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(Circulation. 2006;114:1745-1754.)
© 2006 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Drug-Eluting Stents

The Price Is Not Right

Mark J. Eisenberg, MD, MPH

From the Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.

Correspondence to Mark J. Eisenberg, MD, MPH, Associate Professor of Medicine, Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Cote Ste Catherine Rd, Suite A-118, Montreal, Quebec, Canada H3T 1E2. E-mail meisenberg@epid.jgh.mcgill.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 

"Does it make economic sense to completely abandon a therapy that works well for 85% to 90% of the population for a new therapy costing four times as much to treat a transient health condition with no impact on either death or myocardial infarction?"

J.M. Brophy and L.J. Erickson¹

Since Andreas Gruntzig performed the first percutaneous coronary intervention (PCI) in 1977,² the cost-effectiveness of this procedure has engendered major controversy. Debates have erupted over the clinical value and cost-effectiveness of each new device or therapy that has become available. Controversies have arisen regarding the cost of atherectomy, bare metal stents (BMS), brachytherapy, distal protection devices, glycoprotein IIb/IIIa inhibitors, and intravascular ultrasound.^3–6 Drug-eluting stents (DES) are the most recent devices to have their cost scrutinized.^7–12

Response by Ryan and Cohen p 1754

	Clinical Effectiveness and DES Penetration

 
Balloon angioplasty is associated with restenosis rates of 30% to 40%, whereas PCI with BMS is associated with rates of 20% to 30%,^13,14 and PCI with DES is associated with rates in the single digits.^15,16 My colleagues and I pooled the results of 11 DES trials involving >5000 patients using a hierarchical Bayesian random-effects model.¹⁷ We found that, compared with BMS, DES reduce angiographic restenosis from 29.3% to 8.9% (Table 1 and Figure 1). There was no difference between DES and BMS in terms of mortality (0.9% versus 0.9%, respectively) or myocardial infarction (2.7% versus 2.9%, respectively). There was a suggestion that restenosis was less with sirolimus-eluting stents (SES) compared with polymeric paclitaxel-eluting stents (PES) (6.2% for . . . [Full Text of this Article]

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				J. Ryan, W. Linde-Zwirble, L. Engelhart, L. Cooper, and D. J. Cohen Temporal Changes in Coronary Revascularization Procedures, Outcomes, and Costs in the Bare-Metal Stent and Drug-Eluting Stent Eras: Results From the US Medicare Program Circulation, February 24, 2009; 119(7): 952 - 961. [Abstract] [Full Text] [PDF]

				S.-J. Park and Y.-H. Kim Current Status of Percutaneous Coronary Intervention With Drug-Eluting Stents in Asia Circulation, December 16, 2008; 118(25): 2730 - 2737. [Full Text] [PDF]

				D.J.W Evans, P.V Lawford, J Gunn, D Walker, D.R Hose, R.H Smallwood, B Chopard, M Krafczyk, J Bernsdorf, and A Hoekstra The application of multiscale modelling to the process of development and prevention of stenosis in a stented coronary artery Phil Trans R Soc A, September 28, 2008; 366(1879): 3343 - 3360. [Abstract] [Full Text] [PDF]