Ostomy appliance prices in Europe.

OBJECTIVE: This article aims to compare market prices (i.e., third-party reimbursement and patient co-payment) of one-piece and two-piece colostomy, ileostomy and ureterostomy appliances in Belgium, Denmark, England and the Netherlands in 2005. METHODS: Data were collected through contacts with health authorities, health insurance companies, manufacturers, industry associations and distributors. The price difference between Belgium and another country was expressed as a proportion of the Belgian price. RESULTS: A total of 64 out of the 72 ostomy appliance products considered were cheaper in Belgium. Prices of one-piece colostomy appliances and two-piece ileostomy appliances were consistently lower in Belgium. The highest prices of ostomy appliances were observed in the Netherlands. Sixteen out of 20 products and 21 out of 25 products were more expensive in Denmark and England, respectively, than in Belgium. Colostomy appliances were more expensive in England than in Belgium. CONCLUSIONS: Market prices varied substantially between countries, indicating that manufacturers adapt their pricing strategy to the policy environment existing in the ostomy appliance market of each country. Also, there appears to be scope for reducing prices in some countries.

Estimation and comparison of ostomy appliance costs with tariffs in Belgium.

This study estimated costs of production and distribution of ostomy appliances, and compared cost estimates with tariffs in Belgium. The cost model took into account manufacturing costs, overhead, R&D, warehousing, profits, and distribution margins. Data were derived from manufacturers, a decomposition of finished products, and interviews with stakeholders. The cost model generated estimated retail prices of euro 2.96 for one-piece appliances, euro 1.62 for two-piece pouches, and euro 2.06 for two-piece flanges. Production and distribution costs accounted for 40 and 60% of retail prices, respectively. Estimated retail prices corresponded well with tariffs for one-piece appliances and for two-piece pouches. For two-piece regular flanges, a substantial difference was observed between the calculated price of euro 2.06 and the tariffs of euro 6.05. In the absence of publicly disclosed information on the cost structure of appliances, estimating ostomy appliance costs is valuable to reimbursement agencies when setting tariffs.

Drawing on international experience to reform the Belgian market for ostomy appliances.

This article aims to review the regulatory framework governing the Belgian ostomy appliance market in the light of the experience of Denmark, France, the Netherlands and Ontario (Canada) with regulation of ostomy appliances. Information about the regulatory framework was derived from the international literature, analysis of legal texts and a survey completed by national experts. The comparative analysis revealed that these countries have adopted varying approaches towards regulating their domestic ostomy appliance market. Strategies to keep down prices include public procurement in Denmark, maximum prices in France and exclusion of expensive appliances from reimbursement in the Netherlands. To contain public expenditure on ostomy appliances, consumption patterns are monitored in the Netherlands, the quantity of reimbursed appliances is limited in Belgium and public reimbursement is restricted in Ontario. Ostomy appliances are generally distributed by community pharmacies and medical equipment shops. In countries that emphasise home care delivery such as Denmark, domiciliary distributors dominate the market to the detriment of community pharmacies which do not seem to be able to offer this service at a competitive price. An avenue for reforming the Belgian ostomy appliance market is proposed which valorizes the role of ostomy care nurses in guiding the choice of ostomy appliances. Furthermore, it is recommended that a competitive tendering process determines the price of ostomy appliances, that reimbursement for service provision by distributors is separated from reimbursement of appliances, and that patients receive a fixed grant from the third-party payer to buy ostomy appliances.