Coronary stents, commonly known as heart rings, are implanted when blood flow through the arteries is blocked or nearly blocked due to fat accumulation or other conditions, and cannot be restored with medication alone.

In Bangladesh, prices of coronary stents are regulated by the Directorate General of Drug Administration (DGDA).

However, despite price regulation, the cost of identical brands and models of stents from the same companies remains more than double in Bangladesh compared to India.

According to data from the DGDA, the price of stents in Bangladesh ranges from BDT 14,000 to a maximum of BDT 1,88,000.

An analysis comparing DGDA data with Indian market prices reveals significant discrepancies. For instance, the price of the Xience Prime stent by Ireland-based Abbott Vascular is BDT 66,600 in Bangladesh, while in India it is priced at INR 22,500 (approximately BDT 32,095). The Xience Alpine stent is priced at BDT 1,40,500 in Bangladesh, compared to INR 54,583 (around BDT 77,918) in India. The Xience Expedition costs BDT 71,500 in Bangladesh and INR 54,583 (BDT 77,918) in India.

The Synergy stent from US-based Boston Scientific sells for INR 54,583 (BDT 77,918) in India, while in Bangladesh it is priced at BDT 1,17,000. The Promus Elite model costs INR 22,500 (BDT 32,095) in India and BDT 79,000 in Bangladesh.

The India-made Metafor brand stent is priced at BDT 40,000 in Bangladesh but only INR 22,500 (BDT 32,095) in India. The Biomime stent sells for BDT 45,000 in Bangladesh, compared to INR 22,500 (BDT 32,095) across the border.

The Ireland-manufactured Resolute ONYX cardiac stent is priced at 1,40,500 taka in Bangladesh, while it costs 54,583 taka in India. The Resolute Integrity stent is sold for 78,400 taka in Bangladesh, but in India, it is priced at 32,095 taka.

The Japan-made Ultimaster Tensei stent costs 66,000 taka in Bangladesh, compared to 54,583 taka in India. Switzerland’s Orsiro brand stent is priced at 63,000 taka in Bangladesh, while it is also 54,583 taka in India.

An analysis of the price lists in both countries reveals that the cost of several brands of stents of the same quality is higher in Bangladesh than in India. Some companies’ stents are priced double, and others are nearly three times higher.

There are also allegations of various irregularities in the name of implanting stents in heart patients. It is alleged that a syndicate, in collusion with some unscrupulous doctors and staff, is charging excessive amounts by holding patients hostage.

Fazlur Rahman, a resident of Old Dhaka in the capital, was admitted to Mitford Hospital about two years ago after experiencing chest pain. Doctors advised him to have a stent implanted.

Fazlur Rahman informed the doctor that he lacked the financial means for the procedure. The doctor then advised him to follow certain restrictions, adhere to guidelines, and take prescribed medications regularly, suggesting he get a stent when feasible. Three months later, when he visited the doctor again, he was told to continue the same prescription. Fazlur Rahman is still doing reasonably well.

There are allegations that some unscrupulous doctors, driven by commissions, implant stents in patients who do not need them or recommend the procedure unnecessarily. However, doctors completely deny these allegations.

Specialist doctors have stated that the level of blockage in Fazlur Rahman’s heart could likely have been managed with medication. By regularly taking prescribed drugs, he is now doing well. However, he must continue to follow a doctor’s advice diligently. Some unscrupulous doctors reportedly encourage stent implantation even when unnecessary, replacing medication with procedures in a manner deemed entirely unethical.

When asked whether commissions influence stent pricing, a local importer and a leader of the Medical Device Importers Association of Bangladesh, speaking on condition of anonymity, told Banglanews that the pricing of stents includes a commission for retailers, which is taken by hospital authorities.

Another leader of the Medical Device Importers Association of Bangladesh said that every cardiologist has a specific preference for certain companies’ stents. The stent companies in the country operate based on how they manage relationships, which is their own affair.

A cardiologist, speaking anonymously, said that around 10 million people in Bangladesh suffer from heart disease. Due to financial constraints, many patients cannot afford stent implantation. Some, after great hardship, sell their land to raise funds for treatment, only to be deceived. Claims of implanting high-quality stents are sometimes fulfilled with substandard ones, highlighting the need for stricter oversight.

When asked why stent prices in Bangladesh are several times higher than in India, Dr. Rezaul Karim, associate professor at the National Heart Institute and Hospital, told Banglanews that local businesses aim for 100% profit, buying a product for five taka and selling it for 10 taka. Such high-profit margins are not possible in other countries. Government taxes may contribute to price increases, and the dollar crisis could also be a factor. Citing the rising dollar value, businesses have inflated product prices two to two-and-a-half times. A few individuals monopolize the trade, facing limitations such as difficulties in opening letters of credit or importing sufficient quantities, which may contribute to higher stent prices in Bangladesh.

When asked if doctors receive commissions, Dr. Karim said such practices are outdated and no longer exist. A stent priced at 70,000 taka in Bangladesh is sold for the same amount at Apollo Hospital. The prices of equipment imported for medical procedures are fixed by the government, leaving no room to charge more. Consequently, there is no opportunity for doctors to receive commissions. However, he acknowledged that some doctors may prefer certain companies’ stents, and those companies might offer incentives, such as sponsoring trips to international conferences. Direct commission payments are not possible. He added that, similar to prescribing medications from various companies, which sometimes results in gifts, the situation with stents is comparable.

Professor Dr. Rezwanul Haque Bulbul, former chairman of the Cardiac Surgery Department at Bangladesh Medical University, stated that even with large profit margins, controlling stent prices was challenging, and prices were even higher previously. “We perform surgeries, but we don’t know the exact prices; we only have an estimate of what they might be. The actual price is never disclosed, treated as a trade secret. Even the prices set by the government are, in fact, too high,” he said.

On the issue of higher prices compared to India, Dr. Bulbul noted, “To my knowledge, India has no manufacturing plants. If they did, they might offer lower prices. We need to compare the specifics—stent length, grade, and diameter—between Bangladesh and India. A head-to-head comparison would reveal where profiteering or exploitation is occurring in our country.”

Public health expert and former director of the Disease Control Division at the Directorate General of Health Services, Professor Dr. Benazir Ahmed, told Banglanews that the issue of price hikes is not limited to stents but extends to other medicines due to flaws in how the Drug Administration sets prices. “Public interest is not reflected in pricing decisions. The officials, whether the Director General or others, do not represent the public; they are employees. Importers, backed by political influence from various governments, exert significant control, and officials at the directorate are compelled to comply with their demands,” he said.

He further added, “We sometimes hear of stents being implanted unnecessarily, which is a problem. A large business is involved. If government or private hospitals engage in such malpractices, there should be exemplary punishment—not just fines, but imprisonment—to ensure healthcare remains affordable. People should not be bankrupted seeking medical care.”

On April 13 this year, a notification from the Health Services Division, issued under the President’s order, announced the formation of a 17-member Cardiac Consultant Stent Committee, chaired by the Director General of the Drug Administration.

The committee’s scope includes holding meetings with representatives of cardiac device importers to provide recommendations on reference pricing. It will consider device prices and tax/duty structures in four neighboring countries to propose pricing for devices.

When asked why stent prices are high, Dr. Aktar Hossain, Director and spokesperson of the Drug Administration, told Banglanews, “If such things happened before, they might have occurred, but there’s no such opportunity now. Stent prices are now regulated. A new committee has been formed and is actively working. A meeting will be held soon, and decisions will follow through discussions. The ministry likely recognized past issues, and we are moving forward positively.”

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