Doctors’ alliance: Discard letter opposing cap on prices of stents, orthopaedic implants

Doctors’ alliance: Discard letter opposing cap on prices of stents, orthopaedic implants

Context:

Scientific data suggests that so called innovative re-absorbable stents are in no way superior to the drug-eluting stents, which have a price cap, stated ADEH.

Introduction:

• The Alliance of Doctors for Ethical Healthcare (ADEH), a nation-wide network of doctors in the country, has strongly opposed a suggestion by Ambassador Robert E Lighthizer, US trade representative, opposing a cap on the prices of stents and orthopaedic implants.
• According to ADEH, the Indian government has rejected the company’s’ demand for differential pricing for cardiovascular stents because these companies failed to submit verifiable and credible evidence to show the clinical superiority of the so-called ‘innovative’ stents.
• This price capping on stents and orthopaedic implants has come as a result of people’s movements and judicial intervention
• Earlier, the National Pharmaceutical Pricing Authority (NPPA) had put a cap on the prices of coronary stents and knee joint implants.

What is a Stent?

• A stent is a small mesh tube that’s used to treat narrow or weak arteries.
• Arteries are blood vessels that carry blood away from your heart to other parts of your body.
• Some stents are coated with medicine that is slowly and continuously released into the artery. These stents are called drug-eluting stents.
• The medicine helps prevent the artery from becoming blocked again.
• These metal tubes have revolutionized modern cardiology.

Stenting in India

• There is no regulation of hospitals in India, especially in the private sector where a majority of urban Indians seek health care. At least 25-30% of the stenting done in this country is inappropriate. There are cases of stents being used in absolutely normal patients.
• In our country the major gap is in the counselling which the doctor provides. Normally the patients go by the doctor’s advice. In the absence of any monitoring, patients in India have no protection from unnecessary use of stent.
• In the last 5 years the implant of stenting in India has increased by 5 times. There is not only a boom in the domestic market, bust also foreign patients are coming to India as part of medical tourism to get stenting done because the cost of stenting in India is low. This is because there is increased awareness, increased diagnosis, increased availability of the angiograms and increased availability of doctors.

Uses of Stents:

• Stents are small, expandable tubes that treat narrowed arteries in patient body.
• Coronary stent is a tube shaped device when inserted into blocked blood vessel ,can help to clear d blockage
• In people with coronary heart disease caused by the buildup of plaque, they can:

1. Open narrowed arteries
2. Reduce symptoms like chest pain
3. Help treat a heart attack. These types are called heart stents,but they’re also referred to as cardiac stents or coronary stents.
4. Doctors also may place stents in weak arteries to improve blood flow and help prevent the arteries from bursting
5. A stent is placed in an artery as part of a procedure called percutaneous coronary intervention (PCI), also known as coronary angioplasty
6. A stent helps support the inner wall of the artery in the months or years after PCI.

Advantages of stent:

• The devices save thousands of live every year.
• Emergency angioplasty is the treatment of choice during an acute heart attack, wherein the clot is crushed with a balloon and a stent is placed.
• It improves the chance of the patient surviving by almost 30 per cent when compared to clot dissolving medication (thrombolysis).

Concerns / challenges

• In India there are instances where angioplasty is done for patients having chest pain due to Vitamin D deficiency which is wrong.
• The bypass is done by the surgeon and the stenting is done by the cardiologists. The poor victim of the heart attack or the Coronary artery disease lands up with cardiologist. It is the integrity, honesty and the righteousness of the cardiologists to decide whether the patient really needs stenting or not.
• The stents are very costly. There is no regulation and the Drug Controller is not capable of regulating domestic stent manufacturers. There have been cases where the stent manufacturers have been found making stents in garages.
• In India the coronary artery disease is seen in young age, people do not exercise, do not have adequate sleep, do not have stress free life and do not eat balanced diet to keep their coronaries healthy.

Conclusion:

India needs to have more stent manufacturers and medical device research so that we do not need to depend on imported stents. All aspects involving medical device development like clinical research, animal testing, human trials etc must be fast-tracked and should be as transparent as possible. The current step of price capping taken by the Indian government is only a small step towards making health care accessible for all.