Medicare Could Save Money, Provide More Defibrillators

Newswise — Medicare beneficiaries with heart failure could benefit from new strategies to decide who qualifies for lifesaving implantable cardioverter defibrillators (ICDs), according to a University of Iowa study.

The U.S. Medicare Program spends about $4.6 billion dollars each year providing ICDs to older Americans. The investigation, published in the June 16 online early issue of the journal Value in Health, explored what would happen if Medicare spent the same amount of money to provide more patients with less expensive, yet also less effective, automated external defibrillators (AEDs).

An ICD is a small, pager-sized device implanted beneath the skin that uses electric shock to restore normal heart rhythm and costs about $40,000. An AED is a briefcase-sized device that requires a bystander to use pads that deliver an electric shock to restore the victim's heart rhythm and costs about $2,000.

"ICDs are very expensive and very effective. AEDs are less expensive but not nearly as effective. But for the same total expenditure, it might be reasonable for Medicare to provide the less expensive defibrillator to many more Medicare beneficiaries," said Peter Cram, M.D., the study's lead author and assistant professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine.

"Medicare is facing a budget crunch. The U.S. population is aging. Budgets are tight. Medicare needs to be innovative and think carefully about how to maximize the value it provides to American seniors," Cram added.

The team chose to focus on ICDs because they are both expensive and in high demand for patients enrolled in Medicare. The devices are commonly given to patients whose heart is pumping at less than 30 percent of capacity.

The nearly $4.6 billion Medicare spends annually on implantable defibrillators benefits approximately 40,000 patients. However, the investigators suggested that if Medicare shifted some of this money from purchasing ICDs to purchasing the less expensive AEDs, then thousands of additional patients might benefit.

The study used computer simulations to analyze three scenarios involving hypothetical Medicare patients: patients receiving ICDs, patients receiving AEDS for in-home use, and patients relying on emergency rescue services.

An ICD costs on average $40,000, including implantation. With checkups and device upkeep, the average cost rises to about $115,000 per patient. An AED costs about $2,000, so with accompanying care, the AED cost is about $5,500 for each patient.

"Medicare could potentially assign patients to get either an ICD or AED based upon the patient's level of risk for heart problems," Cram said. "This would ensure that the maximum number of patients benefit while preserving the Medicare budget."

Cram noted the study has several limitations, including the assumption that AEDs would be given only to patients who live with others capable of administering the device.

In addition to Cram, the study team included David Katz, M.D., UI associate professor of internal medicine and epidemiology, and investigators from the Ann Arbor Veterans Affairs Health Services Research and Development Field Program, the University of Michigan School of Medicine, University of Michigan School of Public Health and the Institute for Clinical Research and Health Policy Studies at Tufts-New England Medical Center in Boston.

Cram is supported by a Career Development Award from the National Center for Research Resources of the National Institutes of Health.

The research article also will appear in volume 9, issue 5, of the print issue of Value in Health, the official journal of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Value in Health (ISSN 1098-3015) publishes papers, concepts and ideas that advance the field of pharmacoeconomics and outcomes research and help health care leaders to make decisions that are solidly evidence-based. The journal is published bi-monthly and has a regular readership of over 3,000 clinicians, decision-makers and researchers worldwide.

ISPOR is a nonprofit, international organization that strives to translate pharmacoeconomics and outcomes research into practice to ensure that society allocates scarce health care resources wisely, fairly and efficiently. For further information on ISPOR, visit http://www.ispor.org.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at http://www.uihealthcare.com.

PHOTO: http://www.healthcare.uiowa.edu/InternalMedicine/Divisions/GMed/Directory/PeterCram.html

ABSTRACT: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1524-4733.2006.00118.x