Implanted Defibrillators Found Cost-Effective

doctors in surgeryImplanting defibrillators in high-risk patients not only saves lives but makes good financial sense, researchers have concluded.

In an analysis of data from eight studies, researchers compared the number of added years of life for people who got the devices against the cost of implanting or replacing these devices.

They found that defibrillators meet the current cost-benefit criterion, which sets the dollar value of an extra year of quality life at about $50,000, according to a report in the New England Journal of Medicine.

“These devices are quite expensive, but if used in the appropriate patients they are good value for money,” said study leader Gillian D. Sanders, an associate professor of medicine at Duke University Medical Center.

That conclusion could have enormous financial implications, since the U.S. government this year authorized Medicare and Medicaid to pay for the devices. An estimated 500,000 older Americans might be eligible for defibrillators, whose average implantation cost runs close to $28,000.

Defibrillators, which deliver an electrical jolt to maintain a regular heartbeat, originally were implanted only in people who survived cardiac arrest, but their use quickly expanded to persons with other severe heart problems. The U.S. Food and Drug Administration estimates that 416,000 defibrillators were implanted between 1990 and 2002.

“Doctors began to say, ‘We shouldn’t wait for people to drop dead; let’s use this as a preventive tool,’ said study co-author Dr. Mark Hlatky, a professor of health research and policy at Stanford University.

Because the eight studies included patients with different heart problems, the results had to be analyzed individually, rather than being pooled. Two of the eight trials showed no reduced death rate for implanted defibrillators. But the other six showed defibrillator use adding between 1.01 and 2.99 years of life per patient. The cost per added year of life ranged from $34,000 to $70,000 — well below the $100,000 that is regarded as the “no-go” point in terms of cost-effectiveness, the researchers found.

In comparison, the emergency defibrillators currently installed on commercial airliners cost about $36,000 per added year of life, while the use of stents — flexible tubes that keep arteries open after a heart attack — total about $24,000 per added year of life, the researchers noted.

It will cost billions to implant the devices in people who really need them, Sanders said, and “if physicians extend the use of ICDs [implantable cardioverter defibrillators] in lower-risk patients where cost-effectiveness is even less favorable, the societal costs will increase even more.”

Nevertheless, the study shows that having the government pay for defibrillators “is probably a good decision, a good use of Medicare’s resources,” she said.

But the government did not make that decision on the basis of a cost-benefit analysis, noted Dr. Lee Goldman, professor of medicine at the University of California at San Francisco. Instead, it came to that decision through political pressure, he said.

“It is shameful that Medicare is not allowed to make the decision based on cost- effectiveness,” Goldman said.

More information

For more on implantable defibrillators, head to the U.S. Food and Drug Administration.

SOURCES: Gillian D. Sanders, Ph.D, associate professor, medicine, Duke University Medical Center, Durham, N.C.; Lee Goldman, M.D., professor, medicine, University of California at San Francisco; Oct. 6, 2005, New England Journal of Medicine

Last Updated: Oct. 6, 2005

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