AI Summary & Key Takeaways
AI InsightThe proposed normative simulation framework may also serve as a transparent methodological approach for evaluating reimbursement adequacy in other rare diseases where patient-level cost data are limited.
📌 3 Key Takeaways
Abstract
This study aimed to assess the adequacy of public bundled reimbursement for selected wound care consumables in Epidermolysis Bullosa (EB) in Türkiye by comparing estimated consumable costs with reimbursement capacity using a document-based normative cost simulation. A document-based normative cost simulation was conducted without the use of patient-level data. The analysis modelled a standardized 30-day wound care pathway for a hypothetical patient with moderate-to-severe recessive dystrophic EB from the healthcare provider perspective. Simulation parameters were derived from international clinical wound care guidelines, Turkish reimbursement regulations, structured expert input, and current reimbursement coefficients to estimate the cost of four selected wound care consumable categories. The estimated 30-day cost of the four selected wound care consumable categories was 58,650 TL, with silicone-based non-adherent dressings and silicone foam dressings accounting for the largest share of the selected basket. The simulated monthly reimbursement capacity was 17,343.01 TL, corresponding to a coverage ratio of 29.57% and a funding gap of 41,306.99 TL (70.43%) for the quantified consumable basket. The findings suggest that reimbursement policies for rare, chronic, and resource-intensive conditions such as EB should move beyond procedure-based payment models toward pathway-based, severity-sensitive, and regularly updated reimbursement mechanisms. Incorporating disease severity, specialized material requirements, and real-world market cost fluctuations into reimbursement policy may support more financially responsive reimbursement policies for care. The proposed normative simulation framework may also serve as a transparent methodological approach for evaluating reimbursement adequacy in other rare diseases where patient-level cost data are limited.