With fewer options after supply halt, stent price reduction fails to benefit patients

The government’s decision to fix prices of stents, commonly called heart rings in Bangladesh, has apparently backfired, leaving patients with cardiovascular diseases and their families with fewer but costlier options.

A coronary artery stent is a small, self-expanding, metal mesh tube. It is placed inside a narrowed coronary artery after balloon angioplasty.

According to doctors and suppliers, Bangladesh needs around 35,000 stents every year to treat narrowed coronary arteries and all these stents of 44 brands are imported through 27 companies – four from the US and 23 from Europe.

Amid complaints over high prices of stents, the Directorate General of Drug Administration in two phases in October and December last year cut the prices by up to 45 percent. The new rates range between Tk 14,000 and Tk 140,500 per stent.

The importers of European stents stopped bringing in the products after the readjustment of prices.

The DGDA fixed markups for the importers of the US-manufactured stents, but not those made in Europe, creating an inequality, alleged Wasim Ahmed, acting president of the Medical Device Importers Association of Bangladesh.

“We wanted the system to fix the prices to be the same for all. As our demand was not met, we even moved the High Court. After the DGDA had said they would look into the matter, we withdrew our writ petition. But the DGDA has not said anything officially yet,” he said.

Md Nurul Alam, a deputy director at the DGDA, said they did not cut stent prices, but fixed the rates to bring order in the sector.

“The DGDA has not changed its position on the matter, but the importers can place a new proposal if they want to,” he said.

Md Esam Ebne Yousuf Siddique, chief operating officer at Square Hospitals Ltd, said they are using previously bought stents at the new rates as the importers refused to supply at the DGDA-fixed prices.

The private facility’s stock of stents is sufficient for some more days, according to Esam.

He said the importers cited a rise in cost because of high dollar prices as a reason behind their refusal to supply stents at the government-fixed rates.

“It took them Tk 9,000 to bring a $100 stent earlier. Now it takes Tk 15,000 for the same stent,” he said.

The National Heart Foundation Hospital, the National Institute of Cardiovascular Diseases, Bangabandhu Sheikh Mujib Medical University and Evercare Hospital said the halt on supply by the importers of European stents has not affected their operations much.

But Dr Arif Mahmud, director of medical services at Evercare, said problems will occur if the situation persists for a long time.

“It’s not that everyone will be able to buy stents from the US companies,” he said.

Dr Chowdhury Meshkat Ahmed, head of BSMMU’s cardiovascular diseases department, said the patients who are not able to pay the high prices would have benefited from the decision to cut the rates.

“But it’s not happening because of the halt on supply,” he added.

Abu Rayhan Al Biruni, chief financial officer at United Hospital, said they are also using previously bought stents at the new rates because some of the importers stopped supply.

“But some patients delayed their stenting because we could not provide them with the brands they wanted.”

Rayhan said they are also experiencing a shortage in supply of other equipment needed for stenting. “Stentings will be disrupted if this situation continues.”

DGDA’s Nurul Alam called for the importers’ cooperation to keep the supply of stents normal. “The door to discussion is always open. They can send their proposal anytime.”

Asked about the allegation of inequality in fixing stent prices, he said the DGDA was not directly involved in the process to fix the prices.

“A committee of renowned heart doctors fixed the process. If someone has any objection, they can send it and we will place it before the committee.”