AIM: DES stent use racks up $1.57B bill

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Drug-eluting stents (DES) were introduced to the market in 2003, and since then usage has added $1.57 billion in annual Medicare expenditures among beneficiaries age 66 to 85, according to an editorial published online April 25 in Archives of Internal Medicine.

“A clear understanding of how new technologies like DESs affect healthcare expenditures can provide insight into national trends in healthcare cost growth, of which new technology is presumably the leading driver,” the authors wrote.

To evaluate the impact DES technology has had on Medicare expenditures and healthcare, Peter W. Groeneveld, MD, of the Philadelphia Veterans Affairs (VA) Medical Center in Philadelphia, and colleagues evaluated a cohort of 1,981,088 Medicare beneficiaries with coronary artery disease (CAD) to calculate mean annual payor-perspective costs from 2002 to 2006.

The researchers performed calculations for three separate CAD cohorts: patients with acute MI, patients with acute coronary syndrome (ACS) but no MI and patients without ACS.

Of the 1,981,088 Medicare beneficiaries with CAD, 4.5 percent had a recent acute MI, 3.4 percent had a recent noninfarction ACS and 92 percent had no recent ACS.

Groeneveld et al found that between 2002 and 2006, DES use increased from 0 percent in all cohorts to 23 percent in patients with AMI, 29 percent in patients with noninfarction ACS and 1.1 percent in patients without ACS. Additionally, the researchers reported that inflation-adjusted costs ranged from 4.7 percent to 11.7 percent between 2002 and 2006.

The researchers also reported that each 1 percent increase in DES use was associated with a $28 mean per-patient cost increase in AMI patients, a $35 increase in noninfarct ACS patients and a $133 increase in non-ACS patients.

Lastly, annual costs for patients with AMI, noninfarct ACS and patients without ACS increased by $657, $999 and $146 when a DES was used.

“Drug-eluting coronary stents substantially increased costs for Medicare beneficiaries with CAD,” the authors wrote. “The fraction of DES cost growth attributable to patients without ACS (68 percent) was much larger than the proportion of DESs received by this subcohort (33 percent), 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 found this “troubling,” due to the fact that the limited efficacy of PCI among ACS patients would not “justify sizeable DES-related cost increases among patients without ACS.”

While the authors said that the study could not establish whether DES use and cost growth was causal, they did find that DES use added $1.57 billion in annual Medicare expenditures among beneficiaries age 66 to 85.