Researchers have found coronary stents and pacemakers cost U.S. hospitals up to six times as much as their counterparts in Germany.
On average, U.S. hospitals reported paying $670 for bare-metal stents, as compared to $120 in Germany.
The dramatic divergence in the prices of stents and pacemakers was the most striking finding from an analysis of what hospitals in five countries pay for cardiac implants.
The global medical device market has grown into $370 billion business that accounts for around 7% of all healthcare spending. Yet, the confidentiality of negotiations between manufacturers and buyers means little is known about how much devices cost. The secrecy creates scope for manufacturers to vary their prices from buyer to buyer.
To shed light on the situation, two London-based researchers analyzed survey data collected from hospitals every quarter between 2006 and 2014. The findings, published in Health Affairs, suggest the prices of cardiac implants vary significantly from market to market.
Overall, the dataset suggests hospitals in the U.S. and France pay more for cardiac implants than their counterparts in Germany, Italy and the U.K. Typically, the researchers found prices to be highest in the U.S. and lowest in Germany. While there was some variation from product to product, hospitals in the U.S. reported paying significantly more for most types of device every year from 2006 to 2014.
The differences in the prices of stents and pacemakers was particularly pronounced. Prices of stents generally trended downward in all countries across the years analyzed in the research paper but the magnitude of the difference between the highest and lowest fees increased.
For example, in 2006 U.S. hospitals paid around $1,000 more than their German counterparts for drug-eluting stents. By 2014, the average price paid in Germany had declined from $1,440 to $340. The average price paid in the U.S. fell, too, but remained around $1,000 above the German price in 2014. As such, U.S. hospitals paid 1.6 times as much in 2006 and four times as much in 2014.
Similar trends were seen in the analyses of the prices of other types of stents. The data on the cardiac rhythm management sector paint a slightly different picture. The prices of these devices held steady from 2006 to 2014, potentially reflecting the relative lack of competition in this market.
The authors of the study cite the level of competition as a factor that may account for some of the country-to-country variation. Historically, it has been harder for manufacturers to bring devices to market in the U.S. When paired to differences in procurement mechanisms, the use of health technology assessments and reimbursement requirements, this could contribute to price differences.
These explanations are somewhat speculative, though. Having calculated the variation in device prices, the authors of the study want to see more research into the reasons for these differences so policy makers understand the mechanisms that affect healthcare costs.