In recent times, cardiology is in news for coronary stents price. We are seeing numerous articles in the newspaper and social media. Even we are seeing posters on roads stating 85% reduction in stent prices by our political party leaders. This looks more like a political stunt.
I do agree some stents were overpriced. At the same, a lot of stents were cheaper. Most commonly used stents were cheaper ones around INR 18000 to patients. This is because in India (Karnataka) we have plenty of government schemes meant for BPL and also APL card holder. The total package for them is 65000 to 75000 INR including stent and angioplasty procedure.
High top end expensive stents were used for VIPs and those patients who wished state of art treatment. Now these may become unavailable in Indian market
Price reduction of coronary stents
This new rule has capped MRP of all drug-eluting stents to not more than INR 31000. Thus does not want to differentiate between the various generation of drug-eluting stents. In consequence, top end stents like premier, alpine, synergy, expedition and bioabsorbable scaffolds are being pulled back from Indian market leaving only older stents.
Newer top end stents were easily trackable, had a lesser incidence of restenosis. They also had a lesser need of tablets as compared to older stents.
Price reduction and poor patients
Stents for poor BPL patients were already being given at, lower price around 18000 INR and this rule will actually the harm this.
According to a new rule, stents can not have MRP more than 31000 INR. The total profit margin from the production company to a patient can not exceed more than 8%.
In this stent business, stent damage while using and expire due to needing odd sizes is very common. If the profit margin is very much slim, otherwise cheaper stents will become more expensive or disappear from the Indian market after cooling period of six months. There will be no distributors to market the cheaper stents.
This low-profit margin will prohibit prize reduction of future incoming stents also burdening our poor patients. Truthfully speaking we were able to treat poor patients(BPL) with angioplasty because stents were available at cheaper rate i,e around 18000. If these stents become unavailable then main sufferers are BPL patients.
When poor patients were actually being treated with cheaper stents. what is the benefit of the ceiling the MRP for a stent and the fixing percent profit.
Is this just to please medical insurance companies?
Hospitals were sustaining angioplasty package of INR 65000 along with stents because they were able to recover from rich patients. If the government, induces an increase in the prize of cheaper stents, reduces profit from the rich patient. Further, passes a rule of increase in minimum labour wages how should hospital sustain?
Implication of stent price reduction for affording patients
Now on affording patients have to get satisfied with older stents only. Because newer stents and those in the pipeline will not reach Indian market.
The cardiologist may find it difficult to treat more complex lesions as older stents are harder and difficult to negotiate through complex lesions this may even increase complication rate.
Loss of employment and difficult supply chain
Is angioplasty really expensive for poor patients in India
Before passing any rule please note that cardiologists are doing angioplasty for BPL patient at just 65000 INR. And in Karnataka, 80% of citizens have BPL card and also APL other schemes make this to nearly 100% where packages rates do not cross 70000 INR.
The amount of investment for each cath lab in India is to tune of 2.8 crores to 4.5 crores this excluding building cost. I do not want to go into details of the economics of cath labs and angioplasty in this article. I may write an article in future.
New innovation and cost
The medical field is continuously evolving one, what is considered state of art today or last year may find itself getting replaced by newer technology in coming years.
When new technology arrives it is more often expensive. With newer innovation current or older technology becomes cheaper or totally replaced by newer technology. So, any new innovation has limited time scope in terms of economics.
We have to understand that before delivering any technology huge amount of money is invested in inventing it.
- It is unwise to equate all stents.
- Already existing cheaper stents will become more expensive. This will harm poor patients.
- Newer top end stents will disappear from the Indian market.
- Only medical insurance companies will benefit from this new rule.
- We are not respecting newer innovations.