Cardiovascular Business - March/April 2008 - (Page 34) WRACKED By BAD PRESS, DRuG-ELuTING STENTS START THEIR COMEBACK › stent technologies on the Horizon Bioabsorbable stents have two types of platforms: absorbable metal alloy and bioabsorbable polymers. The stents will slowly dissolve over days or weeks. Companies developing these technologies include Abbott Vascular, Biosensors International, and OrbusNeich. Stents coated with antibodies capture endothelial progenitor cells circulating throughout the blood. A company involved in developing this technology is OrbusNeich. Bioactive stents are not drug-eluting, but are metal stents coated with bioactive materials like titanium nitrous oxide. A bioligand, attached to a biodegradable biocompatible polymer, captures progenitors of endothelial cells to promote endogenous formation of healthy endothelium. Hexacath is actively involved in this technology. make the decision based on an individual patient needs, according to Ellis. Most hospitals offer the choice to their cardiologists of all the stents, even though, some other vendor-specific technologies include: hospitals, like the VA hospitals, may only › Xtent is developing its Custom Nx 60 drug-eluting stent Systems to treat present one option due to their agreelonger sections (up to 60 mm) of diseased artery as compared with curment with a particular stent maker. rent fixed-length alternatives (33 mm or shorter). At Ellis’s institution, the administra› Medlogics Device has patented a hybrid lumen-supporting stent having tors chose a particular DES, which he self-expanding end segments and his fellow cardiologists lobbied to › Miv therapeutics is developing an ultra-thin coated stent that has been change. They were successful. derived from a unique biocompatible material called hydroxyapatite (HAp), As more DES come to market, costs are a biocompatible and bioactive porous material that makes up the bone likely to drop even further, creating a situmineral and matrix of teeth. ation where DES are actually cost-saving, Weintraub said. The utilization of DES in favor of BMS produces two clear winners: patients, who have less restenosis and less additional procedures, differences in revascularizations, and since DES prevent restenoand stent makers, who profit from the sales. Hospitals, however, sis and therefore prevent further procedures, they are obviously are losers because they operate under fairly low margins, which more cost-effective. The only consideration is patient quality of can be tipped over into the red fairly easily. For one, the Diagnosislife, which typically involves eliminating angina, and the angina Related Group (DRG) does not make up for the added cost of DES, associated with restenosis is short-term. and second, hospitals lose revenue from less follow-up procedures, “At the end of the day, what drug-eluting stents have to be is a result of the success of DES. cheaper. On one side, we are evaluating the cost of current procedures. On the other, we are evaluating the cost of drug-eluting stents. Right now, the difference in cost between the two is miniit takes courage mal, which is good news,” Weintraub said. In comparing DES to optimal medical therapy, the COURAGE trial, While the price of the DES has decreased by about $1000 since which appeared in NEJM in March 2007, found that for patients with they launched in 2003, it is still more than six-times that of BMS. stable coronary artery disease, PCI was found to not be cost-effective Cypher and Taxus each cost approximately $2000. Medtronic’s as an initial management strategy. Weintraub, who was part of the Endeavor, the newest FDA-approved DES (February 2008), is exCOURAGE trial, noted that the results do not mean that PCI should pected to cost less than its two predecessors. While the Endeavor not be done, but as an initial strategy in chronic stable coronary dismay be priced slightly less to ease the product into the market, ease, medical therapy should be attempted. If the patients continue to the difference will not be drastic, according to Rajan. have angina, then a procedure might be necessary, he said. Depending on the institution, either the administration or Many cardiologists and other cardiology personnel accused the interventional cardiologists decide which DES to use. When the mainstream media of exaggerating the negative clinical outchoosing a particular brand of DES, administrators take cost comes associated with DES trials, and therefore driving down into consideration far more than cardiologists, who are more the usage of DES. concerned with efficacy, Ellis said. “The negative results often grab the headlines, while the followIn the cases where the cardiologist has the choice, they typically up studies disproving the negative results don’t receive nearly 34 Cardiovascular Business March/April 2008
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