Stents Work Well, But Are Costly: Will Hospitals Continue To Use Them?

November 13, 1996

NEW ORLEANS -- The current boom in implanting tubular devices called stents in heart arteries may go bust when hospitals realize they are losing their profit margins, a researcher has concluded in a study presented at the annual meeting of the American Heart Association.

And if that happens, heart care will take several steps backward to the detriment of patients, Duke University Medical Center cardiologist Dr. Eric Peterson warned. "Sadly, hospitals now need to look at how every dollar is spent, and 'stenting' may become a luxury they can't afford."

Cardiologists insert the mesh-like structures to keep arteries open after clogs have been cleared by balloon angioplasty. Because of its effectiveness, stenting has quickly become a popular procedure: This year, it is estimated that 170,000 stents will be inserted in American hearts, compared to almost none five years ago.

Peterson performed a detailed examination of the costs associated with doing an angioplasty alone, or an angioplasty that delivers a stent. Analyzing the results in about 400 patients, he found that stenting costs about $13,000 -- roughly $2,000 to $3,000 more than regular angioplasty.

To many cardiologists and patients, that extra expense is well worth it, because inserting a stent structure in an artery has been proven to reduce the rate of recurrent blockages in the artery, Peterson said.

But, depending on who is paying the bill, he said these procedures may be a bad financial deal for the hospital.

Medicare gives hospitals one price (from $10,000 to $13,000 depending on the kind of hospital) through its payment system to perform either an angioplasty or an angioplasty that delivers a stent. And managed care companies usually may pay much less than that, Peterson said. That means that, rather than making a slight margin off a regular angioplasty, hospitals are losing thousands of dollars every time a stent is used.

To date, cardiologists have not made decisions on whether to use a stent or not based on how much money their hospitals make or lose, Peterson said. In part, that's because the costs of stenting have fluctuated as the devices and the procedure have been perfected. But the primary reason is that money wasn't such an issue in the past. "Now, with the onset of managed care and diminishing reimbursement from all payers, hospitals need to be very cost conscious."

In looking at medical records, Peterson found out that the extra cost of stenting is not due to medication or length of hospital stay. It is in the fixed price of the devices, which usually cost around $1,600 each, and the extra angioplasty balloons, costing up to $600 each, that are needed to insert the stents.

So now what was a "win/win" situation for patients and society -- better immediate outcomes and less need for repeat procedures -- has become a losing proposition for hospitals, Peterson said. "A treatment that carries a large financial burden may not stay popular," he said.

One obvious answer to the dilemma is to convince the Health Care Financing Administration, the federal agency responsible for setting Medicare reimbursement rates, to set two different prices for the two procedures. But so far, HCFA has been unwilling to do this, Peterson said.

Another solution may be a capitated system of heart treatment, in which a hospital receives a set amount of money to care for a single individual over time. In that system, the benefit of stenting in reducing the need for patients to return to the hospital will likely be recognized.

Peterson said that the trade-off between new, but costly, improvements in patient care and the ability of hospitals and other providers to absorb the differences in reimbursements will become more and more of an issue. "These are growing problems that are going to concern hospitals in the future when their economic motivations are increasingly placed in direct conflict with their desire to do the best for patients," he said.

In a plenary session talk on "The Financial Fallout From the Stent Explosion" to be given Wednesday morning at the conference, Dr. Daniel Mark will review what is known about the benefits and costs of stenting versus balloon angioplasty. Mark, director of the Duke Outcomes Research and Assessment Group, said stenting does "reduce the need for repeat angioplasty and bypass surgery during the year following the procedure. Reduced follow-up procedures allow stenting to recoup some of the extra costs associated with this form of therapy."

Up to 25 percent of patients who had angioplasty will need a repeat procedure in the follow-up year, Mark said. With stenting, current evidence is that the repeat procedure rate falls to about 16 percent, and to fully pay back the extra costs of the procedure, current projections suggest that the repeat procedure rate will need to fall to around 9 percent, Mark said. "Ongoing trials including the latest stent technology will help define how close doctors have come to achieving this level of effectiveness," he said.
-end-


Duke University

Related Angioplasty Articles from Brightsurf:

Ticagrelor was not superior to clopidogrel to reduce heart attack risk during angioplasty
A new study found the rate of heart attack and severe complications before, during or soon after elective surgery to open a blocked artery was similar between patients treated with clopidogrel and those who received the more potent antiplatelet medication ticagrelor.

Study finds significant variability in doctors' angioplasty death rates
Some doctors have higher or lower than expected death rates from coronary angioplasty procedures, also known as percutaneous coronary intervention (PCI); however, doctors should not be judged solely on the rate of patients who die from the procedure.

Beta-blockers following angioplasty show little benefit for some older patients
Following coronary angioplasty, beta-blockers did not significantly improve mortality rates or reduce the number of future cardiovascular incidents for older patients with stable angina but no history of heart attack or heart failure, according to a study published today in the JACC: Cardiovascular Interventions.

Sleep disorders may predict heart events after angioplasty
People who have had procedures to open blocked heart arteries after acute coronary syndrome (ACS) may have a higher risk of death, heart failure, heart attack and stroke if they have sleep disorders, such as sleep apnea, compared to those who don't.

Reasons for hospital-level variations in bleeding post-angioplasty are unclear
The use of bleeding avoidance strategies has only a modest effect on the variation in bleeding rates post-angioplasty among hospitals performing this procedure, leaving about 70 percent of the causes for this variation unexplained, according to a study published today in JACC: Cardiovascular Interventions.

US prediction models for kidney injury following angioplasty hold up in Japan
Models developed by the American College of Cardiology NCDR CathPCI Registry to predict the likelihood of angioplasty patients developing acute kidney injury and acute kidney injury requiring dialysis have proven to be effective among patients in Japan.

IV beta blockers before angioplasty are safe, but offer no clinical benefit
Giving intravenous beta blockers before performing a coronary angioplasty in patients who had experienced the deadliest form of heart attack -- ST-segment elevation myocardial infarction (STEMI) -- was safe but did not reduce heart attack severity or improve blood flow from the heart's main pumping chamber, according to research presented at the American College of Cardiology's 65th Annual Scientific Session.

Life-threatening bowel ischemia can often be treated by balloon angioplasty
Acute mesenteric ischemia (AMI) can be successfully treated with endovascular therapy such as balloon angioplasty, according to research from the University of Eastern Finland.

Radial access used less than femoral approach for emergency angioplasty
Although using the radial artery as the access point for angioplasty has been linked to reduced bleeding compared to use of the femoral artery, only a small number of high-risk heart attack patients who undergo rescue angioplasty -- emergency procedures following failed therapy with clot-busting drugs -- are treated by radial access, according to a study published today in the Journal of the American College of Cardiology: Cardiovascular Interventions.

Use of rarely appropriate angioplasty procedures declined sharply
The number of angioplasty procedures classified as rarely appropriate declined sharply between 2010 and 2014, as did the number of those performed on patients with non-acute conditions, according to a study published today in the Journal of the American Medical Association and simultaneously presented at a meeting of the American Heart Association in Orlando.

Read More: Angioplasty News and Angioplasty Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.