I was watching the NBC Nightly News the other night and saw a Stryker ad for its GetAroundKnee.com. I couldn’t find the TV commercial online, but this is from their website:
That same day, I found this ad in the July issue of Prevention magazine.
Together, hip and knee replacement surgeries already represent the largest hospital expense for Medicare. And, according to an article in Time magazine, the money spent on these two procedures is expected to reach $65.2 billion by 2015.
There is no doubt that part of Medicare reform will involve looking at ways to reduce this cost. One approach is to move the choice of device away from vague “physician preference” and toward evidence-based criteria. The goal will be to use comparative-effectiveness studies to identify which implants are the best-performing, longest-lasting and most cost-effective devices. Many countries have established national registries for hip and knee implant surgeries that include a record of each surgery, the type of device used and reports of complications. Such a registry would improve patient safety and quality of care, according to a report by Kaiser Permanente researchers that was published in November in the Journal of Bone and Joint Surgery. It would make it easier to counsel patients, identify risk factors, track implanted devices during recalls and assess comparative effectiveness of devices, according to lead author Elizabeth Paxton, director of surgical outcomes and analysis at Kaiser.
The American Joint Replacement Registry was created recently, and just this January began a pilot project collecting hip and knee replacement information from 16 representative hospitals. In a statement, the organization (made up of surgeons, executives from the device industry, payers and patient representatives) said that its “long-term goal is to capture data from 90 percent of U.S. hospitals where hip and knee arthroplasty procedures are performed, which amounts to between 5,000 and 6,000 different hospitals, in the next 5 years.”
In the end, marketing devices directly to consumers is antithetical to these other measures that are designed to promote evidence-based treatments. One argument that drug companies have always made to support their (direct-to-consumer) DTC ads is that they are “educational” for consumers. And there may in fact be men in their 40’s or 50’s with degenerative hip disease or other painful, disabling condition that learn about hip resurfacing from a TV ad. Maybe they find out that they don’t have to spend 15 more years disabled as they wait for a total hip replacement. These newly educated fellows may then go to an orthopedic surgeon who (with no conflict of interest) helps them decide whether this is the right approach for them. That is educational.
But DTC ads cast a very wide net. And they work to draw in a wide customer base, raising expectations and brushing over risks and cheaper options. If they didn’t do this, companies like Smith & Nephew wouldn’t spend millions running them. Unless insurers—both public and private—start using evidence-based decision making to set coverage for new hip implant devices, the number of younger patients undergoing more expensive procedures will likely rise—sometimes for the wrong reasons.
We’ll continue to watch.
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