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Insulin pump special eligibility criteria in New Zealand: a survey of prescriber opinion and practice.

AIM
Funding for insulin pump therapy (CSII) in New Zealand for people with type 1 diabetes is determined by meeting PHARMAC special authority (SA) criteria. We aimed to survey the opinion and practice of CSII prescribers with respect to the current SA criteria and contextualise the results with respect to contemporary literature and best practice.


METHOD
Quantitative and semi-qualitative survey of CSII prescribers in New Zealand. Mixed qualitative and quantitative analyses were used.


RESULTS
Of the 94 survey respondents, 88% stated the criteria needed updating. However, 75% maintained CSII funding by PHARMAC should remain under updated SA criteria. Most (60%) of respondents thought the current criteria did not promote health equity for Māori and Pasifika. Only 33% of respondents strictly adhered to the criteria. Thematic analyses of free text responses indicated that the criteria did not reflect quality of life benefits offered by CSII, changes in life course, clinician or patient autonomy, and beneficence of CSII not otherwise stated in the current criteria.


CONCLUSION
The majority of CSII prescribers in New Zealand disagreed with the SA criteria, resulting in most not strictly adhering to them. Updated criteria are required to improve health equity, and reflect best evidence.