The cost per year of quality life for giving ICDs only to risk-stratified patients who had been tested with MTWA was about $50,000, compared with medical therapy. 'This is well within the usual range considered cost-effective for new medical technologies,' said the study's lead author.

The test actually could save Medicare hundreds of millions of dollars in the long run, suggests a study led by University of Michigan researchers.

The team used a sophisticated computer model to calculate the potential impact of using the test MTWA to help determine which patients would benefit most from implanted devices that automatically re-start a stopped heart.

Those devices, called implantable cardioverter defibrillators, or ICDs, have been shown to save lives that would otherwise have been lost to sudden cardiac death, which kills 300,000 Americans each year.

Risk Stratification

Medicare expanded its coverage of ICDs a year ago, and an estimated 500,000 people over age 65 are now candidates to receive this device. ICDs cost $35,000 including implantation. They require periodic battery replacement and pose a device failure risk. Covering the cost of ICDs for patients who have the same characteristics as participants in the trial that led to Medicare approval could add $3 billion annually to the program's budget.

A significant fraction of those costs could be spared if doctors focused on providing ICDs only to patients with an abnormal or inconclusive MTWA test result, the researchers suggest in a presentation at the American College of Cardiology (ACC) Scientific Session. Previous studies have suggested that patients with a negative, or normal, MTWA test result have a far lower risk of sudden cardiac death than others.

Risk stratification could potentially save Medicare $690 million a year -- even after the costs of the MTWA test and the care of patients who don