Problem is that the endpoint is subjective (disposition, as EPs know, is entirely dependent upon who the doc is), so the endpoint is biased - i.e. it's not clear that the lower admission rate was due to the therapy.
But, presuming it is not an unreliable endpoint: Great! Invasive therapy reduces admissions by 5% (1 in 20). Would we want everyone to have an invasive procedure that costs about $15K and includes a 1/200 risk of major end organ damage, and a 1 in 10 chance of bleeding or other minor complication, just so that 1 in 20 people could avoid a later admission?
Doing invasive, dangerous, expensive therapies in everyone in order to avoid a hospital admission for 1 in 20 would be a strange trade-off.
Jeremiah Y., MD - January 19, 2013 9:42 AM
Readmission may not be equal to death, but if all end points are the same wouldn't you want one that avoids repeat admission?
David H Newman - January 19, 2013 10:35 AM
Good question!
Problem is that the endpoint is subjective (disposition, as EPs know, is entirely dependent upon who the doc is), so the endpoint is biased - i.e. it's not clear that the lower admission rate was due to the therapy.
But, presuming it is not an unreliable endpoint: Great! Invasive therapy reduces admissions by 5% (1 in 20). Would we want everyone to have an invasive procedure that costs about $15K and includes a 1/200 risk of major end organ damage, and a 1 in 10 chance of bleeding or other minor complication, just so that 1 in 20 people could avoid a later admission?
Doing invasive, dangerous, expensive therapies in everyone in order to avoid a hospital admission for 1 in 20 would be a strange trade-off.
Hope that answers the question.
DHN
Mazdak M., Dr - May 30, 2013 8:04 AM
Just wondering to know , what was the time frame for early invasive therapy ??