Lower DES use could reduce health care costs

CHICAGO, IL – The use of drug-eluting stents (DES) varies widely among U.S. physicians, and is only modestly correlated with the risk of coronary artery restenosis (renarrowing), according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.

The study background states that DES are effective in reducing restenosis, and prove to be highly beneficial in patients with the highest risk of target-vessel revascularization (TVR). Drug-eluting stents cost more than bare-metal stents (BMS), and require prolonged dual antiplatelet therapy (DAPT), which increases costs and adds certain complication risks.

Amit P. Amin, M.D., M.Sc., of Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, Mo., and colleagues analyzed more than 1.5 million PCI procedures in the National Cardiovascular Data Registry (NCDR) CathPCI registry from 2004 to 2010.

According to the study, DES use is prevalent among U.S. physicians, even with patients at low risk of developing restenosis. A significant variation was also found in the rate of DES use by individual physicians. A reduction in DES use in patients at low risk for restenosis was projected to be associated with substantial costs savings with only a small increase in TVR event rate.

The study results show that drug-eluting stent use was 73.9 percent among those at a low risk for TVR, 78 percent among those at moderate risk and 83.2 percent among those at the highest TVR risk. A 50 percent reduction in DES use among low TVR risk patients was projected to lower health care costs by about $205 million per year in the U.S., while increasing the overall TVR event rate by 0.5 percent.