The prohibitive cost of insulin pump therapy

The upfront cost of insulin pump therapy is prohibitive for some patients over 18 years.

What happens when people with type 1 diabetes grow up? As it stands, in Australia, the Type 1 Diabetes Insulin Pump Program subsidises pumps for children under the age of 18 years. But after that, these patients are on their own.

So far, more than 350 pumps have been distributed to children who would not have otherwise had access. However, feedback comments on the Juvenile Diabetes Research Foundation (JDRF) website express frustration with lack of financial support for patients no longer in their teenage years. In fact, several people voice concerns that the majority of literature and funding exclusively target young people and newly diagnosed patients.

“I think it’s forgotten that children with type 1 diabetes do get older, and keeping healthy is the goal for a long life,” comments one person, whose 18-year-old daughter would benefit from a pump but has found the cost prohibitive.

While adults are eligible for subsidised ‘consumables’ to be used with insulin pumps through the National Diabetes Services Scheme, JDRF’s campaigns for subsidies for adults to cover the upfront costs of a pump have so far been unsuccessful, a spokesperson says.

JDRF CEO Mike Wilson says government subsidies for insulin pumps are available to children under 18 years “because the evidence clearly points to better health and wellbeing”.

A review of insulin pump therapy published in Nature this year concluded that the greatest reduction in HbA_1c levels occurs in patients with the worst glycaemic control, making  insulin pump therapy most appropriate and cost-effective in adults with continued, elevated HbA_1c levels or disabling hypoglycaemic episodes with multiple daily insulin injections (MDI).

However, the author cites two main drawbacks of pumps: higher costs, and the risk of ketosis if the pump fails.

Mr Wilson believes that adults should be free to choose the best method for their own situation without the price barriers.

“Adults in our community have told us they would like the choice of an insulin pump, but are constrained by the initial financial outlay, which is generally up to $8000. Others are happy with an MDI routine,” he says.

“Most people would agree that this decision should be made on the basis of health advice and personal preference, not a person’s financial situation.”

Diabetes Australia national policy adviser Professor Greg Johnson says Diabetes Australia is currently reviewing all aspects of insulin pump therapy, including access to devices, and support services, as well as other related new technologies, such as continuous glucose monitoring devices.

He says his organisation intends to release a new position statement in coming months.
http://www.nature.com/nrendo/journal/vaop/ncurrent/full/nrendo.2012.28.html