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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : OC16 - OC19 Full Version

Impact of Coronary Stent Price Regulation on the Interventional Cardiology Landscape of India: An Assessment of Health Economics Outcomes


Published: March 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55038.16116
Hriday Arora, Alka Gupta, Divya Gupta

1. Program Coordinator, Department of Public Health, Shabbad Trust, New Delhi, India. 2. Professor, Department of School of Health Sciences, Sushant University, Gurugram, Haryana, India. 3. Manager, Department of Clinical Operations, Catalyst Clinical Services Pvt. Ltd., New Delhi, India.

Correspondence Address :
Hriday Arora,
Shabbad Trust, 325, 2nd Floor, Garg Plaza, Plot No. 24, DDA Complex, Road No.
44, Pitampura, New Delhi-110034, India.
E-mail: hriday1205@gmail.com

Abstract

Introduction: The cases of Coronary Artery Diseases (CAD) are on the rise in India, this can be attributed to various factors such as ageing, lifestyle, smoking, food habits, and higher income levels. Although, a large proportion of India’s population has access to some form of health insurance but the out of pocket expenditure is still extremely high as a percentage of total health spendings.

Aim: To assess the impact of coronary stent price regulation on the interventional cardiology field in India.

Materials and Methods: In this retrospective study, data was collected from online search at google and various other external data sources such as websites and published reports of World Health Organisation (WHO), Niti Aayog, National Pharmaceuticals Pricing Authority (NPPA) and Economic Times (ET) Health World. Line graphs for the percentage change in the number of percutaneous coronary intervention procedures, usage of Drug Eluting Stents (DES) pricing for government and private hospitals for the period 2016-2021 were plotted using Microsoft excel.

Results: A high cost of coronary stents ranging from Indian Rupee (INR) 40,000 to INR 1,25,000 was a major contributor to a very high out of pocket expenditure in the field of interventional cardiology. In order to curtail this cost, a ceiling limit of INR 29,600 was imposed with respect to the prices of coronary stents in the year 2017 by the NPPA. Ever since a ceiling limit was imposed on the prices of coronary stents in India, there has been an annual increase of 3.7%, 13.1%, 12.6%, and 12.9% in the number of coronary intervention procedures for the years 2017, 2018, 2019 and 2021, respectively. Similarly, the usage of DES has also shown an annual increase of 8.9%, 14.7%, 10.5%, and 13.3%, respectively for the same years.

Conclusion: At this juncture when the burden of CAD is on a rise in India, the efforts to make coronary stents more affordable will go a long way in the efficient management of CAD in the country.

Keywords

Coronary angiography, National pharmaceutical pricing authority, Percutaneous coronary intervention, Stent pricing

Cardiovascular Diseases (CVD) accounted for 17.9 million deaths in the year 2019 which inturn represents 32% of all global deaths (1). Of the 17.9 million deaths, 15.2 million people died of heart attack and stroke. CVD accounts for 31.5% of all deaths in females and 26.8% of all deaths in males. It is predicted that for low-income countries, Non Communicable Diseases (NCD) will contribute half of the total disease burden leading to 23.3 million deaths from CVDs alone by the year 2030 (2),(3),(4). India accounts for 60% of the world’s heart disease cases with a projection of around 70 million cases by the year 2025. The rise of CVD is directly linked to various factors such as ageing, lifestyle, smoking, food habits, higher income levels, and improvement in the healthcare system. The average life expectancy in India has increased from 48.8 years in 1970 to 69.9 years in 2020 and the number of people above 60 years of age is expected to double by the year 2030 (5),(6).

Coronary Artery Diseases (CAD) is the most common form of CVD. With an increasing prevalence of CAD, the interventional cardiology field is witnessing an exponential growth. The foundation of the interventional cardiology was laid down by Gruntzig A, by performing the balloon angioplasty in the year 1977 (7). The first documented evidence for the use of coronary stents dates back to 1986 when a self-expanding, stainless-steel wire-mesh structure was implanted in a human coronary artery (8). The development of stents continued, and Drug Eluting Stents (DES) were introduced to address the problem of restenosis encountered with Bare Metal Stents (BMS). The first sirolimus-eluting stent was implanted by Eduardo Sousa in the year 1999 and the same became commercially available for clinical use in Europe in the year 2002 (9). Thereafter, a number of DES has been introduced after a careful evaluation of safety and efficacy in large clinical trials.

Health Insurance Landscape-India

It is estimated that around 70% of India’s population has access to some form of health insurance. These include government subsidised schemes, social health insurance schemes, and private voluntary health insurance schemes (10),(11).

