Stents may be too expensive to use in all patients

A device that improves outcome in patients with coronary artery disease may be too expensive to use in all patients, suggests a study published early online and in the upcoming issue of The Lancet.

Stents are small metal tubes that are used to prop open a blocked blood vessel. Drug-eluting stents (DES), which are coated with medication to help stop the vessel from closing up again, work better than bare-metal stents, but are also more expensive.

Matthias Pfisterer and colleagues (University of Basel, Switzerland) investigated whether the benefits of DES outweighed the costs in everyday clinical practise, in order to help hospitals with tight budgets make choices about which patients (if any) should be treated with DES. 826 patients were included in the study, with the primary end-point being cost-effectiveness after 6 months, with effectiveness defined as reduction of major adverse cardiac events.

Their results suggested that overall, DES were not cost-effective compared with bare-metal stents, because they were more expensive and did not substantially reduce the costs of patient follow-up care. However, in some subgroups of patients, such as the elderly, DES use was more cost-effective. Co-investigator Dr Kaiser suggests that “the use of DES could be restricted to certain high-risk patient subgroups as defined in this study, at least until the prices of DES are reduced.”

http://www.thelancet.com