UPDATE:Stents Cost Less Than Bypass For Many Patients -Study
28 Mars 2009 - 7:27PM
Dow Jones News
Angioplasty with stents may be a more cost-effective option than
bypass surgery for many patients with severe cases of clogged heart
arteries, according to study data that come amid a growing U.S.
focus on cost-conscious medicine.
Both methods improved patients' quality of life over one year,
while bypass surgery gave patients slightly better relief from
chest pain. The one-year data from the "Syntax" study were released
Saturday at the American College of Cardiology's annual
conference.
Doctors said the study is limited at this point by its duration,
because trends regarding costs evolve over time. That view could
mute the study's impact if doctors wait to learn more about
longer-term outcomes - Syntax will continue tracking patients
through five years.
Patients who have clogs in three coronary arteries or the
left-main artery, which is a crucial supplier of blood to heart
tissue, tend to have bypass surgery today to address these
problems. But there has long been debate about whether
less-invasive procedures involving tiny stent scaffolds might also
work.
The 1,800-patient Syntax study, sponsored by stent-maker Boston
Scientific Corp. (BSX), failed to show stents measured up when data
were released last year - there was a higher rate of major events
among stent patients compared with bypass patients. That result was
tipped by the increased rate of repeat procedures for stent
recipients, while the combined rates of death, heart attacks and
strokes were similar in both groups.
The study used drug-coated "Taxus" stents from Boston
Scientific. Coated stents use medication to combat scar-tissue
growth, which can close off arteries again, and comprise a $4
billion global market where rivals include Abbott Laboratories
(ABT), Johnson & Johnson (JNJ) and Medtronic Inc. (MDT).
Tapping likely bypass patients could represent a way to expand a
growth-challenged sector.
While some surgeons saw clear validation for their treatment
method in initial Syntax data, there were also some helpful data
points for stent proponents. The key was a subdivision of patients
based on the complexity of their heart problems - bypass looked
best for the most complex group, but there were similar rates of
adverse events between stent and bypass patients in low and
moderately complex groups.
A similar result showed up in the fresh data on cost and
quality-of-life attributes for each procedure. In this case, when
these heart-disease patients are again stratified by complexity,
stents provided a cost benefit for easier and more moderate cases.
Costs after one year were $6,154 lower for the simpler stent cases
compared with bypass, for example.
The cost difference narrowed a bit for moderate patients and
then were about the same for the third of patients who had really
complex problems. Considering an analysis called "quality-adjusted
life expectancy" was also better for bypass patients in this group,
these data seem to further support bypass as the right option in
these cases.
The data have limitations, including the fact that researchers
had to apply U.S. health-care costs for procedures done overseas
and the one-year timeline. Bypass surgery was significantly more
expensive out of the gate - even though stent patients required 4.6
devices on average - but stent patients closed some of the cost gap
over time due to their higher rate of repeat procedures.
"The open question is will this gap in costs narrow further with
longer follow-up or will it be stable," said Mark Hlatky, professor
of health policy at Stanford University, during his review of
Syntax at a conference session. "I think we need further follow-up
to figure that out."
Dr. Robert Guyton, chief of cardiothoracic surgery at Emory
University Hospital in Atlanta, said in an interview he expects the
gap to close over time. After three years, he thinks the sickest
two-thirds of patients will look like clear bypass candidates,
rather than the one-third of complex patients the current datamost
clearly point to.
David Cohen, the doctor who presented Syntax data Saturday, and
director of cardiovascular research at Saint-Luke's Mid America
Heart Institute in Kansas City, also expects the cost differences
to narrow further. He said the gap is unlikely to close for the
least-complex patients, however.
Cohen has received research grants from Boston Scientific.
-By Jon Kamp, Dow Jones Newswires; 617-654-6728;
jon.kamp@dowjones.com