Wider Use of Stents Drives Health Costs

Heart devices known as drug-eluting stents have added as much as $1.57 billion to U.S. health costs since their introduction in 2003, researchers said on Monday.

The study offers an illustration of how new technology can drive health costs, the researchers said in the Archives of Internal Medicine.

Stents, made by companies such as Boston Scientific, Abbott Laboratories, Medtronic Inc., and Johnson & Johnson, are wire-mesh coils used to prop open arteries narrowed by fatty deposits called plaque.

Many models release drugs over time that help prevent scar tissue from building up and blocking the artery.

When they were first introduced to the U.S. market, they were approved mostly for use in previously untreated blood vessels, but their use quickly expanded.

Now, according to some estimates, more than half of all drug-eluting stents are used in so-called off-label indications — uses beyond the scope of their original approval.

Dr. Peter Groeneveld of the University of Pennsylvania School of Medicine and colleagues wanted to see what kind of impact the introduction of a new medical technology such as drug-eluting stents could have on health spending.

They studied data from more than 2,000 people covered by the federal Medicare insurance program for the elderly between 2002 and 2006. The team looked at both direct procedure costs and indirect costs associated with the treatment.

They found that drug-eluting stents may have added $1.57 billion in annual Medicare expenditures.

Dr. Rita Redberg, editor of the journal, called the increase "staggering."

"It is time to clearly define what the value of this extraordinary investment has been in terms of patient benefits and study the harms and determine if we are getting good value for this outlay," she wrote.

Several studies have shown that adding the drug coating to stents helps reduce the need for repeat procedures that were common with earlier, bare metal stents.

The study did not account for increased drug costs, which may have added to the overall increase. Sanofi-Aventis' anti-clotting drug clopidogrel or Plavix is typically prescribed after a stent is implanted to keep patients from developing blood clots.

"This analysis contributes to understanding the cost-increasing effects of technology because the cost effects of drug-eluting stents were measured beyond the price of the new technology itself," the researchers wrote.