Expensive, newer stents not better for all: study
NEW YORK (Reuters Health) - Many heart patients get newer, pricey stents inserted during artery-clearing procedures, even if it's not clear they would be worse off with more basic, less expensive stents, a new study suggests.
The new findings are an example of ways technology gets overused and at times misused in healthcare, according to a commentary accompanying the study.
Along with being more costly, so-called drug-eluting stents require patients to take aspirin and other blood-thinning drugs for a longer period of time after their procedure. That may require them to put off future elective surgeries because of bleeding risks, according to one researcher who worked on the report produced by Dr Robert Yeh and colleagues.
Some patients having a stent inserted are at high risk of having that stent get clogged, requiring a repeat procedure. They include people with diabetes or narrow arteries, for whom drug-eluting stents can help prevent build-up in and around the stent and avoid the need for future surgeries, said Yeh, a cardiologist from Massachusetts General Hospital in Boston.
Such stents release a drug to help prevent the artery becoming blocked.
But in people whose stents probably won't get clogged, the older bare-metal stents can work just as well at a much lower price, he said.
"Non-diabetic patients who have big arteries and have very short blockages, their rate of restenosis can be quite low, even with bare-metal stents," Yeh told Reuters Health.
"Patients need to ideally know an estimate of their individualized risk of requiring a repeat procedure, and they need to know, what are the implications of the different stent choices they might receive?"
Medtronic (MDT.N), Abbott Laboratories (ABT.N) and Boston Scientific (BSX.N) are among the leading manufacturers of drug-eluting stents, which can cost up to $1,000 more per patient than more basic models.
For the new study, Yeh and his colleagues consulted data on 1.5 million patients who had a stent inserted between 2004 and 2010 in the United States. Their findings were reported Monday in the Archives of Internal Medicine bit.ly/OdmdoZ.
Almost three-quarters of patients at very low risk of needing a repeat stent-inserting procedure received drug-eluting stents. That compared with 83 percent of the higher-risk patients, who had more to gain from the extra protection.
Doctors varied greatly in their use of drug-eluting stents: Individual surgeons used the newer devices for between two and 100 percent of procedures.
Yeh's team calculated that if half of low-risk U.S. patients given a drug-eluting stent instead received a bare-metal stent, that could save over $200 million per year on heart procedures, or about $340 per procedure.
As a result, an extra one in 200 patients given a bare-metal stent would eventually need a repeat artery-clearing procedure.
"This is definitely a case where you can't have a general rule that applies in every situation," said Dr. Jack Tu, head of cardiovascular research at the Institute for Clinical Evaluative Sciences in Toronto, who wasn't involved in the new study.
"The higher-risk patients should be getting these (drug-eluting) stents, whereas I think an argument could be made that lower-risk patients should be getting bare-metal stents."
Dr. Peter Groeneveld, who wrote the commentary accompanying the study, said more expensive stents can be a waste of money.
"All the incentives are aligned right now to use the most expensive, newest therapeutic options when often there are much cheaper, tried and true, evidence-based therapies that are going to deliver just as much benefit," Groeneveld, from the University of Pennsylvania in Philadelphia, told Reuters Health.
"If you get an expensive stent, somebody has to pay for it, even if that stent doesn't benefit anybody, including the patient, any more than a cheaper alternative," he added. In that case, Groeneveld added, "That's just money down the drain."
(Editing by Christine Soares, Michele Gershberg, Carol Bishopric and Andrew Hay)
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