Heart of the matter: 

Heart of the matter

Context

  • The article ‘Address this blockage,’ by Cherian and Kumar acknowledges that the capping of stent prices has made them affordable, but flawed arguments have been used to suggest that there may be adverse consequences to patients and the indigenous stent industry.

Major arguments

  • One key argument against price capping is that the “latest generation” of stents will not be available to the Indian public at price mentioned.
  • This is a deceitful assertion. Successive “generations” of stents in the current era represent small improvements in design which have no documented impact on outcomes that are most important to patients (rates of reblockage, heart attacks or death).
  • Currently, the best performing stents are available in the country at or below the current ceiling price.
  • Suggestions like “patients hoping to have advanced stents may have to travel abroad” is a misrepresentation.
  • The second major area of controversy has been the impact of price capping on the indigenous stent industry.
  • While others suggesting a uniform cap on prices unfairly favouring Indian stent manufacturers, the above article claims that it is likely to adversely impact indigenous research and innovation.
  • The actuality is that the uniform price cap has reduced the price differential between the foreign-made and Indian-made stents.
  • While the foreign-made stents have been carefully tested for safety and efficacy in a large number of patients, most Indian stents have undergone perfunctory studies to meet the threshold for approval in India.
  • Therefore, the uniform stent price will, in the long run, likely disincentives Indian stent manufacturers from conducting the research required to make them major international players.
  • Cherian and Kumar also suggest, that as a result of the reduction in stent prices, there is a “disturbing increase” in stenting multiple arteries.
  • This is passing off an anecdote as scientific truth and can only be confirmed or refuted by national level data.
  • Overuse and inappropriate use of procedures is more a result of unregulated, fee-for-service healthcare delivery and should not be blamed on reduced prices.
  • Implementing a uniform price cap is the most pragmatic approach available to put an end to widespread price-gouging.

What is required to be done?

  • Continued vigilance is needed to guard against unintended consequences.
  • The benefit of the reduction in price may not be transferred entirely to patients.
  • Several hospitals can juggle prices of the other components of their angioplasty “package charges” so that the overall price to the patient does not reduce.
  • Seen from a profit maximization perspective, it should be expected that stent manufacturers will make the ceiling price their target price.
  • New stents can get be introduced into the market which are priced at the ceiling even if their actual market price may be lower.
  • A more nuanced approach, which takes into account safety and efficacy metrics from arduous studies, should inform stent pricing.
  • It would make indigenous stents internationally competitive and allow entry to true technological advances.

Importance of Stents

  • The importance of stents lies in the treatment of coronary artery disease.
  • Drugs remain the cornerstone of treatment for stable patients.
  • The use of coronary stents in these patients is only for relief of chest pain that is not controlled with medicines.
  • Only about one-fifth to one-third of patients require stenting or bypass surgery over a period of five years.
  • Stents can be life-saving for patients during a heart attack if implanted in a timely manner.
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