Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Could a simple test save Medicare hundreds of millions?


Study looks at cost-effectiveness of testing heart patients to help decide who needs implanted defibrillators

Next week, the Medicare agency will announce whether it will cover the cost of a $400 heart test that assesses a person’s risk of dying suddenly from a heart condition. Today, a study led by University of Michigan researchers suggests that the test could actually save Medicare hundreds of millions of dollars in the long run.

The researchers used a sophisticated computer model to calculate the potential impact of using the test, called microvolt T-wave alternans (MTWA), to help determine which patients would benefit most from implanted devices that automatically re-start a stopped heart.

Those devices, called implantable cardioverter defibrillators, or ICDs, have been shown to save lives that would otherwise have been lost to sudden cardiac death, which kills 300,000 Americans each year.

One year ago, Medicare expanded its coverage of ICDs to include many more heart patients; an estimated 500,000 people over age 65 are now candidates. Covering the cost of ICDs for patients who have the same characteristics as participants in the MADIT-2 ICD trial that led to Medicare approval could add $3 billion annually to the program’s budget. ICDs cost $35,000 including implantation, require periodic battery replacement, and pose a device failure risk.

In a presentation at the American College of Cardiology Scientific Session, the U-M team suggests that the MTWA test could spare a significant fraction of those costs, if doctors focused on providing ICDs only to patients with an abnormal or inconclusive MTWA test result. Previous studies have suggested that patients with a negative, or normal, MTWA test result have a far lower risk of sudden cardiac death than others.

This risk-stratification of ICD candidates who meet MADIT-2 criteria, say the U-M researchers, could potentially save Medicare $690 million a year -- even after the cost of the MTWA test and the care of patients who don’t receive ICDs are included.

"ICDs have been shown in several studies to be cost-effective, which means the cost is considered acceptable given the benefit to patients," says lead author and U-M cardiology fellow Paul Chan, M.D., M.Sc. "But a very expensive device can be cost-effective and still not affordable to society, if the condition it treats is highly prevalent. Our study demonstrates the potential impact of using additional factors to aid decisions about the use of expensive devices."

The MTWA test, he notes, is gaining acceptance among cardiologists but will likely become more common if Medicare decides to cover it.

Microvolt T-wave alternans are small variations in the electrical impulses in the heart. They can’t be detected on the conventional heart-rhythm test called the electrocardiogram (ECG), but MTWA test equipment can detect them via special sensors placed on the patient’s body during a brief exercise session. Two companies make equipment that are used to perform MTWA tests, but Chan and his colleagues have no association with those companies, nor with companies that make ICDs.

At the ACC meeting, Chan will receive the Parmley Prize for his previous research on the use of the MTWA test as a way to predict sudden cardiac death in patients with heart failure. In a study he presented last fall at the American Heart Association Scientific Sessions that will soon be published in the Journal of the American College of Cardiology, he showed that ICD-eligible patients who met MADIT-2 trial criteria for primary prevention of sudden cardiac death, and who had positive or inconclusive MTWA results, were more than twice as likely to die than similar patients with negative MTWA results. Other MTWA studies have suggested a larger difference, but did not control for other patient characteristics. Chan’s study also showed that about one-third of patients who meet Medicare criteria for an ICD have normal MTWA test results.

For the new study being presented at the ACC meeting, which has been accepted for publication in JACC, Chan and his colleagues used a computer model called a Markov analysis to simulate the costs, benefits, and health outcomes of 65-year-old individuals who meet the MADIT-2 trial criteria for Medicare coverage of an ICD. They looked at three scenarios: all such patients get an ICD, only those with positive or inconclusive MTWA results receive an ICD, or no patients get an ICD.

The model used a range of assumptions about what percentage of patients would suffer sudden cardiac problems and long-term complications with or without an ICD, and how many ICD patients would suffer complications related to their ICDs, It also included assumptions about what proportion of patients would die depending on their treatment or MTWA status. All of these assumptions were based on data from previous ICD trials, or best case/worst case scenarios. Costs for care were also included, such as MTWA test costs, ICD costs, and the cost of medical care for those who stayed healthy or suffered a heart problem with or without an ICD.

