The cardiac implant you get may depend on the company paying your doctor
We’ve written about drug company payments to doctors and the effect this has on prescribing habits. But what about payments from medical device companies? Does receiving money from medical device companies impact the devices doctors implant in patients? A recent study in JAMA suggests that it does.
In this study, researchers looked at a sample of 145,900 patients who received either an implantable cardioverter-defibrillator or cardiac resynchronization therapy-defibrillator device. These are devices for patients with heart failure, which are designed to prevent life-threatening arrhythmias (abnormal heart rhythms) by giving a small “shock” to the heart when necessary.
Of the 4,435 physicians who implanted these devices from 2016-2018, 94% of them received some payment from device manufacturers. The majority of doctors (75%) received payments from 3 or 4 manufacturers; only 8% received payments from just one manufacturer. The vast majority of payments (88%) amounted to $10,000 or less, but some payments were as high as $320,000.
Physicians were much more likely to use the device made by the manufacturer that gave them the largest payment than any of the other manufacturers. Overall, 47% of patients received a device from the manufacturer that gave their physician the most money. For physicians that received more than $25,000 annually, 51.1% to 59.5% of patients received a cardiac device from the manufacturers that provided the largest payment.
Physicians were also more likely to use the device from the manufacturer that paid the second-most, compared to manufacturers that paid less. One of the device makers (known in the study only as “Manufacturer B”) appeared to be the most generous spender. Among the doctors that got the most from Manufacturer B, 74% of the total payment was from this device maker. And among the doctors that got the most from the three other device makers, Manufacturer B’s payments made up the next-largest proportion of their total payments. This may have had an effect on which devices doctors used; in total, 40% of all the devices implanted were from Manufacturer B.
Another interesting finding from the study was a comparison between physicians who had not received any payments and physicians who did. Doctors who did not receive payments were less likely to be giving patients a device for primary prevention (to stop a first cardiac event) as opposed to secondary prevention (prevent another cardiac event). Among doctors who did not receive payments, 75.9% of patients were given a device for primary prevention, compared to 78.3% of the patients in the total sample. These doctors were also more likely to give patients a single-chamber ICD as opposed to a dual chamber ICD or CRT-D. While these differences were slight, they may indicate that doctors receiving payments have a bias toward implanting more expensive devices for patients who may not need them.
In the study, there was no difference in rate of complications or death depending on whether or how much a physician was paid. So why do these payments matter? In an accompanying editorial, Harvard Law professor Carmel Shachar and JAMA Deputy Editor Dr. Gregory Curfman point out that payments to doctors from drug companies raise the price of devices. “The payments to physicians…were funded by ICD sales, and these devices would be less expensive without these payments,” they write.
Shachar and Curfman also note that “these payments may undermine the reputation and trust of the medical profession, potentially damaging the complex relationship between patients and physicians.” If patients knew how much their doctor’s (conscious or unconscious) decision was potentially affected on the amount they were paid by medical device companies, this could certainly reduce trust in the medical profession– trust that we need now more than ever.