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    Heart-Failure Treatment by Device

    Technological breakthroughs are changing the course of heart-failure treatment -- but doubts remain about how many people will benefit in the near future.

    Implants for Everyone?

    According to many, the biggest obstacle to the widespread use of devices in heart-failure treatment is its costs. Drug treatment is definitely cheaper, and for the short term, most people with heart failure are likely to be treated with drugs and not devices. However, costs for devices will probably drop, according to experts.

    "If you have something this effective in this large a market with more than one company making the devices," says Bristow, "the costs are going to come down."

    Many experts observe that medical breakthroughs are always followed by concerns about costs. "People said the same thing about coronary bypass surgery, pacemakers, and defibrillators," says Watson, director of the clinical and molecular medicine program in the National Heart, Lung and Blood Institute's Division of Heart and Vascular Diseases. "By cost-effectiveness analysis, pacemakers and implantable defibrillators show that they save money in the long run."

    As a society, we may also have a blinkered view when it comes to evaluating medical costs. "We have an inappropriate way of looking at the price tags for these devices," says Jay N. Cohn, MD, from the cardiovascular division in the department of medicine at the University of Minnesota Medical School. "Yes, an LVAD might cost a lot, but saving a single life with an airbag costs $25 million. That's money from taxes that we all pay to put airbags in every new car and no one raises an eyebrow at that."

    Rose agrees, and argues that the high costs depend on the comparisons we use. "If you compare implanting an LVAD with administering a measles vaccine, an LVAD is going to be a lot less cost effective," he says. "But there are other procedures that have become accepted, like radiosurgery for brain tumors, that are even costlier."

    Still, the costs are a serious impediment right now, and a great deal depends on what kind of coverage insurance companies provide. As more and more devices are developed, experts are working to devise better ways of figuring out who will benefit from them the most.

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