Barriers Affecting the Adoption of Point-of-Care Technologies Used in Chest Pain Diagnosis Within the UK National Health Service: Part 2-Manufacturer Pricing and Reimbursement Policy Issues.

Adoption and implementation of point-of-care testing (POCT) in the UK National Health Service (NHS) for use in the emergency department during chest pain diagnosis are affected by manufacturer pricing and device procurement routes. The study presents the findings of a Web-based survey of UK POCT manufacturers to appraise their pricing policies and device purchase options to show how these could impact on market uptake. The UK-Northern Ireland survey collected information on the device procurement options, prices, and associated costs and from 5 leading manufacturers of cardiac marker point-of-care (POC) devices. These included the Abbott, i-Stat, Biosite Triage, Dade Behring Stratus CS, Response Biomedical RAMP, and Roche Cobas h232. The POCT device manufacturers surveyed offered 3 purchasing routes to market, direct purchase, lease-rental agreement, and free product placement. The latter procurement option was dependent on achieving a mean annual threshold test panel purchase volume of 1000 tests per year. UK NHS procurement policy favors the free product placement option for POC devices. Cardiac marker test panels for POC devices may be supplied in 2 formats, single-test or multiple-test panels. Manufacturers may adopt 1 of 2 strategies for price setting of POC device test panels in the UK market. In the case of 2 manufacturers, Biosite and Dade Behring, the test panel prices are fixed irrespective of the annual purchase volume at £16.85 per panel for the Biosite Triage and £11.02 per panel for the Dade Behring Stratus CS. The test panel price can also be set by a discounted scale based on exceeding the threshold annual purchase volume. Three manufacturers adopted this pricing policy for test panels. These were Abbott, Response Biomedical, and Roche, for the i-Stat, RAMP, and h232 POC devices, respectively. Test panel pricing discounts for the 3 POC devices were as follows: £13.12 per test (1000-2000 tests/year), reduced to £7.12 per test (≥5000 tests/year) for Abbott i-Stat; £9.81 per test (1000 tests/year), reduced to £8.18 per test (≥1000 tests/year) for Response Biomedical RAMP; and £9.18 per test (1000 tests/year), reduced to £5.67/panel (≥1000 tests/year) for the Roche Cobas h232. Other POC device manufacturers could offer a similar discounted pricing policy for test panels, to increase their market presence and to overcome the perceived test cost procurement barrier when introducing POCT more extensively within the NHS. The recently proposed changes to the NHS Pathology tariff are discussed in the context of its likely future impact on UK POC device uptake.