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Thursday, June 7, 2012

More tongue clucking about the cost of medical supplies: why do veterinary supplies cost so much less?

The other day at my home hospital (which I love and think does a great job of controlling costs and treating patients appropriately) I was sitting around with the intensive care unit nurses and discovered some more irksome facts about how much things cost in hospitals. I had just learned how to place a PICC line (peripherally inserted central catheter) from a nurse anesthetist. When a person is critically ill it is important to have access to the blood stream in such a way as to allow lots of fluid to go in quickly or to make sure that medications that can be irritating to small veins (like potassium and blood pressure support medications) get where they are going without causing damage. That means that a catheter (an IV) needs to go into a central vein. It can go by way of a large vein in the neck or upper chest (the internal jugular vein or subclavian vein) or it can start in a smaller vein in the arm; that catheter is a PICC line. PICC lines can get clotted off, because they are longer and go through smaller veins (maybe that's why) but have less risk of causing significant bleeding and don't result in puncturing the lung. The centrally placed catheters do have higher immediate risks, but if they are placed correctly they have some advantages. In the US, physicians (rarely midlevel providers like PAs or nurse practitioners) put in central lines and nurses put in PICC lines. Physicians almost never put in PICC lines, and will fuss around waiting for a nurse to do it even if that means delaying giving some medication unnecessarily. It's not hard to put in a PICC line, maybe easier than a central line. Maybe not. Just less risky. So it makes no sense that we don't do it, just as an option. So I learned how.

That was a bit of a tangent.

We were sitting around after putting the PICC line in and the nurse scanned the little price tag and said "You know that kit costs $1300."  Whoa! So we scanned the central line kit, a little different but not that different, and it was $879. Still too expensive, but not as expensive. I'm thinking that with nurse vs doctor putting in the line, probably placement of these catheters adds up to about the same amount of money to whoever pays the bills. How weird!

So we scanned some other things, and learned that a foley catheter bag (only the graduated plastic bag that collects the urine, not the tube that goes in the bladder) was $62 and that a regular IV, like what goes in everybody's arm when they come to the hospital, cost $40. Impressive.

I got online to see if there was some value pricing available on such things, but there is no way to access prices or even buy central lines or foley catheters online in the usual competitive marketplace that allows me to buy, say, an iPod for less than Apple would charge. I couldn't find any prices. No "buy now" button, no shopping cart. If you have to ask, you can't afford it?

After wandering around on the interwebs, lonely and frustrated, for a half hour or so, I happened on some veterinary sites, and it turns out you can buy central lines and foley catheters for non-humans online. I priced a triple lumen central line kit, about what I have used on humans, or at least it looks like it, and was able to buy one for.....$29. A central line kit consists of a finder needle, a syringe or two, a little anesthetic, a needle for anesthetizing, an introducer, a springy wire that goes into the vein and the actual central line which goes over the wire. There are sundry other items for sewing it in and such. In a human kit they also include a surgeon's gown and a large head to toe sterile drape, which isn't in the veterinary kit, but I priced those things too, on the vet site, and they cost maybe 3 or 4 dollars each. On the vet site you couldn't buy just a foley catheter bag, but the whole kit, tube and all, cost just shy of $5. A peripheral IV, the kind that costs us $40, was $1.

You can't buy PICC kits for animals, not that I found. They would be really inappropriate for animals, because they could easily reach them with their teeth and chew them out and so the whole advantage for humans would be a disadvantage for non-humans. A PICC kit is a little different than a central line kit in that the long catheter, since it is smaller and less firm, goes through a harder introducer, over the wire, and the hard introducer is then peeled away. It is clever, but I can't imagine that it is costly to make.

When I look at a central line kit I notice that the individual items are made in all sorts of places that can make stuff really cheaply, like China, Southeast Asia and the Dominican Republic. They put central lines in all over the world and I just can't imagine that in resource-poor countries they are paying close to $1000 just for a kit.

The company that produces most of the venous catheters that we use is Arrow International, which was just bought by Teleflex, an multinational multibillion dollar company that produces all kinds of interestingly manufactured products. Arrow has been in business since the 1980s and has been an innovator in the medical business since its inception. From what I read, it looks like they kind of invented the multi-lumen catheter and were the first to use polyurethane and to work out various bugs. They make dialysis catheters and intra-aortic balloon pumps which can bridge a failing heart to a life-saving operation. I don't know how much these products cost, but I'm guessing it's immense. They have been a very successful company.

The company that produces the foley (bladder) catheters that we use is Bard, and is the company that invented the technology years ago and remains active in improving it. Good for them.

So the story is complicated. Companies that are successful are also making important innovations. They are also charging obscenely huge amounts of money for objects that doctors in hospitals are dependent upon and we have no idea how much money we are spending when we use them.

I look forward to getting my box of goodies from the veterinary supply company so I can see how closely the stuff they use resembles what we use. I'm not sure how to tackle a problem like this. Competition does seem key. I'm sure we don't do it by buying veterinary equipment. Probably technologically advanced but resource limited countries have something to teach us.

1 comment:

Ajax said...

Wow! Thanks for the insightful research. Thank you for continuing to bring these important findings into the light.

I've noticed the same buying vet wrap (coban)- the same exact stuff marketed for humans is 3-4 times as expensive. It's a mighty complicated racket. Thanks for navigating those grey and murky waters for us.

This is so important! Thank you for speaking up!