Abstract
Encouraged by the NORSTENT Trial* (NEJM2016;375:1242), it was proposed that our interventional cardiologists become more systematic with selection of drug eluting stents about $1,000 (DES) versus bare metal stents $250 (BMS), without patient compromise. At a meeting of all parties, the cardiologists and administrators agreed on a goal of reducing DES from 81% usage in 2015-2016 financial year (DES 669, cost $673,115, versus 151 BMS for $39,250) with goal of 60% DES for the 2016-2017 FY The National Institute for Health and Care Excellence (NICE) cost saving guidance on stents (https://www.nice.org.uk/about/what-we-do/into-practice/cost-saving-guidance) was implemented through simple guideline reminders placed strategically in the lab. By Jan 2017 a marked change in practice achieved by this simple measure saw DES usage at 60% ($259,300) versus BMS usage at 40% ($49,440), cost savings of $63,000 in 6 months. It is unknown whether this “selective” use of DES avoids negating cost savings by increased later target vessel revascularisation.
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