Doctors’ Opposition To Expanded Carotid Stent Use Could Hurt Medical Devices Companies

by Trefis Team
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Medical devices manufacturers including Abbott Labs (NYSE:ABT), Boston Scientific (NYSE:BSX) and Johnson & Johnson (NYSE:JNJ) may have to brace themselves to forgo potential revenues, if the U.S. federal government pays heed to doctors’ request to not extend Medicare coverage to carotid stents. Medical devices makers have been seeking wider Medicare coverage of carotid stents to prevent strokes in patients with no symptoms. However, doctors have argued that there is no significant difference between current prescription drugs and carotid stents at stroke prevention.

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Carotid stents are used to unblock narrowing of the carotid artery to prevent stroke. In the U.S., about 125,000 patients are treated with either carotid surgery or carotid stents each year. With the extended Medicare coverage,  an additional 100,000 patients could become eligible each year. The extension of the coverage could bring in millions of dollars in revenue each year to carotid stent manufacturers. This explains why these companies have been aggressively lobbying for  wider coverage of carotid stents. [1]

However, doctors have argued that the majority of patients won’t get any benefits from stents or surgery and that they cost about eight times that of drugs. Therefore, the cost-benefits trade-off doesn’t make sense. We believe this could weigh heavily on the Medicare decision as health payers seek cost-effective treatments in the wake of national health reforms.

A decline for wider coverage will certainly not bode well for the manufacturers, especially Boston Scientific, which has been grappling with declining sales in the interventional cardiology business. Also, a strong outlook for the U.S. dollar amid the dwindling global economy and pricing pressure following the healthcare reforms continue to pose concerns in the short term. An approval, however, could open an additional revenue stream and may trigger a slight upside for these companies.

We have a $6 price estimate for Boston Scientific and $67 price estimate for Abbott Labs, which are in-line with the current market price. Our price estimate for JNJ stands at $74, about 10% ahead of current market price.

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Notes:
  1. Are Stroke Drugs Better Than Stents?, Wall Street Journal, Sept 18 2012 []
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Abbott Labs Logo
  • commented 6 months ago
  • tags: BSX JNJ ABT MDT PFE
  • The WSJ article referenced within this article discusses the studies done and the doctors who are arguing against it. From the WSJ article - "A 2010 National Institutes of Health-funded study found that in 2,502 patients, there was "no significant difference" between the consolidated four-year rate of strokes, deaths and heart attacks in patients with stents (7.2% had such events) and surgery (6.8%). Many researchers, however, point out that the 30-day stroke and death rate in stent patients was significantly higher (4.8%) than that of surgery patients (2.6%)."

    Also - "proponents of drug therapy point out that $21,200 carotid operations and $33,500 carotid-stent placements are costing the U.S. taxpayer up to eight times what drug treatment would cost. "

    To clarify, these are not Trefis' findings nor is Trefis arguing this point one way or another. The purpose of this article is to objectively look at the potential impact on these companies' revenues should the Medicare coverage be expanded.
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  • commented 6 months ago
  • tags: BSX JNJ ABT MDT PFE
  • The statement that "doctors have argued that the majority of patients wont get any beneifits from stents or surgery (for carotid disease) and cost about eight times more is taken out of context! First, what doctors are saying this? A few....many, what specialty? What well designed studies are showing this? Are these doctors trying to protect their practice? Are these validated studies that are randomized and have good patient representation? Try to be a little more scientific in your articles and back up claims with objective data and input from various doctor specialities. I follow this area well and your statement is misinformed. Their are lobbying efforts by cardiologists and other practices that are talking to CMS to gain wider distribution of carotid stent coverage....not just medical device companies. These doctors are doing this because their was a recent study done a year ago or so showing that stenting now has equal efficacy and safety to surgery. There are no good studies showing that the use of drugs is better and cheaper than surgery or stents. These studies that claim this are poorly flawed. Talk to doctors who know what they are doing scientifically. Get good representation for your articles before making such claims that can affect patients who decide to refuse treatment because of your flawed article. BTW, the FDA has approved a wider indication for use of Abbott's carotid stent. If they have approved then why wouldn't we cover it with medicare payments? Already private insurers are doing this! Thanks.
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  • commented 8 months ago
  • tags: BSX JNJ MDT PFE
  • What about me????? A stroke patient from 1995 with a bypass in the artery and now 95% closed and I can't get a stent - I have to wait untill I have another stroke - which will probablly be fatal. How fair is that!!!!!
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  • commented 8 months ago
  • tags: BSX JNJ MDT PFE
  • The actual potential revenue for stents alone would be $210-250 million based on an estimated stent cost of $2,100-2,500 and 100,000 potential additional patients. However the $33,500 figure also includes additional devices such as catheters that medical device companies manufacture, bringing the total device cost closer to $5,000 (so $500 million potential incremental revenues). You are correct in that the $33,500 isn't going entirely to the medical device companies as it does include surgeons, hospital stay, etc. The potential revenue for medical device companies is closer to $500 million, thanks for pointing out the lack of clarity.
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  • commented 8 months ago
  • tags: BSX JNJ MDT PFE
  • The math in this article is extremely poor and misleading to say the least. The Carotid Stent Costs quoted as $33,500 are exteremly exagerrated and in fact wrong. While this may be the procedural cost including fees for the hospital stay, consultants, surgeons, follow-up, etc..., the medical device manufacturers only sell the carotid stent. The $1 Billion windfall that the author suggests is revenue for the stent makers, is in fact far closer to $25 Million if the average selling price of carotid stents is $1000/device. Being +/- 50% or reality and the truth would be excusable. Exaggerating the revenue by 40 times is wreckless and inexcusable. It is a shame that TREFIS has idiots working for them.