Adoption of Drug-Eluting Stents Associated With Lower Health Care Costs and Improved Clinical Outcomes
Per Patient Cost Decreased by $1,900 Following Introduction of Innovative Devices
Washington, DC .– The introduction of drug-eluting stents (DES) was associated with reduced health care costs while providing improved clinical outcomes compared to the pre-DES era according to data presented here today at the annual Transcatheter Cardiovascular Therapeutics 2007.
“These results suggest that medical innovation, like the development and introduction of drug-eluting stents, can have value by contributing to improved clinical outcomes and reduced overall health care costs,” said David J. Cohen, M.D., M.Sc., Director of Cardiovascular Research, Saint-Luke’s Mid-America Heart Institute, Kansas City, MO, and senior author of this study. The results were presented by Jason Ryan, M.D., M.P.H., Cardiology Fellow, Beth Israel Deaconess Medical Center in Boston, MA.
“Despite higher up-front costs for DES procedures, aggregate spending for cardiovascular care decreased by more than $1,900 per patient needing revascularization. This reflects both the shift from bypass surgery to percutaneous coronary intervention (PCI) as initial treatment and downstream cost savings due to improved clinical outcomes such as reduced need for re-treatment among these patients.”
Data were analyzed from the Medicare Standard Analytic File (SAF), which contains all inpatient, hospital outpatient, skilled nursing, physician and supplier claims for five percent of fee-for-service Medicare beneficiaries. Two years were chosen to represent the pre-DES (2001) and post-DES (2004) eras. The CYPHER® Sirolimus-eluting Coronary Stent was approved for marketing by the U.S. Food and Drug Administration in 2003.
The primary objectives of the analysis were to examine the impact of the introduction of drug-eluting stents on overall coronary revascularization rates and treatment patterns among the Medicare population, to determine whether changes in revascularization patterns were associated with changes in clinical outcomes, and to determine the overall impact of these changes on total health care costs, as assessed from the perspective of the Medicare program.
Between 2001 and 2004, the introduction of DES was associated with substantial changes in both the practice and the outcomes of coronary revascularization among older Americans. Notably, there was a shift from bypass surgery (CABG) to PCI over this time period. In addition, the proportion of patients over the age of 79 increased from 2001 to 2004 and these patients were more likely at this time point to have co-morbidities including diabetes, heart failure and hypertension.
In 2004, the first full year of DES availability, 75 percent of PCI procedures used DES while the proportion of patients receiving bypass surgery decreased by eight percent. Over this same time frame, there were significant improvements in most clinical outcomes for coronary revascularization patients, including reductions in rates of risk-adjusted mortality by 12 percent and heart attacks (myocardial infarction) by 29 percent. While the introduction of DES was not the only change to the system during these two periods, it was noted as the largest and most significant.
The analysis also showed that the introduction of DES was not associated with any evidence of an adverse safety signal. These findings are consistent with newly released data on the long-term safety of DES including the Swiss Meta analysis, which appeared in The Lancet, the Ontario DES registry from The New England Journal of Medicine, as well as data from the European Society of Cardiology meeting in Vienna, including the SCAAR registry, the Western Denmark registry and data from Bern/Rotterdam.
“Although other factors may have contributed to these results, these findings support both the clinical and economic value of drug-eluting stents in the treatment of older Americans requiring coronary revascularization,” said Liesl Cooper, PhD, Vice President, Health Economics and Reimbursement, Cordis Corporation. “In addition we are pleased to see that these data are consistent with other recent data in terms of the safety of drug-eluting stents.”
Cordis Corporation funded this study and assisted in the analysis of the data.
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