Heart Stent only US$105 in China. The 13,000 heart stents (Coronary stent) are 700 yuan (about US$105), can it be used with confidence? See what the experts say.
On November 5, 2020, Tianjin city held the first centralized procurement of national high-value medical consumables in China. Through the low-price competitive centralized procurement model, 13,000 cardiac stents were about 700 yuan!
The medical industries are suddenly surprised, and the people clapped their hands and cheered, so can the stent be used with confidence? After the cost of the stent is lowered, what adjustments will be made?
Rumor: The price of the stent is greatly reduced, and the quality is not good, so it cannot be used?
The price of the bracket is greatly reduced, and some people say that the quality is not good and it cannot be used.
This is really a rumor, and the rumor must be dispelled first! The reason why it is so cheap is because the central procurement of Chinese government filters out the gray links in the middle, and the middle channel of sales can account for more than 80% of the price, so it is actually a rational return of the bracket price.
First of all, we must start with why the price of high-value medical consumables is so high. Is it because of the high cost? Of course not. You have to know that the difference between the factory price of the stent after investigation and the price paid by the ordinary people is all due to the sales model under market regulation.
In this model, the price of the bracket is not directly proportional to the cost, quality, and performance of the product, but is related to sales channels and profit margins. Therefore, the quality of the stent will not decline, the quality is not good, it is purely a rumor!
Centralized national procurement in China is to cut off the sales model that leads to inflated prices of stents by compressing profit margins. Therefore, the state adopts the policy of purchasing in quantity to concession prices by “quantity”, eliminating many intermediate links.
Under the national macro-control, its prices have returned to their senses. This news should be very exciting. The medical burden of the people will be significantly reduced. It can be said that this is a great thing that benefits the country and the people.
After the cost of the stent is reduced, what adjustments will be made?
The price is low, and everyone can afford it. For the common people, this is naturally good. However, some people are beginning to worry that after enterprises are reorganized through competition, monopolies will emerge. Chinese People intent to trust government and left this issue to government. So what adjustments need to be made?
Doctors need to face the risk of X-ray exposure when performing stent surgery, and the Medical Insurance Bureau did not lower the total medical insurance payment. The remaining profits are still given to medical institutions. Medical institutions should consider increasing the doctor’s stent surgery costs to compensate for the long-term Health damage from radiation exposure.
While prices are restoring rationality, Chinese government won’t reduce its quality supervision of stents. After the price of the stent is reduced, the monitoring of the quality of the heart stent needs to be strengthened, so that the patients can be truly assured, keep the mission in mind, and not forget the original intention. We need to remember: everything is for the patient.
Conclusion
In short, this stent price reduction is a good thing, benefiting the country and the people. It can be said that whether it is centralized procurement of medicines or high-value consumables, Chinese government is starting from further reducing the economic pressure of the people after illness, and at the same time to reduce the burden of national medical insurance. Promote the innovation, transformation and reform of pharmaceutical-related companies to achieve higher levels of development needs.
Knowledge about Heart stent
Heart stent, also known as coronary stent, is a commonly used medical device in interventional heart surgery and has the function of dredging arteries. The main material is stainless steel, nickel-titanium alloy or cobalt-chromium alloy. It first appeared in the 1980s and experienced the development of metal stents, drug-coated stents , and bioabsorbable stents .
Development history:
In the early 1980s, an Argentine doctor imagined using a stent to open up the hardened, narrowed coronary arteries of the heart.
In 1984, China performed its first heart stent intervention.
The first generation of metal brackets
The initial challenge in developing a coronary stent was how to make it tough and rigid. Tough stents can pass through coronary arteries with variable directions and large branch angles; when stents are hard, they can hold the stenotic artery lumen that has been expanded so that it will not retract. Stent design engineers have solved various problems through unremitting efforts in material selection and structure, and finally successfully produced the first generation of arterial stent.
The second generation drug-coated stent
When the metal stent is successfully used in clinical treatment, the second challenge is how to overcome the “attack” of the human body on the stent. It turns out that the body treats the stent as a foreign body, and the contact area between the stent and the arterial membrane as the wound area. With trauma, the human body must repair it. As a result, an inflammatory reaction occurs at the stent of the artery . Many patients, especially those with diabetes , have severe scar tissue proliferation around the metal stent. This kind of scar tissue hyperplasia can cause unblocked arteries to re-narrow or even block in severe cases.
