Why the US will buy defibrillators and Europe won't

A study in this week's New England Journal of Medicine (The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure) demonstrates that bi-ventricular pacemakers for cardiac resynchronization therapy are effective in reducing death rates in heart failure patients. As the Wall Street Journal reports today (A More Affordable Cardiac Device), the effect was essentially the same as a combination bi-ventricular pacer and defibrillator.The combination device costs about $30,000, while the pacer alone is about $12-14,000. The value of the defibrillator is that it can bring the patient back to life from a sudden, abnormal rhythm. The devices are made by Medtronic, Guidant, and St. Jude Medical.What's interesting to me is the different effects the study results are likely to have in the US compared to Europe:

• European health agencies are likely to refuse to pay the extra cost for the combination device --arguing that the money is better spent elsewhere
• In the US, doctors are likely to keep implanting the combination devices --arguing that some patients are saved by defibrillators. Also, there's no global health care budget so there's no real tradeoff being made

The difference in philosophy is a key reason why US health care spending is higher than in Europe. Here, we pay for unproven therapies if they seem plausible. In Europe, they don't.