{"id":35862,"date":"2018-11-01T12:03:00","date_gmt":"2018-11-01T06:33:00","guid":{"rendered":"https:\/\/blog.forumias.com\/?p=35862"},"modified":"2018-11-01T12:03:00","modified_gmt":"2018-11-01T06:33:00","slug":"heart-of-the-matter","status":"publish","type":"post","link":"https:\/\/forumias.com\/blog\/heart-of-the-matter\/","title":{"rendered":"Heart of the matter:\u00a0"},"content":{"rendered":"<p><a href=\"http:\/\/indianexpress.com\/article\/opinion\/columns\/stent-industry-price-capping-heart-angioplasty-4779526\/\"><span style=\"font-weight: 400;\">Heart of the matter<\/span><\/a><span style=\"font-weight: 400;\">:\u00a0<\/span><\/p>\n<p><b>Context<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The article \u2018Address this blockage,\u2019 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.<\/span><\/li>\n<\/ul>\n<p><b>Major arguments<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">One key argument against price capping is that the \u201clatest generation\u201d of stents will not be available to the Indian public at price mentioned.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">This is a deceitful assertion. Successive \u201cgenerations\u201d 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).<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Currently, the best performing stents are available in the country at or below the current ceiling price.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Suggestions like \u201cpatients hoping to have advanced stents may have to travel abroad\u201d is a misrepresentation.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The second major area of controversy has been the impact of price capping on the indigenous stent industry.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">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.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The actuality is that the uniform price cap has reduced the price differential between the foreign-made and Indian-made stents.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">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.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">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.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Cherian and Kumar also suggest, that as a result of the reduction in stent prices, there is a \u201cdisturbing increase\u201d in stenting multiple arteries.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">This is passing off an anecdote as scientific truth and can only be confirmed or refuted by national level data.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">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.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Implementing a uniform price cap is the most pragmatic approach available to put an end to widespread price-gouging.<\/span><\/li>\n<\/ul>\n<p><b>What is required to be done?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Continued vigilance is needed to guard against unintended consequences.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The benefit of the reduction in price may not be transferred entirely to patients.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Several hospitals can juggle prices of the other components of their angioplasty \u201cpackage charges\u201d so that the overall price to the patient does not reduce.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Seen from a profit maximization perspective, it should be expected that stent manufacturers will make the ceiling price their target price.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">New stents can get be introduced into the market which are priced at the ceiling even if their actual market price may be lower.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">A more nuanced approach, which takes into account safety and efficacy metrics from arduous studies, should inform stent pricing.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">It would make indigenous stents internationally competitive and allow entry to true technological advances.<\/span><\/li>\n<\/ul>\n<p><b>Importance of Stents<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The importance of stents lies in the treatment of coronary artery disease.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Drugs remain the cornerstone of treatment for stable patients.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The use of coronary stents in these patients is only for relief of chest pain that is not controlled with medicines.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Only about one-fifth to one-third of patients require stenting or bypass surgery over a period of five years.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Stents can be life-saving for patients during a heart attack if implanted in a timely manner.<\/span><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Heart of the matter:\u00a0 Context The article \u2018Address this blockage,\u2019 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&hellip; <a class=\"more-link\" href=\"https:\/\/forumias.com\/blog\/heart-of-the-matter\/\">Continue reading <span class=\"screen-reader-text\">Heart of the matter:\u00a0<\/span><\/a><\/p>\n","protected":false},"author":61,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"footnotes":""},"categories":[555],"tags":[],"class_list":["post-35862","post","type-post","status-publish","format-standard","hentry","category-test-1","entry"],"jetpack_featured_media_url":"","views":{"total":0,"cached_at":"","cached_date":1704927028},"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/35862","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/users\/61"}],"replies":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/comments?post=35862"}],"version-history":[{"count":0,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/35862\/revisions"}],"wp:attachment":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/media?parent=35862"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/categories?post=35862"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/tags?post=35862"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}