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    Drug-eluting stents for treating coronary artery disease

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    1 Recommendations

    1.1

    NHS trusts should provide access to a range of drug-eluting stents, so that a clinically appropriate stent is available for everyone with coronary artery disease.

    1.2

    Evidence shows that stents are comparable in terms of clinical and cost effectiveness, and that there is no justification for price variation.

    1.3

    If more than one drug-eluting stent is clinically appropriate, choose the least expensive stent.

    What information is needed

    More information is needed to justify price variation between different drug-eluting stents. This can be from primary studies or secondary analyses of real-world data.

    Key outcomes and information that should be captured include:

    • intervention-related adverse events

    • major adverse cardiac events (MACE)

    • target lesion or vessel failure

    • acute and chronic stent failure

    • target lesion and target vessel revascularisation

    • restenosis and stent thrombosis

    • the drug-eluting stent used.

    All studies and analyses of real-world data should adjust for a range of confounding factors, including:

    • the impact of anatomical characteristics of the target vessel and lesion

    • the person's age, sex, ethnicity and medical history.

    What this means in practice

    Procurement and commissioning considerations

    • Although alternative treatments (such as drug-eluting balloons) are in use, clinical experts predict that stents will remain the main treatment for coronary artery disease. So, it is important that the NHS continues to ensure the best value for money when buying drug-eluting stents.

    • If a company introduces a new drug-eluting stent with new features to the market, evidence of clinical superiority should be provided to show additional value. This evidence would ideally be from a randomised controlled trial.

    • If a company introduces a new drug-eluting stent or a new generation of the technology with minor improvements, evidence of clinical non-inferiority is sufficient.

    Healthcare professional considerations

    • When choosing a clinically appropriate drug-eluting stent, healthcare professionals should consider the patient, vessel and lesion characteristics, comorbidities and other factors that can make a stent more suitable.

    • Healthcare professionals should work with commissioners and procurement specialists in their NHS trust to ensure access to a range of stents.

    Why the committee made these recommendations

    Drug-eluting stents are the main treatment to restore blood flow after a heart attack and to reduce the symptoms of coronary artery disease. NHS trusts have access to a range of drug-eluting stents to ensure that a clinically appropriate stent is always available, and this should continue.

    Clinical trial evidence shows that different stents had similar clinical outcomes for people with coronary artery disease. There is no concern about the overall cost-effectiveness of stents. But because there is uncertainty about the cost effectiveness estimates, it is not possible to determine whether some drug-eluting stents are more cost-effective than others. To show any additional value for new stents, more evidence comparing different drug-eluting stents would be needed.