Test Strip Trouble

Last week, an op-ed column by two doctors — one American, one Irish — was published in The New York Times. The authors describe an incident that occurred while they were working together at a remote, impoverished hospital in Haiti. A 12-year-old boy with Type 1 diabetes was brought in by his father, on the verge of death, in a state of diabetic ketoacidosis with his blood glucose levels off the charts due to an infection he had had for several days. Most people in Haiti cannot afford glucose meters and test strips, and the local health center nearest to the boy and father was out of test strips. Only when the boy’s condition worsened did his father make the long, expensive trip to the district hospital, where the two doctors had only 10 test strips at their disposal to monitor his condition. They gave him insulin and flooded him with IV fluids, but it was too late; the boy died soon after arriving at the hospital. In the column, the doctors argue that the lack of a standard, “universal” test strip makes it nearly impossible for remote areas like theirs to have glucose meters and test strips that are compatible with one another. Universal test strips, they argue, would be cheaper and thus more widely available, allowing for blood glucose monitoring on a much greater scale in poor countries.

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There are, of course, many reasons why diabetes care is lacking in countries like Haiti, including the fact that most supplies are donated from rich countries and can take months to reorder. But developing universal test strips could potentially dramatically lower the cost of monitoring in rich countries like the United States, as well. Right now, most manufacturers of blood glucose meters simply give the meters away, or sell them for a fraction of their development and manufacturing costs. The companies get the bulk of their revenue from selling proprietary test strips, designed to work with only their own meters. While it may be tempting to believe that meter manufacturers are colluding to keep this system in place for the sake of profits, in reality the variety of test strips in use is the natural result of competition and innovation. Today’s test strips, after all, are not the test strips of 15 years ago. Meters and strips have been engineered, over time, to require a smaller blood sample and to give faster, more accurate readings.

Nevertheless, one can argue that the cost-saving benefits of universal test strips would outweigh the loss of potential for further innovation. It may be better, for example, for many people with diabetes to monitor their blood glucose more frequently — which cheaper test strips could allow — than to monitor less frequently on a more accurate meter that uses less blood. Of course, requiring companies to offer meters that use universal test strips would be very difficult — even for an agency with broad regulatory authority like the US Food and Drug Administration (FDA) — since cost, rather than safety or effectiveness, would be the motivating factor. And if meter manufacturers were forced to accommodate universal test strips, they would most likely have to start charging customers for their meters. But for many, if not most, people with diabetes, insurance would most likely cover their meters, and insurers (including Medicare) might be less stingy in their coverage of test strips if they cost only a couple of pennies apiece.

What do you think — should blood glucose meters be compatible with universal test strips? Would you buy test strips from a generic manufacturer if they were compatible and cheaper, or would you still trust test strips made by your meter manufacturer more? Would you pay more up front for a glucose meter if it meant you didn’t have to worry as much about the cost of test strips, or about insurance covering them? Should Medicare cover more test strips per month than it currently does, or is it good that the agency tries to keep costs under control? Leave a comment below!

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