American Journal of Drug Delivery

, Volume 1, Issue 4, pp 255–266 | Cite as

Do the benefits of new technology outweigh the costs?

The case of drug-eluting stents
Healthcare Technology Review

Abstract

Over the past decade, coronary stenting has been shown to reduce the rates of angiographic and clinical restenosis compared with conventional balloon angioplasty; however, the use of bare-metal stents remains limited by a high incidence of restenosis, leading to frequent repeat revascularization procedures and substantial economic burden. Antiproliferative drug-eluting stents have recently demonstrated dramatic reductions in in-stent restenosis compared with conventional bare-metal stenting; however, the high cost of drug-eluting stents has raised important questions about the clinical and economic benefits of this ‘disruptive technology’.

Prospective economic evaluations conducted alongside two randomized clinical trials (SIRolImUS-eluting stent in de novo coronary lesions [SIRIUS] trial and the RAndomized study with the sirolimus-eluting VElocity™ balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions [RAVEL]) comparing drug-eluting stents with conventional bare-metal stenting, as well as decision-analytic models, have examined the economic merit of using drug-eluting stents.

Findings from these studies suggest that although the initial treatment costs with drug-eluting stents are substantially higher, much of the difference in initial costs could be offset by reductions in follow-up costs, mainly due to a reduced requirement for repeat revascularization procedures. Results from these studies show that the cost effectiveness of drug-eluting stents varies considerably with the underlying clinical and angiographic characteristics of the patient population. While drug-eluting stents should be reasonably cost effective for most patients who currently undergo percutaneous coronary intervention (and cost saving for a sizeable minority), for certain subgroups with very low expected clinical restenosis rates (e.g. 5–10%), the routine use of drug-eluting stents may be questioned, at least on economic grounds.

In the future, lower incremental costs for drug-eluting stents should render this technology cost saving for a larger subgroup of patients with PCI, and broaden the ideal target population.

Notes

Acknowledgements

Dr Cohen receives grant support from Cordis, Guidant, and Boston Scientific. No financial support was provided for the preparation of this manuscript. The authors have no other conflicts of interest with respect to this manuscript.

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Copyright information

© Adis Data Informotion BV 2003

Authors and Affiliations

  • Dan Gremberg
    • 1
    • 2
    • 3
  • Ameet Bakhai
    • 1
    • 2
    • 4
  • David J. Cohen
    • 1
    • 2
    • 3
  1. 1.Harvard Clinical Research InstituteBostonUSA
  2. 2.Cardiovascular DivisionBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  3. 3.Department of Health Policy and ManagementHarvard School of Public HealthBostonUSA
  4. 4.Clinical Trial and Evaluation UnitRoyal Brompton HospitalLondonUK

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