Current disparities in the prices of medical materials between Japan and the United States: further investigation of cardiovascular medical devices.

OBJECTIVES: Prices of medical devices in Japan were previously reported to be 2 to 4 times higher than those in the United States in 1996 and 1997. However, such data are out of date. We previously compared the market prices in early 2005 between Japan and the US for 16 items in 10 categories of medical materials, and showed that price differences still existed for all these items. However, the number of items investigated was small for each category, and generalization of the results might have been limited. The present study conducted a further investigation into price information for multiple items for each category, focusing on 5 cardiovascular devices. METHODS: The US market price information was obtained from interviews of a healthcare provider network and 2 different group-purchasing organizations. We could obtain price information on 19 items in 5 categories. We substituted the Japanese reimbursement prices for the Japanese market prices. RESULTS: The price ratio (Japanese reimbursement price / US market price)was 2.0-3.5 for coronary stents, 5.9-6.8 for percutaneous transluminal coronary angioplasty catheters, 2.2-3.5 for pacemakers, 1.6-2.5 for mechanical valves, and 3.4-4.7 for oxygenators. CONCLUSIONS: The price disparities for cardiovascular devices between Japan and the US were reconfirmed. Japan's healthcare system should establish group-purchasing organizations, promote centers of clinical excellence, and abolish regulation of parallel imports and protectionism under the Japanese Pharmaceutical Affairs Law.

Study on mechanical circulatory support and currently available supporting parts in China.

The research and development on extracorporeal and assisted circulation in China have been painstaking. On one hand, China has the largest population of 1.3 [corrected] billion in the world, and the demands for supporting equipment are huge. On the other hand, as a developing country, China is not wealthy. It is urgent to design and fabricate affordable circulatory support parts, machines, and artificial hearts for Chinese market. In this regard, we have made our own heart-lung machine, mechanical and tissue valves, oxygenators, and artificial hearts and their improved versions. The cost of these parts is much lower as compared with those in the Western market. Although the results of clinical application are good so far, the quality of these lifesaving parts needs to be continuously improved.

A prospective randomized study of membrane versus bubble oxygenators in children.

We studied 60 children, 2 weeks to 10 years old, prospectively by randomly assigning them to a SciMed membrane oxygenator or Harvey bubble oxygenator. Variables of cardiopulmonary bypass (CPB) were closely controlled: prime, circuit configuration, flow rate, and blood gases. Blood variables measured at eight intervals before, during, and after operation were as follows: seven plasma proteins, free hemoglobin, formed elements, and clotting functions. Preoperatively and postoperatively, we evaluated brain function (psychological testing), renal function (creatinine clearance), and pulmonary function (compliance changes and postoperative shunt function). Postoperative blood loss, fever, and length of hospitalization were also evaluated. We compared 302 variables by computer program. No difference (p greater than 0.05) between the two groups was found in any variable related to CPB or organ function (pulmonary, renal, or cerebral) or in hematological variables except free hemoglobin. After 5 and 60 minutes of CPB and the next day, it was significantly lower (p less than 0.05) in the group with a membrane oxygenator. Safety, cost, and convenience, not physiology, should be the major factors in considering membrane versus bubble oxygenators for cardiac operations in children.