Physicians resist Medicare coverage expansion for carotid stents

Thirty-eight leading physicians in vascular medicine are urging Medicare to not expand coverage for carotid stents, The Wall Street Journal reports, representing a significant challenge to manufacturers pursuing a wider market. Their open-letter argument against the stents' increased use: Research points to today's prescription drugs as being just as good, if not better, at stroke prevention.

If Medicare listens, it would be a major setback for companies like Abbott Laboratories ($ABT), Boston Scientific ($BSX), Johnson & Johnson ($JNJ) and Covidien ($COV), which are among devicemakers seeking wider Medicare coverage of carotid stents to prevent strokes in patients with no systems. In the U.S., about 125,000 people either receive carotid surgery or carotid stents annually, according to the WSJ. But an additional 100,000 patients each year could become eligible with the Medicare approval.

Among those pushing back: Australian neurologist Dr. Anne Abbott, whose research concluded that cholesterol and blood pressure medications, plus modern antiplatelet drugs, such as Plavix, have led to a huge decline in stroke rates, the article points out. What's more, she and others have argued that the $33,500 price tag for carotid-stent procedures is several times the cost of drug treatments, so why pay so much more when drugs can serve as an equal or better alternative? And then there's that 2010 NIH-funded study. As the WSJ notes, researchers found "no significant difference" between the consolidated four-year rate of stroke, death and heart attacks in 2,502 patients. Additionally, the 30-day stroke and death rate for stent patients was much higher than for surgery.

Still, stent makers are fighting back. According to the WSJ, Abbott Laboratories, for example, is joining forces with the Society for Cardiovascular Angiography and Interventions to expand use of carotid stents even to people with carotid blockage who have no stroke symptoms. Other physicians support carotid stents, noting their broad FDA approval in 2011, and counter-research that suggests stenting can equal carotid surgery as beneficial. Patients, they say, should not be deprived of options. And Boston Scientific, Covidien and Johnson & Johnson are also continuing their push for broader Medicare coverage.

- here's the WSJ story (sub. req.)

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