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Drug-Eluting Stents in the Management of Coronary Artery Disease

Implications for Payors and Hospitals

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Disease Management & Health Outcomes

Abstract

Of the >1 million patients who undergo coronary intervention in the US annually, 10–45% develop stent restenosis. Designed to inhibit tissue growth following coronary intervention, the drug-eluting stent (DES) is a breakthrough technology that has been shown to reduce restenosis by 80%, dramatically lowering the percentage of patients requiring repeat intervention. The health-economic implications of DES are complex and depend on the perspective from which they are viewed (i.e. hospital, payor, or physician). For hospitals, DES are a truly disruptive technology. Hospitals are caught between substantially higher costs (DES cost 3-fold more than bare-metal stents), inadequate reimbursement for those higher costs, and potentially declining revenue (fewer bypasses and repeat interventions for restenosis). In contrast, DES appear to be very cost effective for payors. Randomized studies have suggested that the higher initial costs of DES are nearly offset by reduced follow-up costs related to fewer repeat angioplasties and bypass surgeries. Furthermore, overall cost reductions to payors will occur as patients are converted from bypass surgery to multi-vessel coronary intervention with DES. Their high price continues to be a barrier to the use of DES, while the concerns about safety and stent thrombosis have substantially diminished. With greater competition, declining DES prices, and further studies demonstrating safety and efficacy in a wider range of real-world patients, DES will become the default platform for transcatheter coronary intervention in the near future.

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Table I

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgments

Dr Hermiller receives research funding from Cordis, Boston Scientific Corporation, Guidant, and Medtronic. He is a consultant for Guidant and Boston Scientific Corporation.

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Authors and Affiliations

  1. St Vincent Hospital and the Heart Center for Indiana Hospital, The Care Group LLC, 10590 North Meridian Street, Suite 300, Indianapolis, Indiana, 46290, USA

    James B. Hermiller (Director)

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  1. James B. Hermiller
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Correspondence to James B. Hermiller.

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Hermiller, J.B. Drug-Eluting Stents in the Management of Coronary Artery Disease. Dis-Manage-Health-Outcomes 13, 1–7 (2005). https://doi.org/10.2165/00115677-200513010-00001

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