Desmond's non-NICE choice: Dilemmas from drug-eluting stents in the affordability gap

Clinical Ethics

Volumn 1, Issue 2, 2006, Pages 105-108

  Mohindra, Raj K ^a   Hall, Jim A ^b  

^a Northern Deanery   (United Kingdom)

^b JAMES COOK UNIVERSITY HOSPITAL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 84992870628     PISSN: 14777509     EISSN: None     Source Type: Journal    
DOI: 10.1258/147775006777254498     Document Type: Article

References (21)

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2. Para 2 and 4 Directions to Primary Care Trusts and NHS Trusts in England (2003) concerning Arrangements for the Funding of Technology Appraisal Guidance from the National Institute for Clinical Excellence (NICE). Available at http://www.dh.gov.uk/assetRoot/04/07/56/86/04075686.pdf. Made using powers granted to the secretary of State for Health under the National Service Act 1977.
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4. NICE. Guidance on the use of coronary artery stents. Technology appraisal 71 Oct 2003
5. Holmes DR, Leon MB, Moses JW, et al. Analysis of 1-year clinical outcomes in the SIRIUS trial: a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation 2004; 109: 634-40
6. In fact it is likely that there will be an additional cost because the DES usually requires additional treatment with a antiplatelet agent (clopidogrel) for 6-12 months post procedure, whilst the bare metal stent may be treated with only 1 month of clopidogrel. The cost differential between 1 month and 6 months of this additional treatment is estimated to be approximately £175. This makes the cost of the DES procedure marginally more expensive than simply the differential cost between the DES and the BMS. However, for the sake of argument assume this cost is incorporated into the top up fee but that this does not affect Desmond's preference. Given these assumptions the argument is not materially altered.
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