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NHS contract for an insulin pump
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<blockquote data-quote="caius2x8" data-source="post: 2030679" data-attributes="member: 468721"><p>I disagree both as a scientist and an economist. The maxim of " continual improvement" which is the lingua franca of organisations managed without admittibg reality fail to understand the law of depreciating returns. In other words a pump may help a patient lower the HbA1c so far. But to lower it by additionally the same amount would be disproportionately less cost-effective either through raised costs or lowered quality of life. </p><p>Example 1: a patient worries about one of these contracts and exhausts their blood strips to try to meet tge contracts targets. The gp is rationing blood strips and so the patient is without knowledge of tgeir glucose level for x long. They become ketoic and are rushed to hospital. High cost, health loss. Poor value for money.</p><p>Example 2: a different patient over corrects to meet hba1c targets. Has hypo and seiuzure and dies. Fatality. Poor cost-effectiveness.</p><p>Example 3: a patients pump is sanctioned, and the reasons they the pump in the first. place come back. Night hypos recur. Quality of life falls. Poor cost-effectiveness.</p><p></p><p>These a number of scenerios for which evidence may be requested which demonstrates that the policies in the contract are not adverse effects and do not cost more thannthey attempt to save. Good value for money means health improvement, taking all factors into consideration and or a lower cost.</p><p></p><p>On a personal note, i think pumps non-block delivery of long acting insulin is their advantage as the long acting can be shut off for up to 1 hr to temper developing hypos eg if going low and with high amount of residual bolus, as well.as carbs.</p><p></p><p>Secondly i found targetting my sugars to 6mM rather than 4 or 5 gave me a great hypo sensitivity eg i now feel sweaty and sick at 4mM . before i did this i could function at 1.7mM. My hba1cs havent tremedously improved or worsened. But i'm having FAR fewer hypos.</p><p>When i was younger and skint, i used to walk literally everywhere up to 10 miles and 30 miles by accident one day. My hba1c was the lowest tge consultant had ever seen. In old money 4.4. Without hypos.</p></blockquote><p></p>
[QUOTE="caius2x8, post: 2030679, member: 468721"] I disagree both as a scientist and an economist. The maxim of " continual improvement" which is the lingua franca of organisations managed without admittibg reality fail to understand the law of depreciating returns. In other words a pump may help a patient lower the HbA1c so far. But to lower it by additionally the same amount would be disproportionately less cost-effective either through raised costs or lowered quality of life. Example 1: a patient worries about one of these contracts and exhausts their blood strips to try to meet tge contracts targets. The gp is rationing blood strips and so the patient is without knowledge of tgeir glucose level for x long. They become ketoic and are rushed to hospital. High cost, health loss. Poor value for money. Example 2: a different patient over corrects to meet hba1c targets. Has hypo and seiuzure and dies. Fatality. Poor cost-effectiveness. Example 3: a patients pump is sanctioned, and the reasons they the pump in the first. place come back. Night hypos recur. Quality of life falls. Poor cost-effectiveness. These a number of scenerios for which evidence may be requested which demonstrates that the policies in the contract are not adverse effects and do not cost more thannthey attempt to save. Good value for money means health improvement, taking all factors into consideration and or a lower cost. On a personal note, i think pumps non-block delivery of long acting insulin is their advantage as the long acting can be shut off for up to 1 hr to temper developing hypos eg if going low and with high amount of residual bolus, as well.as carbs. Secondly i found targetting my sugars to 6mM rather than 4 or 5 gave me a great hypo sensitivity eg i now feel sweaty and sick at 4mM . before i did this i could function at 1.7mM. My hba1cs havent tremedously improved or worsened. But i'm having FAR fewer hypos. When i was younger and skint, i used to walk literally everywhere up to 10 miles and 30 miles by accident one day. My hba1c was the lowest tge consultant had ever seen. In old money 4.4. Without hypos. [/QUOTE]
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