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TECH: Stents, apparently overused to be replaced by better ones

Here’s the article from the NY Times confirming that drug-eluting stents are being used less since the recent findings of increased risk over bare-metal stents.

But now stent sales are falling and some doctors are rethinking their faith in the devices, driven by emerging evidence that the newest and most common type — drug-coated stents — can sometimes cause potentially fatal blood clots months or even years after they are implanted.

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There is no question that stents have saved countless lives in the short term by preventing impending heart attacks or opening arteries while an attack is being treated. But neither type of stent, no matter how much better it may make a patient feel, has been shown in rigorous clinical trials to improve long-term survival compared with other forms of treatment.

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Drug-coated stents cost an average of about $2,200 each in the United States, nearly three times the price of bare-metal ones. Despite the higher price, they quickly captured more than 85 percent of the United States market after their introduction in this country two years ago. Overseas, where national health insurers have been more reluctant to pay the higher prices, drug-coated stents have caught on more slowly.

SNIP

But other doctors’ uncertainty is starting to show in the declining sales of stents. Just this week, Boston Scientific said that its third-quarter stent sales, $572 million, were 4.8 percent lower than a year earlier.  Johnson & Johnson, whose Cypher is the only other drug-coated stent currently sold in this country, said this week that its worldwide stent sales of $627 million in the quarter included a 6 percent decline from a year earlier in the United States. Its sales in Europe were down 3 percent.

And showing what’s going to replace these drug-eluting stents—more CABGs? more drugs? diet and exercise? Dean Ornish’s program (still waiting for Medicare reimbursement 15 years after it’s been more or less proven to work? Unlikely.

Several competitors are still anxious to enter the domestic market, including medical giants like Medtronic and Abbott Laboratories and smaller players like Conor Medsystems whose products are already on the market overseas. Some have claimed that results to date suggest their products have little or none of the clotting risks. Because none of them plan to apply for F.D.A. approval before next year, it is unclear whether or how the agency’s new scrutiny of stent safety will affect their prospects. New stents will not address the issue of whether too many patients get stents instead of first trying therapy with drugs, including statins, that might improve their condition.

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