After curbing stent prices, will govt follow its heart to cap other life-saving medical devices?
Patients hope that authorities will turn to overpriced pacemakers, knee and hip implants and cataract surgery lensesmumbai Updated: Mar 10, 2017 16:25 IST
On February 13, the Union government capped prices of stents — a tiny metal tube inserted into the narrowed coronary arteries — by nearly 85%, drastically reducing the cost of angioplasty.
The price cap is just one example of how a life-saving medical device can be made affordable when the government intervenes to regulate prices. Prior to the price capping, a stent contributed heavily to the cost of an angioplasty. A patient had to shell out anywhere between Rs50,000 and Rs1.5 lakh for a stent, depending on its brand and range. But, now, no stent, however advanced, can cost more than Rs30,000.
The fall in stent price has brought relief to patients with heart ailments, but other medical devices that are equally life-saving or essential to improving health are still unaffordable because prices are not regulated by the government.
For example, in cardiac care, a conventional pacemaker costs in the range of Rs40,000 to Rs2.3 lakh. It is a small device that is placed in the chest or abdomen to help control abnormal heart beats. According to industry sources, this cost is almost 40% more than its import price and follows a market methodology — a term referring to an arbitrary pricing decided by hospitals. “Pacemakers are as life-saving as stents. But the cost is definitely a financial burden on patients. They have to take up loans or pay for the device on EMI basis,” said a senior cardiologist at a hospital in Vile Parle.
Similarly, orthopedic implants and intraocular lenses are other medical devices which burn big holes in a patient’s pocket.
Hindustan Times has learnt that the MRP of an imported knee implant is anywhere between Rs 90,000 and Rs2 lakh, which is more than 300% of its import cost, according to a dealer.
Dr Pradeep Bhosale, head of hip and joint replacement surgery at Nanavati Hospital, said the number of knee and hip replacement surgeries has increased by 600 times in the past five years, but implants continue to be expensive for patients.
“We often choose imported implants owing to their better longevity. There are many Indian companies that now manufacture these implants, and they are nearly 40% cheaper compared to the imported ones,” he said.
Bhosale added that doctors have their reservations about using Indian implants as there have not been any no long-term clinical trials to prove that they are at par with products approved by the Food and Drugs Administration .
Another essential medical device where there is a wide gap in the import cost and the final price paid by patients is intraocular lens. The heavily-priced intraocular lenses contribute to a major portion of the cost of cataract surgeries.
On the price regulation by the government, doctors argued that medical devices such as intraocular lenses, and knee and hip implants, are neither essential nor life saving, but a means to improve quality of life. “These devices are essential for good quality of life,” said an ophthalmologist from a hospital in south Mumbai.
Dr Abhay Shukla, from Jan Swasthiya Abhiyan, questioned why these devices, which have catastrophic economic implications on a patient, are not included under the National List of essential medicines (NLEM), by the ministry of health and family welfare. Once a device is included under NLEM, the National Pharmaceutical Pricing Authority (NPPA) can regulate its prices.
Giving an example of a injection syringe, Dr Shukla said, “It is manufactured at Rs2, but its MRP is between Rs15 and Rs20. No doubt, a patient ends up paying ten times more than its manufacturing cost, but its economic implication is very little on the patient,” he said.
“But, when you look at medical devices and implants whose cost runs in lakhs, then the patient feels a big financial pinch. These are the products prices of which the government must regulate,” he added.
Two doctors have pointed out that as a device moves from a manufacturer to a patient, hospital earns the maximum commission. “Hospitals and doctors earn the highest margin. They sometimes buy devices from distributors,” said Dr Arun Gadre, a city gynaecologist.
While the NPPA is already looking at regulating the prices of orthopedic implants and intraocular lenses, an industry insider from Hyderabad, said the capping of prices of pacemakers will be tough.
“There are many local manufacturers for orthopedic implants and lenses who can step in if multi-national players withdraw. However, with pacemakers, there are just one or two Indian manufacturers,” he said.