EDITORIAL

Are drug eluting stents really worth the money?

M Thomas

Correspondence to:
Dr Martyn Thomas
Kings College Hospital, London SE6 9RS, UK; mttwins@aol.com

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The cost effectiveness of drug eluting stents is being called into question. But is this fair in the light of all the available clinical data?

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Abbreviations: DES, drug eluting stents; LAD, left anterior descending coronary artery; NICE, National Institute for Health and Clinical Excellence; QUALY, quality of life-year; RAVEL, randomised study with the sirolimus eluting Bx Velocity balloon expandable stent in the treatment of patients with de novo native coronary artery lesions; SIRIUS, sirolimus-eluting balloon expandable stents in the treatment of patients with de novo native coronary artery lesions; TLR, target lesion revascularisation; TVR, target vessel revascularisation

Keywords: drug eluting stents; target lesion revascularisation; target vessel revascularisation

The first 150 words of the full text of this article appear below.

In this issue of Heart Bagust and colleagues¹ report on their view of the cost effectiveness of the drug eluting stents (DES) in the UK. The remarkable conclusion of this manuscript appears to be that DES should only be used in 4% of patients on economic grounds. Previous National Institute for Health and Clinical Excellence (NICE) guidelines² supported DES use in small vessels (< 3 mm) and longer lesions (> 15 mm) and it was anticipated this would result in a 30% use per lesion. The conclusions of the current paper are highly controversial and deserve further comment.

The Bagust paper is based on a 12 month audit from a single centre in the UK, the Cardiothoracic Centre-Liverpool. The main outcome measured was the potential reduction in risk of repeat revascularisation produced by the use of DES rather than bare metal stents within 12 months of an index procedure. A . . . [Full text of this article]

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Relevant Article

Cost effectiveness of drug eluting coronary artery stenting in a UK setting: cost–utility study

A Bagust, A D Grayson, N D Palmer, R A Perry, and T Walley
Heart 2006 92: 68-74. [Abstract] [Full Text] [PDF]

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• Corbett, R. H. (2008). Ethical issues, justification, referral criteria for budget limited and high-dose procedures. Radiat Prot Dosimetry 130: 125-132 [Abstract] [Full Text]  
• Eisenberg, M. J. (2006). Drug-Eluting Stents: The Price Is Not Right. Circulation 114: 1745-1754 [Full Text]  

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Are drug eluting stents worth the money?

Tom Walley, et al.

Online, 16 Aug 2005 [Full text]

Author's reply

Martyn Thomas

Online, 8 Sep 2005 [Full text]