ANN ARBOR — In a landmark decision last February, India's National Pharmaceutical and Pricing Authority capped prices for coronary stents that were sometimes priced even higher than what patients paid in the United States.
This is the first time a cardiac device has been placed on the National List of Essential Medications. The ceiling price set by the government organization is roughly a quarter of the average price charged before the decision. The new price limit in India would fix the ceiling price for bare metal stents at approximately $108 and for drug-eluting stents at about $444.
Brahmajee Nallamothu, M.D., M.P.H., professor of cardiovascular medicine at the University of Michigan, says this is a positive move as rates of noncommunicable disease are soaring among the burgeoning Indian middle class.
"A growing middle class is starting to develop diabetes, hypertension, dyslipidemia, which results in coronary disease," said Nallamothu, senior author of a Perspective piece that was published in the Circulation journal this month. "With the disproportionate high device cost of stents, several people simply didn't have access to the type of care that has become routine in Western countries."
Heart disease in India has increased fourfold over the last 40 years with more than 30 million people suffering from coronary disease. It is now the number one cause of death, with ischemic heart disease and stroke accounting for more than 80 percent of cardiovascular deaths.
Researchers say the decision to include devices like stents in the Essential Medications List may have implications for conditions beyond cardiovascular disease in India.
"India's decision to place stents on NLEM paves the way for other medical devices to be placed on it for price control," said medical student Priya Wadhera, first author of the Perspective piece.
Wadhera says this means that other devices that could significantly alter patient's quality of life—artificial heart valves, intraocular lenses and orthopedic implants—may also be put on the list and become more accessible.
Some anecdotal reports suggest that several international companies that make up 60 percent of the Indian market are withdrawing stents from the market.
"This is the first time the Indian government has focused on improving accessibility for stents," Nallamothu said. "How the market reacts in the next six months will be important to understand as well."
According to the researchers, since India is a major player in the Asia Pacific region, other low- and middle-income countries burdened by the potential for price inflation may take the same action.