Number of cath-labs in country up 100% in 5 years

Coronary Interventions Rise By 51% In Just One Year: Study

Cath-labs and coronary interventions in India are increasing exponentially, adding

substantially to healthcare expenses. While cath-labs have more than doubled in the 

last five years, from 251 in 2010 to 630 in 2015, coronary interventions rose 51% 

within a year, between 2014 and 2015, a new study by a think tank shows.

Increased interventions have resulted in a higher number of stents being used in 

procedures.The data shows 4,75,000 stents were used in 2015 for 3,75,000 coronary 

interventions. The figures stand out as just 1,46,719 stents were used in 1,17,420 

cardiac interventions in 2010. A paper published by Observer Research Foundation 

(ORF), based on analysis of data from different sources, highlights the potential role of 

price control in keeping health care costs in check. Acknowledging stent price capping is 

a significant step by the government, it suggests India needs greater transparency in 

costing systems, out come based measurements and evidence-based policy-making.

Authored by Ramesh Bhat, former professor at IIM Ahmedabad and president of the Indian

Health Economics and Policy Association, and Denny John, Evidence Synthesis Specialist at

Campbell Collaboration, the study says any analysis of the implications of economic

regulations, including price controls, will need a detailed appreciation of market forces.

Cardiovascular diseases are now the leading cause of mortality in India, with a quarter of all

deaths in 2015 attributed to the disease. According to the Global Burden of Disease (GBD)

2015 study , death rate due to heart diseases in the country stood at 272 per 100,000

population. Even with such figures, the paper suggests, cardiovascular diseases in India

remain highly under-diagnosed though the number of coronary interventions like angioplasty

are growing every year.

Moreover, the findings show, the use of expensive high-end drug eluting stents (DES) has

also gone up contributing to the increasing healthcare costs. According to the paper, the share

of DES in the total use of stents has reported a compounded annual growth rate (CAGR) of

53.52% between 2002 to 2015, whereas total stent usage has grown by 22.86% in the same

period.

It also highlighted the sources of financing of coronary procedures in India, which has a great

deal of impact on household expenditures as majority of it is still borne out-of-pocket. The

findings show over 43.9% of the financing of the coronary procedures in 2014 were

conducted through out-ofpocket expenditure. Analysis of the NSSO 71st round done in the

paper also show that one-fifth of hospitalisations due to CVD were paid for by borrowings or

sale of personal assets. The same survey found that 53% of the population suffered from

`catastrophic' health expenditures.

The study says severity of penalty is essential to price control and in determining compliance.

Besides, the government or the regulator will also need to create an ecosystem to ensure

effectiveness of such regulation.

Advocating for more effective monitoring of quality of medical products, the paper says,

“Given the fact that currently the market for medical devices is poorly regulated, and there is

no formal system to monitor quality of care, price control could have a negative impact in

terms of entry of inferior quality and outdated products in market“.

The paper recommends setting up of a Medical Technology Assessment Board (MTAB) to

initiate evidence based health policy process.

Source: The Times of India

Targeted treatment

Lakhs of HIV deaths can be averted as India follows WHO’s recommendations

Two years after the World Health Organisation (WHO) recommended that antiretroviral

therapy (ART) be initiated in people living with HIV irrespective of the CD4 (a type of

white-blood cell) counts, India has aligned its policy with the guideline. In a major shift,

Union Health Minister J.P. Nadda had recently said that any person who tests positive for

HIV will be provided ART “as soon as possible and irrespective of the CD count or clinical

stage”. Nearly 4.5 lakh deaths can be averted through this move.

It was in 2002 that the WHO first issued its ART guidelines. In the absence of AIDS-defining

illnesses, the WHO set CD4 count less than 200 cells per cubic millimetre as the threshold to

begin ART treatment. Over time, it changed its guidelines and, in 2013

increased the threshold to CD4 count less than 500 cells per cu. mm.

Change in WHO guidelines

The recommendation was based on the evidence that an earlier initiation of ART will help

people with HIV live longer, remain healthier and “substantially reduce” the risk of them

transmitting the virus to others. The availability of safer, affordable and easy-to-manage

medicines that could help to lower the amount of virus in the blood played a key role in the

WHO’s decision. Earlier initiation could avert an “additional three million deaths and prevent

3.5 million more new HIV infections between 2013 and 2025,” noted the WHO in 2013.

In 2015, the WHO once again changed its guidelines. Based on evidence from clinical trials

and observational studies since 2013, it became clear that an earlier use of ART, irrespective

of the CD4 count, results in better clinical outcomes. Accordingly, it recommended that ART

be initiated in HIV-positive people at any CD4 cell count.

