Heart patients suffer massive price hikes

THE EXORBITANT price of the life-saving, anti-coagulant drug, Acetrome, is enough to give heart patients a cardiac arrest. Between January 1991 and January 1993, the price of a strip of 10 4-mg Acetrome tablets jumped 1,000 per cent from Rs 5.80 to Rs 59.50, effectively putting it out of reach of several heart valve transplant patients.

Acetrome thins blood and prevents it from clotting. Implanted valves are foreign objects and invite blood clots, which can travel to the brain and cause a stroke. Valve transplant patients need to take the drug for life and are spending between Rs 200 and Rs 500 per month on the tablets.

Curiously, the medical profession has largely chosen to remain silent on the issue, with the exception of Karan Singh Yadav, head of the cardiac department in Jaipur's Sawai Mansingh Hospital. Yadav says many valve transplant cases, who are poor rural folk, miss doses, sometimes for several days, resulting in complications. The reason: the steep price increase.

But Acetrome's manufacturer S G Pharma is unperturbed. Defending the price increase, Pharma spokesperson K G K Murthy says, "The volume of sales is so small, we can cover costs only by selling the drug at a high price. We have to manufacture it in batches of 1.5 lakh strips, but our sales are only 10,000 strips a month.

"The cost of distribution is very high as we send the medicines to users by courier. The cost of the imported component of the drug -- acenocoumarin -- has also more than doubled since mid-1991."

But Yadav feels this argument is specious. "A small increase in input costs does not justify a 1,000 per cent hike in the final product cost."

Other cardiac experts, however, are not disturbed by the increase in Acetrome prices. Says Y P Munjal, joint secretary of the Indian Medical Association and a cardiac specialist, "The price increase is quite in keeping with the all-round inflation." He corroborates Murthy's statement that the prices of Acetrome have shot up because of less demand.

Raj Tandon, formerly head of the cardiac surgery department at the All-India Institute of Medical Sciences and now with the Sitaram Bhartia Institute of Science and Research, concurs: "There has been an increase in the number of open-heart operations and a drop in the number of valve transplant operations since the mid-1980s. Therefore, this has pushed down the demand for the drug even further."

Meanwhile, cardiac patients continue to bear the brunt of high prices. Says Angelina Salhotra, who underwent a valve operation in 1985, "Although I am supposed to take my medicines regularly and for life, the steep increase in their prices means that I miss my dose when I run out of money. There is nothing I can do when that happens except hope for the best."

Her view is echoed by Neeraj Anand, who has been taking Acetrome for the past four years: "I have to survive on my salary. Higher prices for Acetrome mean I have to spend about Rs 500 every month just on this drug. It's a struggle not to miss any doses."