Cost effectiveness of radial access for diagnostic cardiac catheterization and coronary intervention

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Interventional Cardiology

Background:

• Radial artery (RA) access for CATH and PCI offers fewer access site complications than femoral artery (FA) access.
• However, RA access may increase procedure time and resource utilization, raising cost concerns.
• The net economic impact of RA versus FA access remains to be fully elucidated.

Purpose of the Study:

• To compare the cost-effectiveness of diagnostic cardiac catheterizations (CATH) and percutaneous coronary interventions (PCI) using radial artery (RA) versus femoral artery (FA) access.
• To determine if the benefits of reduced complications with RA access outweigh potential increases in procedural costs.

Main Methods:

• A retrospective analysis of 6,726 CATH and PCI procedures (RA: 3,368; FA: 3,358) performed between January 2009 and December 2011.
• Propensity-matched analysis compared procedural costs and access site complication costs for CATH (n=1,222) and PCI (n=570) during a lab-wide transition from FA to RA preference.
• Costs were evaluated throughout the transition period, capturing both procedural and complication-related expenses.

Main Results:

• RA access for CATH was associated with a non-significant $10 increase in mean total costs compared to FA access.
• RA access for PCI demonstrated significant cost savings, with mean total costs $732 lower than FA access.
• RA access was economically dominant for PCI and overall procedures, yielding lower costs and fewer complications than FA access.

Conclusions:

• Radial artery access for CATH and PCI is an economically advantageous strategy.
• It effectively reduces access site complications and overall procedural costs compared to femoral artery access.
• This approach offers a superior economic profile while maintaining similar clinical and procedural characteristics.