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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 from 2014-15.

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 2013-2015.

“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 Dr. Duggal.

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 Maharashtra.

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 added.

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.
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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 BusinessLine.

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.

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