Transradial PCI Cost Savings Come from Reduced Length of Stay, Bleeding Risk

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Percutaneous coronary intervention (PCI) via the transradial route saves hospitals over $800 per procedure, mainly due to the shorter length of stay and reduced bleeding risk that come with the radial access route. The cost analysis was published online July 17, 2013, in JACC: Cardiovascular Interventions.

Researchers led by Steven P. Marso, MD, of Saint Luke’s Mid America Heart Institute (Kansas City, MO), looked at 7,121 PCI procedures performed at 5 US hospitals from January 1, 2010, to March 31, 2011. They compared the cost on the day of PCI through hospital discharge in patients receiving transradial (17%) vs. transfemoral (83%) PCI.

In-hospital bleeding was roughly halved in the transradial vs. transfemoral group (1.1% vs. 2.4%; P = 0.006), a difference that remained significant after adjustment for inverse probability weighting (OR 0.52; 95% CI 0.34-0.79; P = 0.002). Unadjusted in-hospital mortality was also lower in the transradial group, but the difference missed statistical significance (0.3% vs. 0.8%; P = 0.095). Length of hospital stay was a half-day shorter in the transradial vs. the transfemoral group (2.5 vs. 3.0; 95% CI 0.25-0.72; P < 0.001), while the transradial group enjoyed a higher rate of same-day discharge (4.4% vs. 2.8%; P = 0.001). The biggest difference in adjusted length of stay favoring transradial PCI was seen in patients at high risk for bleeding (-0.86 days; P = 0.006). This was followed by low-risk patients (-0.4 days; P < 0.001) and moderate-risk patients (-0.09 days; P = 0.7).

Transradial Saves Money

Total unadjusted costs were $1,541 lower with transradial vs. transfemoral PCI (95% CI $1,052 to $2,031; P < 0.001). This gap narrowed after risk adjustment. Transradial PCI resulted in procedural cost savings of $130, but this difference was not significant (P = 0.112). However, the $705 savings in postprocedural costs with transradial PCI was significant (95% CI $212 to $1,238; P < 0.001). The higher the bleeding risk, the greater the savings achieved in transradial patients (table 1).

Table 1. Adjusted Hospital Cost Savings by Bleeding Risk

 

Radial

Femoral

Difference Between Radial and Femoral

P Value

All Patients

$14,954

$15,784

$830

< 0.001

Low Risk, (< 1%)

$14,074

$14,716

$642

0.035

Moderate Risk (1% to 3%)

$15,161

$15,867

$706

0.029

High Risk (> 3%)

$16,115

$17,776

$1,621

0.038


Twelve percent of the total cost savings ($99) stemmed from decreased bleeding, and half of the cost savings ($414) was due to the shorter length of stay among transradial patients.

Assuming the current study results are validated regarding the roughly $800 savings per procedure with transradial PCI, the study authors note that “US hospitals could realize nearly $50 million in added savings. . . .” adding that “For hospitals performing 1,000 PCI procedures annually, a 10% to 20% [transradial] adoption rate would imply incremental savings of $80,000 to $160,000 per year. These potential savings are meaningful, as hospitals modify staffing and post-PCI discharge patterns or initiate same-day discharge protocols.”

The magnitude of the potential cost savings is large, they stress, “and should be of considerable interest to policy makers, payers, and, most importantly, hospitals implementing [transradial] programs.”

Ian C. Gilchrist, MD, of Hershey Medical Center (Hershey, PA), expressed surprise that more cost savings did not come from reductions in bleeding. “There’s a little bit of savings in the actual procedure but most of it seems to be in reducing length of stay,” he told TCTMD in a telephone interview. “I thought the bleeding event itself was going to cost a lot of money but it was overall length of stay reduction that really did it.”

More Transradial Could Equal More Savings

What was also striking, Dr. Gilchrist added, was how much additional money could be saved. “This group was able to show a fair bit of savings but they only did 17% radial,” he said. “I know hospital operators in other parts of the world who do 90% to 95% transradial. If you think about the savings of $800 a patient, there’s 600,000 PCIs in the United States. If you figure 80% of them could be done radially, and then you think, could we widen that $800 margin with more efficient care processes?”

The point, he emphasized, is that the cost savings could be significant on a system-wide basis. “We’re not talking about saving a couple of dollars per patient; this is real coinage here. If your hospital’s doing 1,000 angioplasties per year and suddenly could save $800 per procedure, that’s $800,000,” Dr. Gilchrist said. “That’s in one year, and that’s a recurrent savings. You could hire quite a few nurses, a couple doctors, you could do a lot of things. You could get yourself a spanking new cath lab, and that’s just one hospital.”

Just as important, he observed, is that reimbursement would not change. “No one’s pointing out reductions in reimbursement,” Dr. Gilchrist stressed, “With reimbursement sitting just where it is, you could save a lot of money by altering your care process, and that money could be reinvested.”

Study Details

Transradial patients were younger and less likely to undergo primary PCI for STEMI; had fewer risk factors and comorbidities; and had higher eGFR and lower risk of bleeding compared with transfemoral patients.

The 5 US hospitals included in the study were:

  • Saint Luke’s Mid America Heart Institute (Kansas City, MO)
  • Spectrum Health (Grand Rapids, MI)
  • Wake Forest Baptist Medical Center (Winston-Salem, NC)
  • Presbyterian Healthcare (Charlotte, NC)
  • Aurora Baycare Medical Center (Green Bay, WI)

 


Source:
Amin AP, House JA, Safley DM, et al. Costs of transradial percutaneous coronary intervention. J Am Coll Cardiol Intv. 2013;Epub ahead of print.

 

 

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Disclosures
  • The study was supported by an unrestricted research grant from Terumo Medical.
  • Dr. Marso reports receiving funding paid directly to the Saint Luke’s Hospital Foundation of Kansas City for research activities from Amylin Pharmaceuticals, Novo Nordisk, St. Jude Medical, Terumo Medical, The Medicines Company, and Volcano.
  • Dr. Gilchrist reports receiving consulting fees from Terumo and The Medicines Company.

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