AICD implant

[Inderpland]

My friend who's 73 years old has developed arrythmia and the doctors strongly urge him to get an AICD (Automated implantable cardioverter defibrillator) implanted as soon as possible after a recent bout of serious arrythmia landed him in the ICU and later CCU in Bangkok Pattaya Hospital.

The hospital quoted him a price for the procedure of 700k which seems pretty steep (he has no insurance). Do any other reputable hospitals offer the same procedure for a lower price? He's a Brit so he could go home and do it for free but the doctors warn him against travelling so not sure that's an option.

Edited December 11, 2019 by Inderpland

[Curt1591]

I would go to a different facility and get a second opinion. 

As far as heading back to the UK, it wouldn't be outside the realm of possibility that the doctors just want to keep the business, rather than have the patient seek it elsewhere. You might have him contact NHS and see what they they say about travel.

 

[Sheryl]

I am actually surprised the quote at BPH was that low, I would have thought at least  1 million as depending on brand and model the device itself would usually  over 900,000 baht. Perhaps unknown to me they have a cheaper source of the device (but if so that would raise other concerns...).

 

Any procedure  will cost less at a government hospital than a private one,  but for this not by as large a margin  as for other procedures because a huge chunk of the cost is the device itself which is an expensive import.

 

If he wants to explore government hospital option he should go to Siriraj Hospital in Bangkok and consult Prof. Rungroj Krittayaphong.  There is a separate building for heart, Her Majesty Queen Sirikit Cardiac Center, and within it a device clinic on I believe the 2nd floor so he should start there. Bringing of course all records with him. If he can get BPH to tell hm the cost of the device separate from the procedure this will (1) make sure they did not underestimate or quote him for the wrong procedure (not at all uncommon if that quote came from the finance office, when they don't see the procedure on the list they often "improvise") and (2) give some idea what cost at a government hospital is likely to be - basically 1/5 BPH price of the procedure plus say 75% the BPH cost of the device (assuming they have done some mark up, they usually do but % is less the more expensive the item is to start with).

 

There are issues around the specific device used he should be aware of as some are more likely to deliver unnecessary shocks than others (i.e. shock him when he does not really need it). These shocks are felt and quite unpleasant, while that is worth going through if the alternative is sudden death it is not something he wants to undergo unnecessarily.  While there is unlikely to be much if any choice of model here in Thailand he should ask about this and the name and model number.

 

The skill and experience of the cardiologist who programs the device is also a factor, for which reason I suggest having it done by Prof. Rungroj regardless of how much savings that represents vs having it done in Patatya. (If he has it done in Thailand at all,  see below).

 

If he wants to try to contact Prof. Rungroj, googling  his name will yield an email address from some publications he has authored, not sure if current but no harm in trying.  He is also on LinkedIn.

 

 Regarding the safety of flying, it is also unsafe for him to delay this and he is unsafe at home as well...especially here in Thailand where the quality if paramedic/ambulance services is pretty  poor. I am frankly not sure it would be that much more dangerous to go into ventricular fibrillation on an airplane than at home in Thailand. Airplanes do carry defibrillators, and though time would be lost first paging for a medical professional,  he might still end up treated more quickly than if an ambulance was called to his home. (Don't tell him all this in quite these words, though).  I suggest he ask his doctors if he can be stabilized on medication and given a "fitness to fly" certificate. If not possible for him traveling alone, ask what conditions they would need to specify to certify him for travel (they can indicate for example safe to travel with medical accompaniment). It might still be cheaper to hire a nurse or doctor to accompany him than have this done here.

 

Good luck.

 

[Inderpland]

8 minutes ago, Sheryl said:

I am actually surprised the quote at BPH was that low, I would have thought at least  1 million as depending on brand and model the device itself would usually  over 900,000 baht. Perhaps unknown to me they have a cheaper source of the device (but if so that would raise other concerns...).

 

Any procedure  will cost less at a government hospital than a private one,  but for this not by as large a margin  as for other procedures because a huge chunk of the cost is the device itself which is an expensive import.

 

If he wants to explore government hospital option he should go to Siriraj Hospital in Bangkok and consult Prof. Rungroj Krittayaphong.  There is a separate building for heart, Her Majesty Queen Sirikit Cardiac Center, and within it a device clinic on I believe the 2nd floor so he should start there. Bringing of course all records with him. If he can get BPH to tell hm the cost of the device separate from the procedure this will (1) make sure they did not underestimate or quote him for the wrong procedure (not at all uncommon if that quote came from the finance office, when they don't see the procedure on the list they often "improvise") and (2) give some idea what cost at a government hospital is likely to be - basically 1/5 BPH price of the procedure plus say 75% the BPH cost of the device (assuming they have done some mark up, they usually do but % is less the more expensive the item is to start with).

 

There are issues around the specific device used he should be aware of as some are more likely to deliver unnecessary shocks than others (i.e. shock him when he does not really need it). These shocks are felt and quite unpleasant, while that is worth going through if the alternative is sudden death it is not something he wants to undergo unnecessarily.  While there is unlikely to be much if any choice of model here in Thailand he should ask about this and the name and model number.

 

The skill and experience of the cardiologist who programs the device is also a factor, for which reason I suggest having it done by Prof. Rungroj regardless of how much savings that represents vs having it done in Patatya. (If he has it done in Thailand at all,  see below).

 

If he wants to try to contact Prof. Rungroj, googling  his name will yield an email address from some publications he has authored, not sure if current but no harm in trying.  He is also on LinkedIn.

 

 Regarding the safety of flying, it is also unsafe for him to delay this and he is unsafe at home as well...especially here in Thailand where the quality if paramedic/ambulance services is pretty  poor. I am frankly not sure it would be that much more dangerous to go into ventricular fibrillation on an airplane than at home in Thailand. Airplanes do carry defibrillators, and though time would be lost first paging for a medical professional,  he might still end up treated more quickly than if an ambulance was called to his home. (Don't tell him all this in quite these words, though).  I suggest he ask his doctors if he can be stabilized on medication and given a "fitness to fly" certificate. If not possible for him traveling alone, ask what conditions they would need to specify to certify him for travel (they can indicate for example safe to travel with medical accompaniment). It might still be cheaper to hire a nurse or doctor to accompany him than have this done here.

 

Good luck.

 

Thanks so much for this informative and helpful reply. There is much information here for him to ponder.

Btw, the cardiologist in BPH said he wouldn't even be allowed on an airplane (assuming the airline knew of his condition) without an accompanying doctor. 

[Sheryl]

20 minutes ago, Inderpland said:

 

Btw, the cardiologist in BPH said he wouldn't even be allowed on an airplane (assuming the airline knew of his condition) without an accompanying doctor. 

That suggests that they might issue a Fit to Fly certificate with condition of medical accompaniment. If so push for them to say doctor or nurse. Nurses who have worked in an ICU or equivalent environment should be skilled in  defibrillation...and the devices in airports and on airplanes are much easier to use than the ones in hospitals, they are in fact designed for lay persons to be able to use.