Drug-Eluting Stents Meet Cost-Effectiveness Standards

Each drug-eluting coronary stent costs a hospital an average of $2,500, about $1,800 more than the cost of a similar bare-metal stent.

Although it looks like the price of drug-eluting stents won't change substantially for at least another year, even at current prices they save costs for certain high-risk patients and are cost-effective for the majority of patients undergoing percutaneous coronary interventions, said David J. Cohen, M.D., associate director of interventional cardiology at Beth Israel Deaconess Medical Center in Boston.

Two brands of drug-eluting stents, Cypher and Taxus, currently compete in the U.S. market, and even though most experts say that there is little clinically or technically to favor one over the other, their competition is not likely to lead to a substantial price drop anytime soon.

“Both companies are selling lots of stents, so they may be happy to keep their current market shares,” Dr. Cohen said in an interview. The next major shakeup in the market will not come until early next year, when Medtronic is expected to get approval to market a third, competing brand of drug-eluting stent.

Using data collected by Medicare, Dr. Cohen and his associates have calculated that an episode of restenosis following coronary artery stenting costs almost $19,000 per year. Given that the restenosis rate among Medicare beneficiaries who received bare-metal stents was about 14% during the first year following treatment, the cost of restenosis works out to about $2,550 per patient per year.

Based on current costs for drug-eluting stents, and on their ability to cut target-vessel restenosis rates by about 80%, drug-eluting stents will save money if they're used in patients with a restenosis rate of 18% or greater, and drug-eluting stents will meet accepted definitions of cost-effectiveness (costing less than $10,000 for each repeat revascularization prevented) for all patients with a bare-metal stent restenosis rate of 12% or greater. This means that drug-eluting stents are cost-effective for the majority of patients who get them, Dr. Cohen said during a talk at the American Heart Association's scientific sessions last November in New Orleans.

Dr. Cohen and his associates tested these assumptions with data collected from two recent trials. In the Sirolimus-Eluting Stent in De Novo Native Coronary Lesions (SIRIUS) trial, which compared sirolimus-eluting stents (Cypher) with bare-metal stents, the 1-year incremental cost of the drug-eluting stent was $309 per patient. The cost per repeat revascularization avoided was $1,650, well within the ceiling for cost-effectiveness. Further analysis of these data showed that the sirolimus-eluting stent cost about $27,000 per quality-life year gained, well within the standard maximum of $50,000 per quality-life year gained based on Medicare's dialysis program.

In the TAXUS IV trial paclitaxel-eluting stents (Taxus) were compared with bare-metal stents. The cost-effectiveness rates were $760 for each repeat revascularization avoided and $5,105 for each quality-life year gained. However, the study did not routinely use follow-up angiography and instead relied on clinical assessment of patients.

Dr. Cohen has received research grants from Cordis, which markets the Cypher stent, and from Boston Scientific, which markets the Taxus stent.

Each drug-eluting coronary stent costs a hospital an average of $2,500, about $1,800 more than the cost of a similar bare-metal stent.

Although it looks like the price of drug-eluting stents won't change substantially for at least another year, even at current prices they save costs for certain high-risk patients and are cost-effective for the majority of patients undergoing percutaneous coronary interventions, said David J. Cohen, M.D., associate director of interventional cardiology at Beth Israel Deaconess Medical Center in Boston.

Two brands of drug-eluting stents, Cypher and Taxus, currently compete in the U.S. market, and even though most experts say that there is little clinically or technically to favor one over the other, their competition is not likely to lead to a substantial price drop anytime soon.

“Both companies are selling lots of stents, so they may be happy to keep their current market shares,” Dr. Cohen said in an interview. The next major shakeup in the market will not come until early next year, when Medtronic is expected to get approval to market a third, competing brand of drug-eluting stent.

Using data collected by Medicare, Dr. Cohen and his associates have calculated that an episode of restenosis following coronary artery stenting costs almost $19,000 per year. Given that the restenosis rate among Medicare beneficiaries who received bare-metal stents was about 14% during the first year following treatment, the cost of restenosis works out to about $2,550 per patient per year.

