Cardiac devices can cost six times more in U.S. than in Europe

(Reuters Health) - Implanted heart devices like pacemakers and stents can cost two to six times more in the U.S. than in Germany, where costs are among the lowest in Europe, a recent study suggests.

Medical devices account for about 6 percent of health expenditures in the U.S. and 7 percent in the European Union. But far less is known about pricing for devices than is known about drug costs, researchers note in Health Affairs. For the current study, they examined data on device prices at hospitals in the U.S., France, Germany, Italy and the UK from 2006 to 2014.

“We have known about price variation across hospitals for cardiac implants for some time,” said Dr. Karandeep Singh, a researcher at the University of Michigan in Ann Arbor who wasn’t involved in the study.

But the extent of the differences across countries was “really surprising,” Singh said by email.

During the study period, the average price of drug-eluting stents - tiny mesh tubes coated with medicines to keep arteries free of clogs - dropped in all countries, but was consistently about $1,000 more in the U.S. than in Germany.

By the end of the study period, bare metal stents used to prop open arteries after surgery to unclog blood vessels cost an average of $670 in the U.S. and $750 in France but just $120 in Germany and $130 in the UK, the analysis found.

A commonly used pacemaker cost $4,200 in the U.S. and $1,400 in Germany, the analysis also found.

Prices could also vary significantly between hospitals in a single country, except in France. But the variation within countries was generally less than between countries, the authors note.

The study didn’t examine whether or how specific factors at individual hospitals or within different countries might directly impact cardiac device prices. Study co-author Martin Wenzl of the London School of Economics and Political Science didn’t respond to requests for comment.

Although this study looks at the prices of implanted cardiac devices, it doesn’t take into account how much health insurance programs might reimburse hospitals for cardiac devices, Singh noted.

“As a result, it’s hard to know if and how patients will experience these price differences,” Singh said. “This makes comparison shopping quite difficult. Additionally, patients may not necessarily be able to comparison shop.”

Higher prices for cardiac devices in the U.S., however, are already reflected in higher health insurance premiums here, said Dr. Peter Groeneveld of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

These prices may also be reflected in higher prices for goods and services or lower wages for workers because companies have to factor costs for providing employee health benefits in the U.S., Groeneveld, who wasn’t involved in the study, said by email.

“It’s not clear that U.S. patients can do much with this information . . . other than move to Europe,” Groeneveld said. “A patient’s out-of-pocket costs for a cardiovascular procedure are generally more a function of his/her insurance plan rather than his/her hospital’s operating costs, so there is typically no incentive to find a more cost-efficient hospital.”

SOURCE: Health Affairs, online October 1, 2018.