Centralized collection of 1.07 million coronary stents: falling from 10000 yuan class to nearly 1000 yuan

 Centralized collection of 1.07 million coronary stents: falling from 10000 yuan class to nearly 1000 yuan

On October 16, the joint procurement platform of national organization medical consumables released the procurement document of centralized coronary stent volume of national organization. For the coronary stent system made of cobalt chromium alloy or platinum chromium alloy and the drug loading type is rapamycin and its derivatives, we will open the band volume procurement.

In the first year, the total number of intention to purchase was 1.075 million, accounting for about 70% of the total amount of coronary stent implantation in China in 2019. The procurement cycle is two years. 27 products from 12 enterprises (7 domestic and 5 imported) meet the requirements, including Abbott, minimally invasive medical, Medtronic, Lepu, etc., will be opened on November 5, this year.

Compared with drugs, the centralized purchase of high-value consumables is more complicated. Because of the different standards of consumables, such as coronary stents have different materials, as well as domestic and imported. So there is no way to conduct expert review. The only criterion is the price. Whoever has a low price will have his own. He said.

On October 19, coronary stent related enterprises began to dive due to concerns about profit shrinkage caused by price reduction. Minimally invasive medical treatment, the leader of coronary stents, decreased by 11.93%, Lepu medical decreased by 8.83%, lanfan medical decreased by 3.88%, and the market value of medical device sector evaporated by nearly 46.2 billion yuan in a single day.

The lower the price, the better

Coronary stent is a branch of the heart disease device market. Coronary stent is a kind of medical device commonly used in percutaneous coronary intervention (PCI), which is implanted into the stenosis area by traditional balloon dilation catheter. Because of its small trauma and good effect, PCI has become one of the main methods to treat cardiovascular stenosis.

This time, the most important thing for the industry is the price. According to the above documents, the products whose application price is within 1.8 times of the lowest application price are to be selected. If the application price is more than 1.8 times of the lowest application price but less than 2850 yuan, it is also proposed to be selected. This 2850 yuan, is the lowest bid price of Jiangsu coronary artery stent collection, has also become the price benchmark of this time.

It should be noted that there is no negotiation mode of bidding combined with expert evaluation in the document, only bidding mode. This means that the enterprise will be the one with the lowest price, and the bidding price of national centralized purchasing will be set at a new low. Guorong securities research report predicts that the lowest bid price may be within 1000 yuan.

Shi lichen speculated that the bid price may be between 1000 and 1300 yuan. I dont think its possible to keep the price below 1000 yuan. Because this kind of product competition is not so full, we still have to keep profits.

No matter whether it is within 1000 yuan or before, this price is undoubtedly much lower than the market price of 7600-23000 yuan. In the centralized collection of coronary stents in Jiangsu Province, the price drop after winning the bid has reached 64.54%, which may reach more than 80%.

Can the low price be changed as scheduled?

The enterprises participating in the centralized purchase can be divided into three categories: first, there are many varieties of products, and some of them intend to purchase large quantities, including Boston science, Abbott, minimally invasive medical and Medtronic, with 6, 6, 4 and 3 products respectively participating in the centralized purchase; second, there is only one variety with a large amount of intention to purchase, including Lepu medical, lanfan medical, Weigao and Eason technology; and the third is that there is only one variety with intention to purchase The purchase volume is also very small, including xinlitai, Wanrui Feihong, biotronik and micell technologies.

According to the calculation of Guorong Securities Research Report, among the 1075000 units, the demand for minimally invasive medical report is the largest, about 390000, accounting for 37%. Boston science, LEP medical, Abbott, Medtronic and bluesail medical reported more than 100000 demand, accounting for 11%, 11%, 10%, 10% and 9% respectively. In the first year of intention to purchase, domestic accounted for 69% and import accounted for 31%, which was similar to the overall pattern of coronary stent terminals in China.

However, at present, the industry is generally worried about whether the quantity can meet the expectation after the price drops?

In fact, this situation has already occurred in the centralized purchase of drugs. The enterprises that participate in the purchase with quantity are not 100% able to increase the increment and increase the profits. It is possible that the price of products purchased with quantity is low, and at the same time, it does not meet the expectation of quantity. He said.

For example, the Bayer Group. On January 17, this year, in the second batch of national drug procurement bidding, Bayers Baitang Apple quoted a shocking low price. The price of 50mg Baitang Apple was 5.42 yuan / box, and the price of each tablet was only 0.18 yuan, a drop of more than 90%. It won the bid at the lowest price of the variety. Bayer Groups latest semi annual report showed that the second quarter sales of bytang apple fell 73.8%. Bayer said that the reason was that the sharp price reduction could not be offset by the increase in volume due to the influence of Chinas volume purchasing policy.

In this regard, Shi lichen gave an example: for example, the original 10000 pieces of support, the sales volume is 30 million, if the price is reduced by half, the manufacturer should sell 20000 pieces to reach the original profit level, but if only 15000 pieces are sold, although the increase is up, it does not meet the manufacturers expectation, and it is not as good as the original sales volume.

It is worth noting that in this centralized purchase document, the terminal doctors are given certain degree of freedom: after the medical institution submits the demand, if the product fails to win the bid, the medical institution can allocate 10% of the total amount to be allocated to the first selected product, and the remaining 90% can be allocated to the selected products that have submitted the demand of the medical institution, or have submitted the demand more than the medical institution The lowest price winning product, the lower price winning product, or the top five winning product.

