Each drug-eluting coronary stent costs a hospital an average of $2,500, about $1,800 more than the cost of a similar bare-metal stent.
Although it looks like the price of drug-eluting stents won't change substantially for at least another year, even at current prices they reduce costs for certain high-risk patients and are cost-effective for most patients undergoing percutaneous coronary interventions, said David J. Cohen, M.D., associate director of interventional cardiology at Beth Israel Deaconess Medical Center in Boston.
Two brands of drug-eluting stents, Cypher and Taxus, currently compete in the U.S. market, and even though most experts say that there is little clinically or technically to favor one over the other, their competition is not likely to lead to a substantial price drop anytime soon.
“Both companies are selling lots of stents, so they may be happy to keep their current market shares,” Dr. Cohen said in an interview. The next major shakeup in the market will not come until early next year, when Medtronic is expected to get approval to market a third, competing brand of drug-eluting stent.
Using Medicare data, Dr. Cohen and his associates calculated that an episode of restenosis after coronary artery stenting costs almost $19,000 per year. Given that the restenosis rate among Medicare beneficiaries who received bare-metal stents was about 14% during the first year after treatment, the cost of restenosis is about $2,550 per patient per year.
Given that drug-eluting stents cut target-vessel restenosis rates by about 80%, they will save money if they're used in patients with a restenosis rate of 18% or greater, and drug-eluting stents will meet accepted definitions of cost effectiveness (costing less than $10,000 for each repeat revascularization prevented) for all patients with a bare-metal stent restenosis rate of 12% or greater. This means that drug-eluting stents are cost-effective for the majority of patients who get them, Dr. Cohen said during a talk at the American Heart Association's scientific sessions last November in New Orleans.
Dr. Cohen and his associates tested these assumptions with data from two recent trials. In the Sirolimus-Eluting Stent in De Novo Native Coronary Lesions (SIRIUS) trial, which compared sirolimus-eluting stents (Cypher) with bare-metal stents, the 1-year incremental cost of the drug-eluting stent was $309 per patient. The cost per repeat revascularization avoided was $1,650, well within the limits for cost effectiveness. Further analysis of these data showed that the sirolimus-eluting stent cost about $27,000 per quality-life year gained, well under the maximum of $50,000 per quality-life year gained based on Medicare's dialysis program.
Their second analysis used data from the TAXUS IV trial, which compared paclitaxel-eluting stents (Taxus) with bare-metal stents. The cost effectiveness figures were $760 for each repeat revascularization avoided and $5,105 for each quality-life year gained.
Dr. Cohen has received research grants from Cordis, which markets the Cypher stent, and from Boston Scientific, which markets the Taxus stent.