India’s growing population of cardiac patients is prompting local medical device firms to eye drug-coated stents, tiny pipes made of plastic and metal used to keep open clogged arteries in the heart, potentially challenging market leaders Boston Scientific and Johnson & Johnson.
About 20 companies in India today make coronary stents and most of them have started developing drug-coated variants, which reduces post-operative complications. Companies such as Relisys Medical Devices, Opto Circuits, Sahajanand Medical Technologies, Vascular Concepts and India Medtronic are leading local efforts.
The Cardiological Society of India estimates over 50 million Indians suffer from cardiac disorders and predicts the population will double by 2020, by when one in two heart patients will be in India. Despite the huge number of cardiac patients, the number of annual procedures that use stents is just 75,000 today in India—less than 40% of which use drug-coated stents.
The value of stents sold in India is Rs650 crore. And, less than half of that—Rs300 crore—is from the sales of drug-coated stents, such as Boston Scientific’s ‘Taxus’ brand that dominates the market with an over 50% share, which sell for between Rs1,00,000 and Rs1,50,000 each.
Relisys has just started human trials of its “porous carbon drug eluting” stent in 11 hospitals in India after successful testing on animals at the Washington Heart Institute in the US. Germany’s Cinvention is providing the carbon composite coating for the stent, which Relisys wants to retail by March 2008 and aims to capture a tenth of the market for drug-coated stents in India in the first year of sales.
The Hyderabad-based company predicts aggressive pricing for its stents both locally and in export markets. “There is a renewed interest in the stents segment as the number of patients with coronary heart disease is high,” says N.G. Badari Narayan, Relisys’ managing director. “Relisys aims at offering drug-coated stents at one-third of the competitors’ price in India.”
The latent demand in India could justify the pricing and resulting volumes, says an expert. “The Indian stents market is at least 40 times underserved and the incidence of heart disease in India is higher than in the US,” says William A. Haseltine, a professor at California-based The Scripps Research Institute. “Indian companies can come out with stents that are cost effective.”
Relisys’ peers are eyeing the opportunity as well. Bangalore-based Vascular Concepts has already sold over 15,000 stents in India. Sahajanand, a Surat-based firm, is taking aim at the exports market selling more than half its production abroad. Opto Circuits, also headquartered in Banglaore, through its German unit Eurocar is developing biodegradable stents aimed at Latin America, Germany and Switzerland.
Heart stents make for a $10 billion (Rs44,100 crore) market every year. Of this, the US accounts for $5 billion with nearly a million stent procedures being performed; the European market is worth $3 billion, while the remaining is contributed by rest of the world.
Concerns over the use of drug-coated stents could dampen demand though. One of the major side-effects of drug-eluting stents has been formation of clots in arteries where the device has been planted, leading to a constriction of the blood vessel. In rare cases, the stent placement procedure can involve complications such as heart attack, bleeding, abnormal heart rhythm or blood vessel injury.
Stent makers argue the benefits of stents far outweigh the complications that can be traced back to the device.