Authors' objectives: Stents are widely used to maintain patency following coronary angioplasty. In recent years, to reduce the rate of in-stent stenosis, bare metal stents (BMS) have been largely replaced by stents that slowly release anti-fibrotic medication, called drug-eluting stents (DES). Since the cost of a single DES is approximately $900 higher than that of a BMS the choice of which stent is used, is a matter of concern to hospital administrators. As a result of a recently observed increase in stent use, the TAU was requested to develop a list of indications for the use of drug-eluting stents (DES) at the MUHC.

Authors' recommendations: Indications for use of DES It is recommended that the recently introduced practice of recording the indications for the use of DES in each procedure be maintained. Although the evidence supporting some of the following indications is inconclusive, the preponderance of evidence suggests that use of DES at the MUHC should be restricted to patients with the following indications: Patients exhibiting two or three of the following risk factors: diabetes, small vessels (<3 mm diameter), and long lesions (=20 mm). Relief of total chronic coronary occlusion. Patients undergoing repeat procedures to relieve in-stent stenosis. Patients undergoing multiple stent insertions. Interventions in the presence of multivessel disease and/or proximal left main stenosis. Current usage of DES at MUHC The indications currently in effect for the use of DES at the MUHC are largely consistent with the above indications. Of 2016 stents used in the budget year 2010-2011, 34% were DES. This is lower than in any other Quebec academic Hospital. Cost Issues The gross cost of this intervention in the past budget year was approximately $607,250. Assuming this use of DES resulted in a 5.9% reduction in repeat angioplasty, the net budget impact would be $448,293, and the cost of each repeat procedure would be $10,934.

Project Status: Completed

Year Published: 2011

URL for published report: http://www.mcgill.ca/tau/files/tau/muhc_tau_2011_55_destents.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Technology Assessment Unit of the McGill University Health Centre (MUHC)

Contact Address: Technology Assessment Unit of the MUHC, Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 boul. de Maisonneuve, Bureau 3F.50, Montreal, Quebec H4A 3S5

Contact Name: nandini.dendukuri@mcgill.ca

Contact Email: nandini.dendukuri@mcgill.ca

Copyright: Technology Assessment Unit of the McGill University Health Centre (MUHC)