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Brahmajee Nallamothu
Brahmajee Nallamothu

More patients opted for stents after prices were slashed: Study 4/18/19

A new study led by cardiologists and policy-makers from public healthcare institutes has found that imposing a price cap on coronary stents has helped a higher number of patients from lower-income groups to undergo life-saving procedures.

The number of patients who underwent heart procedures with stents rose by 43% after the prices were slashed, according to the study.

The findings are significant amid concerns that such price-reduction strategies could compel many foreign players to pull out of the Indian market. As drug-eluting stent (DES) are mostly manufactured by multinational companies, this could lead to decreased use of DES in hospitals, leaving cardiologists with limited options.

“Contrary to these concerns, we found that the proportion of DES use among patients rose after the prices were reduced. In 2013, only 40.7% of the patients could afford the procedures, but after the prices were slashed in 2014, the number rose to 71.3% in 2015. This has made quality healthcare more accessible to the poor,” said lead author Dr Bhanu Duggal, head of cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh.

The researchers studied the impact of state-wide price reduction in Maharashtra in 2014, much before the national price cap was instituted by National Pharmaceutical Pricing Authority (NPPA) in 2017, which had brought down the costs of DES by over 70%.

A coronary stent is a tiny wire mesh tube used to unclog arteries and prevent heart attacks. Before the national price cap was put into place in 2017, the bare-metal stents (BMS) would cost up to ₹8,000, while the DES cost between ₹50,000 and ₹ 1.6 lakh. After the devices were placed on the National List of Essential Medicines (NLEM), the cost of DES decreased from over ₹1 lakh to ₹29,600, easing the burden of spiralling costs of healthcare on the poor.

The manufacturers were, however, disenchanted with the move. “There are market concerns, but these concerns did not materialize in Maharashtra. Rather we were able to reach out to more patients. The agencies running such health insurance schemes, need to study such evidence before reviewing price caps,” said Sujata Saunik, former principal secretary, public health department, Maharashtra. “The number of patients is so high in India that the price reduction would be offset by the number of patients,” said Saunik, now a Takemi fellow at the Harvard T.H. Chan School of Public Health.

The rising discontent among manufacturers led to apprehensions that the drug price regulator could review its decision on price-caps on coronary stents. In its latest decision, the NPPA has increased the rate of stents by 4.2%. A BMS now costs ₹8,261, while DES will cost ₹30,080.

The research team published its findings in the Circulation: Cardiovascular Interventions journal .

The data was collected from 87 public and private hospitals across Maharashtra.

“Before the price cap was instituted, the prices of DES were out of line. In fact, costs of these devices often exceeded costs for them in Europe and the US. That’s a big worry for the average Indian patient with low average incomes,” said the co-author, professor Brahmajee K. Nallamothu from University of Michigan.