Why isn't there a cheap AED (Automated External Defibrillator)?
April 6, 2015 7:18 PM   Subscribe

I've been shopping for AEDs and they're all extremely expensive. In theory an AED is just a battery, some circuitry, a case, and the pads, right? Couldn't a much cheaper one be made? I would think someone could have designed a much more affordable one. Am I missing something?
posted by Slinga to Health & Fitness (21 answers total) 1 user marked this as a favorite
The software that makes it automated?
posted by harrietthespy at 7:20 PM on April 6, 2015

I work for an AED company. The regulatory hoops that we have to go to are considerable, seeing as how this is a little box that can kill you. We have entire departments devoted just to regulatory paperwork for the FDA.

Also, AEDs, like prescription medications, must be prescribed by a doctor. Anything that has to do with health care expenses makes the price go up.

And finally, there's that pesky medical device tax, which doesn't help either.

Lots of reasons.
posted by Melismata at 7:24 PM on April 6, 2015 [24 favorites]

Am I missing something?

Yes. The price of an object is not a function of the components of that object. It is a function of many things with the amount the market can bear being most prominent.

An object isn't expensive because it has expensive innards. An object is expensive because people will pay a lot of money for that object.
posted by saeculorum at 7:26 PM on April 6, 2015 [3 favorites]

Also, I would think the manufacturer is insured out the wazoo since they're likely to be sued when someone misuses the device. And of course the "market" is not just what people will pay, but what people will sell for. The market price is the intersection of those two curves. Given the costs besides design and manufacturing that manufacturers have, the supply curve will be high. Given the life-saving potential and the fact that that many consumers won't pay for their devices and thus may not care too much about the price, the demand curve is high. This the equilibrium point is high.

This comment is in no way an endorsement of it's-all-supply-and-demand-and-the-entire-world-is-kept-in-order-by-an-invisible-and-ultimately-benign-hand quackery. .
posted by If only I had a penguin... at 7:37 PM on April 6, 2015 [2 favorites]

Melismata, what about AED's that are in offices or security stations, first aid stations, etc... presumably those are not prescribed by doctors, correct? I was under the impression that companies ordered those as part of their disaster recovery kits.
posted by vignettist at 7:53 PM on April 6, 2015

Yeah, AEDs in the US are not prescription. I can go on Amazon right now and buy one.

Another thing that makes AEDs so expensive is that there's sophisticated sensing of the heart rhythm that allows the device to trigger only when appropriate -- i.e., not on someone who has a normal heart rhythm, and at the optimal point in a faulty rhythm to get it back in sync. Otherwise it would be a crazy dangerous thing to have in the hands of the public. As it is, if you put an AED on a healthy person and push the button the device will refuse to go off. They also talk you through where to place the pads so that they're effective -- because it would suck to use an AED and not save someone because you placed the pads wrong.
posted by katemonster at 8:02 PM on April 6, 2015 [14 favorites]

Also, AEDs, like prescription medications, must be prescribed by a doctor.

Not true.
posted by Jacqueline at 8:44 PM on April 6, 2015

The regulatory and liability issues far exceed the component price.
posted by bitdamaged at 8:49 PM on April 6, 2015 [4 favorites]

There are thousands and thousands of smart engineers who go to work every day making sure devices like AEDs are perfect. Every capacitor is sourced from a premium domestic manufacturer, every copper lead is tested for degredation under every possible condition, and every line of code is checked and re-checked. The whole thing is tested together on electronic and animal models under every condition they can think of. If the slightest defect comes up, they have to fix it and file mountains of paperwork. That's not cheap.
posted by miyabo at 8:58 PM on April 6, 2015 [2 favorites]

Also, the AED will only activate when the specific type of heart problem is present. If the person is passed out but has no heart trouble, or their heart is stopped altogether, the AED will not activate. Basically it's doing instant automated diagnosis!
posted by wnissen at 9:16 PM on April 6, 2015

Miyabo, you are seriously overstating the level of "perfection" involved in developing medical devices, particularly with regards to software.

