Friday, February 11, 2005

Lo Bat for Implantable Cardiac Defibrillators

Medtronic warned physicians today about the possibility of battery failures in one of its models of implantable cardiac defibrillators (ICDs), 87,000 of which were manufactured before 2003. The market for these devices has recently expanded, since Medicare approved their prophylactic use for patients with congestive heart failure. Medicare planned to pay from $28 to $36K for the device, and the procedure to implant it.
I believe (but cannot find evidence at the moment to prove) that the price of the actual ICD is around $25K. If so, given that its circuitry cannot be that complex in this day and age, one would think that this would have been enough to buy an extremely reliable battery.
This reinforces the questions I recently raised about the pricing of medical devices versus their value to the patient.


Anonymous said...

Not sure what you mean by the "circuitry" not being that complex. But be assured that ICDs are VERY complex and have complicated software - this is required so that the ICD can appropriately treat when indicated (e.g., for VT) but NOT treat when it is not indicated (e.g., rapid afib). Most ICDs can be programmed for 3 zones of therapy - anti-tach pacing, lower energy shock and higher energy shock - couple that with nuances that look at rapidity of onset, R-R interval etc., ICDs are probably more complicated than you realize.

Roy M. Poses MD said...

I would bet that the hardware and software inside an ICD is no more complex than that in, say, a typical up market cell phone, or PDA. DVD player, etc., etc.
Remember all the things such a cell phone can do beyond acting like a two-way radio (color display, internet access, camera function, multiple auxiliary programs, etc). Yes, there must be other design considerations for an ICD, like maintaining a hermetic seal, having electrical leads that will function for a long time in a hostile biological environment, and most importantly, having a battery that will work for years. But it's still hard for me to understand why the price of an ICD is more than 100 times that of a high-end cell phone.
A better analysis could be done by a practicing bio-engineer. (I have a degree but never practiced.) But I also bet that most managed care organizations don't employ bio-engineers to assess the costs of the various devices that that they routinely reimburse in the 5-figure range.