制造商向医师支付报酬影响ICD植入术患者的器械

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制造商向医师支付报酬影响ICD植入术患者的器械

本期文章:《美国医学会杂志》:Vol 324 No 17

美国耶鲁-纽黑文医院Jeptha P. Curtis团队研究了制造商向医师支付报酬是否会影响ICD植入术患者的器械选择。2020年11月3日,该研究发表在《美国医学会杂志》上。

为了评估针对首次植入心律复律除颤器(ICD)或心脏再同步治疗除颤器(CRT-D)的患者,设备制造商支付给医生的费用与设备选择之间的关系,2016年1月1日至2018年12月31日,研究组进行了一项横断面研究,招募首次接受来自4个主要制造商生产的ICD或CRT-D设备的患者。国家心血管数据注册中心(ICD)的数据与开放付款计划的支付数据相关联。研究组将患者分为4组(A、B、C和D),分别对应于进行植入的医师获得最大报酬的制造商。

在这3年期间,共有145900例患者接受了4家制造商的ICD或CRT-D设备,中位年龄为65岁,其中29.6%为女性,由1763家医院的4435名医生实施植入。在这些医生中,共有4152名(94%)接受了设备制造商支付的2至323559美元不等的报酬,平均支付金额为1211美元。

38.5%至54.7%的患者从向医生支付最多费用的制造商那里获取设备。与从其他制造商那里购买设备相比,患者实际上更有可能接受由向实施植入手术的医师提供最大报酬的制造商提供的设备。制造商A的使用比例与预期使用率的绝对差异为22.4% ,制造商B为14.5%,制造商C为18.8%,制造商D为30.6%。

研究结果表明,实施ICD或CRT-D植入的医生大部分都接受了设备制造商提供的报酬。与其他制造商相比,患者更有可能从为实施ICD或CRT-D植入的医生提供最高总报酬的制造商处获得ICD或CRT-D设备。

附:英文原文

Title: Association Between Industry Payments to Physicians and Device Selection in ICD Implantation

Author: Amarnath R. Annapureddy, Shady Henien, Yongfei Wang, Karl E. Minges, Joseph S. Ross, Erica S. Spatz, Nihar R. Desai, Pamela N. Peterson, Frederick A. Masoudi, Jeptha P. Curtis

Issue&Volume: 2020/11/03

Abstract:

Importance  Little is known about the association between industry payments and medical device selection.

Objective  To examine the association between payments from device manufacturers to physicians and device selection for patients undergoing first-time implantation of a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D).

Design, Setting, and Participants  In this cross-sectional study, patients who received a first-time ICD or CRT-D device from any of the 4 major manufacturers (January 1, 2016-December 31, 2018) were identified. The data from the National Cardiovascular Data Registry ICD Registry was linked with the Open Payments Program’s payment data. Patients were categorized into 4 groups (A, B, C, and D) corresponding to the manufacturer from which the physician who performed the implantation received the largest payment. For each patient group, the proportion of patients who received a device from the manufacturer that provided the largest payment to the physician who performed implantation was determined. Within each group, the absolute difference in proportional use of devices between the manufacturer that made the highest payment and the proportion of devices from the same manufacturer in the entire study cohort (expected prevalence) was calculated.

Exposures  Manufacturers’ payments to physicians who performed an ICD or CRT-D implantation.

Main Outcomes and Measures  The primary outcome of the study was the manufacturer of the device used for the implantation.

Results  Over a 3-year period, 145900 patients (median age, 65 years; 29.6% women) received ICD or CRT-D devices from the 4 manufacturers implanted by 4435 physicians at 1763 facilities. Among these physicians, 4152 (94%) received payments from device manufacturers ranging from $2 to $323559 with a median payment of $1211 (interquartile range, $390-$3702). Between 38.5% and 54.7% of patients received devices from the manufacturers that had provided physicians with the largest payments. Patients were substantially more likely to receive devices made by the manufacturer that provided the largest payment to the physician who performed implantation than they were from each other individual manufacturer. The absolute differences in proportional use from the expected prevalence were 22.4% (95% CI, 21.9%-22.9%) for manufacturer A; 14.5% (95% CI, 14.0%-15.0%) for manufacturer B; 18.8% (95% CI, 18.2%-19.4%) for manufacturer C; and 30.6% (95% CI, 30.0%-31.2%) for manufacturer D.

Conclusions and Relevance  In this cross-sectional study, a large proportion of ICD or CRT-D implantations were performed by physicians who received payments from device manufacturers. Patients were more likely to receive ICD or CRT-D devices from the manufacturer that provided the highest total payment to the physician who performed an ICD or CRT-D implantation than each other manufacturer individually.

DOI: 10.1001/jama.2020.17436

Source: https://jamanetwork.com/journals/jama/article-abstract/2772494

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