Mamas A Mamas1, Jon Tosh2, Will Hulme3, Nicki Hoskins2, George Bungey2, Peter Ludman4, Mark de Belder5, Chun Shing Kwok6, Nathalie Verin7, Tim Kinnaird8, Ewan Bennett2, Nick Curzen9, James Nolan6, Evangelos Kontopantelis3. 1. Keele Cardiovascular Research Group, Keele University, and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stokeon-Trent, United Kingdom (M.A.M., C.S.K., J.N.). mamasmamas1@yahoo.co.uk. 2. DRG Abacus, Bicester, Oxfordshire, United Kingdom (J.T., N.H., G.B., E.B.). 3. Health eResearch Centre, Farr Institute for Health Informatics Research and Faculty of Medical and Human Sciences, University of Manchester, United Kingdom (W.H., E.K.). 4. Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.). 5. Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.B.). 6. Keele Cardiovascular Research Group, Keele University, and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stokeon-Trent, United Kingdom (M.A.M., C.S.K., J.N.). 7. Terumo Europe N.V. Leuven, Belgium (N.V.). 8. Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.). 9. Department of Cardiology, University Hospital Southampton and Faculty of Medicine, University of Southampton, United Kingdom (N.C.).
Abstract
BACKGROUND: Transradial access (TRA) for percutaneous coronary intervention (PCI) is associated with a reduced risk of mortality compared with transfemoral access, access site-related bleeding complications, and shorter length of stay. The budget impact from a healthcare system that has largely transitioned to TRA for PCI has not been previously published. METHODS AND RESULTS: Data from 323 656 patients undergoing PCI between 2010 and 2014 were obtained from the British Cardiovascular Intervention Society database. Costs for TRA and transfemoral access PCI were estimated based on procedure cost, length of stay, and differences in the rates of complications (major bleeding and vascular complications). In the base case, a propensity-matched data set between transfemoral access and TRA was used to directly compare the cost per PCI, whereas in the real-world analysis, the full data set was used. Across all indications and all years, TRA offered an average cost saving of £250.59 per procedure (22% reduction) versus transfemoral access with the majority of cost saving derived from reduced length of stay (£190.43) rather than direct costs of complications (£3.71). In the real-world analysis, adoption of TRA was estimated to have provided cost savings of £13.31 million across England between 2010 and 2014; however, if operators in all regions had adopted TRA at the rate of the region with the highest utilization, cost savings of £33.40 million could have been achieved. CONCLUSIONS: The transition to TRA in England has been associated with significant cost savings across the national healthcare system, in addition to the well-established clinical benefits.
BACKGROUND: Transradial access (TRA) for percutaneous coronary intervention (PCI) is associated with a reduced risk of mortality compared with transfemoral access, access site-related bleeding complications, and shorter length of stay. The budget impact from a healthcare system that has largely transitioned to TRA for PCI has not been previously published. METHODS AND RESULTS: Data from 323 656 patients undergoing PCI between 2010 and 2014 were obtained from the British Cardiovascular Intervention Society database. Costs for TRA and transfemoral access PCI were estimated based on procedure cost, length of stay, and differences in the rates of complications (major bleeding and vascular complications). In the base case, a propensity-matched data set between transfemoral access and TRA was used to directly compare the cost per PCI, whereas in the real-world analysis, the full data set was used. Across all indications and all years, TRA offered an average cost saving of £250.59 per procedure (22% reduction) versus transfemoral access with the majority of cost saving derived from reduced length of stay (£190.43) rather than direct costs of complications (£3.71). In the real-world analysis, adoption of TRA was estimated to have provided cost savings of £13.31 million across England between 2010 and 2014; however, if operators in all regions had adopted TRA at the rate of the region with the highest utilization, cost savings of £33.40 million could have been achieved. CONCLUSIONS: The transition to TRA in England has been associated with significant cost savings across the national healthcare system, in addition to the well-established clinical benefits.
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