Lack of faith in the quality of India-made highend equipment and generic drugs, high personnel cost, indiscriminate admission of patients in critical care units and irrational advice on diagnostic tests are some factors that make ICU treatment costly, hospital administrators and health officials said on Wednesday.
Reducing the stay in the ICU, preventing overuse of expensive medicines and consumables, and controlling hospital-acquired infection could help keep costs of critical care treatment in check, speakers said at a conference, Affordable ICU Care: Myth or Reality, organised by AMRI Hospitals.
The two-day conference, under the aegis of the West Bengal Clinical Establishment Regulatory Commission, started on Wednesday.
“Why costs are high? Capital cost is an important factor. Equipment has to be imported,” said Pattatheyil Arun, director of Tata Medical Center and senior surgical oncologist for head and neck.
“Give me one machine which is manufactured in India. Were we able to make a tracheotomy tube? A piece of plastic with a bulb at the end? The imported stuff costs money,” Arun said.
A tracheotomy is a hole made through the front of the neck and into the windpipe or trachea. A tracheotomy tube is placed into the hole to keep it open for breathing.
Arun said that during the Covid pandemic, a lot of ventilators were manufactured by Indian firms.
“Are those being used now? There is a lack of trust in the quality of equipment manufactured in India and that is because there is no proper quality control agency,” Arun said.
“If we have to bring down ICU costs and make it (ICU treatment) affordable, we have to hit at the factors like pharmacy, investigations and consumables,” he said.
Antibiotics, Arun said, account for the maximum share of the ICU costs. “Drug resistance is causing doctors to go for newer generation antibiotics and antifungals, the cost of which shoot through the roof,” he said.
He also spoke about a lack of trust in generic drugs in India.
“We need to raise the confidence of doctors in prescribing generics — the biggest issue being lack of faith in the enforcement of quality. We need to have publications like the Orange Book, published by the FDA (Food and Drug administration, a US federal agency) from time to time, which contains therapeutic equivalence evaluations for approved multisource prescription drugs. Such initiatives will empower doctors to use generics and effect substantial cost reductions in the ICU. We saw a surge in the manufacture of indigenous ventilators during the pandemic, but we are yet to see an Indian brand evolving in quality to take on the foreign brands,” he said.
“The US and the UK prescribe generic drugs. Every month they bring out data about the efficacy of those drugs…. Do we have it in India? A code of conduct advises all doctors to prescribe generics…. You ask a doctor, do you believe in generics? Raise your hand if you do. Not one doctor will raise his or her hand.”
“Do we have a knowledge book and quality control in India? If there is... a book that says this drug is tested every month and gives data on that, we’ll be more empowered.”
Sujit Kar Purkayastha, managing director of Peerless Hospital, said patients should be selected for ICU care “appropriately”.
“ICU admissions are taken as commercial ventures by many hospitals. If some patient gets gastrointestinal bleeding and the Rockall score is zero, that patient can be treated at home despite the bleeding. But if the score is 3 or 4, then the patient definitely needs ICU care. So the differentiation is very important,” he said.
The Rockall score estimates mortality in patients with active upper GI bleed who have not had an endoscopy.
He said 40 per cent of all ICU patients have to sell their assets or borrow money for treatment. “We have to ensure the hygiene in the ICU is up to the standard so infection is controlled and the use of antibiotics will eventually come down. Then the cost will come down,” he said.
“We prescribe diagnostic tests randomly. We need to apply our mind before repeating the tests,” said Kar Purkayastha.
Rupak Barua, group CEO of AMRI, said manpower was a major issue because, in a private hospital, personnel cost is 42 to 45 per cent of the expenses. “There is a fixed cost of manpower, whether the patient is treated or not. It is a myth that private hospitals keep patients for long or on ventilators for money. We have strong committees. Our focus is on how to reduce the length of stay in hospitals,” he said.
Retired judge Ashim Banerjee, chairman of the regulatory commission, said reduction in hospital stay, preventing hospital-acquired infection and controlling the use of consumables can bring down the cost.