Foreign Brands Occupy Part Of The Market

On June 15, according to the Jiangsu Provincial Medical Insurance Bureau, Jiangsu Province has completed the fifth round of centralized procurement negotiation of medical consumables, focusing on five categories of medical consumables, such as pacemakers and intraocular lenses, which are expensive and heavily burdened by the masses.

According to reports, during the negotiation, Jiangsu medical insurance bureau put the quality and safety of cardiac pacemakers in the first place. Finally, through the negotiation, all mainstream products were selected, which can effectively meet the clinical first-line demand, and the price dropped significantly. The original price of pacemakers from 50000 to 60000 yuan dropped to about 20000 yuan.

According to the analysis, Jiangsu Province has carried out five rounds of procurement of medical consumables since 2019, involving 2426 products such as cardiovascular, ophthalmology, orthopedics, general surgery, etc., with an average price drop of 54% and a maximum drop of more than 95%. On December 1, 2020, in the fourth round of consumables procurement in Jiangsu Province, the average decline of staplers was 83.93%, The highest drop rate was 96.29%, of which the linear stapler with more than 2000 yuan was reduced to more than 100 yuan, and the hemorrhoid stapler with RMB 4500 yuan decreased to RMB 2300 yuan.

In addition, in the five rounds of material negotiation, the maximum reduction of artificial knee joint, artificial dura mater, hernia repair material and coronary balloon were 81.9%, 81.4% and 94%, respectively.

In contrast, although the price of some pacemakers dropped by more than 30000 yuan this time, there is still a significant gap between the overall decline and the above consumables. Jiangsu Province has purchased pacemakers twice, with an average decrease of 15.86% in the first round and a maximum decrease of 38.13% in the first round, and a 60% decrease in the second round and a 69% decrease in the fifth round.

In addition to Jiangsu Province, on December 31, 2020, Shandong Province also purchased five types of consumables, such as cardiac pacemakers. Finally, the average price reduction of five products of five cardiac pacemakers enterprises was 51.86%, and the average price decline of the other four types of products was more than 83%, and there was also a significant gap in the reduction rate.

Cardiac pacemaker monopolized by foreign brands

The insufficient market competition and the small market share of domestic enterprises may be the important reasons for the difficulty in reducing the price of cardiac pacemakers.

It is understood that cardiac pacemaker is an electronic therapeutic instrument implanted in the body. It sends out electric pulse through pulse generator, and then conducts it through wire electrode to stimulate the contacted myocardium, so as to excite and contract the heart and treat cardiac dysfunction caused by arrhythmia.

At present, cardiac pacemakers are mainly divided into four types: single chamber, double chamber, three chamber and three chamber defibrillation pacemakers. The market share of dual chamber pacemakers is the highest among all types of pacemakers. The products purchased in Jiangsu Province and Shandong Province are all dual chamber pacemakers.

According to the intelligence research consultation, the single chamber pacemaker is a low-end product with a domestic price of 20000-30000 yuan; The dual chamber pacemaker is an upgraded version, and the price is about 50000 yuan; Three chamber pacemaker is the most high-end product, with a domestic price of about 100000 yuan; Three chamber defibrillation pacemaker is a combination of three chamber pacemaker and defibrillator, with the highest price of 150000-250000 yuan.

From the perspective of manufacturers, at present, the domestic pacemaker market is mainly monopolized by foreign brands, including Medtronic, Abbott, Boston science, baiduoli, SOLIN group, etc., and the domestic pacemaker manufacturers mainly include Lepu medical, Xianjian technology and Chuangling heart rhythm medical (micro innovation medical subsidiary). According to data, Medtronics, Abbott and Boston science occupy more than 80% of the domestic pacemaker market.

The selected manufacturers of pacemakers purchased in Jiangsu province include Abbott, Medtronic, baiduoli and Chuangling heart rhythm medicine. Boston science and Lepu medical products were not selected, and Xianjian technology did not participate.

