| NEW YORK, July 9
NEW YORK, July 9 (Reuters Health) - Many heart patients get
newer, pricey stents inserted during artery-clearing procedures,
even if it's not clear they would be worse off with more basic,
less expensive stents, a new study suggests.
The new findings are an example of ways technology gets
overused and at times misused in healthcare, according to a
commentary accompanying the study.
Along with being more costly, so-called drug-eluting stents
require patients to take aspirin and other blood-thinning drugs
for a longer period of time after their procedure. That may
require them to put off future elective surgeries because of
bleeding risks, according to one researcher who worked on the
report produced by Dr Robert Yeh and colleagues.
Some patients having a stent inserted are at high risk of
having that stent get clogged, requiring a repeat procedure.
They include people with diabetes or narrow arteries, for whom
drug-eluting stents can help prevent build-up in and around the
stent and avoid the need for future surgeries, said Yeh, a
cardiologist from Massachusetts General Hospital in Boston.
Such stents release a drug to help prevent the artery
But in people whose stents probably won't get clogged, the
older bare-metal stents can work just as well at a much lower
price, he said.
"Non-diabetic patients who have big arteries and have very
short blockages, their rate of restenosis can be quite low, even
with bare-metal stents," Yeh told Reuters Health.
"Patients need to ideally know an estimate of their
individualized risk of requiring a repeat procedure, and they
need to know, what are the implications of the different stent
choices they might receive?"
Medtronic, Abbott Laboratories and Boston
Scientific are among the leading manufacturers of
drug-eluting stents, which can cost up to $1,000 more per
patient than more basic models.
Almost three-quarters of patients at very low risk of
needing a repeat stent-inserting procedure received drug-eluting
stents. That compared with 83 percent of the higher-risk
patients, who had more to gain from the extra protection.
Doctors varied greatly in their use of drug-eluting stents:
Individual surgeons used the newer devices for between two and
100 percent of procedures.
Yeh's team calculated that if half of low-risk U.S. patients
given a drug-eluting stent instead received a bare-metal stent,
that could save over $200 million per year on heart procedures,
or about $340 per procedure.
As a result, an extra one in 200 patients given a bare-metal
stent would eventually need a repeat artery-clearing procedure.
"This is definitely a case where you can't have a general
rule that applies in every situation," said Dr. Jack Tu, head of
cardiovascular research at the Institute for Clinical Evaluative
Sciences in Toronto, who wasn't involved in the new study.
"The higher-risk patients should be getting these
(drug-eluting) stents, whereas I think an argument could be made
that lower-risk patients should be getting bare-metal stents."
Dr. Peter Groeneveld, who wrote the commentary accompanying
the study, said more expensive stents can be a waste of money.
"All the incentives are aligned right now to use the most
expensive, newest therapeutic options when often there are much
cheaper, tried and true, evidence-based therapies that are going
to deliver just as much benefit," Groeneveld, from the
University of Pennsylvania in Philadelphia, told Reuters Health.
"If you get an expensive stent, somebody has to pay for it,
even if that stent doesn't benefit anybody, including the
patient, any more than a cheaper alternative," he added. In that
case, Groeneveld added, "That's just money down the drain."