Drug-eluting stents (DESs) cost Medicare an additional $1.57 billion per year, according to a study published online in the Archives of Internal Medicine. Using a random sample of Medicare beneficiaries, Peter Groeneveld and colleagues compared annual costs for patients with coronary artery disease in 2002 (the year before DESs were introduced) to costs in the years from 2002 through 2006.
The researchers then calculated the difference in national expenditures attributable to DESs and found that for each CAD patient (whether or not they received a DES), DES was associated with:
- a $657 increase in patients with acute MI,
- a $999 increase in patients with noninfarct ACS, and
- a $146 increase in patients without any ACS.
On a national level, the annual increase in Medicare costs attributable to DESs totaled $1.57 billion:
- $236 million for acute MI,
- $269 million for noninfarct ACS, and
- $1.067 billion for non-ACS CAD.
Because patients without ACS were by far the largest population, the researchers noted that this group accounted for more than two-thirds (68%) of the increase in cost, “suggesting that DES use among patients without ACS was particularly cost amplifying (ie, DES introduction changed patterns of care for patients without ACS in a more costly manner than for patients with ACS).” The researchers commented: “This is troubling, since the limited efficacy of percutaneous coronary intervention among patients with ACS, whether or not DESs are used, would not justify sizeable DES-related cost increases among patients without ACS.”
In an editor’s note, Rita Redberg wrote that “it is time to clearly define what the value of this extraordinary investment has been in terms of patient benefits and study the harms and determine if we are getting good value for this outlay.”