Standing out in a crowd

A stent may not be a commodity in the same sense as silicon dioxide or carbon black. But what hospitals perceive as slight, if any, clinical differences among drug-eluting stents can make them appear so in purchasing decisions.

Several presenters at the recent MedAxiom Cardiovascular Service Line Symposium discussed initiatives aimed at lowering cost that put stents in their cross hairs. Michael Mack, chair of the cardiovascular governance council and director of cardiovascular surgery at Baylor Scott & White Health based in Dallas and director of cardiovascular research at the Heart Hospital Baylor Plano, shared on June 10 a supply chain strategy that applies a dual vendor approach for coronary stents, peripheral stents and heart rhythm management. Valves are next on the agenda.

The cost-saving program included clinician input but still it was “not necessarily popular,” he said. He admitted it disrupted the cath lab and electrophysiology lab service lines.

The next day two other presenters outlined business strategies that included a revision in drug-eluting stent purchasing. In both cases, they came to the conclusion after a literature review that there was no significant difference in safety and efficacy between stent types.

The approach used at John Ochsner Heart & Vascular Institute in New Orleans gave interventional cardiologists an incentive to cooperate. The initiative selected one vendor who was to supply 50 percent of stents. If a service line used that vendor’s stents in at least half of its cases, operators could choose other types of stents for other cases. The program notched a 53 percent utilization rate and saved them $300,000.

Braden W. Batkoff, MD, president and medical director of Providence Spokane Heart Institute in Washington called the two-vendor system his institute established for stents “service line 101. It is the low-hanging fruit.” Especially when the fruit is perceived to be nearly identical.

Many stent changes are iterative but one international group of engineers has found a way to differentiate their prototype product. They designed a smart stent—my term, not theirs. Their research paper published in the American Chemical Society’s journal Nano described a multifunctional, bioresorbable stent that could deliver drugs and monitor their effect. They embedded it with sensors and wireless transmitters as well as memory storage devices.

The bare-metal stent played a role in the development of microfabrication techniques, making this study a homage of sorts. Of course, do we need or want a stent that can do all that? Can it be scaled up? Can it function reliably? And can it ever compete on cost?

This is big-pie thinking on the part of the engineers. Many innovations wither and this one faces a lot of headwind. But when cell phones came out with cameras, some customers questioned the need for the accessory. Now I could write this column on my cell phone.

Tomorrow’s stents, or bioresorbable scaffolds or other platforms and designs, may offer advantages over existing products when they enter markets. Will it differentiate them? It will be interesting to watch.

Candace Stuart

Editor, Cardiovascular Business