• Direct to consumer advertising (DTCA) for robotic CABC (r-CABG)

    Robots in your chest, repairing your heart vessels.displayItemThis study (Robert Poston is the corresponding author) finds that DTCA of r-CABG is effective in bringing patients to the hospital:

    Between July 2008 and July 2009, a total of 103 potential patients, or their representatives, contacted our office as a consequence of the DTCA campaign, and requested a formal consultation from our office. Most of these were considered a “second opinion” consultation. After completing the consultation, 71 of the DTCA responders were found to be appropriate candidates for r-CABG and 54 (76%) went on to have r-CABG surgery at BMC, while the remainder chose to not have surgery at our center. Additionally, two patients had self-referred to the center in response to the ad, though for cardiac surgical procedures other than CABG (valve replacements).

    During the study period, there were 934 CABG procedures in Massachusetts involving 1 or 2 bypass grafts. Assuming that most of these cases would have been candidates for r-CABG, the DTCA campaign generated 71 qualified leads (a 7.6% potential share of the market) with 54 actual converted leads (a 5.1% actual share of the potential market).

    Moving 5.1% of the Boston CABG market via DTCA is a strong marketing result.

    In other results, the r-CABG patients were younger, healthier and wealthier.  After controlling for these factors, clinical outcomes were similar but the r-CABG patients were slightly less satisfied after 6 months, having expected smaller skin incisions and quicker recovery from the robotic surgery.

    In short:  effective marketing, but no proof of  superior efficacy. People buy robots, even absent evidence that they are better.

    See the prior TIE coverage of agency cost issues in robotic surgery.


    • This study shows that advertising works! (duh)
      As you point out, it may be selling you something that is more expensive and less effective than the standard tried and true procedure.

      • Yes, silly.
        Though I can see why some might doubt. After all, a lot of the pharmaceutical commercials, first of all, make me hope I never have the issues that would call for them, but second, make me hope there’s more alternatives!!

        So I’m trying to wrap my head around people getting excited about having robotic surgery, period.
        Setting aside any efficacy issues, or any present or potential benefits…
        I’m assuming of course that people are generally, like me, horrified by ANY surgery. But I really hadn’t thought society at large had gotten this comfortable with the idea of robots doing it.
        So maybe that’s the real result of the advertising study?
        I’m assuming of course that advertising, while effective, can’t necessarily overnight change an embedded popular attitude with one campaign. Maybe I’m wrong about that though.

    • But wait! Won’t the Republicans cite this as an example of how well the market works in health care? Maybe not.

      Thanks to TIE for exploring the role of the medical-industrial complex in giving the US the highest per capital health care spending in the world, despite mediocre outcomes.

    • Fortunately, medicine is a profession, and its practioners are serious about their responsibility to bring the best evidence based science to their craft free of the influence of fads, trends, or profiteering.