DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20202040

Impact of coronary stent pricing regulation in a private sector health care system in India: a retrospective cohort analysis

Shijin N. Nadar, Nirav Anney, Irfan H. Khan

Abstract


Background: National pharmaceutical pricing authority of India slashed prices of coronary stents by up to 80% (February 2017) to increase affordability of percutaneous coronary interventions (PCI). This study aimed to assess its impact.

Methods: A retrospective cohort study in a private sector tertiary care hospital in Mumbai, India evaluating data of patients admitted for PCI from 13 February 2015 to 12 January 2019. Cost of undergoing PCI before and after price capping of coronary stents was analysed and studied under different subgroups along with other associated parameters.

Results: Of 1015 patients included, 514 of them underwent PCI before and 497 after the price capping. 967 stents at an average 1.88 stents/case and 1011 stents at average 2.03 stents/case were implanted before and after the price capping respectively. Cost of PCI decreased by 11.64% and 28.14% in non GIPSA (private insurance providers and self-paying) and GIPSA (public sector insurance providers) category respectively under single room class and by 2.79% and 19.87% in non GIPSA and GIPSA category respectively under twin sharing room class. In multi sharing room class cost of PCI increased by 3.99% in non GIPSA category and decreased by 26.87% in GIPSA category. Usage of adjunct devices and number of complex PCIs increased significantly.

Conclusions: Cost of undergoing PCI has dropped significantly after price regulation of coronary stents in most subgroups despite increased usage of adjunct devices like IVUS, FFR/iFR for better patient outcomes. There was no effect on number of PCIs performed.

 


Keywords


Medical devices, Stents, Price regulation, PCI, IVUS, FFR

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References


India State-Level Disease Burden Initiative CVD Collaborators. The changing patterns of cardiovascular diseases and their risk factors in the states of India: The Global Burden of Disease Study 1990–2016. Lancet Global Health. 12 September 2018.

Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297(3):286-94.

Mishra S, Chakraborty R, Ramakrishnan S. Coronary Interventional Data, 2012. Available at:www.national interventional council.org. Accessed on 12 Decemeber 2018.

Khanna NN, Rao S, Chandra SK, Bansal M. Growth of Interventional Cardiology in India: The Relevance of National Interventional Council (CSI–NIC2016), 2017 Cardiology Year Book Published in Part II, Section 3, Sub Section (ii) of the Gazette of India Extraordinary, 13th February 2017. Government of India, Ministry of Chemicals and Fertilizers, Department of Pharmaceuticals, National Pharmaceuticals Pricing Authority, New Delhi.

Nagarajan R. Profit on stents ranges from 270% to 1000%’, Times News Network, 17 January, 2017.

Adva Med. Medical Devices in India: An Agenda to Effective Health Care Delivery, IQVIA and Advanced Medical Technology Association (Adva Med), Report dated 29 September 2018. Available at: https://www.advamed.org/resource-center/ medical-devices-india-agenda-effective-healthcare-delivery. Assessed on 25 March 2020.

Tonino PA, Bruyne DB, Pijls NH, Siebert U, Ikeno F, Veer VM, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213-24.

Bruyne DB, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367:991-1001.

Frohlich GM, Redwood S, Rakhit R, Carthy PAM, Lim P, Crake T, et al. Long-term Survival in Patients Undergoing Percutaneous Interventions with or without Intracoronary Pressure Wire Guidance or Intracoronary Ultrasonographic Imaging: A Large Cohort Study. JAMA Intern Med. 2014;174(8):1360-6.

Choi KH, Song KH, Lee JM, Lee SY, Park TK, Yang JH, et al. Impact of IVUS-guided percutaneous coronary intervention on long - term clinical outcomes in patients undergoing complex procedures. JACC cardiovasc Interv. 2019;12(7):607-20.

Zhang J, Gao X, Kan J, Ge Z, Han L, Lu S, et al. Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation. J Am Coll Cardiol. 2018;72(24):3126-37.