NICE - Drug-eluting Stents

Final Appraisal Determination

Friday 1st February 2008


  On 7th August last year the National Institute for Health and Clinical Excellence (NICE) initially recommended the withdrawal of access to drug-eluting stents - the life-saving heart treatment, on the grounds of short term savings. This immediately came under fire from patient groups and cardiologists, who sent in comments to NICE. There were real fears that these recommendations would be unchanged in NICE’s final decision, which would then have had a profound impact on patients and the NHS.

  Following this preliminary decision, the British Cardiac Patients Association (BCPA) wrote to MPs and Ministers, urging them to write to the Secretary of State of Health, Alan Johnson, asking him to recommend NICE look again at the technology and the available evidence.

  NICE announced today the reversal of this preliminary decision, recommending the use of drug eluting stents for the treatment of coronary artery disease if the target artery to be treated is less than 3mm diameter or the lesion is longer than 15mm and the price difference between drug-eluting stents and bare-metal stents is no more than £300.

  DES have been saving lives for more than four years and the BCPA is hugely relieved that access to this essential, life-changing procedure will continue.

  The final decision from NICE has been sent to the formal consultees involved in this appraisal who have 15 working days to consider whether they wish to appeal against it. Subject to any appeal by consultees, this will be used as the basis for the Institute's guidance on the use of the appraised technology in the NHS in England and Wales.

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Drug-eluting stents update

Briefing for BCPA - 28th September 2007


  On 7th August this year the National Institute for Health and Clinical Excellence (NICE) came under fire from patient groups for recommending the withdrawal of access to a life saving heart treatment on the grounds of short term savings. If these recommendations are reflected in NICE’s final decision, it will have a profound impact on patients and on the NHS.

  Drug eluting stents (DES) are special tubes used in the procedure percutaneous coronary intervention (PCI) to reopen the blocked arteries of patients with coronary artery disease. NICE has decided that, despite their clinical effectiveness, they are not cost effective for use on the NHS, which means clinicians will have no choice but to revert to using 20 year old bare metal stent technology.

  Drug eluting stents hold open the artery then release a drug to stop the re-narrowing of the artery after treatment (restenosis), which occurs in up to 50 percent of patients treated with bare metal stents, increasing the need for some form of repeat heart procedure. They were previously approved for use on the NHS in 2003.

  Following this preliminary decision, the British Cardiac Patients Association (BCPA) wrote to MPs and Ministers, urging them to write to the Secretary of State of Health, Alan Johnson, asking him to ask NICE to look again at this technology and the available evidence. We have had numerous positive responses and are currently meeting with some of the MPs.

  Consultees and commentators had four weeks from the preliminary recommendation in August to comment on the decision. The NICE Appraisal Committee will now have a second committee meeting to consider the additional evidence, which will shape the final appraisal determination (FAD), still to be published.

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