A Comparative Study of Coronary Stent Utilization Pattern with respect to Coronary Stent Price Regulation: A hospital-based study from Mumbai, India

Abstract

Introduction: India’s National Pharmaceutical and Pricing Authority (NPPA) fixed a ceiling price for coronary
stents on 13th February 2017. In this study we compare the coronary stent usage patterns in a hospital in India
before and after the coronary stent price regulation was implemented.
Methodology: A retrospective cohort study at a private-sector tertiary care hospital among patients that
underwent PCI from 13th February 2015 to 12th February 2019, i.e., two years before and after the price
regulation of coronary stents. Sampling was done by complete enumeration of the study population & those
fulfilling eligibility criteria. Data were collected from the hospital’s electronic health records and Cath-lab
registry following the inclusion & exclusion criteria. Data on coronary stent utilization patterns were analyzed
under different subgroups using descriptive statistics. The Chi-square test was applied to assess statistical
significance. The results were considered significant when p value <0.05.
Results: 1135 patients were included in the study of which 604 of them underwent PCI before the price regulation
of coronary stents, and 531 after. 1154 and 1092 stents at an average of 1.91 and 2.05 stents were used per case
before and after the price regulation respectively.
Conclusion: The use of DES has increased after the coronary price regulation. Also, more third-generation DES
which is the gold standard in coronary revascularization is being used compared to before. The use of superior
imported stents also saw an increase after the coronary price regulation. There was only a marginal increase in
stents used per case.