Nov 19, 2019

Health industry expects little change from heart study

How a stent works. Photo: BSIP/Universal Images Group via Getty Images

A new federal study said stents and bypass surgery are no more effective than drugs for treating blocked arteries, but the health care industry and its investors aren't banking on major changes to heart care as a result.

The big picture: Placing stents and performing bypasses are two of the most common operating room procedures. Science continues to say we don't need to be doing them so often, but overhauling that standard of care isn't easy — in part because hospitals and device makers make a lot of money from them.

What they're saying: Cardiologists and researchers across the world widely praised the trial's methods and results, and heart care leaders have said the diminished value of stents and bypass surgery would be incorporated into standard care guidelines.

Yes, but: "Established practices die hard, especially when there is a substantial culture, mindset and financial structure reinforcing that behavior," said Vikas Saini, a cardiologist and president of the Lown Institute, who said the trial's results matched up with decades of research.

  • Mike Mahoney, CEO of Boston Scientific, one of the largest makers of stents in the world, told investors in October that if the trial presented a dim view of stenting, the company would lose, at most, $40 million in sales next year as physicians reconsider their practices — a blip within the company's $4 billion cardiovascular business.
  • Physicians surveyed by investment bank SVB Leerink said stent procedures would drop at most 10%, and that could be temporary as heart patients develop more aggressive symptoms and ask for surgery later.
  • "We don't expect a major change in behavior, but do believe many physicians are more likely to opt for conservative therapies going forward," medical device analysts with JPMorgan wrote in a research note.

The bottom line: The prices of individual stents range anywhere from several hundred to several thousand dollars, and the surgeries tack on tens of thousands more for hospitals, which have been pretty dedicated to keeping their beds full whenever possible.

  • "Much of what we do lacks evidence; and even when evidence mounts that a policy is ineffective, our political system often caters to invested stakeholders who benefit from it," health economist Austin Frakt recently wrote in the New York Times.

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