Daybreak - Why foreign stents still rule Indian hearts

Episode Date: November 19, 2025

A cardiologist in Nagpur performs two similar angioplasties. But the stents inside his patients tell two very different stories. One gets Indian-made devices under a government scheme. The other insists on an imported brand. This contrast is now common across India. Price caps pushed foreign stent makers into a corner in 2017. But they never left. And now, they’re back with new valves, pacemakers, and high-margin cardiac devices. Domestic players, meanwhile, grew fast but still struggle with data, technology, and trust. Tune in.Daybreak is produced from the newsroom of The Ken, India’s first subscriber-only business news platform. Subscribe for more exclusive, deeply-reported, and analytical business stories.

Hi, this is Rohan Dharma Kumar. If you've heard any of the Ken's podcasts, you've probably heard me, my interruptions, my analogies, and my contrarian takes on most topics. And you might rightly be wondering why am I interrupting this episode too. It's for a special announcement. For the last few months, I and Sita Ramon Ganeshan, my colleague and the Ken's deputy editor, have been working on an ambitious new podcast. It's called Intermission.

We want to tell the secret sauce stories of India's greatest companies. Stories of how they were born, how they fought to survive, how they build their organizations and culture, how they manage to innovate and thrive over decades, and most importantly, how they're poised today. To do that, Sita and I have been reading books, poring over reports, going through financial statements, digging up archives, and talking to dozens of people. And if that wasn't enough, we also decided to throw in video into the mix. Yes, you heard that right. Intermission has also had to find its footing in the world of multi-camera shoots in professional studios, laborious editing and extensive post-production.

Sita and I are still reeling from the intensity of our first studio recording. Intermission launches on March 23rd. To get an alert as soon as we release our first episode, please follow intermission on Spotify and Apple Podcasts or subscribe to the Ken's YouTube channel. You can find all of the links at the ken.com slash I am. With that, back to your episode. Most Indians do not think about heart stands

until a cardiologist is standing over somebody that they love explaining what is going to happen next. It is one of those medical decisions that arrives suddenly. usually in an emergency, and it is expensive, emotional and confusing. And in India, where heart disease is everywhere, this moment is far from common than we'd like to admit. Late one week in October, inside a busy cat lab in Nagpur, cardiologist Soshant Patil was living the reality behind those moments.

He had back-to-back angioplostes, one for a 75-year-old patient under government scheme, another for a younger privately paying patient. Both procedures were successful, both patients needed stents. And yet, the devices that ended up in their arteries could not have been more different. The older patient received two Indian-made stents. They came pre-purchased under Ayushman-Bharat and Patil actually liked them. Pretty good, he said, reliable for what he needed to do. The private patient, though, wanted one of those important.

imported brands, Abbott, Medtronic, Boston Scientific. He insisted he was willing to pay more because he believed foreign meant safer. This contrast is not rare anymore. Government hospitals push domestic stents, private patients push back, and whether you're a patient or a family member, the choice can feel overwhelming. But here is the twist. While Indians debate which stent is better, global medtech companies are quietly making a comeback. In just one month, Medtronic launched a new surgical valve in India. Abbott rolled out a fresh dual-chambered pacemaker. Now, these products are not new globally, but they are suddenly flowing back into India after years of silence. So, what changed? Why are multinational giants returning to a market that

once forced them into price caps. And if stents are only the beginning, what exactly are these companies hoping every Indian heart will lead them towards? Welcome to Daybreak, a business podcast from the Ken. I'm your host, Nidha Sharma, and I don't chase the news cycle. Instead, every day of the week, my colleague Rachel Vargis and I will come to you with one business story that is worth understanding and worth your time. Today is Thursday, the 20th of November. The turning point came in 2017 when the National Pharmaceutical Pricing Authority decided to cap stent prices. All stents, foreign or Indian, had to fall within that ceiling. Hospitals protected their margins by raising other treatment costs.

But multinational stent makers suffered the real blow. Their biggest selling point had been wiped away overnight. Partil actually put it quite bluntly to my colleague, the Ken reporter Sudetian Array. He said the price cap took a sledge hammer to their margins. But the companies did not leave. India was already a $1.5 billion market, too big to walk away from. Within a year, stent usage jumped 30 to 40 percent, a sudden surge in volume that benefited one group the most,

domestic manufacturers. Their products were now priced shoulder to shoulder with global ones. For the first time, the field looked level. That leveling was dramatic. From 2017 to 2023, foreign players watched their market volume fall from 70 to 40%. Indian players doubled theirs from 30 to 60%. And companies like SMT, which is a 26-year-old Indian company, wrote that momentum. SMT hit 25% market volume and even filed for an IPO.

