NCPA - National Center for Policy Analysis


August 4, 2005

Many heart patients undoubtedly need an implantable defibrillator, a device that sends out an electrical jolt to interrupt a chaotic heart rhythm, but some doctors say the units, which are one of the most costly medical devices in use today, are being implanted in many other patients who may not need them.

The New York Times says both the medical and financial consequences of the debate have been growing as use of the device has soared. Consider:

  • Last year, an estimated 135,000 devices were implanted in patients in the United States alone, a near tripling of the number in 2000.
  • The three major device producers, Guidant, Medtronic and St. Jude Medical, saw domestic sales rise during that same period to $3.5 billion, from $1.3 billion.
  • Defibrillators, increasingly being used as a standard piece of safety equipment, have price-tags ranging from about $20,000 to $35,000 each.
  • In just two years, defibrillator-related costs to both Medicare and private insurers are expected to reach $10 billion, with Medicare covering about half.

Mark Hlatky (Stanford University School of Medicine) says, in theory, almost anyone in the country could benefit from the device. But, experts agree that many, if not the majority, of defibrillator candidates are at a low risk of cardiac arrest.

Patients have little reason to care about cost because insurers like Medicare cover the expense of an implant procedure, which includes the device. And recently, Medicare dramatically expanded the types of heart patients who qualify to receive a unit, meaning hundreds of thousands of heart patients each year will likely get a unit.

The Times says with costs soaring, there is an increased urgency to find a way of both discriminating between high-risk and low-risk patients and holding down, or even reducing, the price of a device.

Source: Barry Meier, "As Their Use Soars, Heart Implants Raise Questions," New York Times, August 2, 2005.

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