Heart of the matter
A coronary stent has been likened to a frame inserted into a diseased artery in the heart, keeping it open and blood flowing. Heart surgeons have used stents for years and NICE guidance on them dates back to 2003.
But technology moves on and in 2008/09 NICE carried out a partial review of its original guidance, looking at the use of ´drug-eluting stents'. These are stents that are coated in a drug that reduces the likelihood of the artery from becoming narrow again after surgery. Once implanted into the artery, the drug is slowly absorbed into the tissues surrounding the stent. The final guidance issued in July 2008 outlines when drug-eluting stents can be used in the NHS.
Drug-eluting stents are more expensive than stents without a coating of the drug ('bare-metal' stents).
The independent Appraisal Committee looked carefully at the evidence of the risks and benefi ts of using different kinds of stents. The Committee also looked at the economic modelling and considered the costs of the stents supplied to the NHS. The provisional guidance put out for consultation did not recommend the use of drug-eluting stents in the NHS. But after consultation, the Appraisal Committee considered new information on the costs of the stents. Broadly, the guidance recommends drugeluting stents for patients who are at high risk of requiring further interventions if a conventional baremetal stent is used instead, provided that the price difference between the two is no more than £300.
In reaching this decision, the independent Appraisal Committee took into account the evidence of the risks and benefits of using different types of stent as well as economic modelling. Carole Longson, Director of NICE's Centre for Health Technology Evaluation, said: "We are aware, both from industry and from the NHS, that the maximum price difference between a drug-eluting stent and a conventional bare-metal stent allowed for in our guidance is available already in some NHS hospitals and achievable for the rest of the NHS.
Therefore, this decision to recommend the use of drug-eluting stents will ensure that, despite their higher cost, they will continue to be an important treatment option for patients who would be at high risk of requiring further interventions if a bare-metal stent was used instead."
This page was last updated: 12 August 2009
