Not Worth The Money - Drug-Coated Stents

by Ann Samuel on Nov 5 2007 12:57 PM

According to Swiss research published in The Lancet, pricey drug-coated stents are not worth their cost.

Stents, which are coated with and elute drugs, are often used to open up clogged coronary arteries. According to the research, these devices are not particular useful in decreasing heart complications or elongating lives, at least in proportion to their costs. At the same time, the researchers noted that the devices could be cost-effective in heart patients who have particularly narrow vessels.

The findings, which stemmed from an 18-month study of 826 patients, do not depict a favorable value-for-money picture than previous research. The research is also expected to stoke fresh controversy over when to use drug stents.

A few days before a key review of the cost-effectiveness of the drug eluting stents was carried out by Britain’s National Institute of Health and Clinical Excellence (NICE). NICE put manufacturers in a panic when in August they proposed that drug stents were not worth using on the state health service. Now, NICE’s appraisal committee is expected to draw up its final draft guidelines on November 6, though the decision will be private for some more time.

Stents provide rollicking business for companies like Boston Scientific and Johnson & Johnson. They manufacture the two drug-eluting stents assessed in the Swiss study.

These devices are designed to prevent arteries re-narrowing. This is case that often happens with bare metal stents. Yet the use of these devices has dipped recently because of fears that deadly blood clots can form inside the devices in rare cases. "If used in all patients, drug-eluting stents are not good value for money, even if prices were substantially reduced," Matthias Pfisterer, of Basel's University Hospital, and colleagues report.

According to study results, only in high-risk patients where small vessels measure less than 3 millimeters or in bypass-graft stenting, which represent about a third of the study sample, are drug-eluting stents worth their money.

"Thus, targeted stent use could be the preferred strategy today. Lower prices of drug-eluting stents alone are unlikely to result in such stents being cost effective in all patients, even if the problems of late stent thrombosis are solved with new generations of drug-eluting stents," conclude the researchers.

The Swiss team figured out that overall long-term treatment costs were higher with drug stents, averaging 11,808 euros ($17,020), as against 10,450 for bare metal ones. Since 2004, prices have fallen yet the cost of bare stents has decreased more than for drug-coated ones. This explains the difference between the two types the researchers add.