Comparison Between Ostomy Systems

One-Piece versus Two-Piece

By:  Bob Baumel, UOA Internet posting

Renard Narcaroti, Chicago's North Suburban Chapter UOA

 

The following comparison had its origin from a response to a question posted on the International UOA Bulletin Board regarding the use of different ostomy products.  We have attempted to edit the original response in order to make it more ubiquitous.  As always, make sure you talk to your ET when considering experimenting with your ostomy system.

 

Some people are unsure of the differences between one-piece and two-piece ostomy systems.  These systems incorporate the newer, disposable, adhesive products now being manufactured by  many companies.  There are quality conscience companies that produce non-adhesive systems as well as custom fitters who manufacture permanent fixtures for people with special needs.  Although there is a definite market for these manufacturers, we are going to limit our discussion to only the disposable products.   We are going to make some controversial  statements about usage and costs.  These are to only serve as a guide.   We could find nobody willing to take a stand on these, so we did.    This information is based on research from our members and the manufacturers.   Costs are rounded so as not to allow price only shopping.    A full cost ostomy supplier may offer added values that are not available through discounters, like direct insurance or Medicare billing, or custom fitting and personal service.    Yet if these advantages are not needed, then a mail order or Internet provider may best suit your needs.    In addition, we want manufacturers to continue to research new products and improve on current offerings.   We want them all to stay financially viable in order to give us many choices.   We strive to keep a competitive marketplace.   We want you to have reliable, high quality avenues from manufacturers and suppliers.   We will do our utmost to keep the market responsive to our changing needs.     

 

Definitions:

 

A one-piece ostomy system is one in which the faceplate, wafer or barrier is bonded to the pouch.  This is placed over the stoma to manage stomal output. 

 

A two-piece ostomy system is one which uses two separate pieces that when joined together will form a single unit which will then manage the stoma output.  The two pieces consist of a faceplate, wafer or barrier which is attached to the skin.  A flange is usually manufactured as part of the wafer.   The flange will then snap into a separate pouch forming a single unit.

 

Barrier creams, lotions and powders are products developed to put on skin to make the

skin prepared for the application of the barrier.   They are not barriers themselves.

 

Faceplate, wafer or barrier refers to the device that fits around the stoma and protects the peristomal skin from the effluent coming from the stoma.

 

The pouch is the physical device which stores the effluent from the stoma until such time when it is disposed.

 

A flange is that piece that is bonded to the barrier when it is manufactured.  It is used to provide a secure connection to the pouch.  Flange sizes are made to the exact specifications of a particular type of pouch.   

 

            A closed pouch is one that only has one opening.  That opening is attached to a barrier.

            It may only be emptied by removing the seal.

 

An open pouch has an opening at the bottom which is used to dispose of the stomal output  without removing the seal. 

 

            A clip holds the bottom of a open pouch.

 

People choose one system over another for many different reasons.  We have assembled some of the considerations in making this decision.   We understand people have their own particular circumstances that may not be addressed here.   This is one reason we always recommend an in person visit with an ET nurse.   We are all different.   The issues of one of us is not exactly like that of another.  

 

If you wear a one-piece, your must change the entire appliance whenever you want a different pouch.   The advantage of a one-piece is usually the cost.   The entire system is between $2 and $8 each.    The following chart offers a recommended usage:

 

Product              Best Designed For         Expected to Last     Cost $                                                                                                     

ConvaTec

  Active Life

         Stomahesive               Colostomies                                                    2-5 days                                  4

         Durahesive                 Ileostomies & Urostomies                             3-7 days                                  5

 

Cymed

 Platinum                           Ileostomies & Urostomies                             2-5 days                                  9

 

Coloplast                             Colostomies, Ileostomies &

                                             Urostomies                                                     2-5 days                                  4

 

Hollister

  Karaya                              

         Standard                     Colostomies, Ileostomies &                          1-3 days                                  2

                                             Urostomies

         Premium                                             "                                              2-4 days                                  4

 

   Contour 1                                                  "                                              1-3 days                                  3

 

   Premium                                                  

         Softflex                       Colostomies                                                    2-5 days                                  4

         Flextend                      Ileostomies & Urostomies                             3-7 days                                  5

 

If you go through pouches at the same rate as barriers when using a two-piece system, a corresponding one-piece appliance would last as long as each piece of the two-piece system.   Since a one-piece  appliance contains both a barrier and pouch, either of these components may limit its wear time.   In this case, we'll show how a one-piece would be more economical to use.    A ConvaTec Stomahesive two-piece costs about $8 a change.   A one-piece is about $4 a change.   If you change the pouch and the barrier at the same time, a one-piece system will cost half as much.

