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Cost-effectiveness of radial vs. femoral approach in primary percutaneous coronary intervention in STEMI -
Łukasz Kołtowski1, Krzysztof J Filipiak1, Janusz Kochman1
11st Department of Cardiology, Medical University of Warsaw, Poland.
Insights
Transradial access for ST-elevation myocardial infarction is cost-effective, with lower indirect costs compared to transfemoral access. This suggests radial access may reduce the overall financial burden from a societal viewpoint.
Area of Science:
- Cardiology
- Health Economics
Background:
- Primary percutaneous coronary intervention is the preferred treatment for ST-elevation myocardial infarction.
- Transradial access has demonstrated improved safety over transfemoral access.
Purpose of the Study:
- To compare the in-hospital and indirect costs associated with transradial versus transfemoral access in ST-elevation myocardial infarction patients.
Main Methods:
- A subanalysis of the OCEAN RACE trial included 103 patients randomized to radial (n=52) or femoral (n=51) access.
- Costs were evaluated using micro-costing and indirect costs via the human capital approach.
Main Results:
- Clinical success was numerically higher in the radial group (90.4% vs. 80.4%).
- No significant differences in major adverse cardiac events or death were observed.
- Average in-hospital costs were similar, but the cost of therapeutic success was lower in the radial group (3,060 EUR vs. 3,374 EUR).
- Indirect costs were lower in the radial group (138 EUR per patient).
Conclusions:
- Total in-hospital costs were comparable between radial and femoral access groups.
- Radial access resulted in lower indirect costs, indicating a reduced societal financial burden.
- Adopting radial access as a default approach could significantly decrease the overall economic impact of ST-elevation myocardial infarction treatment.
Introduction And Objectives:
Primary percutaneous coronary intervention infarction became the preferred method of treatment for myocardial ST segment elevation. Improved safety was reported in transradial access (radial) compared to transfemoral access (femoral). The aim of this study was to compare the cost between the two access points in ST segment elevation myocardial infarction.
Methods:
This is a subanalysis of the OCEAN RACE trial in which 103 myocardial infarction patients were randomized to either the radial (n=52) or femoral (n=51) groups. The clinical safety and efficacy were recorded during the hospital stay. The procedural metrics were meticulously logged, and costs were evaluated using the micro-cost method. The indirect costs were estimated using the human capital approach.
Results:
Clinical success was numerically higher in the radial group (90.4 vs. 80.4%, p=0.123). There were no differences in major adverse cardiac events (9.6% vs. 11.8%, p=0.48) and death (2.0% vs. 6.0%, p=0.31). The average in-hospital cost per patient was 2,740 ± 1,092 EUR. The cost of therapeutic success was lower in the radial group at 3,060 EUR vs. 3,374 EUR. The indirect costs related to absence at work were 138 EUR per patient, which were lower in the radial group compared to the femoral group.
Conclusions:
The total in-hospital costs were similar between the study groups. The indirect costs were lower in the radial group. Introduction of radial access as the default approach in all centers may significantly reduce the overall financial burden from a social perspective.
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