly on info from @katmcd (1 sensor = 3 weeks and 1 transmitter = 4 months) Dexcom is only £20 more than the Libre over 4 months... I now need to work out if I can save £200-£250 for a transmitter every few months ha!

    Ignore this - calculator error ha! It would come out at nearly £550 over 4 months - compared to £303 for the Libre sensors! Still debating it though!
     
    #10 Shannon27, Sep 18, 2017 at 12:52 PM
    Last edited: Sep 18, 2017
  11. Engineer88

    Engineer88 Type 1 · Well-Known Member

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    If you use xdrip you can extend the transmitter life also. There is a facebook group which can help with hints and tips
     
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  12. slip

    slip Type 1 · Well-Known Member

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    So what the life expectancy of an x-driped transmitter?

    IF it's 6months and IF Tims £200 is correct & IF each sensor lasts 3weeks, then over that period a G5 setup will cost you ~£660 (9 sensors at £51 = £459 and 1 transmitter at £200)

    6 months or 27 weeks of continuous Libre would cost you ~£660 (that's 13.5 libres at about £49ish) P&P not included for either if any?!
     
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  13. tim2000s

    tim2000s Type 1 · Expert
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    So... I have yet to get 6 months out of a G5 transmitter from new, but both the ones I bought had older "Made" dates. I'm using a new one now and it will be interesting to see what I get. 4.5 months is definitely achievable.

    Sensor wise, I rarely get three weeks. 2.5 is more realistic, although I've just purchased skintac in the belief this can make quite a difference.

    I paid £200 last week, so I'd go with it being correct. The G4 transmitter is £250.
     
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  14. Snapsy

    Snapsy Type 1 · Well-Known Member

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    Libre sensors are around the £50 mark (if you click the VAT exemption box when checking out) - I think the £35 you mention is what the NHS are able to buy it for.
     
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  15. Key_master_

    Key_master_ Type 1 · Well-Known Member

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    Abbott just gave us free trials with the old stock they had by looks of it. As my mum put it after I couldn't afford to self fund the libre was, how cruel to give you that for two weeks then your on your own to fund it after the difference it made.

    Abbott have brought their way into the NHS, no effort required. If there making £780000000 a year from 300000 users just on sensors already that are self funding or on health insurance. How much are they now gonna cream of the NHS.
     
  16. slip

    slip Type 1 · Well-Known Member

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    probably about as much as the NHS will save on reduced numbers of complications - a win, win, win situations! ;)
     
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  17. Key_master_

    Key_master_ Type 1 · Well-Known Member

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    I disagree, the complications come from us being taught the rubbish we are, the lousy drugs we are given and lack of education. I'm sick of the sugar coated nonsense we are taught and read from our health organisations that are blatantly coining it in and making a career out of keeping us all needing to see them like we do with no re avail and reliant on dangerously high doses of insulin or other drugs like statins. Earlier reading on here someone on nearly 300 units a day. After using the libre free for two weeks I self funded for another 2 months. In the first week, picked up on low carb via dr Bernstein, within 3 weeks hb1ca predicted at 5.4 was a 8.6 last test 1 month before. I always carb counted, avoided fast food, ate whole gran low gi foods. would have one treat a week of take away. Lowest sugar/fat one there is. Very hard and wouldn't dream of eating any now. (I changed that not the libre that was accurate only some of the time meaning finger pricks are nessasary still)

    A libre may help us get on the right track to start with but that's all it's good for. Showing us patterns that's when they are accurate enough. it will not stop the statistics of the people with our disease who are uneducated or just ignore what we have and just eat what they want and drink alcohol in the amounts that some diabetics do. I've witnessed this first, second and third hand in my life.
     
  18. TheBigNewt

    TheBigNewt Type 1 · Well-Known Member

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    My nurse friend whose 17 year old kid uses Dexcom since he was diagnosed about 2 yrs ago said the next generation Dexcom will be via Google, no sensor, no calibration, just plug and play. Which would be great from the sounds of it.
     
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  19. tim2000s

    tim2000s Type 1 · Expert
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    Not sure how you measure glucose levels without some sort of sensor, whether that's invasive or otherwise.

    Great for the insurers in the US who can choose who to cover based on the google data stream. not so good for anyone going anywhere where there is no internet, i.e. large swathes of the US, plus plenty of the UK.
     
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  20. Shannon27

    Shannon27 Type 1 · Well-Known Member

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    Wasn't there something about contact lenses being developed by google (who've teamed up with some medical company) that have a sensor that measures sugar levels?
     
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