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Study Sees Medicare Savings from Drug-Coated Stents

Depending on whose interpretation one wants to believe Medicare may or may not have saved money ever since the introduction of drug-coated heart stents in 2003.

Researchers who analyzed Medicare data on a sampling of patients from 2001 and 2004 said that the government spent 5.4 percent less, adjusted for inflation, in the more recent period for every patient who received treatment to reopen blocked coronary arteries.

The more recent figure was $29,663, contrasted with $31,343 in 2001.

That conclusion may seem to contradict the common wisdom that new drugs and devices are leading to higher, rather than lower, spending on health care. However, it comes with a number of caveats, starting with the fact that Cordis sponsored the study, the stent-making subsidiary of Johnson & Johnson.

In addition, one of the major reasons for the savings appeared to be a fall in the percentage of patients receiving heart bypass surgery to treat blocked arteries, compared with the rising use of balloon angioplasty and stenting.

Almost one-third of the Medicare patients received bypass surgery in 2001. By 2004 that figure had fallen to just below one-fourth of patients.

Since the study followed spending on the patients for only 13 months after their initial procedures, however, it was too short to examine one of bypass surgery's supposed cost advantages, that although bypass costs more initially, it keeps arteries open far longer and so lessens spending on repeat procedures.

Dr, Jason Ryan, a cardiologist at Beth Israel Deaconess Medical Center in Boston, conceded, "The surgeons would probably be screaming." He said the authors were trying to get the paper published in a peer-reviewed journal, after which they would consider analyzing the data over a longer period.

Beyond cost savings from surgeries avoided, the other supposed cost benefit came from fewer repeat stenting procedures in the 2004 group. That gain in fact reflected the main advantage of drug-coated stents over the bare-metal versions used in the 2001 patients: the drug coatings are meant to deter arteries from being blocked again.

According to the study, the benefits were not only economic, death and heart attack rates were lower in 2004. Many factors may have been involved, together with improvements in stenting, better surgical techniques and the wider use of additional drugs like statins and beta-blockers on the patients.

The Medicare data did not comprise spending on drug therapies. Since patients receiving drug-coated stents are presently, also given Plavix, a blood thinner, for no less than a year, the author's estimated Plavix's cost impact. That reduced the Medicare savings to $776 per patient, Dr. Cohen said.

At least one Medicare official expressed doubt about the study. Stephen E. Phurrough, the director of coverage and analysis at the Centers for Medicare and Medicaid Services, the agency that oversees Medicare, said that it missed the main question: How many patients received stents or surgery at Medicare's expense that might have fared just as well without those treatments?

Mr. Phurrough said, "That seemed to be the message of Courage."

He was referring to a clinical trial, known as Courage, which earlier this year concluded that many patients with chest pains who get stents are no better off after five years than those who take the best available drugs and follow healthy lifestyles.



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