<%@LANGUAGE="JAVASCRIPT" CODEPAGE="1252"%> Drug Eluting Stents
BI108: Organ Replacement Web Page Final Project 2004
   
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Implications

The most common techniques used for treating coronary artery disease are implantation of bare metal stents (BMS), performing coronary artery bypass graft (CABG) surgery, and implanting stents using drug eluting devices. The following figure, from a presentation by Dr. Donald Bairn, illustrates a comparison of event free survival for study populations undergoing BMS, CABG surgery, and drug eluting stenting [1].

Based on this graph, it is clear that drug eluting stents have nearly the same event free survival at one year as the control group (95%). Whereas BMS had a 74% survival rate and CABG had an 88% survival rate [2]. This demonstrates the obvious clinical benefit of drug eluting stents to patients needing PCI due to narrowing of the coronary arteries.

In many cases, stenting is preferred by patients over CABG because unlike CABG, stenting is minimally invasive and requires only local anesthetic. However, CABG is used in patients where stenting is contraindicated and does show a better event free survival at one year [2].

On the other side of this issue is cost. The new technology has proved its usefulness, but hospitals are going to be hard pressed to deal with the financial consequences of drug eluting stents. In 2001, there were an estimated 520,000 CABG surgeries in the United States [3]. CABG surgeries cost approximately $20,000 30,000 dollars each, and often constitute a significant portion of the income of many hospitals [4]. As drug eluting stents become more popular, hospitals will lose much of this profitable portion of their services. In general, a stenting procedure has higher equipment and material costs relative to labor costs, and hospitals receive less reimbursement for the procedure. This problem is compounded with drug eluting stents because these devices cost up to three times more than a conventional metal stent [2].

Furthermore, restenosis visits are also an important part of hospital income. It is estimated that the cost of a single hospitalization for restenosis is approximately $11,913 [5]. As drug eluting stents eliminate much of the restenosis occurring with bare metal stents, hospitals will lose this portion of income as well. From an economic point of view, hospitals would like to limit the use of drug eluting stents in order to preserve their institutional economic viability. This will have to be weighed against patient and provider desire for the latest technology with the best clinical outcomes.

In a recent prospective study, doctors at one hospital examined patient referral and treatment method for cardiac intervention. They found that drug eluting stents reduced their CABG surgical volume by 21% from the previous equilibrium of bare metal stenting and CABG [6]. Clearly, the effects of drug eluting stents are already beginning to be felt only a year after their introduction. In time, we may see these devices used in an even greater patient population to treat a greater variety of vascular conditions. Drug eluting stents are poised to have a profound impact on percutaneous coronary interventions and the treatment of heart disease as a whole in the 21 st century.

Implications
 
   
   
   

 

Copyright © 2004 Nick Mark