Doctors debate stent ethics after price cap

Hyderabad: The National Pharmaceutical Pricing Authority (NPPA) decision to put a cap on stent prices has not only dealt a huge blow to hospitals and device manufacturing companies but has also thrown up a question of ethics, with experts locking horns on the appropriateness of stent implants.

Whether one needs a stent implant or not is generally decided by a lone cardiologist. The norm in some developed countries, however, is for a 'heart team' to take a collective decision. The team usually comprises a cardiologist, a cardio thoracic surgeon, a cardiac anesthesiologist, general physician and an outsider.

What's worse in the country is that there is neither a third party watchdog to regulate stent implantation according to established protocol nor is a medical audit done.

"Without a third party watchdog, a medical audit or a heart team to take a collective decision before stent implantation in a patient, as is done in a few developed countries, it will always leave a doubt that stents are being overused," said Dr RV Kumar, cardiothoracic surgeon and head of department of cardiothoracic surgery at Nizam's Institute of Medical Sciences (Nims).

In fact, a medical audit of stents is performed on Aarogyasri patients, but not in the case of private patients. In such cases, even private insurance players do not look into the merits of each angioplasty but merely give procedural clearance to the hospitals.

Dr MSS Mukharjee, director, department of cardiology, Maxcure Hospital, Madhapur, said that the concept of stent appropriateness will develop in due course of time.

"Don't mix stent appropriateness with the stent price capping issue. Now, the problem is stent pricing and how people who can afford to buy the latest fourth generation stents are helpless as device makers have withdrawn them from the market," he said.

He added that cardiologists in India generally follow the protocol and guidelines issued by the Cardiology Society of India and American College of Cardiology while deciding to implant a stent in a patient.

Meanwhile, patients looking for high-end stents continue to suffer as city-based corporate hospitals find themselves in a spot after price cap. "There is a lot of confusion since patients want high-end stents and companies have started withdrawing stocks from the market," said Harish Manian, COO of Continental Hospital.