Drug-eluting stents deployed too much, researchers conclude

Drug-eluting stents may be ubiquitous these days. But a new study suggests they're being used too much for individuals at low risk of restenosis. What's more, the researchers believe that doctors could slash $205 million annually in healthcare spending if just half of those patients received a bare metal stent instead.

MedPage Today and TheHeart.Org report on the study, which was conducted by a large group of academics and published in the Archives of Internal Medicine.

The finding likely isn't something that the medical device industry wants to hear right now. Competition is fierce, with plenty of players in the drug-eluting stent market. Companies including Medtronic ($MDT), Abbott Laboratories ($ABT) and Boston Scientific ($BSX) have focused their energies on growing their global market share through the regulatory approval of new indications and sizes for their products.

But in the wake of national health reform, the industry is increasingly confronting a healthcare system seeking cost-effective treatments and pushing to weed out waste from the system. That makes drug-eluting stents a target because they cost more than bare-metal stents, as MedPage Today notes, and they require long-term dual anti-platelet therapy, which adds another cost to the treatment.

Researchers analyzed more than 1.5 million stenting procedures in the National Cardiovascular Data Registry CathPCI registry from 2004 to 2010. They determined, in part, that 74% of patients received drug-eluting stents, even though they had a less than 10% risk of restenosis. About 78% had an intermediate 10%-20% risk over one year, and 83% had a high risk of restenosis (greater than 20%), the articles explain. The Massachusetts General Hospital's Dr. Robert Yeh, a study author, told MedPage Today that the numbers likely represent overuse of drug-eluting stents.

And as the new report concludes, there may be room for reducing drug-eluting stent use for patients at low-risk of restenosis, because drug-eluting stents appear to work best for patients at high restenosis risk. Also, bare metal stents are cheaper and don't need the long-term, dual anti-platelet therapy, as MedPage Today states. Interestingly, the study determined that restenosis risks only increase slightly by shifting back to bare metal stents.

- read the MedPage Today story
- check out TheHeart.org's coverage (sub. req.)
- consider the study

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