Based on a Medtronic survey of the average cost of $3.28 per day for hospital policies with coverage for insulin pumps. Regression analyses explored the role of sociodemographic factors. Explanatory variables included an indicator for insulin treatment therapy, demographics (sex, marital status), and socioeconomic characteristics (logarithm of disposable income, level of education). [1] recently published the data from a pragmatic randomized controlled trial (RCT) comparing the efficacy, safety and cost-effectiveness of insulin therapy delivered over a period of one year, either as continuous infusion (through a pump) or multiple daily injections, in children with newly diagnosed type 1 diabetes mellitus (T1DM). We observed only a few deaths (n = 353 [2.5% main analysis sample], no difference pump vs. MDI [OR 0.98 (95% CI 0.79–1.23)]) and similar rates of cardiovascular disease for pump and MDI in this study, except for borderline significantly fewer events with angina in the pump group. Table 2 shows univariate estimates of mean annual resource use and costs by type, and Supplementary Table 4 presents median statistics. This allows patients to avoid multiple needle pricks and insulin injections each day. Corresponding author: Katarina Steen Carlsson. Admissions for diabetic ketoacidosis were lower in the insulin-pump group than in the insulin-injection group -- 2.3 and 4.7 per 100 patients per year, respectively, according to the study. Relevance: Blair, et al. A heterogeneous distribution of events was found across nontreatment characteristics: ∼70% of all cardiovascular events occurred among individuals 48 years of age or older, and >90% of the events occurred among individuals with diabetes duration ≥20 years at baseline. Pumps are recommended for children under 12 when multiple daily insulin injections aren’t practical or appropriate. Mean annual costs in 2005–2013 for people with type 1 diabetes on insulin pump or MDI therapy by subgroup. Equipment costs include the glucose meters and consumables (lancets and test strips), insulin pens and consumables (needles), and insulin pumps and consumables (batteries, and infusion sets). AIMS: To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. More information is available at http://www.diabetesjournals.org/content/license. Riley D, Raup G. Impact of a subcutaneous injection device on improving patient care. Objective: To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. If you live in certain areas of the country, you may have to use specific pump suppliers for Medicare to pay for an insulin pump. As outrage over rising drug prices continues to mount, prices for insulin have seen a small decline. Nurs Manage. With tube insulin pumps cost around $4000-$5000 each, while tubeless pumps cost around $6000-$7000 each. AIMS: To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. share joint last authorship. Therefore, it is important for pharmacists to consider the clinical and economic implications of the decision between insulin pens and insulin vials and syringes. However, only 70% of individuals with pump therapy could be matched, and baseline characteristics indicated high standardized differences in age, diabetes duration, and HbA1c between treatment groups in the entire cohort. Available from, Swedish National Board of Health and Welfare (Ed.). The first kind is a traditional insulin pump. Effects of insulin pump vs. injection treatment on quality of life and impact of disease in children with type 1 diabetes mellitus in a randomized, prospective comparison. The account is genuine, typical and documented. Exclusion criteria were filled prescription of implantable insulin pump or extemporaneous insulin, intermittent use of insulin pump therapy, one or more insulin pumps in the Swedish Prescribed Drug Register >1 year before entry as a pump user in the NDR, or entry in the NDR after the date of death. Stockholm, Sweden, Socialstyrelsen, 2016 (publication no. Clinically, insulin pens show an advantage through i … Five of the studies reported long-term discounted incremental costs of insulin pumps of $20,000–$40,000, whereas two studies reported lower and one higher additional costs for insulin pump therapy. We assumed that 28% of MDI users in the United States use pen devices and inject four times per day (Medtronic data on file). The hormone that controls blood sugar among diabetics is one of the oldest medicines used today. The authors thank the regional NDR coordinators and contributing nurses, physicians, and patients. Healio.com. Author Contributions. While there are many different insulin pumps available on the