Monday, 28 July 2014

The price of life... and death

We have a very sick HIV positive woman admitted at Jeevan Sahara Kendra - who we will call Mrs. Devpriya.

Mrs. Devpriya has virtually no immunity left.  Her CD4 count is a paltry 5.

Most healthy people have between 1200-1500 or so  CD4 cells per cubic mm of blood.

Sheba and the medical team have diagnosed that Mrs. Devpriya is suffering from a brain infection caused by a fungus.  She was admitted with repeated seizures.  Our medical and nursing staff have worked hard to control these - but she urgently needs intravenous medication.  Sadly she has slipped into a coma.

There is still hope.  Amphotericin B is a powerful - antifungal drug that can be given intravenously.  The treatment may yet save Mrs. Devpriya's life.

The problem was that it is prohibitively expensive.  A single vial, used for 1 day treatment costs about Rs. 5,500/-.  The course of treatment would be 2 weeks.  Just the medication alone would cost them Rs. 77,000/-!

We explained this to Mrs. Devpriya's 17 year old son and her husband.  They hesitated for a while. Then said that we should go ahead.  They mumbled something that they would get someone in their village to sell off some land to pay.

We are in a big city, but the ties to land go back into the hinterland.  This is a family with roots in Rajasthan. They were about to do what an estimated almost 1 million or so people in India do each year - sell whatever assets they have in order to pay for a medical emergency.   Some say many more are impoverished due to catastrophic out-of-pocket medical expenses.

We had put no pressure on them to do so - we just gave them the option.  But that is what they chose.

Then we got the actual vial of amphoteracin B.   When Sheba looked at it and prepared to administer it, she realised that for Mrs. Devpriya's weight we would need 4 vials a day.  Rs. 22,000/- per day.

Now the Rs. 77,000/ - became Rs. 336,000/-.  A third of a million rupees.  And no guarantee that Mrs. Devpriya will even survive, since her immunity is so low.

Sheba called up the pharmacy of our parent hospital.  She noticed that the vial was in a lipidized form that was meant to reduce adverse effects.  Was there no other option, a non-lipidized form perhaps?

The pharmacist was helpful.  He said that there was another kind available - but that they did not have it in stock and that he would find out about it.

He called back and said that there amphotericin B was available at the price of Rs. 300 per vial.


Rs. 5500/- vs. Rs. 300/-?


Rs. 336,000/- vs.  Rs. 4,200/?


We got the far far cheaper version of the drug by noon today, and have started it on Mrs. Devpriya.  The unused Rs. 5,500/- vial was sent back to the pharmacy at our parent hospital.

Mrs. Devpriya is still in a coma as I write this - and your prayers are deeply sought for her healing.

But how can there be such a big difference in the cost of a life-saving drug like amphotericin B?

A quick web search found that there is a company flogging amphotericin at Rs. 11,300 per 50 mg vial. While the company whose version we purchased has a listing of Rs. 295 for the same 50 mg.  Interestingly, that company also has a more expensive version - selling the 50 mg at 50 mls with a sticker price of Rs. 6300.

It's mind-boggling that a drug can be sold at 3800% more expensively.  You can see why the pharma industry is such a black hole of corruption.  Why the medical representatives bribe doctors with junkets to Malaysia to get them to prescribe their company's drugs.

You can literally see people's blood being sucked, their assets stripped as they come to "the healing profession" with trust that what they are being told is in their best interest.

You can see now why doctor in India no more enjoy the sacred trust they had in our growing up years - and why more and more groups turn to violence against the medical profession when things don't work for their patient.

We are still shaken by this episode.  

1 comment:

  1. Sure that the costly one is not liposomal form which is always costly ?