Like Narayana Health, SMT makes heart surgery affordable with cardiac stents

By Rishabh Mansur|12th Feb 2019
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Cardiovascular (heart) diseases have become one of the leading causes of death in India. The country has millions of people who suffer from coronary artery disease (CAD), the most common type of cardiovascular disease. When afflicted with CAD, blockages in arteries lead to heart attacks. Patients then require immediate and life-saving heart procedures.


There are typically two options for patients with CAD. The first is coronary artery bypass graft (CABG). Here, an artery or vein is taken from elsewhere in the body and stitched in the heart to reroute blood around the blocked artery.


The second option is angioplasty plus stenting. In this method, a small balloon wrapped in a collapsed wire mesh stent is inserted into a blood vessel elsewhere in the body. It is then directed into the heart. Inflating the balloon causes the blockages in the artery to flatten and clear the path for blood to flow.


The balloon is removed but the stent remains behind to keep the artery open. This type of heart surgery is usually preferred when the left anterior descending artery in the heart isn’t blocked.


These procedures used to be expensive and unaffordable for the masses. In this sense, it can be said that their lives had a price, and the price was the cost of heart surgery. But a few brilliant minds in India were determined to bring cheap, good-quality and accessible healthcare to millions in India.


Perhaps the most famous example of affordable healthcare in India is when heart surgeon Devi Shetty turned entrepreneur in 2000 and set up his world-famous Narayana Health (previously known as Narayana Hrudyalaya). Shetty’s impact on cardiac healthcare in India was so big that the Narayana model is being studied in business courses in universities across the world, including Harvard Business School.


But before Shetty launched Narayana, there was a company that was excelling in manufacturing life-saving healthcare devices. Sahajanand Medical Technologies (SMT), founded by Dhirajlal Kotadia in 1997, was India’s first manufacturer of affordable cardiovascular medical stents which matched global standards.


SMT heart stent

Bhargav Kotadia, MD, SMT

Due to its affordable stents, SMT achieved a product-market fit early on. Over the years, SMT leveraged this strength to grow and became India’s largest manufacturer of stents. It  also exports to over 60 countries.


The Rs 300-crore turnover, Mumbai-based company also emerged as a pioneer in biodegradable polymer and ultra-thin strut technologies used to manufacture coronary drug-eluting stents (DES).


It has a large manufacturing unit in Surat, Gujarat, with a capacity of producing over five lakh cardiac stents a year. SMT also has two state-of-the-art R&D centres in Surat, and Galway, Ireland. SMT is led by Dhirajlal Kotadia’ son Bhargav Kotadia, who joined the company right after his education. He is now Managing Director and is involved in product development, cost efficiency, business growth, and developing go-to-market strategies.


How SMT started

“Before SMT, my father had created an indigenous laser-technology machine meant for diamond cutting and polishing. His primary aim was to cater to the diamond industry with the latest in laser technology,” Bhargav says. “Eventually, we became forerunners in automating the diamond manufacturing industry. My father always had the attitude to manufacture and improve products that benefited people,” Bhargav says.


In the early nineties, Dhirajlal noticed that heart diseases were prevalent in India and that treatment was limited to a small portion of the population due to high costs.


This led Dhirajlal to wonder if he could manufacture stents locally and make them affordable.


“My father reasoned that because there were no Indian-manufactured stents, they needed to be imported. This made them expensive and hard to source,” he says.


Knowing that cheaper stents would greatly reduce the cost of heart surgery, Dhirajlal worked with his team of engineers and scientists to develop and manufacture the first Made in India stent. “They named the company Sahajanand Medical Technologies and took on a ‘Pledge to Save Millions’ by making critical healthcare affordable for millions of people around the world,” he adds.


As the son took over from the father, SMT’s Surat manufacturing facility acquired the European CE regulatory certification, and is going strong in driving the Make in India initiative. SMT is now second in terms of market share in India, having captured around 30 percent of the market.

SMT heart stent

SMT is headquartered in Mumbai

“We were successful in producing one of the world’s best stents here in India. I consider that as the first and the biggest milestone – to get the product right. The next milestone was when we came out with our first drug-eluting stent in 2004. SMT was the first player to introduce biodegradable polymer in 2004-05 and became the first company in the world to secure a CE mark on it in the year 2006,” Bhargav says.


Through clinical trials and the talent randomised clinical trials (RCT), SMT’s stents were proven to be at par with established global standards on safety parameters, Bhargav maintains. The Talent RCT trial, based on a sample size of 1,435 heart patients, was conducted for SMT’s Supraflex stent across seven countries in Europe and 23 renowned centres.


The way ahead for SMT

The cardiac healthcare market is enormous and there is always room for bringing doctors and patients closer. “Globally, it is a $5 billion sector, and the Indian stent market growing at around 20 percent per year,” he says.


He welcomes healthy competition so that the company “doesn’t become self-satisfied” and “strives for doing even better and raising the bar.” Doing better means developing new technologies and making products even cheaper, which is in contrast to Western cardiac healthcare models, he says.


“As a matter of principle and core philosophy, we ensure our stents are made available to a wide section of patients and in an affordable manner,” he adds. Bhargav also believes that SMT’s Make in India efforts since the early 1990s have set an example for others in the manufacturing sector to follow.


Regardless of past success, managing growth is a challenge Bhargav has to deal with. As manufacturing businesses scale, they often find it hard to amplify their production capabilities and meet demand. Further, quality cannot be compromised on while scaling.


“Since we manufacture critical, life-saving products, the challenge is always making sure that our quality standards are maintained at their absolute best levels. This challenge is of course amplified when the production has to grow at more than 50 percent per year,” he says. “However, as tough as the challenge is, we have been addressing it and will continue to do so.”


He believes that nothing can be taken for granted in heart diseases and cardiac healthcare. “I advise those who want to be part of this sector to ensure quality and standard of products. Quality is also the most important aspect to ensure customer loyalty and trust,” he adds.


SMT now wants to become even bigger and expand to new geographic areas. Its mid-to-long term vision is to become a global leader for heart devices as it considers this area its greatest strength, Bhargav maintains.


The company is also looking at expanding its product portfolio by benchmarking against its flagship DES device. It is also working on launching an online platform sometime soon. This platform will enable SMT to drive cardiac health patient education programmes as well as serve as the singular platform for its stakeholders to connect with the business.


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