August 15th, 2011

Bare Metal Stents: The Next New Thing?

Although drug-eluting stents (DES) have largely supplanted bare metal stents (BMS) in clinical practice, a new study published in Circulation suggests that using these devices in all patients may represent an inefficient use of healthcare resources. Lakshmi Venkitachalam and colleagues analyzed data from 10,144 PCI patients enrolled in the Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) registry.

Largely in response to concerns about the possible risks associated with DES, the use of DES decreased from 92% to 68% from 2004 to 2007, according to the registry. However, the rates of death and MI did not change over time, although the rate of target lesion revascularization (TLR) increased absolutely by 1% (from 4.1% to 5.1%). Total cardiovascular cost per patient decreased by $401. The authors estimate that the risk-adjusted incremental cost-effectiveness ratio for the more liberal compared with selective use of DES was $16,000 per TLR avoided, $27,000 per repeat revascularization avoided, and $433,000 per quality-adjusted life-year gained.

The authors write that their findings “suggest that in an era of constrained resources, a more selective approach to DES use would be preferred, at least on economic grounds. With nearly 1 million PCI procedures annually in the United States, adoption of the more selective DES strategy would be expected to result in ~$400 million/y in annual cost savings to the US healthcare system.”

“The bottom-line was that using drug-eluting stents in a relatively unselected way was only resulting in marginal improvement compared to more selective use,” said David Cohen, the senior author of the study, in an AHA press release. “Because of the safety concerns, we were able to verify what many of us had suspected — that using drug-eluting stents in virtually all patients is not that efficient.”

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