BENGALURU: WITH the National Pharmaceutical Pricing Authority (NPPA) displaying trade margins on knee implants both in the primary surgery and revision surgery, and inviting comments on the same, orthopaedic surgeons are worried about the quality of indigenously manufactured implants if a price cap is put in place and imports reduced.
While total average trade margin for total knee system is 313 per cent, according to the NPPA, in revision surgeries (where the first surgery fails) it is 369 per cent, based on single company data.
Dr Thomas Chandy, director and chief of Orthopaedics, HOSMAT hospital, said it performs 600 to 800 bone surgeries per month, which includes around 100 joint replacement surgeries. A high percentage of implants in the hospital includes those for broken bones and trauma.
“We have seen the treatment outcomes in imported implants. There is not enough research available on Indian manufactured implants. While price regulation is good, if foreign companies pull out of Indian market, are domestically manufactured implants good enough? This is exactly what happened with coronary stents. Foreign manufacturers refused to sell at the fixed price,” he told Express.
“I am up to date with domestic products. They are not on par with imported ones,” he said.
Dr Chandrashekar H S, director of Sanjay Gandhi Institute of Trauma and Orthopaedics, said the hospital has fitted both BPL cardholders and general category patients with imported knee implants.
“We see around 25 to 30 total knee replacement surgeries per month. The longevity has not been studied in Indian implants. A minimum 15-20 years study is required and we do not have the instrumentation to get the precision required. Hence quality suffers.”
While the minimum price for total knee system has been displayed by NPPA as `59,091, the maximum has been displayed as `4,13,059. “Though ours is a government hospital, for general category patients, a total knee replacement including hospital charges costs `1 lakh in which the implant alone costs `65,000 to `70,000. A second surgery is not only expensive, its success also depends on patient factors like whether they can withstand it,” Dr Chandrashekar said.