market, there are typically two kinds of pumps you can get. The oldest age-group in this study experienced diabetes onset in the 1960s–1980s, when treatment options differed from today’s standard care. Annual resource use and annual costs in 2005–2013 for individuals with type 1 diabetes on insulin pump or MDI therapy. This large nationwide study of 4,991 individuals with type 1 diabetes and insulin pump therapy and 9,247 propensity score–matched control subjects with MDI treatment showed higher annual total costs for pump therapy (∼$3,900). From 2014 to 2019, the average cash price for insulins climbed substantially — the average price per insulin unit rose 47%, from $0.23 to $0.34. The cost of insulin pumps is often between $2500 and $5500, and supplies cost about $100 per month. The sensitivity analyses of cohort specifications and matching criteria indicated that average annual costs for individuals with type 1 diabetes were robust and similar to results from the main analysis (pump therapy range −0.6% to −8.5%, MDI range 0.5% to −10.5%) (full results in Supplementary Table 9). Health care costs are higher for Swedish adults with type 1 diabetes who use insulin pump therapy compared with those who use multiple daily injections, according to findings published in Diabetes Care. Imputation, matching, and construction of cohorts were performed with SAS 9.3 software (SAS Institute, Cary, NC). We understand that trying to get an insulin pump can be very frustrating, and you might feel disappointed if you can’t get one. CBS News quotes a college student saying her bill for insulin has risen from $130 to $495 per month. With the use of propensity score matching, a real-world study of German-Austrian registry data (age up to 20 years) on type 1 diabetes found lower rates of severe hypoglycemia and diabetic ketoacidosis associated with pump therapy than with MDI and for the unmatched entire cohort (14). Abstract Importance: Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. The pump acquisition cost was amortized over 5 years. Including unemployment benefits, a small difference was found in total production loss, with higher costs in the pump users (P = 0.041). Time-invariant covariates included sex, education, and country of origin, and time-variant covariates were age, marital status, diabetes duration, HbA1c, systolic and diastolic blood pressure, BMI, LDL and HDL cholesterol, estimated glomerular filtration rate, microalbuminuria, macroalbuminuria, smoking status, preventive treatment (use of statins for hyperlipidemia, antihypertensive drugs, acetylsalicylic acid for platelet inhibition, use of other anticoagulants), previous disease (cancer, atrial fibrillation, myocardial infarction, coronary heart disease, cardiovascular disease, heart failure, hyperglycemia, liver disease, mental disease, renal failure, stroke), and yearly disposable income. This pump uses a tube to connect the pump to the cannula. Pump users were less likely to have a period of unemployment (unadjusted OR 0.803 [95% CI 0.721–0.894], adjusted OR 0.821 [0.736–0.915]). The difference in research questions between this study and the NDR study required alternative estimation methods. © 2021 by the American Diabetes Association. Attrition of the panel was a result of death. The corresponding cost for a 40-year time horizon is $95,000. We considered observations with ≤24 months between multiple entries in the NDR as valid for analysis of continuous treatment. Social insurance payments underestimate the value of lost production because they are subject to floor and ceiling effects and are lower than wages. Regression analyses controlling for demographic and socioeconomic factors underscored the robustness of results on cost differences related to pump therapy. However, cost differences between the study groups of the sensitivity analyses were stable at ∼$4,000 (range $3,600–$4,600). Also, being attached to the pump via tubing or pod is a 24/7 thing and for some this makes a pump a constant reminder of diabetes. With an insulin pump, it’s harder to hide. No tedious technical management. No tedious technical management. This is a great feature that I have yet to use. The Supplementary Data presents additional panel data regressions on the risk of at least some inpatient care, sickness episodes, and use of unemployment benefits. The second type of insulin pump is a patch pump. Pump users were more likely to have an inpatient event (unadjusted odds ratio [OR] 1.072 [95% CI 1.013–1.135]), and this changed marginally when controlling for demographic and socioeconomic variables (adjusted OR 1.087 [1.027–1.151]). Registration