WASHINGTON, Oct. 23 — Depending on whose interpretation one wants to believe, Medicare may — or may not — have saved money 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 today that the government spent 5.4 percent less — adjusted for inflation — in the more recent period for each patient who received treatment to reopen blocked coronary arteries.
The more recent figure was $29,663, compared with $31,343 in 2001.
That conclusion might seem to contradict the common wisdom that new drugs and devices are leading to higher, rather than lower, spending on health care. But it comes with several caveats, starting with the fact that the study was sponsored by Cordis, the stent-making subsidiary of Johnson & Johnson.
Moreover, one of the main reasons for the savings appeared to be a decline in the percentage of patients receiving heart bypass surgery to treat blocked arteries, compared with the rising use of balloon angioplasty and stenting.
Nearly one-third of the Medicare patients received bypass surgery in 2001. By 2004 that figure had fallen to just below one-fourth of patients.
Because 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 reduces spending on repeat procedures.
“The surgeons would probably be screaming,” conceded Dr, Jason Ryan, a cardiologist at Beth Israel Deaconess Medical Center in Boston, who presented the data this morning. 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 apparently 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 becoming blocked again.
The benefits were not only economic, according to the study. Death and heart attack rates were also lower in 2004. Numerous factors may have been involved, including 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 include spending on drug therapies. Since patients receiving drug-coated stents are currently also given Plavix, a blood thinner, for at least 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 skepticism 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 who might have fared just as well without those treatments?
“That seemed to be the message of Courage,” Mr. Phurrough said.
He was referring to a clinical trial, known as Courage, which earlier this year concluded that many patients with chest pains who receive stents are no better off after five years than those who take the best available drugs and follow healthy lifestyles.
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