Coronary stents cost 6 times more in US than some European countries

The prices of implantable medical devices to treat heart patients are up to six times higher in the United States than in Germany, according to a study published Oct. 1 in Health Affairs.

Two policy and economics researchers from London analyzed hospital survey data from the U.S. and four countries in the European Union, with an eye on how prices differed both within and between countries for coronary stents and rhythm management devices including pacemakers, implantable cardioverter-defibrillators and cardiac resynchronization devices.

Martin Wenzl and Elias Mossialos noted they undertook the study to help policymakers in both regions understand the magnitude of price variation and begin exploring what mechanisms contribute to those differences. Also, it’s difficult to enact policies encouraging efficient spending on medical technology, they said, without knowing the prices of devices and information on their appropriateness of use.

“Although prior studies from the U.S. and Italy suggest that prices of similar implantable devices can vary significantly between buyers, little is known about how those prices compare between high-income countries,” Wenzl and Mossialos wrote. “This is because purchase prices are often the result of negotiations or tendering between manufacturers and individual hospitals, group purchasing organizations, or healthcare payers. It is commonly accepted that prices are confidential, which allows manufacturers to increase profits by charging different prices to different buyers, depending on their bargaining power.”

Using surveys that provided quarterly data from 2006 to 2014 on hospitals’ device volumes and prices, the authors found marked variation between countries.

The gap was comparatively largest for bare-metal stents in 2014, which cost around $670 in the U.S. but only $120 and $130 in Germany and the U.K., respectively. Drug-eluting stents remained about $1,000 more expensive in the U.S. than Germany throughout the study period.

Approximate prices of pacemakers were three- to five-fold higher in the U.S. than Germany in 2014—$4,200 versus $1,400 for dual-chamber pacemakers and $3,700 versus $800 for single-chamber pacemakers. The rest of the implantable cardiac devices were about twice was costly in the U.S. than Germany in the later years of the study, Wenzl and Mossialos reported.

“Prices of most device categories also varied between EU countries, despite the absence of formal trade barriers in the EU single market,” wrote the authors, who also analyzed data from France and Italy. “Variation in prices of similar and identical devices suggests that factors other than their comparative effectiveness determine prices.”

The researchers noted there was significant price variation between hospitals within the same country, with the exception of France.

“Variation within countries suggests that manufacturers exploit varying levels of willingness-to-pay and bargaining power between buyers to charge different prices across hospitals and increase profits,” they wrote.

The study relied on the accuracy of self-reported survey data and couldn’t take into account any negotiated discounts, rebates or bundling that may have made net purchase prices different from invoiced prices. Another limitation of the study is it couldn’t explain the reasons for the price variations, which the authors suggested as an area for further study.

“While these findings can help assess whether technology-related policies effectively control the prices of cardiac devices, future research is necessary to establish a causal relationship between prices and several possible explanatory factors and help policy makers understand which mechanisms are available to control device prices,” they wrote.

根据10月1日发表在《健康事务》上的一项研究,在美国,用于治疗心脏病患者的植入式医疗设备的价格比德国高出六倍。

伦敦的两名政策和经济学研究人员分析了美国和欧盟四个国家的医院调查数据,着眼于各国内部和国家之间冠状动脉支架和心律管理设备(包括起搏器,植入式心脏复律除颤器和心脏)的价格差异如何 重新同步设备。

Martin Wenzl和Elias Mossialos表示,他们进行了这项研究,以帮助这两个地区的决策者了解价格差异的严重程度,并开始探索导致这些差异的机制。此外,他们说,在不了解设备价格和使用适当性的信息的情况下,很难制定政策鼓励有效地支出医疗技术。

“尽管美国和意大利的先前研究表明,相似的植入式设备的价格在购买者之间可能有很大差异,但对于高收入国家之间的价格之间的比较了解甚少,” Wenzl和Mossialos写道。 “这是因为购买价格通常是制造商与各个医院,团体购买组织或医疗保健付款人之间进行谈判或招标的结果。人们普遍认为价格是机密的,这使制造商可以根据其议价能力向不同的买家收取不同的价格,从而增加利润。”

通过使用提供2006年至2014年季度数据的医院设备数量和价格的调查,作者发现各国之间存在明显差异。

2014年,裸金属支架的缺口相对最大,在美国的价格约为670美元,但在德国和英国分别仅为120美元和130美元。在整个研究期间,药物洗脱支架在美国的价格仍比德国贵约1,000美元。

2014年,美国起搏器的大约价格比德国高出三到五倍,其中双腔起搏器的价格为4,200美元,而德国双腔起搏器的价格为1,400美元,单腔起搏器美国为3,700美元,而德国价格为800美元。 Wenzl和Mossialos报告说,在这项研究的后期,其余的可植入心脏装置在美国的价格是德国的两倍,是德国的。

作者写道:“尽管在欧盟单一市场中没有正式的贸易壁垒,但大多数欧盟国家之间的大多数设备类别的价格也有所不同。”作者还分析了法国和意大利的数据。 “相似和相同设备的价格变化表明,除了其相对有效性之外,其他因素还决定了价格。”

研究人员指出,除法国外,同一国家/地区内各医院之间的价格差异很大。

他们写道:“各国内部的差异表明,制造商利用买方之间不同程度的支付意愿和议价能力,以向医院收取不同的价格并增加利润。”

这项研究依靠自我报告的调查数据的准确性,并且没有考虑到可能导致净购买价格与发票价格不同的任何议定折扣,折扣或捆绑销售。该研究的另一个局限性是无法解释价格波动的原因,作者建议将其作为进一步研究的领域。

“尽管这些发现可以帮助评估技术相关政策是否有效地控制了心脏设备的价格,但仍需要进行进一步的研究以建立价格与若干可能的解释因素之间的因果关系,并帮助政策制定者了解可用于控制设备价格的机制, “ 他们写。

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