ICD Implants More Likely For Patients Treated By Doctors Receiving Large Payouts From Manufacturer: Study

The findings of a new study highlight the influence payments from medical device manufacturers may have on treatment decisions, finding that doctors receiving payouts are more likely to recommend that heart patients receive an implantable cardioverter-defibrillator (ICD).

More than 94% of doctors who implanted ICDs in patients were paid by device manufacturers for using that particular brand, according to a report published this week in the Journal of the American Medical Association (JAMA).

An ICD is implanted in the chest, much like a pacemaker. However, it continually monitors a person’s heart and can send electrical pulses to the heart to correct abnormal heart rhythm. The pulses initially begin at a low strength, but can progress to higher strength if the pulses are ineffective.

Researchers conducted a cross-sectional study of nearly 146,000 patients who received a first time ICD by 4,400 doctors at 1,700 facilities from 2016 to 2018. Doctors used devices from four device manufacturers. Data from the National Cardiovascular Data Registry ICD Registry was linked with the Open Payments Program’s payment data, tracking pharmaceutical and device manufacturer payments made to doctors.

The findings indicate patients who needed an ICD placed in their chest were more likely to receive one from a manufacturer that was paying their doctor. In fact, 94% of patients received devices from manufacturers that provided payments to their doctor.

Payments to doctors for ICDs ranged from $2 to $323,000, and the average payment was $1200. Between 38% to 55% of patients received devices from manufacturers that had provided doctors with the largest payments.

Other studies have focused on pharmaceutical company payments to doctors and the increased likelihood of doctors to prescribe those particular drugs after receiving payments. Drug and device kickback payments to doctors has long been a controversial subject.

However, the new study highlights an important issue. Doctors may not be choosing the best device for their patients. Instead, they are simply choosing devices based on how much they will receive in compensation from the device manufacturer, the researchers warn.

This is especially concerning considering a recent study indicated patients with advanced heart failure face increased risks of complication rates from ICDs.

These patients are more likely to experience in-hospital death and cardiac arrest. If doctors are recommending these devices based on payment kickback and not the best benefit to the patients, important changes to the process may need to be considered.

“In this cross-sectional study, a large proportion of ICD or CRT-D implantations were performed by physicians who received payments from device manufacturers,” wrote study authors. “Patients were more likely to receive ICD or CRT-D devices from the manufacturer that provided the highest total payment to the physician who performed an ICD or CRT-D implantation than each other manufacturer individually.”