Jiangsu medical insurance bureau also said that cardiac pacemaker implantation can effectively treat cardiovascular disease, but the price of cardiac pacemaker is expensive, especially the market competition of such products is not sufficient, a few enterprises occupy the vast majority of market share, the inherent price system is difficult to break, and the burden of patients has always been heavy. If the whole body is compatible with MRI dual chamber pacemaker, the price is basically between 50000 and 60000 yuan.

It is understood that some cardiac pacemakers are listed as contraindications of MRI examination. Because of the extensive demand for MRI examination in patients, whether they can be compatible with MRI has become one of the important competitive points of cardiac pacemakers. Medtronic, Abbott, baiduoli and Boston science have launched full body compatible MRI products. Among domestic enterprises, the pacemaker system with MRI compatible Vega electrode lead of minimally invasive medicine has been submitted for registration in the United States, and the compatible MRI full-automatic pacemaker of Lepu medical is in the development stage.

Some high homogeneity consumables may be included in the national centralized purchase

Due to insufficient competition and limited price reduction of cardiac pacemakers, the possibility of expanding the scope of purchasing such consumables in multiple provinces or nationwide may be relatively small, but some consumables with sufficient competition and high degree of homogeneity may be purchased nationwide.

Recently, the National Health Insurance Bureau and other eight departments issued the guidance on the centralized procurement and use of high-value medical consumables organized by the state (hereinafter referred to as the "guidance") which requires that some high-value medical consumables with large clinical dosage, high procurement amount, mature clinical use, sufficient market competition and high homogeneity level should be included in the procurement scope. Among them, the main purpose of the requirement of "sufficient market competition" may be to ensure the price reduction range of consumables.

In addition, the person in charge of bidding business of a well-known medical device enterprise told the 21st century economic report that the guidance also requires "a high level of homogeneity" in the selection of purchased varieties with quantity, and clearly defines "ensuring quality" and "scientifically and rigorously formulating the quality and technical standards for purchasing high-value medical consumables". These two points are added to the previous relevant documents to ensure that the products of different manufacturers can replace each other when purchasing with quantity. It is required that the procurement with quantity shall be grouped and evaluated on the basis of product homogeneity.

According to the analysis of the person in charge, there is a close relationship between the homogenization requirements and the product quality and grouping rules of bulk purchase. At present, there is no consistent evaluation method and Practice for medical consumables in China, and the health economic evaluation that can be referred to is also carried out less. If only the low price is selected, then the quality of the final bid winning product may be at risk“ Homogenization means that products from different manufacturers can compete in the same quality group, which has little impact on clinical substitution after winning the bid. "

In fact, in addition to quality, whether the winning enterprise can ensure long-term and stable supply is also one of the key factors to be considered in purchasing with quantity. The guiding opinions require that the selected enterprises should do a good job in market risk prediction and prevention, strengthen production arrangement, report production capacity, inventory and supply as required, so as to ensure that the procurement demand of selected products in medical institutions can be met in a timely manner within the procurement cycle.

The above-mentioned person in charge said that the safeguard measures of the "guiding opinions" clearly define "ensuring supply and distribution", ensuring supply is very important for purchasing with quantity. High value medical consumables are labor-intensive industries, and it is impossible for production enterprises to increase production capacity significantly by increasing equipment and operators in a short period of time, while at the same time ensuring the quality of the increased capacity.

"If the annual maximum production capacity of a manufacturing enterprise does not reach the minimum procurement volume of a province or inter provincial alliance, theoretically, the enterprise should be limited to participate in the procurement with quantity or put the enterprise into the less quantity group. A single letter of supply commitment issued by a production enterprise may not guarantee that the enterprise has the ability to complete the continuous, stable and reliable supply of goods. Therefore, it is very necessary to organize scientific and objective investigation and audit of the production enterprise in the early stage. " The person in charge said.

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