Implementation of Guidelines and a Decision Support Tool for Blood Glucose Monitoring Device Prescriptions in Saudi Arabia: Compliance Assessment and Potential Cost Savings and Coverage Expansion

Introduction The Saudi Ministry of Health implemented prescribing guidelines and an integrated Decision Support Tool within the electronic prescription system to enforce eligibility, quantity, and timing criteria for blood glucose monitoring devices. This study assessed guideline compliance, estimated potential cost savings, and modeled the potential expansion in patient coverage resulting from the rejection of non-compliant prescriptions. Methods This was a cross-sectional, descriptive study. Data were collected from the records of the electronic prescription system ("Wasfaty"), covering prescriptions for blood glucose monitoring devices issued between January and December 2023, both overall and by specific item. The data also included the number of prescriptions rejected due to non-compliance with guidelines, both in total and by item type, and the costs of the different blood glucose monitoring devices. Potential new patient coverage was modeled by dividing rejected items by the standard per-patient allocation over the prescribed interval. Results The Decision Support Tool rejected 1,600,517 non-compliant prescriptions for blood glucose monitoring devices, constituting 0.9% of the total prescriptions issued in 2023. Continuous glucose monitoring (CGM) system readers showed the highest non-compliance rate (64.6%), followed by glucometers (49.3%) and CGM system sensors (31.1%), while glucometer strips and lancets had minimal non-compliance rates (0.70% and 0.50%, respectively). The potential cost savings from rejecting non-compliant prescriptions totaled approximately USD 25.6 million (96 million Saudi Riyals). The greatest savings came from flash glucose monitoring system sensors (62.5%), followed by glucometer devices (14.6%), and glucometer strips (11.5%). The rejection of non-compliant prescriptions could enable expanded coverage of new patients, including 63,367 annually for glucometer strips, 56,399 for glucometer lancets, 212,529 for glucometers, 64,394 for glucose monitoring system sensors, and 28,025 for glucose monitoring system readers, based on standard prescription intervals. Conclusion Non-compliance was highest for CGM system readers, glucometers, and CGM system sensors. The rejection of non-compliant prescriptions through prescribing guidelines using the Decision Support Tool potentially leads to cost savings and expansion of blood glucose monitoring device coverage. Further research in Saudi Arabia is needed to identify factors influencing guideline adherence and to evaluate the intervention's impact on clinical outcomes.