Choice of ICD Device, Manufacturer Payment to Physicians May Be Linked

As association was established between initial implantation of cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) device and payment to physicians by manufacturers of those devices, according to a study published in the Journal of the American Medical Association.

In this multicenter cross-sectional study, the records of 145,900 patients (median age, 65 years; 29.6% women) who were implanted an initial ICD or CRT-D at 1 of at 1,763 facilities across the United States between January 2016 and December 2018, were examined. Patients received a device from 1 of 4 major manufacturers. National Cardiovascular Data Registry ICD data and payment information from the Open Payments Program were analyzed. Patients were grouped based on physician payments by manufacturers (named A to D).

The study’s primary exposure was payment by manufacturers to physicians performing ICD or CRT-D implantation. The primary study outcome was the manufacturer of the implanted device.

During the 3-year study period, 4435 physicians performed ICD or CRT-D implantations using devices from 1 of the 4 manufacturers considered. Of those physicians, 4152 (93.6%) received payments from the device makers. The median payment was $1211 (interquartile range, $390-$3,702; overall range, $2-$323,559). The percentages of patients who received devices by the manufacturer offering the largest payment to physicians ranged from 38.5% to 54.7%.

The absolute difference between the percentage of medical devices originating from highest payers in a group of patients vs the entire cohort were the following: 22.4% (95% CI, 21.9%-22.9%), 14.5% (95% CI, 14.0%-15.0%), 18.8% (95% CI, 18.2%-19.4%), and 30.6% (95% CI, 30.0%-31.2%) for manufacturers A, B, C, and D, respectively.

Study limitations include its observational and cross-sectional design that precluded the establishment of causal relationships, possible unmeasured confounders, lack of evidence regarding device selection and long-term outcomes, inability to examine different payment types, and potentially inaccurate information regarding payments.

“This study’s findings raise the possibility that payments from device manufacturers may influence the physician’s choice in selection of a manufacturer’s device. However, this may not be the only contributing factor,” noted the authors.

Funding and Conflicts of Interest Disclosures:

Please see original article for funding and conflict of interest information.

Reference

Annapureddy AR, Henien S, Wang Y, et al. Association between industry payments to physicians and device selection in ICD implantation. JAMA. 2020;324(17):1755-1764. doi:10.1001/jama.2020.17436