Transradial percutaneous coronary intervention (PCI) is significantly less expensive than transfemoral PCI from the hospital perspective, as procedural costs for the two access routes are similar, but transradial PCI is associated with lower bleeding rates and a shorter length of stay, which reduces associated costs, according to a study published in JACC: Cardiovascular Interventions.

Additional Resources Full Study 2011 ACCF/AHA/SCAI Guideline for PCI ACCF/SCAI Premier Interventional Cardiology Overview and Board Preparatory Course

A retrospective study of 7,121 PCI procedures performed at five U.S. centers between Jan. 1, 2010, and March 31, 2011, found that transradial access was used in 17 percent of patients. Transradial access was associated with a shorter length of stay, 2.5 days versus 3.0 days (p<0.001) and fewer bleeding events (OR 0.52, p=0.002). Transradial access showed a net cost savings of $830 versus transfemoral access (p<0.001). Procedural costs for transradial access were $130 less than transfemoral access (p=0.112), and the bulk of the savings, $705, were associated with post procedural costs (p<0.001). Researchers found a positive association between increasing predicted bleeding risk and increasing savings from transradial access. Patients at low risk had a savings of $642 (p=0.035), patients at moderate risk had a savings of $706 (p=0.029) and patients at high risk had a savings of $1,621 (p=0.039).

"For hospitals performing 1,000 PCI procedures annually, a 10 percent to 20 percent transradial adoption rate would imply incremental savings of $80,000 to $160,000 per year," said lead author Amit Amin, MD, MSc, Washington University School of Medicine, St. Louis. "As hospitals increasingly use same-day discharge protocols for transradial access patients, length of stay will decrease and cost savings attributable to transradial access will likely increase further."

These cost implications will grow in importance as reimbursement models evolve, Dr. Amin adds. Current fee-for-service models typically pay a flat reimbursement for PCI regardless of the access route. As per-episode bundled payment models become more prevalent, comparative costs at the hospital level will become a more important factor in selecting between treatment options that offer similar clinical outcomes.

Keywords: Prevalence, Fee-for-Service Plans, Cost Savings, Patient Discharge, Percutaneous Coronary Intervention, Length of Stay

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