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

Abstract

IMPORTANCELittle 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 PARTICIPANTSIn 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 MEASURESThe primary outcome of the study was the manufacturer of the device used for the implantation.RESULTS Over a 3-year period, 145 900 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.

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