In recent years, more Indian patients have made the choice to travel overseas for medical treatment, seeking expertise in advanced procedures, technology, medical products that are not available back in India. Singapore is fast becoming the choice destination for treatment for cardiac aliments especially for the Indians. The number of angioplasty has increased manifold in Singapore after the Indian government’s decision to cap prices of stents in 2017, a device used for patients with heart conditions to facilitate blood flow in arteries.
Dr Dinesh Nair, Senior Interventional Cardiologist from Mount Elizabeth Hospital, Singapore, informed us that they are flooded with requests for high end stents in Singapore. These stents have disappeared from the Indian hospitals. The majorities of the Indian patient who are asking for this are the rich and affluent, and have the purchasing power to avail the newest medical health facility.
“An older generation stent may not give a good result in a complex blockage as compared to a new generation product. Interventional cardiologists need good products to tackle complex cases.”, Dr Dinesh explained.
It is estimated that approximately 600,000 cardiac stents are sold across India every year. The NPPA capped prices of cardiac stents at Rs 29,600 a piece, by up to 85 percent in February 2017.
In India, despite government's capping on coronary stent pricing, the cost of angioplasties has more or less remained the same, indicating that the benefit was not passed on to patients by hospitals. Moreover, the move has limited the access to cutting-edge technologies in coronary stents for Indian patients.
India has become a favorable market for obsolete stents which has made the future of coronary artery stenting uncertain. Furthermore, these obsolete stents are subjected to a higher rate of ‘restenosis’ (a medical term meaning recurrence of blockage at the same arterial site). “An older generation stent may not give a good result in a complex blockage as compared to a newer generation product with good science and research behind it. Interventional cardiologists need the best devices to tackle complex cases.”, Dr Dinesh explained.
The highest quality stents with the best supporting data come with the highest price tags. This is reflective of the Research and Development (R&D) costs of the companies producing them, and also the continuous monitoring of outcomes in the years after implantation. Unfortunately, the more affordable stents do not have the equivalent data.
Dr Dinesh Nair explained, “One example of how on-going studies can benefit the patient is the Absorb Bioabsorbable Scaffold (Stent), which was widely used previously. Subsequent follow up over several years had shown poorer long-term outcomes / results. As a result, this Stent has been taken off the market world- wide. It is not available commercially anywhere in the world now, but only for research. This is the advantage of continuing trials on these high end stents. If they are seen not to benefit patients, then they are withdrawn.”
“In view of this, it is therefore only appropriate that the patients get to choose the right treatment, and in particular, the right stent for them according to their unique circumstances after an informed discussion with their cardiologist at all times. I usually spend a good deal of time discussing the pros and cons of each stent with the patient and family,” says Dr Nair.
In Singapore, you can have access to high-quality stents and implantation techniques, such as Intra-Vascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT), which can help to ensure you are given the correct stent size and that your doctor can implant the stent successfully. This, in turn, helps to minimise the chances of stent failure later down the line.