Expensive new stents may save money in the end by reducing complications
Monday, March 31st 2003, 12:00 am
By: News On 6
CHICAGO (AP) _ Much-anticipated new drug-covered stents, expected to cost three times more than the standard variety, could actually save money in the long run by reducing heart patients' need for expensive repeat angioplasty and bypass surgery, according to a new analysis.
While there is little argument about the new stents' technical superiority, their higher cost worries many, considering that most of the 1 million patients undergoing routine angioplasty each year are likely to receive them.
However, the new analysis, released Sunday at a meeting of the American College of Cardiology, offers some assurance that the stents will be worth the price, even though they might be a money-loser for hospitals.
Dr. David Cohen of Harvard's Beth Israel Deaconess Medical Center in Boston based his conclusion on a follow-up of patients receiving Johnson & Johnson's new drug-coated stent, expected to be the first on the market in the United States. That study, financed by the manufacturer, showed the stent to be highly effective at keeping arteries flowing smoothly after angioplasty.
For several years, doctors have routinely left behind stainless steel wire coils to prop open heart arteries after forcing them open with balloon angioplasty. Nevertheless, the arteries fill up with scar tissue within a few weeks in about one-quarter of patients.
The new stents are like the old ones but are coated with medicines intended to prevent fresh muscle tissue from growing into the artery and forming scars. They nearly eliminate angioplasty failure.
The Johnson & Johnson stent, coated with the drug sirolimus, is expected to be approved by the U.S. Food and Drug Administration sometime this year. Many rival products coated with different medicines are in testing.
``This represents a truly remarkable and revolutionary advance for cardiology,'' said Dr. Howard Hermann of the University of Pennsylvania.
The price of the new stent has not been set. Cohen assumed each would cost about $3,000 and that patients would need an average of 1.4 apiece.
No matter what the cost, doctors expect the new stents to quickly replace the ordinary variety for many patients. One drawback, at least at the start, will be having stents available in all the sizes required. Also, still to be tested is how well they will work when angioplasty is used to treat heart attacks, as well as whether they can be put inside other stents that have become blocked.
Cohen's team found that after one year the medical bills for patients getting the new stents were just $309 more than for those with the ordinary kind. The extra cost was almost completely offset by the reduction in the cost of caring for failed angioplasties.
Cohen says the balance actually tips in favor of the new stents if all patients _ not just those with the new stents _ get three months of the drug Plavix, as is now becoming standard. In that case, treatment including the new stents cost $96 less after one year.
For hospitals, though, the math works out differently. Most patients who get angioplasty are covered by Medicare, which pays for their entire hospital stay regardless of how much treatment they need.
Cohen noted that although Medicare is raising its reimbursement to cover the new stents, the extra money will not entirely make up for the extra cost, especially if patients need several stents. One way around this, he said, is for hospitals to encourage doctors to put in one or two stents at a time, rather than all of them at once. This would mean several admissions for each patient.
``It's sort of gaming the system,'' he said, ``but that's the way the system is set up.''
Some doctors also routinely give patients the vitamin folate to lessen the return of blockages. A recent Swiss study showed it cut angioplasty failure in half. Folate reduces homocysteine, which promotes hardening of the arteries.
However, a new study at Germany's Bremen Heart Center, undertaken to test the strategy, came to a surprising opposite conclusion: People getting folate had more blockage, not less.
That conclusion was disputed by Dr. David Williams of Rhode Island Hospital. ``I don't buy it,'' he said, because the study, involving 636 people, was too small to draw a firm conclusion.