Using transradial rather than transfemoral access for PCI saves a hospital on average $553, according to an analysis published in the March issue of the American Heart Journal. Much of the decrease in costs was attributed to a shorter post-procedural length of stay, “and that [savings] went up to $1,000 in people who were at high risk to bleed,” the senior author told Cardiovascular Business.
“From a hospital perspective, transradial is one way to drive down institutional cost,” said Steven P. Marso, MD, an interventional cardiologist at St. Luke’s Mid America Heart Institute in Kansas City, Mo .
Marso, lead author David M. Safley, MD, also of St. Luke’s Mid America, and colleagues conducted the cost comparison between transradial and transfemoral PCIs using data from the Premier research database. The database captures about 20 percent of all acute care hospitalizations in the U.S. and includes a diverse group of hospitals.
For their analysis, they used ICD-9 codes to identify patients who underwent PCI between 2004 and 2009 and designed and validated an algorithm that teased out whether the operator used transfemoral or transradial access. Patients in the transradial group (609 patients) were matched to 100 patients in the transfemoral group (60,900 patients). Researchers estimated the risk of bleeding using a variation of the National Cardiovascular Data Registry risk model and stratified patients to low (less than 1 percent), moderate (1 to 3 percent) and high (greater than 3 percent) risk of bleeding.
The primary outcome was total cost of the hospitalization on the day of the procedure through the day of discharge. They converted costs into 2012 U.S. dollars.
Overall, the transradial group had a lower rate of inhospital bleeding complications, at 1.5 percent compared with 2.3 percent in the transfemoral group. Bleeding complications by access site and risk were 0 percent for transradial vs. 0.4 percent for transfemoral in the low-risk groups; 0.8 percent vs. 1.6 percent in the moderate-risk groups; and 3.9 percent vs. 5.4 percent in the high-risk groups.
Post-PCI length of stay was lower by a difference of 0.31 days in the transradial group for all cases, and by 0.4 days in patients at high risk of bleeding.
Overall, inhospital costs using transradial access totaled $11,736 vs. $12,288 for transfemoral, for an average savings of $553. The cost of care was similar for both approaches on the day of the procedure, but post-procedure costs were much lower with transradial, mostly attributed to the decrease in post-procedure length of stay.
“What we were trying to do was get a handle on where costs savings come from a hospital perspective when transradial PCI was performed.” Marso explained. “The general answer is that the majority of cost savings can be realized by decreasing the length of stay.”
Although not statistically significant, savings trended as greater in the groups at moderate and high risk of bleeding, with a decrease in total adjusted inhospital costs of $585 for moderate-risk patients and of $1,046 for high-risk patients compared with the transfemoral approach.
The analysis did not include same-day discharges, which are possible with transradial PCI because of potentially lower bleeding and vascular complications and because the approach allows patients to ambulate quicker. As a consequence, Marso considered the cost estimates to be conservative.
While the analysis provides a contemporary look at PCI costs by access sites, it may understate the savings in a scenario that includes outpatient procedures. “The way I see this going forward is, if health systems want to recoup cost, they will convert to transradial and then have strategies in place to greatly reduce their length of stay,” Marso said, “because that is where the money is.”
The study was funded with an extramural grant from The Medicines Company.
For more on costs associated with transradial access, please read “Transradial PCI: A Handy Way to Reduce Costs” in the February 2012 issue of Cardiovascular Business.