Selective DES use supported
MedWire News: Selective use of drug-eluting stents (DES) in percutaneous coronary intervention (PCI) patients does not increase the risk for adverse outcomes and saves billions in healthcare costs, study results indicate.
"These findings suggest that in an era of constrained resources, a more selective approach to DES use would be preferred, at least on economic grounds," write David Cohen (University of Missouri-Kansas City, USA) and colleagues in the journal Circulation.
In 2007, the US Food and Drug Administration (FDA) issued an advisory statement cautioning against the use of DES in patients with unapproved or untested indications. In the current study, the team compared the clinical value and cost-effectiveness of the liberal DES approach, commonplace before the FDA statement, with the selective DES approach adopted after the FDA statement.
They investigated the occurrence of postdischarge target lesion revascularization (TLR), death, and myocardial infarction (MI) in 7587 PCI patients who were implanted with DES between 2004 and 2006 (period of liberal DES use) and 2557 PCI patients implanted in 2007 (selective DES use).
The findings revealed that the proportion of patients receiving at least one DES decreased from a mean of 92% during 2004-2006 to 68% in 2007 (p<0.001).
However, patients treated in 2007 were more likely to require TLR during the 1-year follow-up period, at 5.1%, than those who were treated in 2004-2006, at 4.1% (p=0.03). This difference remained significant after adjusting for clinical and angiographic risk factors.
In contrast, there were no significant differences in risk for mortality or MI between the two periods in unadjusted and risk-adjusted analyses.
Healthcare costs were US$ 659 (€ 462.49) higher for each patient treated between 2004 and 2006 than for those treated in 2007 (p<0.001). Moreover, this difference was driven primarily by the more frequent use of DES and greater numbers of stents implanted per patient through 2004-2006, report the authors.
"These findings suggest that although clinical outcomes may be marginally better, an overall strategy of unrestricted use of DES may not represent an efficient use of scarce healthcare resources," they conclude.
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By Piriya Mahendra