Heart implants raise questions as their use soars
- From: pluto <pluto@xxxxxxxxxxxx>
- Date: Thu, 04 Aug 2005 07:19:04 +0800
http://www.iht.com/articles/2005/08/02/business/heart.php
Heart implants raise questions as their use soars
By Barry Meier The New York Times
WEDNESDAY, AUGUST 3, 2005
NEW YORK A little-known heart device, an implantable defibrillator, has
been under the spotlight since a recent disclosure that a manufacturer,
Guidant, did not tell doctors for years that one of its models had a defect
that could render it useless.
But well before that, medical experts had been increasingly debating other
aspects of the device, namely its benefits and its costs.
Many heart patients need a defibrillator, which sends out an electrical
jolt to interrupt a chaotic heart rhythm that can lead to cardiac arrest.
But some doctors say the units, which are rapidly becoming among the most
costly medical devices in use, are being implanted in patients who may not
need them, patients who are either too healthy or too ill.
Both the medical and financial consequences of that debate have been
growing as use of the device has soared. Last year, an estimated 135,000
devices were implanted in patients in the United States alone, nearly
triple the number in 2000. That number is expected to rise quickly as a
result of a ruling in January mandating government payments for the devices
in a greatly expanded pool of the elderly.
Meanwhile, the three major device producers, Guidant, Medtronic and St.
Jude Medical, have seen a financial bonanza as domestic sales rose to $3.5
billion last year, from $1.3 billion in 2000, according to Harris Nesbitt,
an investment firm.
The overuse or inappropriate use of medical treatments is a familiar theme.
But defibrillators raise unique problems because they are increasingly
being used as a standard piece of safety equipment, like an air bag in an
automobile, in heart patients whose need for them is not clear.
Defibrillators range from about $20,000 to $35,000 each.
"They are expensive, and in theory almost anyone in the country could
benefit," said Dr. Mark Hlatky, a professor of health research and policy
at Stanford University School of Medicine. "So where do you draw the line?"
Implanted defibrillators were first used in the 1980s in patients who had
survived a sudden cardiac arrest.
Research has since expanded the pool of potential beneficiaries but has not
determined which patients in these broader groups are at high risk of
cardiac arrest and which ones are at low risk, said Dr. Douglas Zipes, a
cardiology professor at Indiana University School of Medicine. The result:
They all qualify for a unit.
The steady broadening of the device's use also means that more patients are
receiving defibrillators for each one who will benefit.
Meanwhile, prices rise as manufacturers add features like new ways to
measure heart rhythms. While specialists differ on the usefulness of some
of these features, there is no question that they make the units more
expensive than one that only does the basic job. "These companies don't
compete on price; they compete on features," Hlatky said.
The companies say that their prices are fair and that they are responding
to doctors' suggestions by producing the devices they want.
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