THE PAEDIATRIC SOCIETY
OF NEW ZEALAND
Secretariat:
Email:
Website:
Weee
Denise Tringham
P O Box 22 234
Wellington 6441
Tel:
(04) 938 4827
Fax: (04) 976 4827
denise@paediatrics.org.nz
www.paediatrics.org.nz
3 March 2012
Natalie Davis
Therapeutic Group Manager
PHARMAC
PO Box 10 254
Wellington 6243
Natalie.davis@pharmac.govt.nz
Dear Ms Davis,
Re:
Proposals Relating to Multiple Diabetes Management Products
Proposal to List Insulin Pumps and Consumables
I am writing on behalf of the Special Interest Group in Paediatric Endocrinology and Diabetes, a
subgroup of the Paediatric Society of New Zealand. Our members consist of General Paediatricians,
Specialist Paediatric Endocrinologists, Diabetes Nurse Specialists and other Allied Health professionals
involved in the care of Children and Adolescents with diabetes throughout New Zealand. We have
noted the above proposals with interest and were delighted to see that Insulin Pumps will now been
more available to our patients. We were also very pleased to see that access to Blood Glucose meters
will be available to a wider group of patients. Both of these changes will be of significant benefit to our
patients.
However we have significant concerns regarding the proposal to award sole supply of blood glucose
meters and test strips to Pharmco, to supply CareSens products. While we fully support the need to
reduce costs and understand what Pharmac are trying to achieve with this proposal, we have concerns
that are specific to Paediatric patients with Type 1 Diabetes:
1) The ability to frequently and accurately measure blood glucose is life-preserving in this patient
group. We are concerned that moving to a single supplier, regardless of who that supplier is,
creates a significant problem if the strips should be found to be underperforming or inaccurate in
the future (you may recall that this happened in 2007 with Roche). The market would be
compromised and no other company likely to be available to supply products at short notice.
2) It is already very difficult for families who have children with diabetes without this distraction and
disruption. Often they have trained family and friends on the use of their meter in order to have
their support, re-education will be a significant burden for them.
3) A number of families have purchased additional meters as fail safes or for use at school or with
other care-givers. The cost of replacing these will be significant.
4) It's not clear from the RFP whether any consideration of use in very young children has been
required, particularly in neonates. Many blood glucose meters lack precision at low blood glucose
levels, which are the levels where clinical treatment decisions are being made for these infants.
5) Changing the type of lancets can be very distressing for children who can be very resistant to
change, particularly when the procedure involves even a small amount of pain. Can we be
assured that the lancets are as painless as those currently available? If not this may lead to less
frequent testing and poorer health outcomes.
6) Having two meters for blood glucose and ketone testing creates an extra layer of complexity for
families. A number of our members manage most of their patients to Optium meters as they work
well for blood glucose and ketone measurements. They have noticed that hospital admission
rates have dropped as patients and their families better understand the importance of ketone
testing and have the convenience of being able to test on the same meter. There is concern that
we will lose our patient / parent confidence if we take a step backwards to two meters again.
“Health of our children: Wealth of our nation”
7) Users of Roche Pumps will be significantly disadvantaged as their meter is used to remotely
access the pump via wireless technology. Families who have invested in this smart technology
will no longer have access to it. Young people using these pumps are able to make insulin
adjustments using their meter rather than having to find somewhere private to make adjustments
to the pump manually, as the pump is under their clothing. This is particularly important for
adolescent patients who are often less complaint in their diabetes management.
Other issues raised by our members relate to the significant logistical issues that this change will
engender.
1) This change will require re- education to health professionals which will be time consuming and
will of necessity reduce the time available to spend dealing with other issues. Normally when a
new product is added to the schedule there is a small initial uptake which allows the education
process to be spread out over a longer period.
2) There will be a great deal of extra work educating families which will carry a significant cost to
services.
3) Getting the new software installed on DHB workstations will be problematic. Information Services
are generally very reluctant and there will be significant delays. In the past it has taken up to a
year for new software to be approved and installed.
4) Members are not familiar with the software; they question whether it has the same functionality as
Optium and Accu-chek.
Thank you for taking these issues into consideration.
Yours sincerely,
Dr Fran Mouat
Chair, Paediatric Diabetes and Endocrinology SIG
Paediatric Society of New Zealand