Implanted heart defibrillators cost around $25,000 each, but which patients will require or be benefited by having one remains uncertain. In 2004 Government and industry stuck a deal. Medicare agreed to expand the device’s use, nearly doubling the number of patients who qualified for one. The companies, in return, agreed to pay for a study to see which patients really benefited. But the companies reneged, backing out after putting in a measly $4 million, and the Government of the last Administration did not pick up the remaining tab. As a result, researchers still cannot gather data to determine the types of patients who would most benefit from a defibrillator, and doctors keep implanting them in patients who may not benefit at all. Many of these patients may even be harmed, especially if the device has to be removed, a dangerous procedure-something that often occurs, particularly when the batteries ultimately fail. No one even knows whether one producer’s model performs better than a competitor’s.
The problem is not limited to defibrillators or even cardiac stents. Tens of thousands of artificial hips, knees, and now shoulders are implanted every year. Doctors placing these devices have little or no reliable comparative data on which brands last longest or work best in a given patient. According to the McKinsey Global Institute, a consulting group, expenditures on implanted devices stand at about $76 billion annually in this country and are rising at a rate faster than the cost of drugs. (See this excellent article in the New York Times.)
Unlike other hospital products, implants are so-called physician preference items, meaning that doctors — not the hospitals — often choose which manufacturer’s implant to use. Profit margins on medical devices are also among the highest for any medical products, over 20% in the case of a defibrillator or an artificial hip, according to analysts.