Twenty years on with use of cardiac stents, the essential life-saving device in the emergency care, there is no clarity yet on how much it should cost.Unlike the surety of a maximum retail price on any drug, there is no such MRP for the stents, it is not available in retail stores and the patient is at the mercy of the hospital where one gets treated.When angioplasty procedures have become common in every tertiary care hospital worth a cardiac care department, the high cost continues to be a big burden on the commoners.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.A manufacturer in Andhra Pradesh told that the indigenous bare metal stents are provided to the distributor at Rs. 10,000 to Rs. 15,000. If the hospital is directly getting the product, the device costs even 25 per cent less. A drug-eluting stent is supplied in the range of Rs. 25,000 to 40,000 and the hospital gets it lesser by 10-15 per cent directly.The multinational companies give their products in the range of Rs. 80,000 to Rs. 1.5 lakh, and the hospitals charge an extra 25-30 per cent more.
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 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.There were about 30-40 per cent lesions where bare metal stents could be used without causing a repeat procedure because of narrowing of the blood vessel, said Dr. Kamath. The drug-eluting stents had brought down the risk of narrowing of the blood vessel to a great level, he said.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. The government and the professionals from the public and the private sector should put their heads together to come up with a reasonable pricing, he said.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 were included in the package charges, he said.
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 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.There were about 30-40 per cent lesions where bare metal stents could be used without causing a repeat procedure because of narrowing of the blood vessel, said Dr. Kamath. The drug-eluting stents had brought down the risk of narrowing of the blood vessel to a great level, he said.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. The government and the professionals from the public and the private sector should put their heads together to come up with a reasonable pricing, he said.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 were included in the package charges, he said.
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