Jayadeva Institute of Cardiovascular
Sciences does 9,000 angioplasties across all its branches in Karnataka annually, one of the highest for a government heart hospital in India, next only to Delhi’s GB Pant Hospital. Director of the hospital writes for The New Indian Express on the problems faced by doctors over the past year due to unavailability of high-end stents. Dr CN Manjunath
The regulation of healthcare costs is always a welcome move and the need of the hour, but quality of care should not be compromised. Also, new technology should be encouraged. Ever since stent prices were capped, gradually high-end and new generation stents started disappearing from the shelves. Now, we are left with second generation stents, and price cap should be differential based on technology, performance, superiority and long-term results with periodic reviews.
Ideally, there should have been three categories of stents depending on technological efficacy, safety and performance. All types of stents available in the market are not the same with respect to safety, efficiency and deliverability. Three level price cap should have been done based on this. All patients are also not the same. Low-end and middle-end stents are available, and they are used for simple blockages. But for complex blockages and for high risk patients, we need high technology stents.
It is also true that Renarrowing (Restenosis) is definitely more with low and mid-end stents to an extent of up to 12 per cent which requires repeat procedure with another stent within six to nine months of first procedure resulting in additional cost to the patient. During this period, it adds to higher morbidity and heart attack. The stent thrombosis (blood clot) is relatively more with second generation stents compared to new generation stents; this can be fatal.
At present, there are six crore diabetic patients in India where high-end stents are proved to be superior, especially in this subgroup of patients. Coronary Artery Disease is five times more common among diabetic patients and 40 per cent of those requiring stents are diabetic. New generation/high-end stents are preferred in this category of patients and this is proven in many international trials on thousands of patients. Bypass surgery is not a preferred option for single vessel blockage.
Medicated stents are not just a metal. On the stent, there is a very high technology research product in the form of a polymer which regulates the drug release and this technology is patented and one company will not transfer this to the other. The heart is a highly delicate structure, so we cannot compromise the quality and outcome in high risk/complex patients. High-end and new generation stents should be made available without any hindrance. Also, continuous quality monitoring of stent products is very important. Price cap needs to be revised on an annual basis considering inflation, rupee value, import duties and patient needs.