Article Source: msnbc.com
from:msnbc.comStents: How new technology drives health costs
Seeded on Mon Apr 25, 2011 7:48 PM EDT (msnbc.com)
— Filed under: health
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You really have to look closely at the data...this article is somewhat misleading. Drug eluting stents have at least a 30% lower rate of re-stenosis when compared to earlier generation bare metal stents. Restenosis not only means another expensive procedure, but possible complications including heart attack and death. Yes, drug eluting stents cost more up front, but I'd like to see a true comparison of overall costs
@eric,
Exactly. Here's a link to the full paper:
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T18-4SJJFKY-4&_user=10&_coverDate=05%2F27%2F2008&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_searchStrId=1731430847&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=83c957dbbfa3786d52f21cb33b29ecdc&searchtype=a
You will see that the re-vascularization rates are in the 2-3% range, not 30% as you stated. There was an additional improvement of 2-2.5% in subsequent AMI rates. Even the two together only add up to a 4-5.5% improvement. I cannot find any credible reference to a 30% "re-stenosis" rate.
The study was supportive of DES use. Here are the conclusions:
"Conclusions
Among elderly Medicare beneficiaries treated with coronary stents between 2002 and 2003, receipt of DES was associated with a statically significant reduction in the rate of subsequent revascularization procedures, decreasing rates of subsequent hospitalization for acute myocardial infarction, and improved survival."
You have to remember who is advising physicians on these off-label uses. For example for the past seven years (not counting 2011) the entire cheerleading squad at the University of Kentucky has been hired as drug company sales reps. They do their rah-rah-sis-boom-bah for physicians and convince him that if it is good for General Motors, it is good for every patient.
Physicians who jack up costs in this way should be automatically referred for licensure review. Unless they can specifically and factually support their decision to go off-label, they should have their license forfeit. Maybe the drug companies will then hire them as a sales rep.
The point of the article is that Medicare has a finite amount of dollars to treat a huge number of patients at end-of-life. The issue is whether or not those dollars are being spent wisely. The question that the article asks is whether a 4-4.5% improvement in outcomes is worth $1.6 billion in annual additional medical costs.
People want to talk about death panels and such, but seldom are off-label uses of drugs and medical devices favorable. They mostly result from drug companies attempting (illegally) to get physicians to prescribe their drugs for things they have not been approved for. Rarely does the FDA approve these uses, even years later, because it was never justified and there was often data that was a contraindication.
But this underlies a more serious question in health economics: Do marginal increases in efficacy justify huge expenditures that may actually steal funds from other, more effective and more proven, uses for the same dollars? Do "treatments" that actually shorten life, but that have some very marginal impact on quality of life (Aricept comes to mind) have any real value? The whole idea of medical economics is to put scarce dollars where they will do the most real good for the most people. Real good in improvement of quality of life and length of life and not in just prolonging death and transferring the elder's assets to the for-profit medical industry which alrfeady consumes one out of every six dollars in the GDP..
found this in a 2 second search
Second- and third-generation drug-eluting coronary stents : Progress and safety.
Akin I, Schneider H, Ince H, Kische S, Rehders TC, Chatterjee T, Nienaber CA.
Source
Heart Center RostockDepartment of Internal Medicine I, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
Abstract
Drug-eluting stents (DES) have revolutionized the treatment of coronary artery disease by reducing the rate of in-stent restenosis from 20-40% with bare-metal stent (BMS) to 6-8% with DES. However, with widespread use of DES, safety concerns have risen due to the observation of late stent thrombosis. With this in mind and better understanding of mechanism and pathophysiology of stent thrombosis, the technological platform, especially innovative anti-restenotic agents, polymeric coatings, and stent platforms, improved with newer DES. Two second-generation DES, the Endeavor zotarolimus-eluting stent (ZES) and the Xience-V everolimus-eluting stent (EES), have provided promising results in both randomized controlled trials (SPIRIT and ENDEAVOR) and registries (E-Five, COMPARE) compared with bare-metal stents (BMS) and first-generation DES. Newer third-generation stent technology, especially biodegradable polymers, polymer-free stents, and biodegradable stents on the basis of poly-L-lactide (PLLA) or magnesium, has been evaluated in preclinical and initial clinical trials. However, despite encouraging initial results, long-term data of large-scale randomized trials as well as registries comparing them to currently approved first- and second-generation DES are still lacking.
