Dollars and stents: the economics of drug-eluting stents.
By averting restenoses, drug-eluting stents (DES) reduce the need for repeat revascularization procedures and improve quality of life. Large, randomized clinical trials including the Sirolimus-Eluting Balloon Expandable Stent in Treatment of Patients With De Novo Native Coronary Artery Lesions (SIRIUS) suggest that DES may be cost-effective to the Medicare system over time. However, the high cost of DES and the loss of revenues from revascularization procedures coupled with inadequate Medicare reimbursement are likely to have adverse effects on hospitals, making it hard to meet their bottom line. Key contributors to this problem include the unequal distribution of Medicare reimbursement based on diagnosis-related groups or diagnosis-related group calculations and the lack of price competition for DES. The economic burden of restenoses, the efficacy of DES in averting restenoses, the cost-effectiveness of DES, and the interaction of Medicare, DES manufacturers, and hospitals are reviewed. Using specific cost-containment strategies, hospitals can better maneuver the financial barriers to optimize DES utilization.
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