As the average age of the U.S. population and the number of patients at high risk for cardiovascular disease increase, the usage of coronary stents continues to grow. Interventional cardiologists and registered nurses in the United States were recently asked about their perceptions and attitudes regarding current percutaneous coronary interventional (PCI) procedures and devices. They were also asked their stent brand and drug type preferences. In a statistically significant survey, they divulged which procedures and manufacturers they preferred. This window into micro-level stent usage offers informed insights into the overall market and reveals how dynamics between medical organizations and device manufacturers contribute to market trends.
Cardiologists in the United States perform four times as many PCI procedures as coronary artery bypass graft (CABG) procedures, with an average of 11 each week. The procedure’s popularity has grown since its introduction in the late 1970s for numerous reasons. First, the procedures are performed percutaneously through the lumen of an artery and do not require open surgery. Additionally, they can be completed by many different medical professionals and require only a local anesthetic. The most common type is percutaneous transluminal coronary angioplasty (PTCA) with stenting, comprising 60 percent of all PCI procedures performed. CABG remains the superior form of revascularization for certain types of coronary disease, such as multi-vessel disease, and is an important part of coronary interventions in the United States. These procedures are performed by cardiac surgeons rather than interventional cardiologists. Many trials are now underway to compare the long-term efficacy of these two procedure types, and their results have the potential to significantly shift the interventional cardiology market in the United States.
Preferred Stent Type
The U.S. market for drug-eluting stents stabilized in the last couple of years, following initial concerns over the likelihood of thrombosis occurring when using their stents. However, these stents are used in PCI procedures, which are driven by shifts in patient demographics and are expected to increase modestly over the next few years. An aging population of more Americans with cardiovascular disease is not the only influencing factor. The introduction of new drug-eluting stent technologies, such as drug coatings and polymers, is expected to have a significant impact in the foreseeable future. The most popular stent brands are Promus by Boston Scientific and Xience by Abbott Vascular — the same stent in different packaging. Under an agreement between the companies from when Abbott purchased the Xience technology, Boston Scientific pays a substantial royalty fee to Abbott for every Promus device it sells, and there has been much competition between these stents, with both companies attempting to use lowered prices and their well-established sales teams to promote their specific version.
Various factors contribute to stent purchases: price, existing business relationships between the doctor or hospital and a stent manufacturer, type of drug used, and duration of drug delivery. While doctors and hospitals are always looking for ways to mitigate the ever-increasing cost of interventional procedures, the short- to long-term effectiveness of the procedure is still their primary concern. Many U.S. hospitals are part of large group purchasing organizations (GPOs), which pool their collective resources to buy devices. This makes existing relationships with device manufacturers that much more influential on the overall trends in the market.
Vendor Relationship is Key
The U.S. market for cardio and endovascular stents is growing. Cardiologists report that they perform PCI procedures and use drug-eluting stents more often. While many variables affect which stents are used, ultimately cardiologists assert that using the most effective stent is favorable. Overall market fluctuations depend on an aging demographic and especially on the device manufacturer’s relationship with a GPO, due to its strong buying power.
Editor’s note: The information contained in this article is taken from a detailed and comprehensive report published by iData Research (www.idataresearch.com), entitled “U.S. Physician Survey: Stents by Brand, Length, Diameter, Type and Coating.” For more information and a free synopsis of the above report, please contact iData Research at: [email protected]