Heart patients at serious risk in using stents

The country's heart patients are in serious risks in stenting, including wrong treatment and fraudulence, in absence of regulation and monitoring on use of medical devices.
Stenting is a minimally invasive operation for the heart patients, who need by-pass. Stents are implanted in their narrowed coronary arteries during a procedure called angioplasty. But in most cases cardiologists, who perform angiogram, alone take the decision of stenting.
There is no scope of judgment as to whether the decision is right or wrong. The decision is often taken out of malpractice, popularly known as 'commission business', experts and health rights activists alleged.
Talking to the FE, Health Rights Movement Bangladesh president Dr Rashid-e-Mahbub said unlike global practice, there is no institutional audit in Bangladesh to verify whether the decision of using stent is justified or not.
In Hyderabad of India, the state government has made a rule to take decision for the heart patients jointly by cardiologists and surgeons.
He said there is no authority here to control the procedure, quality and price of medical devices and re-agents, although Drug Administration is supposed to do the work.
"The patients should get quality stents at fair prices. The state must ensure this."
Patients do not buy any stent from the market. Rather "the deal" takes place between the supplier and the doctor, he added.
Heart patients, both in public and private sector, often have to pay exorbitant rates than the real price of stents, though in the government hospitals the authority has fixed rates.
Bangabandhu Sheikh Mujib Medical University (BSMMU), in a circular issued by its additional registrar Professor Asadul Islam in August 2014, fixed the prices of various treatment devices, like - stents and pacemakers, used in the cardiology department.
Minimum price of a US- or EU-made bare metal stent is Tk 30,000, and Cobalt Chromium/ drug-coated stent of EU Tk 45,000 and US Tk 50,000.
Besides, price of medicated drug/ eluting first generation stent of US origin is Tk 0.115 million to 0.14 million and that of EU-made is 0.12 million, and second generation medicated drug stent of US costs Tk 0.13 to 0.14 million each.  
In invoice of a French stent supplier, it was found that prices of stent range from minimum Euro 150 to maximum Euro 300. One Euro equals Tk 87.22.
Seeking anonymity, a doctor said quality of the US-made stents is the best, which will not be more than $500.
"If I consider the duty, VAT, profit and others charges, the best medicated stent may cost at best Tk 80,000 to 90,000 each, and the metal one Tk 60,000. But now the patients are paying even Tk 0.25 million for the medicated one," he said.
According to data of Ibrahim Cardiac Hospital and Research Institute, patients have to pay Tk 0.1 million to Tk 0.25 million for installing stent.
Dr Rashid, also former pro vice-chancellor of BSMMU, also said monitoring and regulation are totally absent for medical devices and re-agents, resulting different diagnosis reports in different laboratories.
"This is a mess. In private sector there is abuse of stent, and in public sector it is neglected," he said.
The Supreme Court has recently issued a rule prohibiting use of any device in human body beyond its expiry date in the backdrop of a scam in National Institute of Cardiovascular Diseases (NICVD). The centre was using stents, whose shelf-life were expired.
Regarding the allegations, organising secretary of Bangladesh Society of Cardiovascular Interventions (BSCI) Dr Raquibul Islam Litu acknowledged that in Bangladesh there is malpractice in almost every sector.
In case of stenting it can happen mainly for two reasons - ignorance and wilful wrongdoing, he said.
The quality is guaranteed here, as stents are certified by the Food and Drug Administration (FDA) and the Common European (CE).  
Experts stressed the need for purchasing stents in bulk by the government, so that poor patients can purchase these at fair prices from public hospitals.  
Registrar of Ibrahim Cardiac Hospital Dr Salahuddin said there may be some malpractices in the small centres. He said Ibrahim Cardiac has a published price-list of various stents.
He, however, admitted in case of any malpractice, it is hard for the patient to prove.
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