Mucormycosis treatment costs lakhs: Patients’ kin
Total cost runs into ₹10 lakh-₹12 lakh; patients were treated at half the expense pre-covid; shortage, demand pushes cost of one injection to ₹8,000-₹10,000
MUMBAI: Even after winning the battle against Covid-19, there is no respite for many patients who are falling prey to black fungus infection — mucormycosis. A serious but rare fungal infection, mucormycosis is caused by a group of molds called mucormycetes. It causes blindness, organ dysfunction, loss of body tissue and even death if not treated on time, said doctors.
Due to the sudden surge in the price of life-saving antifungal medicines, patients at private hospitals have to shell out lakhs during their treatment that stretches between four and six weeks. Siddhesh Parulekar, 71, who recovered from Covid-19, lost his left eye to mucormycosis. The Girgaum resident was detected with Covid-19 in April. With moderate infection — his oxygen saturation levels were around 92 — he underwent treatment at the Worli Covid care centre for almost two weeks and returned home. But within a month, his left eye started drooping and he started squinting. When he was rushed to an ophthalmologist, his MRI report revealed that he had been infected with mucormycosis. On May 9, he was admitted to Saifee Hospital. Struggling to arrange ₹10 lakh for the treatment, the family has started a campaign on the crowdfunding portal— Impactguru.com. “Last week, he underwent surgery where his left eye was removed. His condition is quite critical as the fungus has reached his brain. Currently, he is in the intensive care unit (ICU),” said his son Sunil Parulekar.
In another case, Sudhir Mishra, 56, is raising funds for his father’s treatment who has been diagnosed with mucormycosis. Only last month, Mishra spent ₹4 lakhs on his father Anand who tested positive for Covid-19. Currently, Anand is at Lotus Hospital, Borivli that has given the family an estimate of ₹12 lakh towards the treatment of mucormycosis.
Pre-covid, patients with mucormycosis were treated at half the current expense. With the sudden surge in mucormycosis cases, however, there has been a severe shortage of lifesaving drug Liposomal Amphotericin B in the market. Taking advantage of the increasing demand, drug suppliers have increased the price of one injection from ₹8,000 to over ₹10,000, said doctors. “There are two types of drugs — Liposomal Amphotericin B and plain Amphotericin B. During precovid days, the first one used to cost ₹3000-5,000 and the latter ₹150. However, we preferred giving Liposomal Amphotericin B as it is more effective even for Rhino mucormycosis when the infection reaches the brain. So, during the second wave, when cases increased, suppliers surged their price to over ₹10,000. While the price of Amphotericin B has been raised to ₹500,” said Dr Chandraveer Singh, consultant otorhinolaryngologist, head and neck oncosurgeon, Wockhardt Hospital, Mira Road.
As per treatment protocol, when black fungus infects the nose, sinus or palate, doctors give 5mg dose per kilogram (kg) of body weight. For instance, if a person weighs 60kgs, he would require 300mg of the dose. Each vial consists of 50mg of the drugs. So, the patient needs six vials which costs ₹60,000 daily. But when the infection reaches the brain, doctors have to give 8-10mg per kg of the body weight. This doubles the daily medical expenditures.
Dr Milind Navalakhe, consultant ENT, Global Hospital, Parel, said that plain Amphotericin B often affects kidneys, so patients who can afford the medical expenditure opt for Liposomal Amphotericin B. “Patients have to spend a minimum of ₹60,000 daily on the medicines for foursix weeks,” he said.
After receiving several complaints of overcharging and to channelise the supply of these drugs, hospitals have been instructed to procure the injections directly through the collector’s office. “For the past twothree days, case wise, we send the details to the collector’s office who then supply us the injections. This has helped break the chain of middlemen and overpricing of doses,” said Dr Singh.
Abhay Pandey, national president of All Food and Drug Licence Holder Foundation (AFDLHF), said mucormycosis before Covid-19 was considered an extremely rare fungal infection. A handful of pharmaceutical companies produce Liposomal Amphotericin B. Now, with the surge in cases, companies are struggling to meet the demand and arrange for raw materials. “When the pandemic started in March last year, suppliers increased the price of masks and sanitisers for their profit. So now, as cases of mucormycosis have increased, they are using the opportunity by surging prices of the injections,” he said. A spokesperson from Cipla, which is one of the manufacturers of the injection, said, “The demand for the antifungal medicines has increased by three-four times. We are getting orders from all across the country. We have escalated production and we believe the demand will soon be met.”
Meanwhile, doctors said unlike last year, the black fungal infection during the second wave is more aggressive which deteriorates the condition of patients faster. “In the second wave, the infection rate is not only more, but it is also affecting younger patients. I have a patient who is just 25-year-old. Also, the infection is so aggressive that it is quickly spreading to eyes, palate and even brain,” said Navalakhe. Doctors said incidences of mucormycosis can be controlled by stopping unregulated usage of insulin.
“This black fungus was earlier visible among patients with immunosuppressants like diabetes and cancer. Patients with Covid-19 are unnecessarily given a large number of steroids which compromises their immunity. So, it (dispensing steriods) needs to be controlled,” said Dr Shashank Joshi, part of the state’s Covid-19 task force.