Government subsidised health insurance schemes: These provide fully or partially subsidised insurance coverage to the low-income earners in the country. The prominent schemes include Rashtriya Swasthya Bima Yojana (RSBY) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in 2018. RSBY was initiated in the year 2008 to provide hospitalisation coverage upto Rs. 30,000 for most of the diseases that require hospitalisation for Below Poverty Line (BPL) families. AB-PMJAY was launched in 2018 to provide a fully subsidised comprehensive secondary and tertiary healthcare package with an annual coverage of Rs. 5 lakhs per family for low-income earners in the country (12),(13).

Social health insurance schemes: These are compulsory health insurance schemes for organised sector employees requiring contribution by both the employer as well as the employee. The prominent schemes include Employer State Insurance scheme (ESI), 1948; Central Government Health Insurance Scheme (CGHS), 1954; Ex-servicemen Contributory Health Scheme (ECHS), 2003 etc. Of the various social health insurance schemes, CGHS and ESIS are the only schemes that provide comprehensive healthcare coverage, including outpatient care, preventive care and hospitalisation (14).

Private voluntary health insurance schemes: These are either individual or group insurance schemes that are contributory and voluntary in nature. While 50% of the country’s population is covered under Government Subsidised Health Insurance Schemes and nearly 20% of the population is covered under Social Health and Private Voluntary (10).

Health Insurance Schemes, a large segment i.e., 30% of population lack any financial protection for health. It is this segment that accounts for a very high out of pocket expenditure of 63% as a percent of current health spending (10),(11).

Interventional Cardiology Landscape-India

According to an editorial from Cardiological Society of India (CSI), the largest association of cardiologists in India, 62 million people in India have some form of CVD (15). What is more alarming is that, there is almost a two third rise in the number of CVD cases as compared to 36 million people around a decade ago. Further, the report estimates that around 1500 interventional cardiologists are working across 4185 cardiac catheterisation labs in the country (15). A relatively high cost of coronary stent could be a major barrier for offering coronary intervention services to a large proportion of CVD patients. To address this, Government of India has put a ceiling limit on the price of coronary stents in the year 2017 (16). Thus, this study was undertaken to assess the impact of coronary stent price regulation on the interventional cardiology field in India.

Material and Methods

The present study was a retrospective study, in which data for the period 2013-2021 was collected between December 2021 to January 2022, from online search at google and various other external data sources such as websites (11),(15),(17),(18) and published reports of WHO (1), Niti Aayog (10), NPPA (16),(19),(20),(21),(22) and ET Health World (23).

Data on the pricing of DES for the period 2013-2015 both for government and private hospitals was collected from the medical device industry sources. Since, there was a variation in the pricing of different companies/institutions, a range of lowest and highest price have been included to give an idea of the price range prior to the implementation of fixation of ceiling price by the NPPA.

Statistical Analysis

Line graphs for the percentage change in the number of percutaneous coronary intervention procedures, usage of DES as well as DES pricing for government and private hospitals for the period of 2016-2021 were plotted using Microsoft excel. Graphs were plotted considering 2016 as the base year as this was the immediately preceding year prior to the implementation of the price regulation and the number of participating centres in the coronary interventional registry remained relatively uniform from this point onwards.

Results

Data from the industry sources revealed that prior to February 2017 the cost of coronary stents was very high ranging from INR 40,000 to INR 65,000 for government hospitals and INR 90,000 to INR 1,25,000 for private hospitals. (Table/Fig 1) represents the coronary interventional registry data for the period 2013 to 2021 (16),(18),(19). The number of participating centres in the coronary interventional registry rose from 404 in the year 2013 to 751 in the year 2020 (15),(17),(18). While the number of PCI procedures increased from 0.22 million in the year 2013 to 0.4 million in the year 2021, the corresponding usage of DES increased from 0.26 million to 0.54 million during the same period. The data on the pricing of DES for the period 2013 to 2021 is presented in (Table/Fig 2) (17),(20),(21),(22),(23).

With the exception of year 2020, there has been an annual increase of 3.7%, 13.1%, 12.6% and 12.9% in the number of coronary intervention procedures for the years 2017, 2018, 2019 and 2021, respectively (Table/Fig 3). Similarly, the usage of DES has also shown an annual increase of 8.9%, 14.7%, 10.5% and 13.3%, for the years 2017, 2018, 2019 and 2021, respectively (Table/Fig 4). The data in (Table/Fig 3), (Table/Fig 4) has been presented considering 2016 as the base year for two reasons viz., it was the immediately preceding year prior to the price regulation and the number of participating centres in the coronary interventional registry remained relatively uniform after 2016 thereby limiting the chances of any potential interpretation bias.

(Table/Fig 5), (Table/Fig 6) presents the percentage change in the DES pricing for the period 2016-2021 for government as well as private hospitals. The numbers in (Table/Fig 3), (Table/Fig 4), (Table/Fig 5), (Table/Fig 6) has been shown to reflect the percentage change on an annual basis based on the data for the preceding and the next year.

