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Transradial PCI Saves Money Compared with Transfemoral Access

By L.A. McKeown

CHICAGO, IL—Using the transradial approach for percutaneous coronary intervention (PCI) has been associated with less bleeding compared with the transfemoral approach, but new data suggest that it also saves healthcare dollars—about $553 per case—particularly for those at highest bleeding risk, according to a study presented March 24, 2012, at the annual American College of Cardiology/i2 Scientific Session.

David M. Safley, MD, of the Mid America Heart and Vascular Institute (Kansas City, MO), and colleagues compared actual hospital costs in the United States for transradial and transfemoral PCI. Using an inpatient administrative database that includes approximately one-sixth of all US hospitalizations, they identified PCI patients treated from 2004 to 2009. Of these, 60, 900 were treated transfemorally and 609 were treated transradially. Each transradial patient was propensity matched to several transfemoral patients on a long list of relevant variables.

Although there are no CPT codes for type of access, available data included center-level charges for radial equipment such as hydrophilic-coated sheaths and hemostasis bands, and medications such as vasodilators. Total costs were considered to be all costs from admission through discharge.

The groups were well matched in most areas, but Dr. Safley reported a slightly lower percentage of Caucasians and transfer patients in the radial group along with a slightly higher percentage of obese patients.

Significant Savings Seen

When total hospital costs were compared, there was a significant cost savings of $553 per case favoring the transradial group (P = 0.033).

In a secondary analysis of patients at low (< 1%), moderate (1%-3%) or high (> 3%) bleeding risk, there was no signal of a cost savings in the low-risk group (P = 0.419). However, there was a trend for significance in both the moderate and high risk groups (P = 0.071 and P = 0.086, respectively).

Cost data were further broken down by admission through day of PCI and post-PCI. Overall, there was no difference in admission through day of PCI costs based on access (P = 0.920) and no difference for any of the bleeding risk categories. However, for the post-PCI period, there was a $571 cost savings per case associated with the transradial approach (P = 0.001). Again, there was no cost signal for the group at low risk of bleeding, but the savings for the moderate and high risk groups were $478 (P = 0.022) and $917 (P = 0.045) per case, respectively.

Length of stay post-PCI also favored the transradial group, saving about one-third of a day of hospitalization (P < 0.001), with a similar savings seen in the moderate bleeding risk group (P = 0.002). A length of stay savings was not seen in the low-risk group and was only a trend in the high-risk group.

In terms of clinical outcomes, there was no significant difference between the access groups in bleeding or mortality, although there was a trend toward more bleeding with the transfemoral approach and a doubling of mortality but “the numbers are small and it’s certainly not statistically significant,” Dr. Safley said.

‘David and Goliath’

He added that although the data require further study, he believes much of the cost savings in the radial patients likely comes from less need for further in-hospital testing and equipment after the procedure.

Session co-chair Robert J. Applegate, MD, of Wake Forest Baptist Medical Center (Winston-Salem, NC), described the study as a “David and Goliath comparison in terms of the numbers” and commented that cost savings alone is not a gauge of better clinical outcomes.

Dr. Safley agreed, saying the study is “a good administrative view of these procedures and hopefully we’ll have access to some more clinical databases in the future to address that.”

 

 

 

Source:Safley DM. Economic impact of transradial percutaneous coronary intervention. Presented at: American College of Cardiology Annual Scientific Session/i2 Summit; March 24, 2012; Chicago, IL.

 

 

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