makes the rest of your post moot. Drug eluting stents are clearly superior by a large margin, justifying their cost
I just realized you are probably confusing absolute risk reduction with relative risk reduction. Two statistical terms you may or may not be familiar with. You're right that the absolute risk reduction may be only a few percentage points, but multiplied by the many patients undergoing this procedure, its a lot of people
Plus again, for comparison purposes the relative risk reduction is useful, which again, shows a sizable reduction in the range of 30%
How much money was saved by the prevention of heart attack and cardiac arrest that would have happened without these stents? How much more money was earned and taxes paid by those who would have died earlier without these stents. How do you measure the quality of life difference between a man or woman who can still walk with their grandchildren instead of being stuck in bed for a short time until death. Arizona decide to cut all funds to Medicaid for foot doctors for adults. On paper they save money for the moment. These feet will end up in Emergency Rooms, wound centers, and needing surgery for orthopedic surgeons that are all much more expensive than good foot doctor care. Any idea of the cost for the surgery and follow up for a foot or leg amputation? Same story, different part of the body. If they do less stents they will have more costs.
The study was about the relative effectiveness of DES versus BMS, the two types of stents. The study was supportive of the use of DES. See the link and "Conclusion" in my post at 1.1.
The article was not about the study. It just used information from the study to bring up a legitimate question: Do off-label treatments that show small improvements in outcomes justify huge additional expenditures in Medicare and Medicaid expenses? Medicare and Medicaid have finite amounts of money to spend. When money is put into one pocket (DES stents) it has to be taken out of another. Is $1.6 billion annually best spent on DES stents (versus BMS stents) or would it save more lives if spent in some other way?
DES are probably overused, but are clearly superior. See my post above
My wife has a stent put in last August. The ongoing cost of Plavex($8 per dayx2) cot so bad Medicare and Medicaid told us to find an alternative. As it turns out, My wife incurred a viral infection and now has stopped Plavix. Now Medicare and Medicaid want to know why the cost has dropped to zero almost overnight. The fact that she is now on Hospice care at home makes no difference to them. I wish these clowns would listen the the doctors in cases like this because the endless inquiry's about this is driving me crazy! They should be happy they aren't paying for it any more.
Bob,
You have my heart'sfelt sypathy. This kind of outrage should not be happening to decent Americans.
V/r,
LTC Rattus, USA, ret.
Thanks much. Bob
I am sure that this Article is rooted in the Republican theory of Die Quickly, you do not need a Stent of any kind. Especially the ones that cost 10% more than the Bare Metal Stents.
Now go Die Quickly and Quietly, not to be heard from again.
Now go give some CEO or Bought Off Politician a Huge Unearned Bonus with the Stent Savings !!!
and we have yet another example of why more spending on mental health care is needed. It is ObamaCare and his death panel that keeps coming up with more and more procedures that aren't needed, all aimed at the elderly.
True.
What a terrible study that tells us nothing. Typical study garbage with no facts just a lot theory. Someone should do a study on the benefit and costs of studies to see if they are really cost effective in terms of policies and results of their study based on the subject matter studied and not studied and the effect this may have had on any previous undisclosed studies that were disclosed albiet under dubiuos conditions not relevant to the content of the study when studied. They should take into condiseration various factors that could have affected the privious undisclosed study that was disclosed to see if the disclosure may have had an adverse effect on any follow up studies that were conducted to support the original disclosed study and how they could have affected undisclosed studies that were not disclosed and so if not disclosed then how can we determine their overall value relevent to all previous studies this in itself may require further study , AW @!$%# IT THIS IS TOO MUCH TROUBLE.
Additional costs ? .....as "compared" to WHAT ?
(once again --- poor reporting !!! )
As the personal recipient of 3 illiac stents, thank goodness for medical advancement! Proven techniques that improve people's lives. Besides the conservatives, who is complaining about quality health care?
The conservatives suck.
Since this is primarily related to older Americans, Obama should immediately stop this procedure.
.
Dramatic article. Bent facts. Accusatory opinions.
If there's several hundred million dollars' worth of these "procedures" done every year, MAYBE THAT'S BECAUSE THEY HELP. Does anyone seriously believe that (a hellful lot of) crooked doctors are suddenly convinced that this is the cash cow they've been dreaming of?
Aside from all the esoteric medico/legal/stats high-priest jargon ("off-label, outcomes, contraindication, ), it's really not clear what an off-label use is.
If these scar-preventing stents were originally developed for heart problems, but they work well for, say, Tina's illiac problem or my Mom's lousy leg circulation, then are those "off-label" uses? Is that where the fluffy $ number comes from? Does that cost include all the associated testing and professionals' evaluation?
I'd sure hate to see Tina's or my Mom's relief denied because it's "off-label," or because doctors find this tool surprisingly useful for more than it was initially developed for...
What the H*ll does this mean?
"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," she wrote.
Better to let them die?