By Mathew Cherian
India has a population that is second only to China, so the number of patients who require interventional radiology treatment are in the millions. However, a major challenge that we face in interventional radiology practice in India is to make it available to the many who cannot afford the cost of the hardware necessary for treatment, Mathew Cherian writes.
All the products that are currently used in interventional radiology procedures are imported from Europe, the USA, or Japan. This means that the pricing of devices follows the pattern of pricing in these countries. However, the average income in India is far less than in developed countries; more than 60% of Indians earn less than US$500 a month. The vast majority of these patients have no insurance systems to help pay for their medical bills
We believe that the biggest breakthrough that would rapidly result in an increased use of interventional radiology procedures would be if India could indigenously manufacture the hardware required for intervention, thus significantly bringing down the cost of these devices. This would make it more practical for use in huge population of patients.
Few trained centres and a large population
Lack of access to interventional radiology centres is also one of the difficulties in popularising the use of interventional radiology and expanding the pool of patients who could benefit from minimally invasive procedures.
Even today, the number of centres actively performing the full range of interventional radiology procedures in India would be less than a hundred. Interventional radiology procedures are divided among interventional radiologists, interventional cardiologists with an interest in peripheral vascular disease and vascular surgeons.
While the cardiologists and vascular surgeons tend to carry out revascularisation procedures, the radiologists perform both revascularisation and embolization.
For aspiring interventional radiologists, barring those within a few recognised centres, there are no organised training programmes available in interventional radiology and this translates to why the number of interventional radiologists is still very small.
Middle class growth spurs interventional radiology treatment
There has been a growth in the number of cases and the number of practising doctors due to the growing middle class in India, as the latter is prepared to pay for high-end, health-related costs. In addition, a few of the state governments (such as those on Tamil Nadu and Andhra Pradesh) in India are willing to support the treatment provided that patients are genuinely economically disadvantaged. This has benefited several patients, especially those with peripheral vascular disease who tend to be from a lower economic status.
Further, the Indian society of Vascular and Interventional Radiology has been making every attempt to train doctors and increase awareness of the specialty in India.
We hope that with the support of the industry and the government that these numbers would increase in the next few years. The potential number of patients who could benefit is huge—all we need is more trained interventional radiologists, financial support from the Government and a special pricing of products for the Indian market to allow the specialty to grow.
Mathew Cherian is director, Interventional Radiology, Kovai Medical Centre and Hospital Ltd, Coimbatore, India. Cherian is a past president of the Indian Society of Vascular and Interventional Radiology