Case study: FreeStyle Libre
What did we do?
We appraised evidence on the FreeStyle Libre flash glucose monitoring system for diabetes, in response to FreeStyle Libre becoming available on the NHS Drugs Tariff. We published Guidance in November 2018.
We adapted a report published by the European Network for Health Technology Assessment (EUnetHTA), to verify our findings. Similarly, we engaged with the Scottish Health Technologies Group (SHTG) and benefitted from access to a patient organisation submission from Diabetes Scotland.
We engaged with a range of clinical experts from NHS Wales, including pharmacists and representatives of the Diabetes Network, as well as Diabetes UK Cymru. The device manufacturer also provided information and comments.
What were the reactions?
Stakeholders felt the review was high quality and they had confidence in our appraisal methods. They also felt that appropriate evidence had been reviewed and the process was robust.
What did we learn?
The quality and quantity of evidence wasn’t sufficient to recommend routine adoption of FreeStyle Libre for all people with diabetes. However, FreeStyle Libre was considered an appropriate alternative to finger-prick self-monitoring of blood glucose, in circumstances where multiple testing (eight or more times per day) is required.
Adapting evidence appraisals conducted by other health technology assessment organisations yields potential time and resource savings. The evidence base for clinical effectiveness is likely to be generalisable, but guidance should be tailored to local health service delivery and organisational considerations, including patient pathways and costs.
What difference did this make?
By supporting use of FreeStyle Libre only in people with diabetes who routinely undertake eight or more finger-prick tests per day, it will improve both technical and allocative efficiency in NHS Wales, i.e. get the most out of available resources and distribute them to the best effect. FreeStyle Libre is expected to be cost saving for NHS Wales when offered to people where evidence of benefit is demonstrated, saving £835,226. This cost saving is based on the assumption that there would be 50% uptake of the technology without HTW Guidance.
In an interview, one stakeholder commented that targeting the use of the FreeStyle Libre technology has improved the way in which it is being delivered in Wales.
The need for further data collection was identified, specifically to help fill gaps in knowledge about the effectiveness of the technology in specific populations.