Discussion

The 4A’s i.e., Awareness, Availability, Accessibility and Affordability are playing a major role in increasing the number of intervention cardiology procedures over the past few years. The coronary interventional registry established by the National Interventional Council (NIC); CSI is the largest source of coronary intervention data in the country (15). The data on coronary interventions from centres spread across the country is collected, analysed and published periodically. The high cost of coronary stents was perceived to be a major contributor to a very high out of pocket expenditure in the field of interventional cardiology. Therefore, in order to curtail this high out of pocket expenditure on healthcare, Government of India included coronary stents in the National List of Essential Medicines (NLEM) 2015 on 19th July 2016.

Further, the Ministry of Chemicals and Fertilizers, Department of Pharmaceuticals, by notification dated 21st December 2016 has incorporated coronary stents as ‘scheduled formulations’ under the provisions of the Drug Prices Control Order (DPCO), 2013. Finally, the NPPA fixed the ceiling prices in respect of coronary stents via Gazette notification dated on 13th February 2017 (17). Ever since the NPPA put a ceiling limit on the prices of coronary stents, there has been an annual increase in the number of coronary intervention procedures for the years 2017, 2018, 2019 and 2021, respectively. The only exception being year 2020, where the number of coronary intervention procedures marked a decrease of 28%. This may be attributed to the fact that most of the cardiac catheterisation labs in the country were closed for almost six months owing to the emergence of COVID-19 pandemic. The impact continued in the year 2021 also, when the cardiac catheterisation labs operated to a very little capacity for almost three months.

With the exception of year 2020, the usage of DES has also shown an annual increase for the years 2017, 2018, 2019 and 2021. A decrease in the usage pattern of 24.3% in the year 2020 can be attributed to COVID-19 pandemic. Of the overall stents used, the usage pattern of DES was 97.3% whereas only 2.7% stents deployed are BMS. The NPPA after putting a ceiling limit in the year 2017 reviewed the stent prices on an annual basis. While there has been a significant reduction of 43.6% and 72.5%, respectively in the prices of DES for government and private hospitals in the year 2017, there has been only a marginal increase owning to the fluctuation in the prices of the raw material (16),(19),(20),(21),(22).

Limitation(s)

One of the major limitations of the study was the lack of financial data to assess the economic impact of coronary stent price regulation on the interventional cardiology field in India. No such financial data is currently available from any reliable data source. Future studies in this regard seem warranted as and when the required financial data becomes available in the public domain.

Conclusion

The coronary stent price fixation has played a major role in the exponential growth of coronary intervention procedures as well as the usage pattern of stents in India. NPPA has fixed the prices of different categories of stents in an attempt to make it more affordable with the ultimate aim of reducing the overall healthcare spent by different stakeholders. The same is evident by the steadily increasing number of percutaneous coronary intervention procedures as well as the usage of DES over the years. An increase of 12.9% in the number of coronary intervention procedures and 13.3% in the usage of DES for the period 2016 and 2021, clearly demonstrate the effectiveness of coronary stent price regulation in India. At this juncture when the burden of CAD is on a rise in India, an effective participation of various stakeholders (government, healthcare providers, insurer, medical device/pharmaceutical companies) to make the coronary stents more affordable will go a long way in the efficient management of CAD in the country.

Acknowledgement

Authors would like to acknowledge all the data sources especially the coronary interventional registry of NIC as well as various circulars of the NPPA that has helped us in compiling the primary data for this publication.

References

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WHO: Fact sheets/ Details/ Cardiovascular diseases (CVDs), available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) (Accessed: 7 December 2021).
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Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011. (Accessed: 7 December 2021).
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Global atlas on cardiovascular disease prevention and control. Geneva, World Health Organization, 2011. (Accessed: 7 December 2021).
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Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e442. [crossref] [PubMed]
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Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A race against time: The challenge of cardiovascular disease in developing economies. New York: Columbia University. 2004 Apr 25.
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United Nations- World Population Prospects, available from: https://www.macrotrends.net/countries/IND/india/life-expectancy (Accessed: 8 December 2021).
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Gruntzig A. Transluminal dilatation of coronary-artery stenosis. Lancet. 1978;1(8058):263. [crossref]
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DOI and Others

DOI: 10.7860/JCDR/2022/55038.16116

Date of Submission: Jan 19, 2022
Date of Peer Review: Feb 02, 2022
Date of Acceptance: Feb 21, 2022
Date of Publishing: Mar 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 20, 2022
• Manual Googling: Feb 19, 2022
• iThenticate Software: Feb 26, 2022 (11%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com