It closed the financial year 2025 with a $1,000 crore rupee in revenue up by 13%. Ganesh Sabat, who has long represented the Indian Medtech industry, recalled how multinational companies once sold stents at three times the price in India compared to the rest of the world. People bought them anyway because alternatives did not exist. But the price cap changed that overnight. Some foreign companies tried to. to pull out their newest devices.

Boston Scientific even attempted to withdraw its latest stent. The NPPA, though, shut down that move. Essential product rules kept them in the game, even if unwillingly. MNCs eventually complied with the cap, and then they stopped launching new cardiac products in India. The tap shut. But, interestingly, their revenue share barely changed. Even today, they hold 60% of the revenue.

Their stents still cost 15 to 20,000 more than the Indian ones, even under the cap. And those higher-priced stents still have takeers, mostly private patients. Government schemes buy domestic stents, which helps Indian companies in theory. But payments often arrive a year late. Hospitals struggle, and Indian manufacturers struggle with them. Meanwhile, patients who can pay, especially those with good insurance, continue to choose for instance. Some government hospitals even allow patients to request them for an additional fee. This uneven reality creates a two-tier system.

Premium-paying patients with foreign stents in one lane, everybody else pushed towards Indian products in the other. Domestic manufacturers have tried to close the gap by bending the margins. They stick to the official 8% hospital markup, but sometimes add quiet incentives, cash for referrals, support under the table. It wins them favour, but not sustainability. Foreign players, though, are not really sweating it. Their eyes are fixed on a much bigger price. To find out, stay tuned for the next segment. The heart of the problem, pardon my pun, and the opportunity, is data.

Foreign stents come with decades of real-world evidence. Indian's tents don't. Indians deploy roughly 1.5 million stents a year, one of the highest in the world. Yet, cardiologists still rely on foreign data to make decisions. And Patil finds that absurd. He says, we should be giving MNCs our data. Instead, we are using theirs. And that is where the gap widens.

Some Indian companies are trying to catch up. SMT compared its superflex stent to Abbott's science. Their study claimed that superflex was at least as safe and efficacious. But the comparison only goes so far. Superflex has about a dozen published study. Science, on the other hand, has over 120. Beyond that, even the drugs differ. For instance, commonly use every,

lymus, which is a drug considered stronger and longer-lasting. Indian stents often use syrolimus, which is a different compound. Reverse engineering only goes so far when the active ingredient itself is different. So, the patient's preference remains. When the stakes feel life or death, people want the device with deeper data behind it. But why are MNCs suddenly back to launching products after years of silence in India. Partly because India's heart disease burden is massive. It is the leading cause of debt, around 31% of all deaths, and heart attacks among adults under 45 have risen by 13% since 2020.

But the bigger reason is strategic. Stents are the doorway. Everything else behind the door is not price-capped. Once a patient needs a stent, they may also need new tools around it. pacemakers, microcatheters, cutting balloons, and more. And these products carry huge margins. Indian pacemakers, for example, are not considered comparable with foreign ones. And that leaves room for higher-priced imported devices. The margins are striking. A rotoblation device can retail for over one-lack rupees, though its manufacturing cost

sits between 3,000 to 7,000 only. Intravascular ultrasound catheter costs $70,000, cutting balloons cost $30,000, and none of these prices are capped. For foreign companies, the logic is simple. If the stent goes in, the entire kit follows. Indian companies, however, are stuck. They lack deep R&D long-term data and the infrastructure to build comparable high-end devices. Many are turning to China for technology tie-ups.

Chinese blueprints are appearing inside Indian factories. But that only highlights what India is not building on its own. And even an upcoming U.S. trade deal will not level that field. Indian firms cannot block high-end imports when they cannot make high-end products. American companies guard their IP tightly. Ensuring that it meets FDA standards is expensive. Without a technological backbone, Indian manufacturers risk-pictory. becoming contractors, not innovators. So for now, and likely for a long time, the balance favors

these giants. The price caps squeezed their margins, but it also cleared out weaker competition. As domestic players stumble over regulation, data and design, companies like Abbott and Medtronic are turning what once looked like a setback into a strategic advantage. The stent wars never really ended. They just shifted focus. So the question now is, as foreign companies dig deeper roots into India's cardiac market, who will actually shape the future of cardiac care? And at what cost? Daybreak is produced from the newsroom of the Ken, India's first subscriber-focused business news platform.

What you're listening to is just a small sample of a subscriber-only offerings and a full subscription offers daily, long-form feature stories, newsletters and a whole bunch of premium podcasts. To subscribe, head to the Ken.com. and click on the red subscribe button on the top of the website. Today's episode was hosted and produced by my colleague Snitha Sharma and edited by Rajiv Sien.