The Stoma Appliance Scheme can improve the clinical outcomes and quality of life of ostomates, if the following were taken into consideration.

Recommendations of 5 previous SAS reviews and SAS outcomes consultation have been dismissed.

1.

• Taking an evidence-based approach to new applications – like the PBS (Deakin University, 2010).

• Price of stoma appliances be reviewed annually (Coopers & Lybrand, 1996) and fair compensation for suppliers (Carla Cranny and Associates, 2002).

• Arrangements for emergency and new member supplies must be improved (Carla Cranny and Associates, 2002).

• Regular patient reviews (Coopers & Lybrand, 1996; Carla Cranny and Associates, 2002).

• Limited access to Health professionals (Department of Health, 2020) and shortage of stomal therapy nurses (Colorectal Surgery Clinical Committee, MBS review 2018) limits access to products.

• Lack of GP awareness in caring for an ostomate (Department of Health, 2020).

There has been no increase in price for stoma appliances in more than a decade, which is hurting the Medical Technology Industry, Stomal Therapy Nurses (STNs) and patients.

2.

• There has been no increase in prices of stoma appliances since 2012.

• The benchmark prices take no consideration of the effects of inflation, which has risen by over 39 per cent since the scheme stopped annual indexation.

• At present, over 5% of the total SAS expenditure is borne free of charge by manufacturers, due to a just in time multi site distribution of stoma appliances.

• Industry spend on STN education is reducing and will continue to do so.

• For over a decade there has been no significant increase in Government expenditure.

• Patients in Australia do not have access to stoma products available elsewhere in the world, and over half of the products on the scheme’s schedule are over 25 years old.

• This is because the price of products in the SAS are benchmarked and have not changed since 2012. Benchmark prices stifle innovation.

• Newer, more advanced products cannot enter the Australian market at prices more than a decade old.

• Many patients find that the SAS products they need are restricted by the Stoma Products Assessment Panel (SPAP).

• This means the patient must seek approval from an STN or surgeon.

• In light of the shortage of STNs and other qualified health professionals, access to these products is reduced.

• STNs are qualified health care professionals who care for ostomates.

• There is a shortage of nurses with sufficient stomal therapy qualifications, and many patients are not:

Having their stomas reviewed regularly (12 months)

Not receiving the most clinically suitable products from the SAS

Are not accessing the scheme altogether.

• Due to the shortage of STNs, ostomates visit their GPs.

• GPs lack awareness and understanding of patient needs.

• Because of this, patients are not fully aware of the restrictions, maximum quantities available to them, and general guidance and education around product suitability.

• Changes in body shape can impact the stoma shape and size, along with a stoma appliance that may not accommodate the needs of a changing stoma.

• This can invariably lead to leakage and subsequent burnt and damaged skin, forcing frequent changes to stoma appliances.

• Supporting products are an essential part of the solution, suited to the individual patient’s stoma size, shape and body type.

• The range of clinical presentations, treatments and products required for ostomates is bespoke.

• Patients that need stoma products include bowel cancer patients, those with Crohn’s disease, and premature babies. A stoma often changes in the first three months after surgery. 

• Increasing or decreasing weight (or other body changes) can cause a stoma to change, thus patients require regular assessments of stomas to ensure the most appropriate products are being used.

• The needs of ostomates cannot be met by a tender process, which would further limit the products available to those successful in the process.

• An HTA process that indexes prices, following a historical price correction is the best way to ensure the SAS provides the products that Australian patients need.