It appears guidelines developed as a result of the 2006 Occluded Artery Trial (OAT) have not reduced stent utilization in the U.S. as intended. With approximately 600,000 stents prescribed every year, there is a lot at stake in controlling costs.
In recent years, consumables, such as stents, have played a larger role in cath lab costs. One factor is the changing demographics of a cath lab driven by advancements in screening and pharmaceuticals. Before these advances, cath labs had a mix of 20% therapeutic / 80% diagnostic procedures. As of 2010, this mix had progressed to 35% therapeutic / 65% diagnostic. Because of this, stents are used in a higher percentage of procedures, making them a focus of cost control.
When I asked Dr. Howard Kruth, MD, head of NIH Cardiovascular Branch, in Bethesda, Md., about treating intravascular blockage, he stated, “There’s a lot we are still learning about plaque and heart disease. We try to focus on what is known to be effective for most patients but this is still an evolving process.”
The fact still remains that physicians are the experts in deciding how to treat each patient on a case by case basis. Second opinions are typically not an option during a cath lab procedure, so when to use a stent is still up to the doctor.
So, what options do hospitals have? I found a bare metal stent can cost anywhere from $800 to $1,595; a drug-eluting stent, from $1,400 to $2,500. In a few months, we will start to see dissolvable stents, which should fetch a premium price. So although the hospital has little say on when and how many stents are used, they do have a say on what they cost, which can make an impact.