Review of the Stoma Appliance Scheme

Purpose

The project involved conducting a comprehensive review of the Stoma Appliance Scheme (the Scheme), which provides fully subsidised stoma appliances and products to approximately 49,000 ostomates in Australia. The review aimed to assess the Scheme's clinical eligibility criteria, product pricing methodology, accessibility for marginalised groups, and potential duplication with other schemes, in addition to identifying opportunities to improve the efficiency, sustainability, and accessibility of the Scheme.

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Approach

We undertook the following key tasks:

• Document review and stakeholder consultations: Engaged with key stakeholders, including stomal therapy nurses, stoma associations, product suppliers, and government representatives, to gather insights on clinical eligibility, accessibility, and pricing mechanisms.
• Assessment of clinical eligibility: We assessed the current clinical eligibility to ensure it aligned with the Scheme's principles and intent. We also investigated the possible inclusion of stomas that occur outside the gastrointestinal tract or stomas that do not facilitate the removal of waste products.
• Duplication analysis: Investigated other government subsidy schemes (national and state/territory) to identify potential duplication in the current eligibility criteria or opportunities for expanded eligibility.
• Pricing methodology review: Evaluated the pricing methodology and cost models for products under the Scheme and explored the feasibility of periodic price reviews to align with health technology assessment methods and other subsidy schemes.
• Budgetary analysis: Nineteen agreed scenarios were modelled, and the budgetary implications assessed. The analysis identified some cost-saving measures, such as the removal of certain products and/or reduction of product quantities, to contribute to enhancing the Scheme’s cost-effectiveness.
• ‍Data analysis: Conducted in-depth analysis of Pharmaceutical Benefits Scheme (PBS) data to evaluate product utilisation, cost trends, and the impact of changes in clinical eligibility over time.

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Outcome

Our report was published by the Department of Health and Aged Care and its 10 recommendations informed the Stoma Appliance Scheme Panel's considerations and recommendations to government.

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Client

Department of Health and Aged Care