Wrist or groin? Kudos to release on angioplasty routes for paying close attention to costs

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The main benefit discussed here was the cost savings since that was the focus of the study. But what are the tangible benefits to patients who might be facing this procedure? The claims made are backed up by estimates of the cost savings based on the 9% of PCI patients that had the procedure using the wrist method. The first author of the study mentions reduced bleeding and fewer complications from angioplasty procedures that use the wrist artery and discharge patients on the same day, but it doesn’t provide any numbers for a reference point.

The published report stated that bleeding at the arterial site, the most common problem examined, occurred in 1.4% of patients receiving the lower cost wrist procedure and in 3% of those receiving the traditional groin entrance procedure (use of the femoral artery and at least one overnight hospital stay). While the complication rates are pretty low in both procedures, it’s something that could have been better explained in the release.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The news release does not discuss any possible downsides associated with the new technique. Although the disadvantages of using the wrist rather than the groin approach are minor and perhaps not clinically relevant for most people, it would have been better for the release to at least mention them.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

The release does an adequate job of explaining how the costs savings were calculated and how researchers gathered their data for the analysis. It states:

“The analysis demonstrated an average cost of $13,389 for the wrist approach with same-day discharge, compared with $17,076 for the groin approach with at least one night of hospitalization, resulting in a cost savings of about $3,700 for outpatients who get the wrist-access procedure. Independent of the length of stay, the wrist approach costs about $900 less than the groin approach, on average.”

However, this was an observational study, which has important limitations. The researchers discussed this in the study, and the release should have included it, too.

From the study: “First, the observational nature of these data may be subject to selection bias and unmeasured confounding, despite rigorous exclusions and propensity score methods with IPW to adjust for confounding associated with TRI use and SDD. Propensity score methods do not account for unmeasured confounding or selection bias (45–47).”

Does the news release establish the true novelty of the approach?

Not Satisfactory

The idea of going through the wrist is not novel. In fact, the main author published a very similar paper in 2013  and others have done similar work.

There is a large body of evidence on this issue and the news release could have acknowledged that.