of insulin pump therapy started in 2002 in the NDR, and use of pump therapy among individuals with type 1 diabetes increased from 10% in 2002 to 22% in 2015 (6). Background Facts 2016: 1. The subgroup analyses explored duration of continuous pump therapy (≥6 study years), individuals with an observed switch to pump therapy (at least one entry of MDI in the NDR before switching to insulin pump), three levels of HbA1c at the index date (Diabetes Control and Complications Trial [DCCT] <6.5%, 6.5–8.5%, ≥8.6%; International Federation of Clinical Chemistry and Laboratory Medicine <48 mmol/mol, 48–69 mmol/mol, ≥70 mmol/mol), four age-groups, and sex. Approximately one-quarter of additional annual costs for individuals with type 1 diabetes age ≥48 years (∼25% of the cohort) could be prevented with insulin pump therapy. Continuous subcutaneous insulin infusion, or insulin pump, therapy for individuals with type 1 diabetes has increased gradually since the 1980s. The final analysis set included data in 2005–2013 for 14,238 individuals with type 1 diabetes, of whom 4,991 had insulin pump therapy (598 individuals switched to pump therapy in 2005 or later after original inclusion as control subjects with MDI). With tube insulin pumps cost around $4000-$5000 each, while tubeless pumps cost around $6000-$7000 each. Disclosures: Carlsson reports she is an employee of the Swedish Institute for Health Economics. The second type of insulin pump is a patch pump. For moderate insulin users, the costs were about the same at $22,380 for injections and $23,002 for pump therapy. 2016-5-9) [in Swedish], Statistics Sweden (Ed.). This observational study calculated costs of insulin pump therapy and MDI in individuals with type 1 diabetes using real-world data with 9 years of follow-up. This study followed 345 young people on pump therapy over the course of seven years, matching them to controls using insulin injections. There were also more annual outpatient visits among pump users compared with multiple daily injection users (3.8 vs. 3.5; P < .001). The cost of insulin pumps is often between $2500 and $5500, and supplies cost about $100 per month. METHODS: We constructed a Markov model to estimate the costs and outcomes for patients with insulin-dependent diabetes (IDDM) treated with CSII using an insulin pump compared with MDI. The NDR includes ∼97% of all Swedish individuals with type 1 diabetes age 18 years and older. For instance, 1.5% of person-years had a cardiovascular event, and 5% had at least one health care contact with a cardiovascular diagnosis. BMJ. 1 shows a flowchart of study inclusion and exclusion. A.-M.S. Mean age at baseline was 34 years, with 21 years of diabetes duration and a mean HbA1c of 8.1% (65 mmol/mol). If that were the case, the incidence of diabetic complications would not differ between the two treatment alternatives, at least not those associated with maintaining adequate glycemic control. The greatest deviation (pump −8.5%, MDI −10.5%) was observed for the smallest cohort with a strict definition of continuous treatment and no imputation (complete cases cohort D2) (Supplementary Table 3 and Supplementary Fig. S.G. and K.S.C. still is. However, real-world data on health care and societal costs of insulin pump therapy compared with MDI therapy are scarce. Supplementary Fig. Semilogarithmic population-averaged panel data regression analysis was used to investigate the correlation between total costs and explanatory variables with and without a time trend. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. References. With tube insulin pumps cost less than tubeless or implanted pumps. This pump uses a tube to connect the pump to the cannula. Most people in the UK who have a pump have it funded by the NHS. The hormone that controls blood sugar among diabetics is one of the oldest medicines used today. The distribution of annual costs was left-skewed with a tail of observations with high costs, although the most person-years incurred costs corresponding to typical insulin therapy and up to two regular follow-up appointments (Supplementary Fig. Since an insulin pump is delivering rapid-acting insulin all the time, you most likely will have too much insulin in your system for any type of spontaneous movement the majority of the time. In addition, higher HbA1c levels at enrollment in the Swedish National Diabetes Register were associated with increased costs (P <.001), as was starting therapy at age 18 years or older compared with younger (P < .001). Now, with the pump, it’s one injection every 3 days. In the UK you get injections on the NHS while you might