The news story focuses on a recent JAMA article that reports some stroke patients would benefit from surgically removing a blood clot — via a process called endovascular thrombectomy — up to 7.3 hours after stroke symptoms appear. This is a departure from existing guidelines, which say the surgery should only be done within 6 hours of the onset of symptoms.
The story does a good job of illustrating how the new research findings may affect the current standard of care for stroke patients–though it should have been clearer about which patients are eligible for this surgery. Also, the story only addresses costs indirectly, and does not address potential risks associated with endovascular thrombectomy nor adequately quantify the potential benefits of the surgical intervention.
Strokes are a big deal. According to the CDC, strokes account for 5 percent of deaths in the United States; more than 795,000 people have a stroke each year in the U.S.; and strokes are estimated to cost the U.S. $34 billion each year. Given the number of people affected by strokes — both patients and their loved ones — new research on stroke treatment is big news. This is not only because it may reduce mortality, but because the type and quality of treatment in the hours immediately following the stroke can have an enormous impact on a patient’s independence — affecting the quality of life for both patients and their loved ones.
For all of these reasons, it is important for news about stroke treatment to clearly outline potential risks, costs and benefits associated with various treatment options. The story does a fair job here, but there is room for improvement.
The story does a lot of things right here. For example, the story notes that long-term disability caused by stroke is more expensive than the cost of hospitalization (presumably referring to hospitalization costs related to receiving endovascular thrombectomy). That’s a good point: if the surgical procedure reduces stroke-related disability, long-term costs may well be lower than the costs of the procedure (a point made in a 2016 article in the journal Neurology). Similarly, the story highlights the importance of this research (and any future research) that might encourage insurance companies to cover the cost of endovascular thrombectomy.
But while these points are important, and are worth making, the story fails to address a fundamental question: How much does endovascular thrombectomy cost? It’s tough to find clear numbers on this, but a 2011 article on the website TCTMD says that “median hospital costs in 2008 dollars were $36,999 for patients with a good outcome and $50,628 for those with severe disability.” What that means in terms of out-of-pocket costs for patients may vary widely, but given that we’re talking about tens of thousands of dollars, it’s a point worth addressing in any news story on the procedure.
Again, the story does a lot of things right here. First, it makes clear that the benefits being discussed are reduced disability. i.e., the benefit is that a patient who receives the endovascular thrombectomy in a timely way experiences less stroke-related disability in the long-term than he or she would have experienced without the intervention. Second, the story makes clear that the benefit decreases with each hour of delay in the intervention. In other words, the more time has passed between the onset of symptoms and the surgical intervention, the less benefit there is for the patient.
However, these benefits are not quantified. And that’s a sticking point. Here’s the thing: The news story is focused on the evidence that there is still benefit for patients after six hours, and up to 7.3 hours (or 7 hours, 18 minutes), of stroke symptoms. Since that is the focal point of the news story, it seems reasonable for readers to want to know what that benefit is. Instead, they’re simply told that the benefit is less than if a patient receives it earlier. Okay — how much less? What are we talking about here?
Harms aren’t discussed. Given that we’re talking about a surgical procedure, potential harms really must be discussed. Those potential harms may well be outweighed by the potential benefits, but readers should be allowed to make those decisions for themselves. It’s impossible for readers to perform a cost/benefit analysis if they’re not aware of costs (in terms of money and potential harms).
The story does a good job of capturing the essence of the work covered in the JAMA article, which evaluated outcomes from five studies. It would have been useful to note that the studies were phase 3 randomized clinical trials, but the story covers the most important bases here, including the number of patients involved and which data the study authors were evaluating. The story could have been clearer about the fact that these studies were randomized, a high quality study design.
No disease mongering here.
The story does cite one independent source, to good effect. But it missed the potential conflicts of interest noted in the study for the authors, related to research funding and fees some authors have received from relevant health care industry sources.
The story makes clear that this research was focused on comparing outcomes associated with standard medical treatment for a stroke, versus standard treatment along with endovascular thrombectomy surgery.
The story makes clear that endovascular thrombectomy is neither new nor uncommon, but doesn’t explain that the procedure is only available at certain stroke treatment centers and applies to only a subset of patients. (It tells us only “certain” patients are eligible, but doesn’t explain beyond that.)
The story makes clear that what is new here is the fact that the window of opportunity for stroke patients to benefit from endovascular thrombectomy is larger than previously thought.
The story does not appear to be based on a news release.