The Centre’s move to control prices of coronary stents is among this administration’s first and certainly its most high-profile directive on medical devices. That’s why it is important to do it for the right scientific reasons that are pro-patient, and not swayed by any lobby. Price control on coronary stents will set a precedent for other medical devices, with similar action expected on technologies such as pace-makers, orthopaedic implants and intra-ocular lenses. This, even as similar control on condoms met with a different fate at the courts. Coronary stents caught the public eye as the usage of such devices shot up. And the experience often left the families of patients uneasy, both on the decision and price paid for the stent. The distrust and unease stemmed from the way stents were hawked by hospitals — as “packages”, at various price levels. If a patient did need a stent, shouldn’t the decision have been based on the best type of product suited for the condition, rather than the lowest price package? Prices vary from about ₹25,000 for bare metal stents to about ₹1.8 lakh for drug-eluting stents and almost ₹2 lakh for the absorbable variety.
The Centre needs to be mindful of some key points while exercising price control. It should not mix safety and price. Standards need to be clear on the safety criteria to measure all stents, locally made or foreign. So safety data for, say, three years need to be reviewed by an institution such as the Indian Council of Medical Research or the All India Institute of Medical Sciences so the general public is aware of the comparative safety record of different stents. Currently, patients have to go with either the company’s or the doctor’s word that a particular stent produces the best outcomes. Secondly, while the price ladder of landed cost of importers, ex-factory price of manufacturers, distribution margins, hospitals discounts and so on are scrutinised to curb steep mark-ups, care needs to be taken to reward an innovation if indeed it demonstrates an additional benefit over existing products in the market. Forcing price control on an innovative product could result in the product being taken out of the local market, which would be a setback for patients. Since companies need to remain profitable and patients need to have a basket of products to choose from, the Government could push for mass procurement to command a better price. And this sets a benchmark for private hospital procurement too.
Finally, the Centre has to ensure that hospitals pass on procurement discounts to patients. Hospitals and doctors need to be governed by guidelines that outline both the use and the type of stent in a given type of heart condition. Without bringing doctors and hospitals into the discussion and controlling promotional practices on products, the benefit of controlling prices may fall short of reaching the patient.