After the initial wave of relief, the cap on prices of stents used in cardiac surgery is now leading to apprehensions among patients over the availability of top-grade stents.
Doctors are trying to convince elective angioplasty patients to go ahead with the procedure using second-generation drug eluting stents and not postpone surgery in the hope of getting the best implants. On Friday, the Food and Drug Administration (FDA) made surprise visits to several city hospitals, and issued a statement saying there was no shortfall in stents.
“The stents are very much there, but these are first- and second-generation drug eluting stents that have been left behind by the companies, which have taken back third generation stents [from hospital stocks],” says cardiologist Dr. Nitin Gokhale, who practices at Lilavati and Holy Family hospitals. He says three of his patients have postponed planned angioplasties as they want the latest stents. “The decision [to cap prices] is excellent but the mistake that the government has made is bunching all of them. Imagine, if an iPhone 4 and an iPhone 7 are capped at the same price.”
A backward tech slide?
When stents first made their appearance in the Indian medical market in 2000, bare metal ones were priced at ₹85,000. Today, these are sold for anything between ₹8,000 and ₹9,000. The National Pharmaceutical Pricing Authority (NPPA) has now capped their price at ₹7,260, and those of the more advanced drug eluting and biodegradable stents at ₹29,600.
“We were using third-generation drug eluting stents for most patients, but after the NPPA order, the suppliers have taken them away,” Dr. Dev Pahlajani, a cardiologist who practices at Breach Candy Hospital, said. He says several patients are insisting on newer versions. “In emergency cases, I try to convince relatives to go ahead with stents available.” Dr. Pahlajani cites the example of a man who insisted his mother be implanted with the latest biodegradable stent that dissolves after two years. “I had to convince him that we couldn’t wait for long as his mother could have a heart attack,” he added.
While a key supplier has maintained that the latest stents were taken back from hospitals for relabelling, a fresh NPPA circular has said this is not needed. It also says stents can be billed separately depending on the price cap. Anand Kadkol, Director, Public Affairs at Abbott, the only firm supplying biodegradable stents, said their products are available at all hospitals.
“Abbott continues to market our full range of coronary stents available in India, per the NPPA order of Feb 13, 2017. In certain cases, we had initiated the process of relabelling to comply with the revised pricing notified by the government order of February 13. We have also advised trade partners and hospital partners to abide by the ceiling prices determined by the NPPA order,” he said.
Doctors argue that new-generation stents have better deliverability, trackability and results overall. “These stents are more flexible and the metal manoeuvres through the artery swiftly, and are preferred,” says Dr. Ghokale.
