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Transradial PCI associated with cost savings
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Transradial PCI was associated with cost savings of more than $800 per patient compared with transfemoral PCI in an analysis of procedures performed at five US hospitals.
Cost savings were greater for procedures performed on patients at higher risk for bleeding. Researchers identified reduced length of hospital stay as the biggest factor in cost savings, and reductions in bleeding as another factor.
“The magnitude of cost savings … may be appealing to hospitals that consider adopting [transradial PCI] for PCI,” Amit P. Amin, MD, MSc, assistant professor in the cardiovascular division at Washington University School of Medicine, St. Louis, Mo., and colleagues wrote.
The researchers performed a retrospective cohort study of 7,121 patients who underwent PCI at five US hospitals from January 2010 through March 2011. Patients who received more than one PCI procedure during a hospital stay were excluded from the study, as were patients with cardiogenic shock and chronic total occlusion.
The primary outcome was cost of PCI hospitalization, defined as costs incurred by the hospital from the day of PCI through hospital discharge. Direct and indirect costs were combined. Secondary outcomes included post-PCI bleeding within 72 hours, length of hospital stay and all-cause in-hospital mortality.
Seventeen percent of patients (n=1,219) received transradial PCI. Transradial PCI was associated with shorter lengths of stay (2.5 days vs. 3 days; P>.001) and a reduced rate of bleeding events (1.1% vs. 2.4%; adjusted OR=0.52; 95% CI, 0.34-0.79). Overall, transradial PCI was associated with cost savings of $830 per patient (95% CI, $296-$1,364). Specifically, transradial PCI was associated with procedural savings of $130 per patient (95% CI, –$99 to $361) and post-procedural savings of $705 per patient (95% CI, $212-$1,238).
Savings from transradial PCI increased the more the patient was at risk for bleeding. Transradial PCI was associated with costs savings of $642 per patient with low risk for bleeding (95% CI, $43-$1,236), $706 per patient with medium risk for bleeding (95% CI, $104-$1,308), and $1,621 per patient at high risk for bleeding (95% CI, $271-$2,971).
The researchers concluded that a hospital performing 1,000 PCI procedures per year would reap an annual savings of $80,000 to $160,000 if they increased their use of transradial PCI by 10% to 20%. Further, if transradial PCI use increases by 10% across the United States, it could mean approximately $50 million in annual savings for US hospitals.
The study’s association of transradial PCI with reduced bleeding compared with transfemoral PCI was consistent with the results of previous studies, the researchers wrote.
Steven P. Marso
“Transradial access is clearly an efficacious medical treatment strategy. Many studies have demonstrated the clinical benefits of transradial access, such as reduced bleeding and substantially lower patient length of stay,” researcher Steven P. Marso, MD, professor of medicine, University of Missouri-Kansas City at Saint Luke’s Mid America Heart Institute, said in a press release.
Disclosure: The study was funded by Terumo Medical Corp. See the full study for a list of the researchers’ relevant financial disclosures.
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