And I'm kind of surprised to hear people citing regulation as a major factor in the cost when the FDA only very weakly regulated AED's until January of this year, prompted by the industry's inability to fix long standing problems on their own.
posted by Poldo at 6:10 AM on April 7, 2015

I'm just not having the same initial reaction to the price that you are. Skimming through Amazon, it looks like an AED runs for about $1k? And it's a device that diagnoses your heart's rhythm and decides whether to shoot electricity into it to restart your heart and save your life? That price is comparable to a plastic whitewater kayak. Or a good suit, which is made out of sheep. The price just doesn't seem patently unreasonable to me.
posted by craven_morhead at 7:45 AM on April 7, 2015 [2 favorites]

In theory an AED is just a battery, some circuitry, a case, and the pads, right?
I would call such a device an "ED." The extra expense is for the "A".
posted by fantabulous timewaster at 7:51 AM on April 7, 2015

I'd also like to second craven_morhead: take a look at prices for electric vehicle chargers, which are essentially a few basic components operating at high voltages. They're easily $800+ unless you go for the DIY route.

Part of this is a supply-demand thing. Few people have EVs, so the otherwise basic connectors (like the plastic handle that connects to the car) seem more expensive than they "should" be, but that impression is because you're used to injection-molded plastic components being unreasonably cheap in every other respect, due to huge volumes with no, or negative, profit margins.

The same is true of the AED components. They're high quality, relatively low volume (as compared to say, a consumer laptop or television), and they have a positive profit margin built in.
posted by odinsdream at 8:19 AM on April 7, 2015

Seconding wnissen. Just did CPR training, including using the AED, and it does heart rate monitoring (plus verbal guidance though I suspect that bit doesn't add a lot to production costs). No idea how much all that's worth, but it's definitely more than a battery, case and circuitry.
posted by pennypiper at 8:48 AM on April 7, 2015

Sorry, I may have been inaccurate about the prescription information. However, there's still plenty of work for our employees to do. According to our AED customer manual:

"U.S Federal Law (21 CFR 821) requires the tracking of defibrillators. As an owner of this device, you have the responsibility under this law to notify [my company] if this product has been received, lost, stolen or destroyed or has been donated, resold or otherwise distributed to a different organization."

So in addition to a large regulatory department (which will now be larger, thanks to the new regulations cited in Poldo's links), we also have to have a department that keeps track of all the devices that we have sold to anyone, anywhere, since we started selling them >20 years ago. These things cost money.
posted by Melismata at 8:51 AM on April 7, 2015

(plus verbal guidance though I suspect that bit doesn't add a lot to production costs)

Well, a little. We have to hire professional voice recorders for ~50 voice prompts (per language), have software engineers incorporate that into the code, have other engineers test it, send the recordings around to staff members for approval, have someone write a check to pay them...you get the idea.
posted by Melismata at 8:54 AM on April 7, 2015 [2 favorites]

I recently got recertified in CPR, which included how to use an AED.
The instructor told us that used ones can be purchased relatively inexpensively at our local university's resale warehouse because the U has to, by law, replace all of their AED's with new ones every year.
BTW if you ever need to use one, don't hesitate. The recording gives very clear instructions, is virtually fool proof, and is a literal life saver.
posted by Otterone at 5:50 PM on April 7, 2015

BTW if you ever need to use one, don't hesitate. The recording gives very clear instructions, is virtually fool proof, and is a literal life saver.

Seconding this. I'd imagine a huge amount of work (and money) went into getting it so seamless and foolproof. It's not like a recording that just accompanies a machine you have to operate, its like having a really calm and competent instructor with you who is caring for the patient and teaching you at the same time. When they brought it out at my first aid training course it made me realise that even someone so unfortunate as to have me be the only bystander had some hope if one was around.
posted by kitten magic at 2:43 AM on April 8, 2015

Oh, wait. According to Poldo's last link:
Another deterrent is that many AEDs are labeled “For use by trained personnel only.” These labels arose because virtually all AEDs are prescription-only devices, bought under the authority—and responsibility—of a medi­cal officer at the airport, mall, or school. If an AED were somehow misused—or even correctly used by someone not explicitly authorized by the ­prescribing physician—that doctor could be held legally liable and theoretically even lose his or her medical license.
So I guess a prescription is needed.
posted by Melismata at 12:35 PM on April 14, 2015

Our church just bought one, we certainly don't have an attending physician or a prescription for it. It's not labeled specially for only certain people to use.
posted by odinsdream at 1:19 PM on April 14, 2015

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