 

Product              Best Designed For         Expected to Last        Cost $

 

ConvaTec

  Natural

         Stomahesive               Same as Above                                              Same as above                      

            Barrier                                                                                                                                             6

            Pouch

Closed                                                                                                                                     1

Open                                                                                                                                       3

         Durahesive

            Barrier                                                                                                                                          10

            Pouch

                     Closed                                                                                                                                     1

                     Open                                                                                                                                       3

 

Cymed

  Platinum

         Barrier                                                                                                                                              10

         Pouch                                                                                                                                                  3

 

Coloplast

         Barrier                                                                                                                                                6

         Pouch                                                                                                                                                  3

 

Hollister

  New Image

         Softflex

           Barrier                                                                                                                                              6

           Pouch

                     Closed                                                                                                                                     1

                     Open                                                                                                                                       3

         Flextend

           Barrier                                                                                                                                              7

           Pouch

                     Closed                                                                                                                                     1

                     Open                                                                                                                                       3

 

If your pouches lasts longer than the barriers when using a two-piece, you would change one-piece appliances as often as you would change barriers on the two-piece.  In this case, a one-piece is always more economical than a two-piece.   e.g.  Suppose you use a ConvaTec Durahesive barrier and your open pouches last 14 days and your barriers last seven days.  Then, during a 14 day period, you would use two barriers and one pouch.  Therefore, your cost would be about $23.   During that time, if you used a one-piece appliance, you would have used two at a total cost of $10. You would have saved $13 during that period, or about $400 a year.

 

If your pouches wear out faster than the barriers, you would change a one-piece appliance as often as you change pouches of the two-piece system.   In this situation, a two-piece may be more economical.   e.g.  Suppose you use a Hollister New Image Flextend barrier, and you use four open pouches for each barrier change.   If your barrier lasts eight days, each pouch would last two, therefore your cost would be $19.   If you used a one piece Premium and changed every two days, the length of time a pouch lasts, then you would have spent $20.   In addition, auxiliary products like

pastes and removers used at each complete change, would be used in greater quantity in this case thus widening the cost gap.   It should be noted that this is the only case where a two-piece is less expensive than a one-piece. 

 

If you are a two-piece user who already gets two weeks wear time from each barrier, you are probably paying so little for ostomy supplies that even if you could save some money by switching to a one-piece, the savings may not be worth the trouble.   Some two-piece users have developed complicated rituals which would not be possible with a one-piece.   These include daily rotations among several pouches; washing out the pouches not in use; using different sized pouches for  particular individual activities like intimacy; the ability to burp a pouch with air in it, etc.   Two-piece systems have a higher profile that one-piece systems.    But we are only talking about 1/8 to 1/4 of an inch, and the flange does offer some protection around the stoma in case of accidental contact.    

 

If you have a colostomy and you irrigate, your unique needs  may be meet with the special one-piece  closed pouches.   The pouch is worn just for protection in case of diarrhea or some spontaneous activity of the bowel.   In fact, there are now some European manufactures that have throw away appliances for just such purposes.

 

Some product lines include minor variations at slightly different prices.  These included barriers with or without tape; pre-sized or cut-to-fit; flat or with convexity; extended wear barriers; tan or white tape; opaque or transparent; smaller or larger sizes; special locking features, etc.

 

When discussing cost issues we should mention insurance reimbursement.   Medicare has  guidelines that you may see by clicking on their Internet site at http://www.hcfa.gov/ .   The code numbers in parentheses are HCPCS codes, which stands for Health  Care Financing Administration Common Procedure Coding System.    The U.S. federal agency that administers Medicare, Medicaid and Child Health Insurance Programs uses these codes as well as all other public and private insurance.   You will notice from this site that the reimbursements allowed are sometimes less than the commercial prices of these products.   When the actual cost of an item is so much higher than the Medicare allowable, any supplier who sells that item and takes a Medicare assignment loses money.   Most suppliers will not take a Medicare assignment on certain items.   Most private insurance allows people to purchase the supplies needed with only a note from their doctor saying the supplies are medically necessary.   UOA has a special committee that lobbies the U.S. government on a variety of ostomy issues.    There are people who are working very hard to help assure that we all have the best quality supplies available.   These people are volunteers, spending and investing their own time and money, who make a difference.

 

Don’t settle on a product that does not fit, or that does not meet your exact needs.   Most insurance

in the U.S. is designed to make sure your needs are meet with the best quality equipment available.

You need to be businesslike in your dealings with insurance.   You are going against a system created by lawyers and bureaucrats.   You can get very high quality care, but you must navigate the

system.   Always be calm and focused.   You need skills of persuasion,  not childlike outbursts.  You need to follow up on each detail, not assume the system will take care of everything.   There is no such thing as too honest, but there is such a thing as too naïve.    The system punishes the naïve, and rewards the honest, persistent, and intelligent.   Insurance, be it private or public, is not the mama.  Most people have problems because of their inability or unwillingness to work the system to their advantage.   Stay positive, don't give up, and be happy.   You've been given a new life.

 

Experimenting with new products

By:  Alice Bowman and Bob Baumel,

Stillwater-Ponca City, OK  Chapter UOA

                     

If You Like to Experiment

 

Some of us like to try every new ostomy appliance that comes along.    These include obtaining product samples available at UOA Chapter meetings; by accepting offers of free samples from ads in the Ostomy Quarterly; and contacting manufacturers who are always willing to have us try their products.    This is one way  we may keep up with advances in ostomy products.  But if you do this, remember that chemicals used in different types of appliances aren't always compatible.  Therefore, use lots of adhesive remover when switching types of appliances.


Normally, when changing appliances, it doesn't matter if you leave a little residue from the old one.  However, when changing to a different type of appliance, residue may significantly affect adhesion or wearing time of the new type you are testing.  For this reason, it is also best to try two samples of any new appliance type.  Your second sample may be a better test than the first one.

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