To account for the uncertainties inherent in each of the clinical variables, the researchers performed various levels of sensitivity analyses, including an analysis using 10,000 simulations in which all model variables were randomly sampled. This latter analysis, known as a Monte Carlo simulation, allowed them to examine the distribution of possible cost-effectiveness ratios for every quality-adjusted life year (QALY) saved, and is a standard way to assess the cost-effectiveness of a medical intervention. It allows researchers to assess the cost of saving a year of a person’s life, adjusted for the quality of that life and the life-saving power of a particular course of action.

In general, the cost per QALY for giving ICDs only to risk-stratified patients who had been tested with MTWA was about $50,000, compared with medical therapy. "This is well within the usual range considered cost-effective for new medical technologies," says Chan. However, compared with MTWA testing followed by ICD use only in those with a positive or inconclusive MTWA result, the all-ICD option would cost $88,700 per QALY gained -- under best-case scenarios.

Chan cautions that the new results are not meant to guide doctors in decisions about whether or not to suggest that particular primary prevention patients receive ICDs. But he hopes the data may be useful in decisions about how to spend resources for this type of care -- and that further research will examine how often doctors should conduct MTWA tests in patients who don’t receive an ICD, to help them monitor for changes in sudden cardiac death risk over time that might warrant an ICD.

In addition to Chan, the authors of the ACC presentation are: Kenneth Stein, M.D., of Weill Cornell Medical Center; Theodore Chow, M.D. of the Ohio Heart and Vascular Center; A. Mark Fendrick, M.D., and Sandeep Vijan, M.D., M.Sc., of the U-M Division of General Medicine; and J. Thomas Bigger, M.D., of Columbia University.

Kara Gavin | EurekAlert!
Further information:

More articles from Studies and Analyses:

nachricht Diagnoses: When Are Several Opinions Better Than One?
19.07.2016 | Max-Planck-Institut für Bildungsforschung

nachricht High in calories and low in nutrients when adolescents share pictures of food online
07.04.2016 | University of Gothenburg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New 3-D wiring technique brings scalable quantum computers closer to reality

Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.

"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...

Im Focus: Scientists develop a semiconductor nanocomposite material that moves in response to light

In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.

A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...

Im Focus: Diamonds aren't forever: Sandia, Harvard team create first quantum computer bridge

By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.

"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...

Im Focus: New Products - Highlights of COMPAMED 2016

COMPAMED has become the leading international marketplace for suppliers of medical manufacturing. The trade fair, which takes place every November and is co-located to MEDICA in Dusseldorf, has been steadily growing over the past years and shows that medical technology remains a rapidly growing market.

In 2016, the joint pavilion by the IVAM Microtechnology Network, the Product Market “High-tech for Medical Devices”, will be located in Hall 8a again and will...

Im Focus: Ultra-thin ferroelectric material for next-generation electronics

'Ferroelectric' materials can switch between different states of electrical polarization in response to an external electric field. This flexibility means they show promise for many applications, for example in electronic devices and computer memory. Current ferroelectric materials are highly valued for their thermal and chemical stability and rapid electro-mechanical responses, but creating a material that is scalable down to the tiny sizes needed for technologies like silicon-based semiconductors (Si-based CMOS) has proven challenging.

Now, Hiroshi Funakubo and co-workers at the Tokyo Institute of Technology, in collaboration with researchers across Japan, have conducted experiments to...

All Focus news of the innovation-report >>>



Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

Agricultural Trade Developments and Potentials in Central Asia and the South Caucasus

14.10.2016 | Event News

World Health Summit – Day Three: A Call to Action

12.10.2016 | Event News

Latest News

Resolving the mystery of preeclampsia

21.10.2016 | Health and Medicine

Stanford researchers create new special-purpose computer that may someday save us billions

21.10.2016 | Information Technology

From ancient fossils to future cars

21.10.2016 | Materials Sciences

More VideoLinks >>>