THIRUVANANTHAPURAM: The National Pharmaceutical Pricing Authority had slashed the prices of life saving coronary stents by more than 80 per cent about four months ago. But the price slash seems to have made no significant difference to the treatment of cardiac diseases. NPPA had fixed a ceiling price of Rs 7,250 per piece of bare metal stent and allowed a maximum retail price of Rs 29,600 for drug eluting stents. However, this price policy is yet to be implemented. Many hospitals, especially those in the private sector, have come up with packages to circumvent the slashing of prices of the stents. Experts say putting a ceiling on the price of implants may not be enough to bring down the costs. The authorities should think about regulating the overall cost including that of the entire non- invasive procedure, diagnostic procedures and post implantation care.
The cost of the procedure continues to remain on the higher side. Since technological advancement and practical skills of experts have helped in effectively treating complex cardiac ailments with coronary angioplasty procedures, the number of people coming for the procedure is increasing by the day. Many hospitals have increased charges of cath labs, consumables, consultation, lab rental, equipment charges, floor area cost and annual maintenance cost. So the cost advantage that the patient would have got through reduction in stent prices, has become minimal. A high level committee constituted by IMA is currently looking into the cost of coronary stents and its impact on treatment charges. The panel which will submit its report next month will also look into the cost of orthopaedic implants. “We are looking into all these issues. A detailed report on the cost of implants will be submitted to the national committee and state government,” said IMA state president Dr V G Pradeep Kumar.
Nearly 50,000 patients were successfully treated with angioplasty last year. Many of these cases were primary angioplasty which means coming to hospital soon after heart attacks and having elective angioplasty. According to cardiologists, the state has the largest number of hospitals equipped with catheterization labs. These labs are playing a significant role in opening blocked or narrow coronary arteries through minimally invasive procedures that restore easy blood flow to heart muscles. But there is huge difference in the rates charged by private hospitals and government hospitals. Sources said in private hospitals, especially the high-end hospitals, one stent angioplasty could cost anywhere between Rs 90,000 to Rs 1 lakh. In case of management of infections in patients with uncontrolled diabetes and blood pressure, the cost could go up from Rs 1.3 lakh to Rs 1.9 lakh.
It is alleged that the cost of an imported stent at the time of procurement is Rs 45,000 but it shoots up by three times on reaching the patient. The angioplasty procedure in government medical colleges and general hospitals could cost Rs 15,000 and a stent costs Rs 30,000 as per the latest price fixation of the government. The total cost for hospitalization, procedure and treatment for a single stent angioplasty roughly comes to Rs 45,000. It could go up if the patient is highly diabetic and prone to infections. Apart from the seven government medical colleges, only two hospitals under the health service department are doing angioplasty procedures in the state. The facility is available at Ernakulam general hospital and Palakkad district hospital. There is no waiting period for a primary angioplasty which is done on patients coming in with heart attacks. However, in elective angioplasty the wait on an average is up to one month or even more in government hospitals. But the delay is not always related to patient rush.
“Angioplasty is advanced only if the block is found to be more than 70 per cent. Otherwise the effort is to bring it down through medical therapy. The site of the block, other related complications and medical history like diabetes, hypertension, are factored in while deciding on angioplasty,” said a cardiologist. After the procedure, the patient may be required to stay in hospital for a couple of days. Angioplasty has a definite edge when it comes to treatment of serious heart attacks. The procedure can also reduce the chances of having another heart attack in the future. Percutaneous Coronary Intervention (PCI), commonly known as coronary angioplasty is one of the most effective and minimally invasive procedures to open blocked or narrow coronary arteries to restore easy blood flow to heart muscles.
Since hospitals are now equipped with advanced invasive techniques, the imaging of the inner walls of blood vessels of the heart can correctly identify the extent of plaque built up leading to narrowing of blood vessels or heart attack. The cost of open heart surgery in the private sector is also considerably high compared to government hospitals. While, open heart surgery in the medical college could cost between 1.1 lakh and Rs 1.30 lakh, in private hospitals, especially the high-end ones, the cost ranges from Rs 2 lakh to Rs 3 lakh and even more. However, experts say the additional cost in the private sector is because of various factors including modern infrastructure facilities, highly professional environment, quality nursing care and state of the art equipment. Most hospitals are now following a uniform treatment protocol for heart attacks. When a patient with heart complications reaches the hospital, he is put through ECG, Angiogram and if required given heparin or advised angioplasty, bypass or stent. But for initial management there is a definite protocol and in patients coming with acute chest pain, this pattern is followed.
Better tech on its way to treat heart
Percutaneous Coronary Intervention (PCI), commonly known as coronary angioplasty, is one of the most effective and minimally invasive procedures.
A thin flexible tube (catheter) is inserted into the femoral artery through a small incision in the groin and threaded to the affected coronary artery. Then through the tube, a thin wire is guided across the blockage (plaque). Over the wire, a balloon tip catheter is guided. The balloon is passed across the blockage and inflated to stretch open the narrowed or blocked artery. Once the artery is widened, a short wire-mesh tube called stent is fixed there with the aid of another balloon to prevent re-narrowing.
The patient is numbed with local anesthetics only at the groin where the catheter is inserted. Patients are usually given only medicines to relax. The procedure, done without any major incision, is therefore minimally invasive, safe and except for a feeling of some pressure, is not painful. The procedure requires only minimal hospitalization. There are new technologies now available in hospitals for treating hardened calcified plaques. A procedure known as rotational atherectomy is carried out for such cases. A nano drill (rotating Burr) is guided through the femoral artery to the affected area in the coronary artery and the calcified plaque is scraped away. Fractional Flow Reserve (FFR) estimation helps in physiological assessment of a borderline heart block precisely and results in judicious usage of coronary stents. FFR assesses the severity of coronary blocks (narrowing of artery due to plaque built up) by measuring the blood flow inside the coronary arteries. An interventional cardiologist could then decide whether a case requires angioplasty.
