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Purchasing Insight: Coronary Stents

Lower prices on stents are often achievable by introducing competitive bids and negotiating based on an external analysis

The delivery of coronary artery stents is a procedure that affects over 1 million patients each year in the United States. With an aging population, the declining cost of stents, and reimbursement tracking with the consumer price index (2-4 percent margins), the market for stenting continues to grow.

Coronary artery stenting has seen its share of evolution through the years, starting with bare metal stent (BMS) technology, with its evolving structural designs and metal alloys, to the drug eluting stents (DES) that were developed to combat the restenosis issues of the BMS.

Pricing for both BMS and DES are listed below. Lately we’ve been seeing a downward trend in terms of cost. The original BMSs were priced at $1,595, and DES prices were set at a sky-high price of over $3,000. With the stiff competition spread over three main vendors, prices have seen a sharp drop, to as low as $450 for BMSs and $1,150 for DESs.

In the outpatient setting stent reimbursement for bare-metal stents (BMS) and drug-eluting stents (DES) are seeing a small increase of approximately 5 percent for 2014. In the inpatient setting, the 2014 reimbursement has seen a 1.3 percent decrease for therapies with complications. Against that backdrop, purchasers need to know how to get the best price on these critical items.

Lower prices are often achievable by introducing competitive bids and negotiating based on an external analysis. Additional savings may require some creativity by agreeing to market-share commitments, and/or agreeing to bulk purchases. Rebates have been offered in multiple ways, but these can be very complex and require a significant number of hours to ensure compliance.

Pricing for Bare Metal Stents:

Low                          High                                          Average Price

$450                         $1,050                                     $628

Pricing for Drug-Eluting Stents:

Low                          High                                          Average Price

$1,150                     $2,070                                     $1,419

In Europe, bioabsorbable polymers have been approved which show promising long term results, and the first bioabsorbable scaffold stent was released in Europe in 2012, also with high hopes. An additional new technology being studied in Europe is the DFS – drug filled stent.

Here in the U.S., the first trial for an absorbable polymer stent is ongoing with the final patient enrollment completed in September 2013. FDA approval of this stent is expected sometime in the next year or two. The bio-absorbable scaffold stent is also in the trial phase with the first patient enrolled in January 2013. FDA approval for this stent is anticipated in late 2015 or 2016. Drug elution and complete polymer absorption in these stents are expected to reduce the risk of late thrombosis without limiting future therapies to that vessel.

Source: MD Buyline (Please note these numbers have been adjusted to exclude special deals, outliers and unique circumstances)

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