Implantable cardioverter-defibrillator: A Volkswagen or a Rolls Royce: how much will we pay to save a life?

A45-year-old man with end-stage cardiomyopathy died while waiting for a heart transplant after living almost 1 year in a coronary care unit supported by intravenous medications. Around the time of his death, an off-duty police officer in a neighboring town watching a high school football game saw one of the player’s fathers slump forward unconscious. The officer ran to his patrol car, grabbed the automated external defibrillator he had recently been assigned, and defibrillated the father’s ventricular fibrillation. The man immediately regained consciousness and protested being taken to the hospital because he wanted to watch his son finish the game! These extremes provide dramatic bookends to the spectrum of how we spend money to save a life. Some therapies are inexpensive and others are not, and society has to make difficult choices about how to use our limited resources.