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Comparison of costs between transradial and transfemoral percutaneous coronary intervention: a cohort analysis from
David M Safley1, Amit P Amin, John A House
1St. Lukes's Mid America Heart Institute, St Luke's Hospital, Kansas City, MO, USA.
Insights
Transradial intervention (TRI) for percutaneous coronary intervention (PCI) is more cost-effective than transfemoral intervention (TFI). TRI is associated with lower overall hospitalization costs, particularly in patients with higher bleeding risks.
Area of Science:
- Cardiovascular Interventions
- Health Economics
- Interventional Cardiology
Background:
- Transradial intervention (TRI) for percutaneous coronary intervention (PCI) offers benefits like shorter hospital stays and reduced bleeding.
- However, the economic implications of contemporary TRI practice require further investigation.
Purpose of the Study:
- To compare the total hospitalization costs of transradial intervention (TRI) versus transfemoral intervention (TFI) in a large, nationwide inpatient cohort.
- To analyze cost differences based on periprocedural bleeding risk.
Main Methods:
- Retrospective analysis of US acute care hospitalizations from the Premier research database (2004-2009).
- Matched cohort analysis comparing TRI (n=609) with transfemoral intervention (TFI) (n=60,900) undergoing PCI.
- Adjusted total hospitalization costs and periprocedural bleeding risk were compared.
Main Results:
- Total adjusted hospitalization costs were $553 lower for TRI ($11,736 ± $6,748) compared to TFI ($12,288 ± $23,418) (P = .033).
- While day-of-procedure costs were similar, costs from the day after through discharge were significantly lower for TRI (-$571, P = .001).
- Postprocedure costs were reduced for TRI in moderate (-$478, P = .022) and high (-$917, P = .045) bleeding risk groups.
Conclusions:
- Transradial PCI access is associated with lower average direct hospital costs and shorter lengths of stay compared to transfemoral PCI access.
- TRI demonstrates cost savings, especially in patients with increased bleeding risk, supporting its economic advantage.
Background:
Transradial intervention (TRI) for percutaneous coronary intervention (PCI) is associated with shorter length of stay, fewer bleeding complications, and higher patient satisfaction. Less is known about the economic implications of TRI in contemporary practice.
Methods:
This is a retrospective inpatient cohort analysis using medical data from the Premier research database (Premier Inc, Charlotte, NC), which contains approximately one-fifth of all acute care hospitalizations in the US annually. The database was queried to identify patients undergoing PCI from 2004 to 2009. Patients with TRI 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 between patients undergoing TRI and TFI. Patients were additionally classified by periprocedural risk of bleeding as low (<1%), moderate (1%-3%), and high (>3%).
Results:
There were 609 TRI cases matched with 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, P = .033). Day-of-procedure costs were similar, at $17 higher for TRI compared with TFI (95% CI -$318 to $353, P = .37); however, costs from the following day until discharge were significantly lower for TRI (-$571, 95 % CI -$912 to $229, P = .001). Postprocedure costs were lower for patients with TRI vs patients with TFI at moderate (-$478, 95% CI -$887 to $69, P = .022) and high (-$917, 95% CI -$1,814 to $19, P = .045) risk of bleeding.
Conclusions:
In a nationwide administrative hospital database, transradial compared with transfemoral PCI access was associated with lower average direct hospital costs and shorter length of hospital stay. Postprocedure costs associated with TRI were also lower in patients at greater bleeding risk.
