Clinical Research
Costs of Transradial Percutaneous Coronary Intervention

https://doi.org/10.1016/j.jcin.2013.04.014Get rights and content
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Objectives

This study sought to evaluate the costs of transradial percutaneous coronary intervention (TRI) and transfemoral percutaneous coronary intervention (TFI) from a contemporary hospital perspective.

Background

Whereas the TRI approach to percutaneous coronary intervention (PCI) has been shown to reduce access-site complications compared with TFI, whether it is associated with lower costs is unknown.

Methods

TRI and TFI patients were identified at 5 U.S. centers. The primary outcome was the cost of percutaneous coronary intervention (PCI) hospitalization, defined as cost on the day of PCI through hospital discharge. Cost was obtained from each hospital’s cost accounting system. Independent costs of TRI were identified using propensity-scoring methods with inverse probability weighting. Secondary outcomes of interest were bleeding, in-hospital mortality, and length of stay, which were stratified by pre-procedural risk and PCI indication.

Results

In 7,121 PCI procedures performed from January 1, 2010, to March 31, 2011, TRI was performed in 1,219 (17%) patients and was associated with shorter lengths of stay (2.5 vs. 3.0 days; p < 0.001) and lower bleeding events (1.1% vs. 2.4%, adjusted odds ratio [OR]: 0.52, 95% confidence interval [CI]: 0.34 to 0.79; p = 0.002). TRI was associated with a total cost savings of $830 (95% CI: $296 to $1,364; p < 0.001), of which $130 (95% CI: –$99 to $361; p = 0.112) were procedural savings and $705 (95% CI: $212 to $1,238; p < 0.001) were post-procedural savings. There was an associated graded increase in savings among patients at higher predicted risk of bleeding: low risk: $642 (95% CI: $43 to $1,236; p = 0.035); moderate risk: $706 (95% CI: $104 to $1,308; p = 0.029); and high risk: $1,621 (95% CI: $271 to $2,971, p = 0.039).

Conclusions

TRI was associated with a cost savings exceeding $800 per patient relative to TFI. Increased adoption of TRI may result in cost savings at hospitals.

Key Words

catheterization
costs
femoral artery
outcomes
percutaneous coronary intervention
radial artery

Abbreviations and Acronyms

CI
confidence interval(s)
IPW
inverse probability weighting
LOS
length of stay
OR
odds ratio(s)
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction
TFI
transfemoral percutaneous coronary intervention
TRI
transradial percutaneous coronary intervention

Cited by (0)

Supported by an unrestricted research grant from Terumo Medical Corporation. Dr. Amin has reported that he is a KM1 scholar and is funded by a comparative effectiveness research career development award from the National Center for Advancing Translational Sciences Clinical and Translational Science Award (CTSA) program (UL1TR000448, KL2TR000450, and TL1TR000449) and the National Cancer Institute (1KM1CA156708-01). Dr. Safley has received compensation paid directly to the Saint Luke’s Hospital Foundation of Kansas City for his research activities from Merck & Co, Inc.. Drs. Giersiefen and Bremer are employees of ViTA Solutions, a product-independent consulting division of The Medicines Company, and they participated in the study design, data collection, and review of the manuscript. Dr. Hamon has received consulting fees from The Medicines Company. Dr. Baklanov has received research grants from Blue Cross Blue Shield of Kansas City and consulting fees from Heart.org. Dr. Wohns has served on the Speakers’ Bureaus/advisory boards of Terumo and The Medicines Company. Dr. Mathias has served on the Speakers’ Bureaus for Terumo Medical and Medtronic; and has received speakers’ honoraria from Terumo Medical, The Medicines Company, and Medtronic. Dr. Applegate has received research grants from Abbott Vascular, ACIST Medical Systems, St. Jude Medical, and Terumo Medical; has served on the advisory board of Abbott Vascular; and has received honoraria from Abbott Vascular. Dr. Cohen has received institutional research grants from Medtronic, Boston Scientific, Abbott Vascular, Edwards Lifesciences, Biomet, Inc., Eli Lilly, Daiichi-Sankyo, AstraZeneca; and has received consulting fees from Medtronic, Abbott Vascular, and Eli Lilly. Dr. Marso has received funding paid directly to the Saint Luke’s Hospital Foundation of Kansas City for research activities from The Medicines Company, Novo Nordisk, Amylin Pharmaceuticals, Volcano Corporation, St. Jude Medical, and Terumo Medical. All other authors have reported that they have no conflicts relevant to the contents of this paper to disclose.