have to pay for a pump. These smart insulin pens have a lot of functionality like tracking insulin dosing, insulin delivery to the .1u (beginning at .5u), Bluetooth or USB function to read data on a computer, etc. The main findings included a lower adjusted hazard ratio of fatal coronary heart disease and fatal cardiovascular disease as well as lower all-cause mortality. If you have an insulin pump on the NHS , you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. No other potential conflicts of interest relevant to this article were reported. Swedish National Diabetes Register. Injection Delivery. Insulin via subcutaneous injection delivers insulin … The NDR documents insulin treatment regimens since entry in the register, and the start date of insulin pump therapy is available for individuals who initiate treatment while entered in the NDR. The indication for insulin pump is broad with no out-of-pocket expenses for the patient. According to the same website, the average insulin pump price, is expensive and some patients cannot afford it, not without the help of their insurance coverage. Control subjects on MDI were matched 2:1 using time-varying propensity scores. RESEARCH DESIGN AND METHODS Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. Data on sickness benefits, unemployment benefits, and early retirement benefits were taken from the National Integrated Database for Labor Market Research (10). Of the total cohort, 4,991 used insulin pump therapy (mean age, 33.8 years; 51.1% women). Data from the Swedish National Diabetes Register (NDR) have shown a lower incidence of some cardiovascular events and all-cause mortality for individuals with type 1 diabetes on insulin pump therapy in 2005–2012 (5). Enter multiple addresses on separate lines or separate them with commas. Yet, a Cochrane review concluded in 2010 that although some evidence indicates that insulin pumps improve glycemic control compared with standard multiple daily injection (MDI) therapy, insufficient evidence exists regarding mortality, morbidity, and costs (1). Research design and methods: Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. Visit www.pparx.org or call 1‑888-4PPA-NOW. Stockholm, Sweden, Statens beredning för medicinsk och social utvärdering, 2013 (publication no. There was no significant difference in body mass index between pump therapy and injection therapy groups. (2) performed a meta-review of model-based studies that compared pump therapy and MDI, concluding that pump therapy can be cost effective. 20 Years of Successful Improvements. Real-World Costs of Continuous Insulin Pump Therapy and Multiple Daily Injections for Type 1 Diabetes: A Population-Based and Propensity-Matched Cohort From the Swedish National Diabetes Register, Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus, Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in type 1 diabetes: a systematic review, Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis, Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study, Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18,168 people with type 1 diabetes: observational study, Propensity score matching with time-dependent covariates, Review of statistical methods for analysing healthcare resources and costs, Comparison of evidence on harms of medical interventions in randomized and nonrandomized studies, Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes, Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes: a health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial, Range of risk factor levels: control, mortality, and cardiovascular outcomes in type 1 diabetes mellitus, Mortality and cardiovascular disease in type 1 and type 2 diabetes, Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study, Postintervention Effects of Varying Treatment Arms on Glycemic Failure and β-Cell Function in the TODAY Trial, Worldwide Epidemiology of Diabetes-Related End-Stage Renal Disease, 2000–2015, Incident Type 2 Diabetes and Risk of Fracture: A Comparative Cohort Analysis Using U.K. Primary Care Records, Institutional Subscriptions and Site Licenses, Special Podcast Series: Therapeutic Inertia, Special Podcast Series: Influenza Podcasts, http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc18-1850/-/DC1, http://www.diabetesjournals.org/content/license, http://www.socialstyrelsen.se/klassificeringochkoder/norddrg/vikter. Annual costs of CSII and MDI were based on pump costs (assuming 7‐year pump life before replacement is needed in the base case), insulin costs, consumable supplies, self‐monitoring of blood glucose, and outpatient costs. Health care costs, including medications and disposables, accounted for 73% of the costs for pump therapy and 63% of the costs for MDI therapy. Periods of sick leave <14 days are not included in national registers, and some of the workforce may not yet be eligible for unemployment benefits (e.g., young people with short contracts). With tube insulin pumps cost less than tubeless or implanted pumps. Abstract Importance: Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. NICE guidance in 2008 records the following costs of insulin pumps: A single pump cost about $5,500 dollars already, while the supplies cost about $100 monthly. and A.