Drug-eluting stents should be limited to high risk patients
Drug-eluting stents are more cost-effective when limited to patients in high-risk groups than when used in all patients, a study has shown
(Lancet 2005;366:921).
The study of 826 patients treated with angioplasty and stenting found
that the higher costs of drug-eluting stents were not compensated for
by lower follow-up costs.
However, subgroup analysis showed that drug-eluting stents were more
cost-effective for elderly patients in specific high-risk groups.
The authors say that use of drug-eluting stents was more cost effective,
or even cost saving, in subgroups of high-risk elderly
patients with three-vessel disease or who
required treatment in multiple segments, long segments or small vessels.
“Therefore, the use of drug-eluting stents could be restricted
to certain high-risk patient subgroups … at least until the prices
of drug-eluting
stents are reduced,” they
conclude.
The National Institute for Health and Clinical Excellence currently recommends
the use of sirolimus-eluting or paclitaxel-eluting stents for patients
with coronary artery disease in whom the target artery is less than
3mm in internal
diameter or the lesion is longer than 15mm. |
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