Resource impact summary report
Resource impact summary report
Recommendations
NICE has recommended that:
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There is not enough evidence to determine whether price variation is justified between different one-piece closed bags for adults with a colostomy.
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Stoma care services should have access to a broad range of one-piece closed bags available for prescription in the NHS, so that adults with a colostomy can have the most appropriate bag for them.
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A healthcare professional and the person with a colostomy should decide together which one-piece closed bag to use. Decisions should take into account clinical appropriateness and the person with a colostomy's needs and preferences (including preventing leakage, seepage and peristomal skin complications), which may change over time.
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If more than 1 one-piece closed bag is clinically appropriate and meets the needs and preferences of the person with a colostomy, use the least expensive option.
Eligible population
It is estimated that there are between 176,000 and 205,000 people in the UK, equivalent to between 148,700 and 173,200 people in England, living with any type of stoma. It is also estimated that between 13,500 and 21,000 people have stoma surgery each year (Osborne et al. 2022).
One-piece closed bags are typically used by people with a colostomy, but they can also be used by people with an ileostomy. The exact number of people who use one-piece closed bags is unknown.
Treatment options
After surgery, people with a colostomy get their bags and other stoma supplies through prescription from local dispensing appliance contractors (DACs) or community pharmacies. The choice of one-piece closed bag should be based on clinical appropriateness and the needs and preferences of the person with a colostomy.
Over 80% of hospitals in England have a formal sponsorship agreement (awarded by an NHS tender process) with stoma appliance suppliers or manufacturers. These agreements may include funding for clinical nurse specialists in stoma care, training, IT equipment and administration support. In the East of England it was reported that, for 12 out of 13 hospitals with formal sponsorship agreements, the sponsor was the market leader in product use (see the StoMap Programme Baseline Report 2019).
NHS England's commissioned report Delivering Excellence in Stoma Care (2020; PDF only) highlights that clinical nurse specialists in stoma care operate independently of the sponsoring company and may recommend competitor products. But it also notes that they may receive training on sponsored products and be most familiar with bags from the sponsoring company. This can result in users being given sponsored products on discharge and continuing to use these products in the community, potentially impacting user choice.
Financial resource impact (cash items)
The prices of one-piece closed bags prescribed in primary care are based on the NHS Drug Tariff Part IX. Prices vary across different suppliers and ranges of bags.
Using the least expensive bag if more than 1 bag is clinically appropriate and meets the needs and preferences of the user may lead to cost savings. But potential savings are uncertain and would depend on local prescribing practice.
Prescribing practice can be based on a number of factors including clinical appropriateness, a person's needs and preferences (which can change over time), volumes prescribed and company sponsorship influence, where agreements are in place. Savings would also be dependent on clinical practice to minimise complications and the number of supporting products needed.
Key information
| Speciality area |
Gastroenterology |
|---|---|
| Disease area |
Colostomy |
| Programme budgeting category |
PBC 13B – Lower GI |
| Pathway position |
Primary and community care |
| Commissioner(s) |
Integrated care boards |
| Provider(s) |
Dispensing appliance contractors (DACs), community pharmacies and other community care settings |
About this resource impact summary report
This resource impact summary report accompanies the NICE late-stage assessment guidance on one-piece closed bags for colostomies and should be read with it.
ISBN: 978-1-4731-7111-4
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