-M.S. Results from regression analyses of the annual risk of having an inpatient admission (15% of person-years), a period of sick leave (12% of person-years), and a period of unemployment (6% of person-years) are shown in Supplementary Table 6. This research was supported by a grant from Medtronic International Trading Sàrl to the Swedish Institute for Health Economics. Total annual costs increased with age for both insulin therapies, and pump therapy was associated with higher costs across age-groups. No worrying. If you have an insulin pump on the NHS, you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. Five of the studies reported long-term discounted incremental costs of insulin pumps of $20,000–$40,000, whereas two studies reported lower and one higher additional costs for insulin pump therapy. However, the cost increments for insulin pump therapy decreased with age (differences ranging from 56% for those 18–27 years of age to 44% for those ≥48 years [reference: MDI 18–27 years]). Research design and methods: Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. For low-dose patients, injections were less expensive than pumps, with the former costing $9,172 for four years versus $14,994 for the latter. We used diagnosis-related group (DRG) codes and the main diagnosis to assign costs to inpatient and outpatient specialist appointments. All prices are at the 2013 level, using the Consumer Price Index to adjust costs of medications, disposables, and income and the Län (County) Price Index to adjust prices of appointments. This is very difficult to answer straight off the bat, because this is a highly individual topic. Gothenburg, Sweden, Centre of Registers Västra Götaland, 2016, Swedish National Board of Health and Welfare. Pediatr Diabetes 2008; 9 (4pt1): 291-6. doi: 10.1111/j.1399-5448.2008.00396.x pmid: 18466210 © 2019 by the American Diabetes Association. Introduction: Fasting Ramadan carries a high risk for patients with type 1 diabetes (T1DM). Overall, we found similar results for both study groups in terms of health care resource use other than medications and disposables. There was no significant difference in body mass index between pump therapy and injection therapy groups. However, real-world data on health care and societal costs of insulin pump therapy compared with MDI therapy are scarce. The largest cost difference was found for individuals with middle HbA1c levels (6.5–8.5% [48–69 mmol/mol], pump $12,824 vs. MDI $8,083; P < 0.001). Cost & Reputed Branded Insulin Pump. This might be beneficial for some, but a psychological downer for others. and K.S.C. The costs of insulin were calculated by two methods: insulin dispensed and insulin used. The study cohort was younger than the average individual with type 1 diabetes in the NDR (34 vs. 46 years), had a shorter duration of diabetes (21 vs. 24 years), and had a higher HbA1c (8.1 vs. 7.8% [65 vs. 62 mmol/mol]) at baseline. Pump users also spent more annually on medication costs, including disposables ($5,861; 95% CI, 5,814-5,907), than multiple daily injection users ($2,285; 95% CI, 2,270-2,300). In principle, optimal glycemic control may be achieved by either MDI or insulin pump therapy. No worrying. The difference in study design and construction of cohorts suggests that cohort characteristics may differ. This subgroup had a slightly younger mean age and mean diabetes duration when entering the cost analysis than the cohort for the main analysis. Mean cost for women and individuals starting insulin pump therapy while entered in the NDR were slightly higher, but the difference was lower between treatment groups than in the main analysis. A total of 748 individuals switched from MDI to pump therapy after inclusion as a control subject and contributed data in each group. We found lower rates of events in our adult population than the German-Austrian study (14). The current data represent real-world use of insulin pumps in 2005–2013, with significant proportions of young adults and other