After hard work, the researchers finally combined the drug and the stent, that is, “plating” a layer of drug film on the surface of the metal stent. After the stent is implanted in the body, the drug will be slowly released, inhibiting the growth of scar tissue around the stent and keeping the coronary arteries unobstructed. After the worries about the stent as a foreign body irritating local tissues were eliminated, the doctor’s hands and feet were released, and the length and scope of the stent increased. Some patients even implant 2 to 3 end-to-end stents to “enlarge the results” before and after the original stenosis. This drug-treated stent is the second-generation arterial stent.
The third generation of bioabsorbable stent.
The drug on the coated stent will eventually be exhausted, and by then, doctors and patients will face the initial problems again. At the beginning of the 21st century, Belgian scientists reported a new type of arterial stent. This kind of stent is different from traditional stents in that it can dissolve in the body and be absorbed by the body. This new type of stent can expand blood vessels when arteries are narrowed. When the acute phase is over, the stent is completed and the blood vessel is reshaped, it can dissolve and disappear, thereby avoiding the adverse consequences of local inflammation .
The study found that the new stent began to be absorbed by the body 7 to 10 days after implantation and disappeared completely within 3 months. After 6 months, nearly 80% of the arteries remained unblocked. Most importantly, compared with classic stents, this soluble stent may leave patients with room for multiple catheter treatments. Although there were only a small number of patients in the initial trial, and the dilated artery was not the coronary artery, but the small artery below the knee joint. However, large-scale clinical trials are already planned. Once the coronary artery expansion experiment proves that the expansion effect of this new type of stent is comparable to that of the drug-coated stent , both doctors and patients can choose the third-generation arterial stent.
Recently, the National Medical Products Administration approved the first domestic bioabsorbable stent for the treatment of intravascular stenosis in patients with primary coronary atherosclerosis after review, which will enrich the clinical treatment options for patients with coronary heart disease.
Category:
Design of the stent: it can be divided into a mesh stent (wallstent), a tubular stent, a winding stent, and a ring stent. ,
Materials: it can be divided into 316L stainless steel stents, nickel stents, and tantalum stents.
Delivery methods: it is divided into balloon expandable stent and self-expandable stent.
Different stents are designed according to special purposes, such as stents suitable for bifurcation lesions and stents suitable for branching, and covered stents for coronary aneurysms or perforations.
Stent structure:
The materials used in the heart stent are stainless steel , nickel-titanium alloy or cobalt-chromium alloy, and different stents have different structures:
Traditional stent (bare-metal stent), simple metal mesh tube.
Drug-eluting stent, which uses drugs to inhibit the proliferation of duct cells to prevent the formation of thrombus and expand the stent.
Covering bracket.
The polymer composite stent can prevent thrombosis and expand the stent without the need for drugs to inhibit the proliferation of the duct cells.
Quality:
The ideal stent should have the following characteristics:
Flexible;
Good traceability;
The head end (profile) is small;
X-ray opaque;
Anti-thrombosis;
Good biocompatibility;
Reliable expansion performance;
Good support;
Good coverage;
Small surface area;
Comply with fluid mechanics.
As of 2011, none of the stents used can fully meet all the above characteristics. Each stent has its own characteristics. Familiarity with the characteristics of various stents is a guarantee for the success of interventional therapy .
Scope of application:
Not every patient with coronary heart disease is suitable for heart stents, and about 20% of patients really need interventional treatment .
Acute myocardial infarction
Within 6 hours after the occurrence of myocardial infarction , you should go to a qualified hospital for interventional treatment as soon as possible, and quickly open the occluded blood vessels, and the effect of the recovery of heart function is better than thrombolysis and drug treatment.
Unstable angina pectoris
Because it may develop into an acute myocardial infarction, it is suitable to place a heart stent.
Exertional angina pectoris
If the patient walks a little farther, discomfort such as chest pain and tightness may occur. And sitting quietly or resting for a while will relieve the symptoms.
Tetralogy of Fallot
The patient’s coronary artery anatomy is abnormal. Percutaneous right ventricular outflow tract implantation of a heart stent is less risky than surgery alone.
Complex congenital heart disease
Severe pulmonary artery stenosis or pulmonary atresia and other complicated congenital heart diseases are suitable for percutaneous arterial catheter placement.
Instructions
During treatment, the doctor first stretches a very thin catheter through the blood vessel to the narrowed part of the artery; then, uses an inflatable rubber balloon to open the narrowed part; finally, the arterial stent is supported on the narrowed part of the artery that has been expanded to prevent It retracts. After all the catheters were withdrawn, the arterial stent remained in the narrowed artery that had been expanded.
