The U.S. Medicare Program spends about $4.6 billion dollars each year providing ICDs to older Americans. A University of Iowa study 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. The devices are commonly given to patients whose heart is pumping at less than 30 percent of capacity.

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 analyse 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."; Source: University of Iowa (Health Sciences)