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Varied Use of Drug-Eluting Stents: Examining the Effect

Varied Use of Drug-Eluting Stents: Examining the Effect

Research has shown that drug-eluting stents (DES) effectively help reduce restenosis, with a 50% to 70% relative risk reduction in target vessel revascularization (TVR) rates. “Drug-eluting stents have been an important technological innovation,” explains Robert W. Yeh, MD, MSc, “but their benefits are concentrated to subsets of patients at higher risk of restenosis with bare-metal stents (BMS). As a result, some studies have suggested that DES be targeted selectively to the higher- TVR-risk lesions.” Examining the use of DES as a function of patients’ TVR risk may have important implications regarding the costs of PCI. Economic analyses in clinical trials have shown that DES is generally cost-effective for patients at moderate or high risk of restenosis, but a recent study has found that the annual costs associated with DES use were $1.57 billion between 2002 and 2006. In addition, DES use currently requires prolonged dual-antiplatelet therapy when used in stable patients, whereas BMS does not. DES therapy can increase long-term medication costs and elevate patients’ risk of bleeding events. Patients can also be subjected to serious complications if dual-antiplatelet therapy is discontinued prematurely. DES Use Variations Dr. Yeh and colleagues conducted a study to assess whether DES are preferentially used in patients with higher predicted TVR risk. The analysis, which was published in the July 9, 2012 Archives of Internal Medicine, also sought to estimate if lower use of DES in low-TVR-risk patients would be more cost-effective than how DES are currently being used. “Given the financial pressures on the nation’s healthcare system today,” Dr. Yeh says, “efforts are warranted to more closely examine the decisions being made when...
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