NEW DELHI: A hearty business in India is that of stents, bloodied with malpractices that cost patients a bomb. And sometimes their lives. Last month, the National Pharmaceutical Pricing Authority (NPPA) slashed prices of coronary stents by over 75 per cent, capped the ceiling prices of Drug Eluting Stents (DES) and Bioresorbable Vascular Scaffolds (BVS) at Rs 29,600, and Bare Metal Stents (BMS) at Rs 7,260.
These stents will now cost Rs 31,080 and Rs 7,623 respectively after inclusion of VAT. NPPA says “huge” and “unethical” markups were charged on the devices throughout the supply chain.
NPPA claimed stents were being sold with a 400 per cent profit margin. Over 90 per cent of stents in India are DES, and cost Rs 1.21 lakh, while BMS are sold for Rs 45,095.
Getting an inexpensive third generation stent in India is not easy. Amit’s 69-year-old father was admitted to a hospital after a heart attack. Doctors told him that a third generation stent was not available. As his father had three blocked arteries, a second generation stent would not be feasible. Amit paid Rs 50,000 for a Rs 8,000 stent.
NPPA’s order of capping the price of stents comes as a huge relief to lakhs of patients who have to undergo angioplasty.
Indian Medical Association (IMA) has welcomed the order but is also apprehensive. “In the absence of proper monitoring, hospitals will raise the price of disposable material used in angioplasty to maintain their profit margin to what it was before,” said IMA president Dr K K Aggarwal.
“After this order, hospitals will continue their malpractices by charging patients heavily in other ways,” said Dr Sanjay Jaiswal, member of Parliamentary Standing Committee of Health.
Chairman of NPPA, Bhupendra Singh, said “exorbitant pricing in the health system will be dealt strongly”.
“Because of the huge profit margin, at least 25-30 per cent of stenting in India is inappropriate. There are cases of stents being used in normal patients to make money,” said a senior cardiologist.
Another stunning revelation is that older and cheaper stents, which cost Rs 4,000-7,000, disapppeared from hospitals two years ago so that newer and more expensive ones could be sold. “Some stent companies are offering a Rs 10,000-15,000 commission to hospitals on each stent sold. The government should ban first generation stents,” said Dr Aggarwal.
According to data submitted by stent companies to NPPA, the average manufacturing cost of a DES is Rs 8,000, while the price of imported DES starts at Rs 5,000. Over 95 per cent of stents used in India are DES.
“The move could discourage reliable stent makers and lead to a growth in companies that produce poor quality stents,” said a senior official of Indian stent company Translumina Therapeutics.
NPPA has received complaints against over 30 hospitals, including Max Hospital, New Delhi; Lilavati Hospital, Mumbai; Metro Hospital, Faridabad, and PGI Hospital, Chandigarh, among others, for overcharging for stents and creating their artificial shortage.
“Out of 100, there are some challenging cases where we need to use latest generation stents to access the blockage. They are dissolvable and are made of platinum,” said Dr R R Mantri, senior cardiologist at Gangaram Hospital, Delhi. He said the government should consider capping the latest version of expensive stents in another category.