Cardiac stent has been here for almost 20 years. But still there is no clarity on how much the life-saving device should cost.
Unlike the surety of a maximum retail price on drugs, there is no such MRP for the stents as it is not available in retail stores. And the patients have Hobson's choice — take it or leave — as they are at the mercy of the hospital during emergency care.
The angioplasty procedure has become common in every tertiary care hospital worth a cardiac care department, but the high cost continues to be give heartaches to those who foot the bill.
The hospitals and the distributors in the supply chain making a killing as it is a device generally used in patients for emergency treatment.
Principal Health Secretary Rajeev Sadanandan said while the government had received a complaint through the petition’s committee of the Kerala Legislature on such variable pricing, there would be no market intervention as such. However, the government has asked the Hindustan Latex Limited to probe the possibility of providing the stents to medical colleges.
First-generation cardiac stents were made of bare metal. Though they almost removed the risk of the artery collapsing, they could only modestly reduce the risk of restenosis — the reoccurrence of stenosis or narrowing of a blood vessel. A manufacturer in Andhra Pradesh told The Hindu that the indigenous bare metal stents are provided to the distributor at Rs.10,000 to Rs. 15,000. If the hospital directly gets the product, the device is further cheaper by 25 per cent.
Advanced stents coated with drugs to curb restenosis (drug-eluting stent) is supplied in the range of Rs. 25,000 to 40,000 and the hospital can have it cheaper through direct purchase. For an angioplasty procedure, hospitals in the city charge between Rs 75,000 and Rs 2 lakh. And they could pocket Rs 60,000 for a stent that cost them around Rs 25,000 or less.
An interventional cardiologist said that there was no uniform pricing in hospitals as some centres, where more cardiac interventions happen, manage to get the stents at a very low price compared to other centres. Again, the patient is offered not the stent but a whole package of angioplasty. Besides the stent, coronary wire, balloon, injecting device, catheter and handling charges in cathlab are included in the package charges.
The reimbursement rates mentioned in the Central Government Health Scheme remains the only guideline for the price of a stent. In February 2013, the CGHS revised the ceiling rates for all drug-eluting stents to Rs. 25,000, provided it is approved by USFDA, CE (European Union) or the Drug Controller General of India.
Indigenous stent manufacturers told The Hindu that since CGHS covers 30 per cent of patients in the country, MNCs have introduced another brand for the segment while keeping the original price for patients who are not covered by the health scheme.
Though the multinational companies make their claim to higher prices on USFDA approvals as it involves a number of clinical trials, cardiologist Prakash Kamath feels that there could be commercial, academic or scientific bias while prescribing a stent that could not be beneficial for the patient.
A manufacturer from Gujarat said that when the cardiac stents made an entry, they cost around like Rs. 5 lakh till about 2001. When Indian companies entered the market, the price plunged to Rs. 1 lakh for the foreign-made, while indigenous companies started supplying it in the range of 60,000 to 70,000.
The high cost is the “developing costs” as the companies prefer to call it or the innovation in the latest product that is said to be technologically more advanced.
However, the cardiologists had responsibility in making these choices, said Dr. Kamath. While the manufacturers’ cost of making the stents was not much, it was the hospitals and the distributors that made the most of the ambiguity in pricing, he said. The bio-absorbable stent might have a technological advantage, but it didn’t justify the huge cost, said Dr. Kamath. It is believed that these stents may cost up to Rs. 3 lakh or more to the patient.