Heart surgery is $200‐300k having it twice in your lifetime because of clicking and some dirt cheap rat poison?
interesting perspective, and in societies where medical systems are publically funded I believe that there is less "informed patient choice" and more mechanical valve + Anti Coagulation Therapy.
To get answers, I often say "follow the money
From 2012: EDWARDS LIFESCIENCES REPORTS THIRD QUARTER RESULTS
• Global THV Sales Grew 50 Percent, or 66 Percent Excluding FX
• EPS Up 35 Percent, or 53 Percent Excluding Special Items
• Fourth Quarter Sales and Earnings Guidance Trimmed
“Given our updated projections, we now expect full year sales at the bottom of our previous $1.90 billion to $1.97 billion range, which represents an underlying growth rate of more than 15 percent. For the fourth quarter 2012, we project total sales of $490 million to $520 million. “We expect diluted earnings per share to be between $0.76 and $0.80 for the fourth quarter, and between $2.54 and $2.58 for the full year 2012. Full year net income growth is expected to be between 25 and 27 percent,” Mussallem added. The company’s guidance for diluted earnings per share and net income growth excludes special items and assumes renewal of the R&D tax credit.
Then from: 2013;95:S1–S66 AORTIC VALVE/ASCENDING AORTA MANAGEMENT & QUALITY MEASURES
The potential population needing AVR for severe AS is estimated at 350,000 and increasing. The exact number of aortic valve procedures, including repairs and replacements, is unknown. A number of 48,000 has been reported ; however, a number of 95,000 Medicare patients was reported in a recent publication  (Tables 2 and 3). Table 2 shows the number of valves sold to hospitals for one year (92,514).
I think there is some small errors in that table, I calculate this:
mech (all makers)
total all valves
cost per valve tissue valve
So while I know (because its in the guidelines and the subject of many studies) that in specific a age groups picking a tissue prosthesis is a reasonable choice, it does not mean that for a younger cohort its statistically a good idea. Further its well established that something like 60% of patients on a tissue prosthesis require ACT by the time they are 15 years into having that valve.
why sell a durable product to people who will mismanage their INR (contributed to by a background setting of not promoting self management) when you can make more money out of reselling valves.
I wonder when the music will stop on the funding merry-go-round of the US health care "industry".
myself "... dunno
", but I wouldn't be comfortable with relying on the status quo as the economics go forward.