Dave Fornell, DAIC Editor

Dave Fornell, Editor DAIC

Blog | Dave Fornell, DAIC Editor | July 09, 2014

Drawing the Line When Evaluating Cost vs. Benefit

A big fly in the ointment for widespread adoption of many new technologies is cost. In today’s cost-conscience environment of healthcare reform, there needs to be a clear, quantifiable return of investment (ROI). This is especially true for new medical technologies that are competing with a long-established standard of care, where the new technology must show either a cost-benefit over the older technology, or must show a big improvement in patient outcomes to justify the added expense. With a device that shows only an incremental increase in benefit, say a 1-2 percent or less improvement over existing technology, the question may become one of economics rather than device effectiveness.

This is not only a question for physicians, as it applies to vendors developing these products as well. One of the biggest examples of this is the case of drug-eluting stents. During the last decade, key stent vendors were in an arms race to build a better device and capture a large share of the then lucrative coronary stent market. This included extremely expensive, blockbuster clinical trials, massive R&D efforts, and lawsuits and countersuits to try to slow down the competition. However, this came to a halt with the SPIRIT IV trial results in 2010, which proved the Abbott Xience stent was the best in the market for patient outcomes and beat out the long-time market leader, the Boston Scientific Taxus stent.  

However, the victory only just edged out Taxus. Stent thrombosis improvements were measured in fractions of less than 1 percent, and ischemia-driven target-lesion revascularization improvements were less than a 2.6 percentage-point absolute reduction. The data proving that Abbott was the top performer by only a small margin came at a staggering cost of nearly a billion dollars and several years of data collection. Few vendors are willing to shell out that sort of cash today to conduct similar sized trials that will be powered with enough patients to show only small incremental improvements.  

In reality, all the drug-eluting stents on the U.S. market today are good devices and all have similar patient outcomes. This has led to stents becoming commodity items, where lower pricing can often trump slightly better trial data. This is why the Xience stent does not master the entire stent market and why competitors remain in the game. 

I shared some additional thoughts on things to consider when looking at new devices and software in the article The Basics for Evaluating New Technology in the July-August issue of DAIC.

Related Content

Sponsored Content | Videos | Structural Heart| June 30, 2016
Interview with Steven Little, M.D., medical director of the Valve Clinic at the Houston Methodist DeBakey Heart and V
Sponsored Content | Videos | Cardiovascular Ultrasound| June 28, 2016
Interview with Rebecca Hahn, M.D., FASE, Columbia University Medical Center, New York, at the American Society of Ech
Zoll LifeVest wearable defibrillator, WEARIT-II Registry results, CardioStim EuroPace 2016
News | Defibrillator Monitors| June 21, 2016
Zoll Medical Corp. announced that patients experience a high one-year survival rate following use of the LifeVest...
Sponsored Content | Videos | Structural Heart Occluders| June 16, 2016
This is an animation of how a Gore Cardioform Septal Occluder is implanted for the transcatheter closure of ASDs or P
GE Healthcare, Getinge Group, Maquet, Discovery IGS 730 angiography system, Magnus operating table, integrated, hybrid OR

GE Healthcare's Discovery IGS 730 angiography system

Technology | Hybrid OR| June 13, 2016
GE Healthcare and Getinge Group announced the U.S. launch of a new, highly flexible angiography solution for surgery,...
Inventory management, cath lab inventory management, automated inventory management
Sponsored Content | Webinar | Inventory Management| June 10, 2016
Do you find products are stocked based on intuition rather than actual utilization based on clinical demand?
heart failure, muscle bleeding, British Cardiovascular Conference, MRI
News | Heart Failure| June 08, 2016
The amount a heart ‘bleeds’ following a heart attack can predict the severity of future heart failure, according to...
Biotronik, ORIENT trial results, EuroPCR 2016, Orsiro DES, hybrid drug-eluting stent
News | Stents Drug Eluting| June 03, 2016
Biotronik announced results establishing non-inferiority of the Orsiro hybrid drug-eluting stent (DES) to the Resolute...
Overlay Init