Based on current costs for drug-eluting stents, and on their ability to cut target-vessel restenosis rates by about 80%, drug-eluting stents will save money if they're used in patients with a restenosis rate of 18% or greater, and drug-eluting stents will meet accepted definitions of cost-effectiveness (costing less than $10,000 for each repeat revascularization prevented) for all patients with a bare-metal stent restenosis rate of 12% or greater. This means that drug-eluting stents are cost-effective for the majority of patients who get them, Dr. Cohen said during a talk at the American Heart Association's scientific sessions last November in New Orleans.

Dr. Cohen and his associates tested these assumptions with data collected from two recent trials. In the Sirolimus-Eluting Stent in De Novo Native Coronary Lesions (SIRIUS) trial, which compared sirolimus-eluting stents (Cypher) with bare-metal stents, the 1-year incremental cost of the drug-eluting stent was $309 per patient. The cost per repeat revascularization avoided was $1,650, well within the ceiling for cost-effectiveness. Further analysis of these data showed that the sirolimus-eluting stent cost about $27,000 per quality-life year gained, well within the standard maximum of $50,000 per quality-life year gained based on Medicare's dialysis program.

In the TAXUS IV trial paclitaxel-eluting stents (Taxus) were compared with bare-metal stents. The cost-effectiveness rates were $760 for each repeat revascularization avoided and $5,105 for each quality-life year gained. However, the study did not routinely use follow-up angiography and instead relied on clinical assessment of patients.

Dr. Cohen has received research grants from Cordis, which markets the Cypher stent, and from Boston Scientific, which markets the Taxus stent.

Each drug-eluting coronary stent costs a hospital an average of $2,500, about $1,800 more than the cost of a similar bare-metal stent.

Although it looks like the price of drug-eluting stents won't change substantially for at least another year, even at current prices they save costs for certain high-risk patients and are cost-effective for the majority of patients undergoing percutaneous coronary interventions, said David J. Cohen, M.D., associate director of interventional cardiology at Beth Israel Deaconess Medical Center in Boston.

Two brands of drug-eluting stents, Cypher and Taxus, currently compete in the U.S. market, and even though most experts say that there is little clinically or technically to favor one over the other, their competition is not likely to lead to a substantial price drop anytime soon.

“Both companies are selling lots of stents, so they may be happy to keep their current market shares,” Dr. Cohen said in an interview. The next major shakeup in the market will not come until early next year, when Medtronic is expected to get approval to market a third, competing brand of drug-eluting stent.

Using data collected by Medicare, Dr. Cohen and his associates have calculated that an episode of restenosis following coronary artery stenting costs almost $19,000 per year. Given that the restenosis rate among Medicare beneficiaries who received bare-metal stents was about 14% during the first year following treatment, the cost of restenosis works out to about $2,550 per patient per year.

Based on current costs for drug-eluting stents, and on their ability to cut target-vessel restenosis rates by about 80%, drug-eluting stents will save money if they're used in patients with a restenosis rate of 18% or greater, and drug-eluting stents will meet accepted definitions of cost-effectiveness (costing less than $10,000 for each repeat revascularization prevented) for all patients with a bare-metal stent restenosis rate of 12% or greater. This means that drug-eluting stents are cost-effective for the majority of patients who get them, Dr. Cohen said during a talk at the American Heart Association's scientific sessions last November in New Orleans.

Dr. Cohen and his associates tested these assumptions with data collected from two recent trials. In the Sirolimus-Eluting Stent in De Novo Native Coronary Lesions (SIRIUS) trial, which compared sirolimus-eluting stents (Cypher) with bare-metal stents, the 1-year incremental cost of the drug-eluting stent was $309 per patient. The cost per repeat revascularization avoided was $1,650, well within the ceiling for cost-effectiveness. Further analysis of these data showed that the sirolimus-eluting stent cost about $27,000 per quality-life year gained, well within the standard maximum of $50,000 per quality-life year gained based on Medicare's dialysis program.

In the TAXUS IV trial paclitaxel-eluting stents (Taxus) were compared with bare-metal stents. The cost-effectiveness rates were $760 for each repeat revascularization avoided and $5,105 for each quality-life year gained. However, the study did not routinely use follow-up angiography and instead relied on clinical assessment of patients.

Dr. Cohen has received research grants from Cordis, which markets the Cypher stent, and from Boston Scientific, which markets the Taxus stent.