Period of use
Stent restenosis may occur 6 to 8 months after implantation, which means that the stent may be re-blocked. The incidence of restenosis in the initial metal stents was about 20% (15%-40%); the incidence of restenosis in the drug stent era dropped to about 9%. If the coronary angiography is rechecked six months after the operation , there is no in-stent restenosis, generally speaking, restenosis will rarely occur afterwards.
But it is not that restenosis will never occur. The reason for this situation may not be entirely due to the stent itself. If the patient fails to take the medication after the stent is implanted, does not change a bad lifestyle, and the blood pressure, blood lipids, and blood sugar are not well controlled, new lesions may occur in the originally normal blood vessels, and the stent may be restenosis.
Quality issues：
Problem exposure
On October 14, 2012, some countries’s well-known cardiovascular expert Hu Dayi said at the 23rd Great Wall International Cardiology Conference that the heart stent was half unreliable, and the profit was 9 times more than drug trafficking. Under stable conditions, stents are not recommended.
Background introduction
China is a big market for interventional cardiac surgery, and its growth rate is amazing. In 2000, the number of interventional cardiac operations in China was 20,000. By 2011, this number had surged to 408,000, a 20-fold increase! According to industry insiders, an average of 1.6 stents are used for each interventional heart operation in China. Based on this calculation, the number of interventional stents used in China in 2011 exceeded 650,000!
Cause Analysis
The frenzy of stents is firstly related to the outbreak of cardiovascular disease. As of 2009, there were at least 230 million cardiovascular patients in some countries, 200 million patients with hypertension, 7 million patients with stroke, 2 million patients with myocardial infarction, 4.2 million patients with heart failure, and 2 million patients with congenital heart disease. On average, every 10 adults Two people suffer from cardiovascular disease. At the same time, the report also estimated that the number of deaths from cardiovascular diseases in some countries is about 3 million each year, and an average of 1 person will die of cardiovascular diseases every 10 seconds.
Another reason for madness is huge profits. To install a heart stent, patients have to pay several times or even ten times higher than the factory price. A domestic heart stent has an ex-factory price of only 3,000 yuan, but it costs 27,000 yuan at the hospital; an imported heart stent has a CIF price of only 6,000 yuan, and it costs 38,000 yuan at the hospital. 9 times the huge profits of heart stents have surpassed drug trafficking.
Solution
There is nothing wrong with the rational use of interventional technology, but the proliferation of stents is a very sad phenomenon in the Chinese medical community. The most important way to fight against cardiovascular disease is to change the lifestyle, not to make stents. After all, the root cause of this disease is acquired bad habits.
“Playing mahjong without moving for more than ten to twenty hours a day will not only cause myocardial infarction and stroke, but also cause a series of bad effects. Sitting still for a long time will cause blood clots in the legs, and once the blood clots fall off and go to the lungs , Can cause sudden death, faster than myocardial infarction. Therefore, we must change the unhealthy habits and behaviors from the cultural tradition. Moreover, the mahjong table is also prone to excitement, and there are some dangerous events that should be avoided.
In fact, in the 18th century, some medical experts described the symptoms of coronary heart disease and angina pectoris. There was no stent, no bridge, and no nitroglycerin in that era. At that time, a British doctor organized the patients and fell trees in the forest with fresh air. After sawing the tree for 30 minutes, the angina of most patients disappeared after three months.
The road is underfoot, towards health, starting from the heart. I think being able to walk and move actively will obviously have the greatest effect on chronic diseases such as high blood pressure and obesity. If we get up, we will find the fulcrum to move healthy China. This power can achieve comprehensive prevention and treatment effects, and achieve the effect of multiple birds with one stone against diabetes, tumors, and chronic respiratory diseases.
Volume Purchase
On November 5, 2020, it was learned from the National Medical Insurance Administration that the National Medical Insurance Administration, together with relevant departments, organized various provinces across the country and the Xinjiang Production and Construction Corps to form an alliance. Starting from coronary stents, it was the first time that the state organized centralized procurement of high-value medical consumables. And on November 5th, the proposed selection result was produced in Tianjin. The coronary stents purchased this time are made of cobalt-chromium alloy or platinum-chromium alloy, and the drug-loaded type is rapamycin and its derivatives. The procurement period is two years.
Through competition, 10 products to be selected were produced, which belonged to:
Shanghai MicroPort Medical Equipment (Group) Co., Ltd., and
Lepu (Beijing) Medical Equipment Co., Ltd. ,
Medtronic (Shanghai) Management Co., Ltd.
Other 8 companies.
After this centralized procurement, the price of the bracket dropped from an average price of about 13,000 yuan to about 700 yuan. The mainstream products commonly used clinically by medical institutions are basically selected, covering more than 70% of the intended purchases by medical institutions.
