BMJ  2007;334:599-600 (24 March), doi:10.1136/bmj.39150.648762.BE

Letters

Drug eluting stents

What fuels public policy?

Around 60-75% of the millions of drug eluting stents inserted globally are not licensed.¹ What has fuelled the high unlicensed use of a device associated with thrombosis? This question was not dealt with by the Food and Drug Administration panel or recent articles on such stents.² But it is fundamental to public policy issues arising from the extensive off label or unlicensed use of an expensive medical device.

A complex interplay of factors may underpin the high use of drug eluting stents beyond an evidence base. These include collaboration between the cardiology community and device industry to push new technology, an interventionist community that romanticises new technology, and overdependence on interventionism when treating coronary syndromes. A recent analysis raises concern that the current invasive trend—which rests on a poor evidence base—is putting financial pressure and stress on healthcare systems that have limited resources.³ The factors that fuel the off-licence use of these stents may be part of a larger public policy concern.

A recent editorial on drug eluting stents noted that some common interventionist practices had little empirical justification. It argued that the cost of drug eluting stents is excessive and that that the current conditions for adopting new medical technologies are not necessarily in the public interest.⁴ A related cost effectiveness analysis of these stents suggests that lower quality studies and industry sponsored studies have favoured their widespread use.⁵

Health Research Associates, Ottawa, Canada K2B 6J4

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Competing interests: None declared.

References

1. Shuchman M. Debating the risks of drug-eluting stents. N Engl J Med 2007;356:325-8.[Free Full Text]
2. Drug eluting stents may increase long term mortality due to late stent thrombosis. BMJ 2007;334:390. (24 February.)[Free Full Text]
3. Bogardy P, Brophy J. Acute ischemic heart disease and interventional cardiology: a time for pause. BMC Med 2006;4:25.[CrossRef][Medline]
4. Knudtson ML. Drug-eluting coronary stents: faith and hope, but no charity. CMAJ 2007;176:185-90.[Abstract/Free Full Text]
5. Ligthart S, Vlemmix F, Dendukuri N, Brophy JM. The cost-effectiveness of drug-eluting stents: a systematic review. CMAJ 2007;176:199-205.[Abstract/Free Full Text]

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Related Article

Drug eluting stents may increase long term mortality due to late stent thrombosis
BMJ 2007 334: 390. [Extract] [Full Text] [PDF]

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Correction to email and position

Sharon Davies
bmj.com, 23 Mar 2007 [Full text]