SPONSORED BY MD Buyline
Buyer’s Brief:
Coronary Artery Stents
W
orking with purchasing staff, hospital CFOs and other senior financial leaders should play a key role in
analyzing and prioritizing the organization’s opportunities for supply cost savings.
Comparative pricing information, although an important component, isn’t enough, notes Todd Nelson, HFMA
technical director. “Hospitals often fail to fully benefit from the types of information that may be available to them
to leverage better terms with their vendors and strengthen relationships, whether it’s knowing about shifts in
payment, evidence-based clinical preference, or discount availability,” he says.
The Buyer’s Brief below, sponsored by MD Buyline, shows how keeping abreast of market trends and having
the right data in hand can inform one’s negotiation leverage.
▶ ▶ Why Stents?
▶ ▶ At-a-Glance Product Information
• More than 1 million patients in the United States receive
coronary artery stent procedures each year
• Reimbursement tracks with the Consumer Price Index
(2-4% margins), and continued lowered pricing in the
marketplace is expected
• Clinical evidence supports a move toward outpatient
stenting, and outpatient reimbursement tracks higher
than inpatient
Stents, when used in conjunction with percutaneous transluminal
coronary angioplasty (PTCA), serve to therapeutically open
vessels and improve blood flow where atherosclerotic disease
has led to blood flow obstruction. Placement can be done with a
bare metal stent (BMS) or drug-eluting stent (DES), which makes
use of a coating to combat restenosis. DES placements are more
widely used. DES products vary by design/deliverability, drug
type, stent coating (polymer), and length of drug elution.
Drug-Eluting Stent (DES) Comparison
Available Sizes
MDB Database
Price Range
(past 12 months)
Drug
Stent Composition
Elution Period
Product A
2.25mm - 4.0mm x 8mm - 38mm
$1,300 - $2,525
Everolimus
Cobalt Chromium (L605)
Drug elution - 120 days
Product B
2.25mm - 4.0mm x 8mm - 28mm
$1,350 - $1,850
Everolimus
Cobalt Chromium (L605)
Drug elution - 120 days
Product C
2.25mm - 4.0mm x 8mm - 38mm
$1,350 - $2,050
Everolimus
Platinum Chromium (PtCr)
Drug elution - 120 days
Product D
2.25mm - 4.0mm x 8mm - 38mm
$1,350 - $2,100
Paclitaxel
Stainless Steel (SS316L)
Drug never fully elutes
Product E
2.25mm - 4.0mm x 8mm - 38mm
$1,350 - $1,850
Paclitaxel
Platinum Chromium (PtCr)
Drug never fully elutes
Product F
2.5mm - 3.5mm x 8mm - 30mm
$1,345 - $2,225
Zotarolimus
Cobalt Alloy (MP35N)
Drug elution - 28 days
Product G
2.25mm - 4.0mm x 8mm - 38mm
$1,345 - $1,900
Zotarolimus
Cobalt Alloy (MP35N)
Drug elution - 180 days
Coronary DrugEluting Stent
Source: MD Buyline. Adapted by HFMA.
Pricing for each product has varied significantly over the past 12 months, as seen in this exhibit (manufacturer and product name blinded).
Buyer’s Brief
Buyer’s Brief SPONSORED BY MD Buyline
▶ ▶ Reimbursement Outlook
Reimbursement for stent placement in the outpatient setting
(where clinical evidence shows the majority of elective
placements should be done) for BMS use (APC 104) will see an
increase of 6.34 percent, or $6,100; DES use reimbursement
will increase 4.3 percent, or $7,763.
▶ ▶ What to Know When Purchasing
Dropping prices are expected to continue. Originally, prices
were set at $1,595 for BMS and $3,000 for DES use. With stiff
competition among vendors, prices have seen a sharp drop to as
low as $450 for BMS and $1,300 for DES use.
Market competition is on your side. Three major players
dominate both the BMS and DES markets. A few newer companies
are vying for a spot, and several of them will likely use the
approval of their BMS products as a stepping stone for approval
of their more advanced DES products. Hospitals can use this
competition to their advantage, often securing low-end prices by
obtaining a competitive bid. Some leverage also may be obtained
by agreeing to market share commitments and/or bulk purchases.
Save rebate talk for another time. Rebates have been
offered in multiple ways, but these arrangements can be very
complex and require a significant number of hours dedicated
to ensuring compliance. Instead, focus on stiffer negotiations
backed by customized analyses and competitive bids.
Financial Impact of Variation in Stent Pricing*
Capital Equipment Purchase Price
Term in Years
Scenario 1
High Price
Scenario 2
Medium Price
Scenario 3
Low Price
$922,500.00
$922,500.00
$922,500.00
3
3
3
SPECIFIC PROCEDURE VOLUMES (YEAR 1)
Proc#1 APC 0104 Bare Metal Stent
83
83
83
Proc#2 APC 0656 Drug-Coated Stent
217
217
217
Proc#3 APC 80 Diag. Cath.
700
700
700
SUPPLIES/CONSUMABLES
Consumables Procedure #1 Bare Metal Stent
$1,100.00
$692.00
$450.00
Consumables Procedure #2 Drug-Coated Stent
$2,525.00
$1,503.00
$1,300.00
Importance of Securing Lowest Pricing
Total Cost over Term
$10,595,982
$9,829,068
$9,636,657
Revenue over the Term ($)
$12,138,003
$12,138,003
$12,138,003
Profit over the Term ($)
$1,542,021
$2,308,935
$2,501,346
Discount Rate (%)
4.00%
4.00%
4.00%
Net Present Value
$1,360,816
$2,070,234
$2,248,220
73.8%
105.9%
113.7%
Internal Rate of Return
* Material condensed to exclude cost of capital, residual or buyout volume, warranty, reimbursement per procedure, service, and labor cost.
Source: Breakeven Calculator (abridged), MD Buyline.
This exhibit shows how differences in consumable pricing and volume between the first and third scenarios can translate into almost $1 million in higher margins
over a three-year term.
For access to an expanded debrief on coronary artery stents, see http://info.mdbuyline.com/HFMA.
For over 30 years, MD Buyline Inc. has been the leading provider of healthcare clinical and technology research to drive improved financial performance
across the healthcare supply chain. MD Buyline provides the majority of the nation’s hospitals with objective evidence-based information to help them
drive millons of dollars in savings annually. MD Buyline’s healthcare provider members access critical information about their supply chain investments
every day through personalized analyst support and a comprehensive technology platform comprised of real-time data and analyses. For more information
on how MD Buyline can support your facility, find us online at www.mdbuyline.com, and on Twitter @mdbuyline.
This published piece is provided solely for informational purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions by participants are those of the participants
and not those of HFMA. References to commercial manufacturers, vendors, products, or services that may appear do not constitute endorsements by HFMA.
May 2013 © 2013 Healthcare Financial Management Association hfma.org