individuals who had <20 years of diabetes duration. Association Of Insulin Pump Therapy Vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, And Glycemic Control Among Children, Adolescents, And Young Adults With Type 1 Diabetes. Mean annual costs were analyzed using univariate analysis. “Identification of tangible and intangible patient benefits from insulin pump therapy over time remain important to the valuation of technology and support of resource allocation decisions.” – by Phil Neuffer. At baseline, the proportion of previous cardiovascular disease in the NDR study (5) was 5% versus 8% of the pump versus MDI groups, respectively, whereas it was ∼2.5% in both groups of the current study. Objective: To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. The risk for inpatient admissions was higher for women, increased with age, and decreased with disposable income and years of education. All costs are indexed to 2013 values. Overall inpatient costs were higher for pump users ($1,972; 95% CI, 1.864-2,081) compared with multiple daily injection users ($1,897; 95% CI, 1,826-1,968), specifically in relation to inpatient services for diabetes complications (P < .012). This cohort contained the highest number of individuals. But more than 90 years after its discovery, a low-cost version is no longer available in the U.S. Diabetes Care. The controls are located on the pump, which is kept in your pocket. The strength of this observational study is the size and completeness of the study population, with virtually all adults with type 1 diabetes in Sweden included, longitudinal national register data, and a matching technique that accounts for time-variant variables, including diabetes duration, diabetes-related conditions and comorbidities, and demographic and socioeconomic factors. Cox proportional hazard functions were used to account for time-variant covariates in the matching equations and to model the time since last measurement for control subjects (7). Equipment costs include the glucose meters and consumables (lancets and test strips), insulin pens and consumables (needles), and insulin pumps and consumables (batteries, and infusion sets). 1A and B). Insulin costs have soared from $100–$200 per month a few years ago to $400–$500 a month now. Longitudinal data on health care resource use, antidiabetes treatment, sickness absence, and early retirement were taken from national registers for 2005–2013. Extended bolus. Whether insulin pump therapy is cost efficient ultimately depends on therapeutic effects beyond resource use and costs as well as on how much the payer is prepared to invest in additional quality-adjusted life-years (QALYs). Pump users also had relatively more events related to ketoacidosis, hyperglycemia, and atrial fibrillation, but all those rates were <50 per 1,000 person-years. The risk for unmarried individuals was higher and showed an inverted U shape for age and education, with the highest risk for those 28–37 years old and for those with 10–12 years of education. The main analysis used cohort A1, combining a liberal definition that allowed for single information gaps and the most extensive imputation strategy. Duality of Interest. Insulin pumps, cartridges, and infusion sets may be far more expensive than syringes used for insulin injection. Insulin pumps are expensive and no matter the style or brand will cost at least several thousand dollars. reports personal fees from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Mundipharma, Navamedic, Novo Nordisk, Sanofi, and RLS Global and unrestricted research support from Sanofi, all outside the submitted work. As the longest and largest study of the effectiveness of pump therapy, the study found that episodes of severe hypoglycaemia (dangerously low blood glucose) more than halved, while events in the control group increased. The study cohort was young (mean baseline age 34 years) with relatively few diabetic complications in both study groups. And please don’t be fooled into believing that an insulin pump provides better control. Before I was on the pump I would give about 10 injections a day (including my long-acting insulin). The Supplementary Data further describes the costing strategy and variables (Supplementary Table 2).
Deltapoint Pro Battery Life 2019,
Command Hooks Heavy Duty,
Safeway Alcohol Hours,
Eotech Hhs1 Vs Hhs 2,
Single Recliner Sofa Singapore,
Car Paint Supplies Online,
Herriman House Fire,
Ocean Reef Key Largo Membership Cost,
Minute Quinoa Cups Nutrition Facts,
Where To Buy Kiss My Keto,
Zagnut Candy Bar Where To Buy,
What Are Supervisory Skills,
Where To Buy Sanka Coffee,