October 5, 2005

Pricey implantable defibrillators worth it – study

By Gene Emery

BOSTON (Reuters) - They may cost about $28,000 each, and
500,000 people in the United States could benefit from them,
but implantable defibrillators that automatically shock an
erratic heart into beating normally justify the cost, a study
showed on Wednesday.

The finding, published in The New England Journal of
Medicine, supports a January decision by the U.S. government to
pay for the devices in Medicare recipients whose heart disease
puts them at risk of sudden death.

The devices, known as implantable cardioverter
defibrillators, are already widely accepted as a cost-effective
way of protecting the lives of people who barely escaped death
when their hearts essentially stopped beating.

The new study, led by Gillian Sanders of Duke University,
was designed to see if the devices were cost-effective in less
extreme cases.

"These are patients with heart disease whose life
expectancy isn't that great," she told Reuters. "This study is
coming back and saying this is good value for the money."

U.S. Vice President Dick Cheney had the device implanted in
his chest in June 2001 to guard against potentially dangerous
heart rhythms.

By looking at the costs associated with the procedure and
using eight existing studies to assess the devices, the
researchers concluded that the defibrillators added two to six
years of life to a typical patient.

When all expenses were considered, installing a
defibrillator costs $34,000 to $70,000 for each additional year
of life.

She acknowledged that because a half-million Americans
might be candidates for the devices, paying for them is a
pricey proposition.

"They're expensive devices. But given the increase in life
expectancy, they're a good value and comparable to other
things" covered by insurance companies and the federal Medicare

Kidney dialysis, for example, costs $50,000 for each
additional year of life earned, heart bypass surgery costs
about $18,000, treating high blood pressure costs $5,000 to
$50,000, and giving statin drugs to bring down cholesterol
levels and prevent heart attacks costs about $21,000, she said.

"It's still a dilemma, even though it's a good value," said
co-author Douglas Owens of the Veterans Affairs Palo Alto
Health Care System. "The total number of dollars that are going
to go into this is projected to be very large, so there's no
question it will be a sizable expenditure."

Sanders said further studies may reduce the cost if doctors
discover how to predict which patients are most likely to need
the devices, which are usually implanted during an overnight
stay in the hospital.