Considerable savings by halving DES use for those at low-risk of target vessel revascularization
WEDNESDAY, July 11 (HealthDay News) -- The use of drug-eluting stents (DES) after percutaneous coronary intervention (PCI) is not related to the patients' predicted risk of target-vessel revascularization (TVR), according to a study published online July 9 in the Archives of Internal Medicine.
Utilizing information from the National Cardiovascular Data Registry CathPCI registry for more than 1.5 million PCI procedures, Amit P. Amin, M.D., of Saint Luke's Mid America Heart and Vascular Institute in Kansas City, Mo., and colleagues used a validated model to estimate the one-year TVR risk with bare-metal stents. The correlation between TVR risk and DES use was examined and the cost-effectiveness of lower DES use in patients at low-risk of TVR was compared with existing use of DES.
The researchers found that DES use varied significantly among physicians and was high among all TVR risk categories, ranging from 73.9 percent for a TVR risk of <10 percent to 83.2 percent for a TVR risk of >20 percent. The authors projected that reducing DES use by half for low-TVR-risk patients could reduce U.S. health care expenditures by $205 million annually while increasing the absolute overall TVR event rate by 0.5 percent.
"As the resources to pay for health care are limited, it is inevitable that medical decision making in the United States will be increasingly driven by value maximization," write the authors of an accompanying editorial. "The use pattern of DES during the past nine years illustrates how far away the system is from consistently embracing value-based medical decision making."
Several authors disclosed financial ties to the pharmaceutical industry.