Maharashtra Price Cut Boosts Use Of
Drug- Eluting Stents : Study
MUMBAI: Underlining the effect of price control in
healthcare, a new research paper by state government doctors and high ranking
bureaucrats shows that the use of drug eluting stents (DES) among poor cardiac
patients ballooned to 70% from 40% after these became cheaper.
Till 2013, a majority of poor patients-almost 60% - got bare
metal stents which cost one-fifth of DES but are not as effective in preventing
reappearance of blockages in arteries. Maharashtra took up price control
strategies in 2014 after it introduced free health insurance for families that
earn less than Rs. 1 Lakh per annum. It invited tenders from various companies
for DES and managed to get the latest generation stents for around Rs. 30,000
State bureaucrats shared a note on this experiment with the Centre, which capped
the price of stents at Rs. 29,600 in 2017.
Now, the effect of the state experience from 2013 to 2015 has
been captured in a research paper appearing in the April issue ofthe medical
journal ‘Circulation: Cardiovascular Interventions’. Authored by former health
secretary Sujata Saunik and cardiologist Bhanu Duggal from state-run J J
Hospital in Byculla, the paper looked at stent use among 2,274 beneficiaries of
the state government’s free health Insurance scheme in 87 hospitals from
“The proportion of DES use rose in the overall study
population from 40.7% to 71.3% after institution of the price reduction
strategy,” said the paper. Dr. Duggal said, “By the price lowering strategy,
millions of people of lower socio-economic strata suddenly had access to the
best drug-eluting stents.”
The increase was seen in both public and private hospitals,
with almost 96.2% patients in public hospitals and 65.2% in private hospitals
getting DES. “In private hospitals, only 32.7% of all angioplasty patients under
the scheme would get DES and the remaining would get bare metal stents,: said
The study, though, found that the use of DES continued to be
lower despite the price reduction in vulnerable groups such as the elderly,
women, and the poorly educated.
The paper underlines how pricing mechanism is important to
improve healthcare access. “Our people deserve better quality stents. Just
because they are getting treated in public sector, should they be implanted with
bare metal stents? Asked Saunik. A previous study last year by the same doctors
found that the use of DES had led to better survival outcomes among patients in
Incidentally, on April 1, the Union government increased the
cost of stents by 4.2% to Rs. 30,080. Saunik, who conducted this research as a
part of her study leave to Harvard T H Chan School of Public Health in Boston,
said, “As a policy-maker, the evidence is clear that government can control the
prices and also provide insurance coverage as it reduces costs. In this way,
insurance cover can remain sustainable over time.” If costs keep rising every
two years and volumes increase, the government spend will also increase, she
Dr. Brahmajee Nallamothu from the University of Michigan, who
is also an author in the study, noted that improvement in the quality of made-in
India stents might help. “Stents are a cornerstone therapy for coronary artery
disease, a growing problem in India. In Western countries, DES are the most
common type of stent used. But their high costs have led to limited access among
lowincome patients in India, but the study shows improved access,” he added.
Cipla Targets Small Airway Respiratory Disease With An
Innovative Two-In-One Inhaler
In an effort to address patients with small airway respiratory diseases,
drugmaker Cipla has rolled out its extra-fine particle beclomethasone-formoterol
combination hydrofluoroalkane (HFA) inhaler for adults, touted to be the first
of its kind in the country.
This is not an innovation in isolation, said Cipla’s India business head Nikhil
Chopra, referring to other novel respiratory products from the company including
its breath-actuated inhaler with dose counter called Synchrobreathe. The latest
two-in-one inhaler Niveoli is a product of about three years of research, and
addresses an unmet need associated with obstructive airway diseases (OAD) such
as asthma and chronic obstructive pulmonary disorder (COPD), Chopra told
Role in asthma, COPD
Small airway diseases are known to have a significant role in asthma and COPD,
he said, and often such patients were seen to not get the desired relief from
their existing medication. The new inhaler is priced at ?595 for 120 doses,
working out to about a month’s supply for a person with mild or moderate asthma,
doctors familiar with the product said.
Sujeet Rajan, a consultant respiratory physician with Bombay Hospital, observed
that CT scans were revealing more people with small airway diseases. And this
accounted for why some patients were not responding as desired to their earlier
medication, he said, adding that the extra fine-particle inhaler would bring
much relief such patients.
In fact, even regular patients with mild or moderate asthma were seen to be open
to this inhaler that used half the dose of steroid (beclomethasone), he said.
The next step should be to have a similar product with greater strength so it
can be used in severe cases, he suggested.
Chopra said that there were about 93 million people with asthma and COPD and
only half that number is diagnosed. Making matters worse, only 15 per cent
adhered to their treatment regimen, he said.