Moreover, the market outside the standard still has a large share, accounting for about 40-50%. Guosheng Securities Research Report believes that the amount of coronary stent implantation in 2019 will be about 1.5 million. After deducting some stainless steel stent implantation amount, the reported procurement amount is basically close to the current actual use. Based on the current average annual growth rate of about 10-15%, the actual use of PCI in China will be expanded to about 1.8-2 million in 2021, and the intended purchase volume of this centralized purchase will account for 50-60% of the total usage.

Lu Guifeng, manager of snowball private equity fund and a senior pharmaceutical expert, wrote that enterprises can actively lower the price of medium and low-end products to ensure that they win the bid, while high-end products can offer a high price to fight for, and even high-end products can choose to directly abandon the bid to become the off standard market. Because it is not unacceptable to do the market outside the bid after losing the bid.

A senior investor in the industry also told our reporter that the current centralized collection of coronary stents is the mainstream product in the market, aiming at the low-end category. However, the high-value consumables products update faster, and enterprises can win the favor of patients by constantly launching high-end new products, and compete for the remaining market, so as to have a larger profit margin.

When replying to the investors questions on whether there is the risk of carrying volume procurement on the interactive platform of the exchange, Lepu medical said that the company realized 1.53 billion yuan of revenue from coronary stent products in 2019. After excluding the stent export part, the domestic cobalt based stent accounted for about 2% of the companys total revenue, while the expected revenue share of cobalt based stents included in 500 units / year hospital belt purchase was lower.

Why coronary stents?

This time, we chose the coronary stent for centralized collection because of the particularity of the stent. If we do not consider the specific parameters of different products, the homogeneity level of stent products in a larger dimension is strong, and the domestic substitution rate is high, which can reach 80%.

In addition, coronary stents have always been a disaster area of medical bribery, often caused by kickbacks and high prices.

In 2015, Zhong Nanshan, academician of the Chinese Academy of engineering, in his capacity as a deputy to the National Peoples Congress, criticized doctors in some public hospitals for not paying attention to medical ethics and illegally using heart stents to generate income: a cardiac catheterist from a hospital in Guangdong province did coronary angiography for patients, which was not a big problem at first, but finally put five stents.

At present, the price of coronary stent in the market is concentrated in 7600-23000 yuan. According to the data of Guosheng Research Report, a total of 1.04 million cases of PCI (coronary intervention surgery) were performed in China in 2019, that is, one out of 1346 people used coronary stents, and more than one was used. In recent years, the per capita amount of stent implantation was 1.4-1.5 per case.

In Jiangsu Province, which is actively carrying out the water test of coronary stent collection, five cardiovascular experts have fallen off in the second half of 2019, which may be why Jiangsu Province is determined to squeeze out the water in high-value consumables.

Perhaps the most famous expert is Chen Jianchang, former deputy director of cardiovascular department of the Second Affiliated Hospital of Suzhou University. From 2010 to 2019, he accepted more than 5.16 million yuan in bribes, which helped the sales and use of medical consumables for cardiac intervention of Medtronic and minimally invasive fire hawk brands in the cardiovascular department of the hospital.

According to fan, one of the bribers and consumables agent, Chen Jianchang collected two sums of money each time, one of which was left by himself (200000-500000 yuan) and the other was given to doctors and nurses in Keli (200000-450000 yuan). Every year in the evening of January and February, fan will come to the building where Chen Jianchang lives and give him money. He recalled, I gave Chen Jianchang about 3.25 million yuan, Chen Jianchang and Keli personnel about 2.8 million yuan.

The rebate of coronary stent is between 1600-2400 yuan. According to a judgment in Anhui Province in 2019, doctors will receive a rebate of 2400 yuan for each installation of imported heart stents from internationally renowned manufacturers; the rebate standard for a domestic brand is that in 2015 and 2016, the Commission will be 1600 yuan for each installation, and it will rise to 1800 yuan in 2017. This time, the centralized collection of coronary stents is undoubtedly the first shot of high-value consumables in China. According to the analysis of Southwest Securities Research Report, from the perspective of products, channels and terminals, there are many difficulties in carrying out the procurement of consumables with quantity. With the completion of unified coding, the exploration of grouping and classification by provincial pilot schemes, and the gradual solution of difficulties in unified procurement of sets, the subsequent promotion of consumables procurement with quantity is expected to accelerate. Editor in charge: Fang Fengjiao editor in chief: Chen Yanpeng extended reading Liu He: Chinas realization of positive economic growth in 2020 is a big probability event. Uber founder karanik has purchased more than 130 million US dollars of real estate: march into the shared kitchen agriculture and rural department: Chinas chicken farming is in deficit, and a broiler is losing 3 cents per chicken. Source: China Times editor in charge: Zhong Qiming_ NF5619

The rebate of coronary stent is between 1600-2400 yuan. According to a judgment in Anhui Province in 2019, doctors will receive a rebate of 2400 yuan for each installation of imported heart stents from internationally renowned manufacturers; the rebate standard for a domestic brand is that in 2015 and 2016, the Commission will be 1600 yuan for each installation, and it will rise to 1800 yuan in 2017.

Editor in charge: Fang Fengjiao editor in chief: Chen Yanpeng