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Transradial access lowered cost, shortened length of stay vs. transfemoral
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Transradial stent access was associated with lower average direct hospital costs and shorter length of hospital stay compared with transfemoral access, and post-procedure costs were lower in patients at greater bleeding risk, according to data from a nationwide administrative hospital database.
To determine the economic implications of transradial intervention (TRI) in contemporary practice, researchers conducted a retrospective inpatient cohort analysis from a database that contains information for about one-fifth of all acute care hospitalizations in the United States annually.
Patients with TRI who had undergone PCI from 2004 to 2009 were identified by center-level charge codes for radial-specific devices and matched one-to-many with patients undergoing transfemoral intervention (TFI). Adjusted total hospitalization costs were compared, and patients were classified by periprocedural risk of bleeding as low (<1%), moderate (1%-3%) and high (>3%).
Among the 609 TRI cases and 60,900 TFI cases, total adjusted costs for TRI were $11,736 ± $6,748 vs. $12,288 ± $23,418 for TFI, a difference of $553 favoring TRI (95% CI, 45-1,060). Day-of-procedure costs were $17 higher for TRI compared with TFI (95% CI, −318 to 353). Costs from the following day until discharge were $571 lower for TRI (95 % CI, −912 to 229). Additionally, post-procedure costs were $478 lower for patients with TRI vs. patients at moderate risk for bleeding (95% CI, −887 to 69) and $917 lower for patients at high risk of bleeding (95% CI, −1,814 to 19).
“Such findings are consistent with previous work evaluating therapeutic interventions in PCI patients at elevated periprocedural risk of bleeding treated with bivalirudin,” the researchers wrote. “Similarly, our results demonstrated differences in costs as a function of bleeding risk.”
Disclosure: Safley reports no relevant financial disclosures.
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