In his regular e-mail newsletter and commentary, former U.S. Senator David Durenberger writes:
FDA approval of Abbott Lab's new drug-coated stent called Xience means there will now be four large corporate competitors in a relatively small field selling Taxus from Boston Scientific, Cypher from J and J, Endeavor from Medtronic, and a version of the Xience stent called Promus from Boston Scientific (with a drug coating different from Taxus). Multiply those products by thousands of sales persons in the cardiac market and the answer is a gradual expansion of the now $2 billion a year market for stents in this country. Since insurance payments go to hospitals who have financial incentives to encourage the heart surgery in which the stent is implaced, and surgical fees to surgeons who do them, the definition of "medical necessity" is determined by the surgeon's judgment and by the device supply market, not necessarily by the appropriateness nor by the cost-effectiveness of a particular surgery or stent.