As per 2015 estimates, India has 2.1 million HIV-positive people, of which only 1.6 million

have been diagnosed and about a million are on treatment. But over half a million people are

not even aware of their HIV status.

With the government changing its treatment guidelines, the 0.6 million who have been

diagnosed but not been on treatment are now eligible for treatment. Of the 0.6 million, about

0.25 million have been enrolled for pre-ART care and can be started on treatment almost

immediately. But the biggest challenge will be to identify the 0.35 million who have been

diagnosed but not on treatment and the 0.5 million who have been infected but have not been

diagnosed. Also, nearly 80,000 people get infected each year.

Even as efforts are on to expand the 1,600 treatment delivery sites that are currently

operational, there should be greater focus now on identifying people with HIV. The

government has plans to start community-based testing to bring it closer to those in need, and

target special groups that are more vulnerable to infection such as partners of people who are

HIV-positive.

Source: The Hindu

http://www.thehindu.com/opinion/op-ed/targeted-treatment/article18358522.ece 

India to screen 25 lakh people for hypertension through May

India is set to embark on the largest-ever screening of its population for hypertension in 
one go. Starting tomorrow (May 1), the Indian Council of Medical Research (ICMR) in

association with local collaborators will reach 25 lakh Indians for high blood pressure

screening.

“This is the largest-ever screening undertaken in the country for hypertension. India has

decided to join an initiative of the World Hypertension League which will screen people

across nations for high BP to mark this year’s World Hypertension Day on May 17. 
Indian target population of 25 lakh is the highest globally,” Dr Meenakshi Sharma, the 
scientist handling non-communicable diseases in ICMR, told The Tribune today.

India doesn’t have an official national-level estimation of high blood pressure, the silent 
killer responsible for 10 per cent of all deaths annually across the world. Available 
estimations of prevalence come from local studies that cover a section of Indian states 
at the most.

The ICMR, government’s apex research body, has decided to partner The Public Health

Foundation of India (PHFI) for the exercise. Only recently, the government had cancelled

PHFI’s licence under the Foreign Contributions Regulation Act barring it from receiving

foreign funds, citing some irregularities. The NGO’s local operations remain unaffected.

“The exercise will be jointly conducted by the ICMR, Public Health Foundation of India 
and the Centre for Chronic Diseases and Prevention. The aim is to encourage doctors for

opportunistic screening of people entering healthcare settings. It is seen that doctors don’t

normally screen patients for hypertension and lose the opportunity. Partners have now

developed an application for doctors, which they can download on Android and even from

the Internet to feed in details of screening and hypertension investigation throughout May,”

said Dr Prabhakaran from CCDP and Council Member, International Society of

Hypertension.

The screening will happen through May with ICMR calling the activity “May Measurement

Month (May 1 to 31) to reach 2.5 million Indians”.

“Current estimates say 40 per cent urban Indians above 30 years are hypertensive and 
25 per cent rural population above this age group has high blood pressure. High BP is 
linked to strokes, heart attacks, heart failures and kidney diseases but 50 per cent of 
those with hypertension don’t know it,” said Dr Prabhakaran.

Largest-ever exercise

The Indian Council of Medical Research has tied up with Public Health Foundation of 
India to embark on the largest-ever exercise to screen people for the silent killer

The screening will happen through May with the ICMR calling the activity “May

Measurement Month to reach 2.5 million Indians”. It will get a chance to assess high 
blood pressure burden in large sample size.

Source: The Tribune

Malaria vaccine to be tested in 3 African nations

POOR COUNTRIES HAVE THE CHALLENGE OF DELIVERING THE REQUIRED 4 DOSES OF THE VACCINE FOR EACH CHILD

JOHANNESBURG : Three African countries have been chosen to test the world’s first malaria vaccine, the World Health Organization announced Monday.

Ghana, Kenya and Malawi will begin piloting the injectable vaccine next year with hundreds of thousands of young children, who have been at highest risk of death.

The vaccine, which has partial effectiveness, has the potential to save tens of thousands of lives if used with existing measures, the WHO regional director for Africa, Dr. Matshidiso Moeti, said in a statement. The challenge is whether impoverished countries can deliver the required four doses of the vaccine for each child. Malaria remains one of the world’s most stubborn health challenges, infecting more than 200 million people every year and killing about half a million, most of them children in Africa.Bed netting and insecticides are the chief protection. Sub-Saharan Africa is hardest hit by the disease, with about 90 percent of the world’s cases in 2015.

Malaria spreads when a mosquito bites someone already infected, sucks up blood and parasites, and then bites another person.

A global effort to counter malaria has led to a 62% cut in deaths between 2000 and 2015, WHO said. The vaccine will be tested on children five to 17 months old.

Source: Hindustan Times