Abstract 267: Cost-Effectiveness of Transradial PCI: A Decision-Analytic Model

Abstract

Introduction: Transradial percutaneous coronary intervention (TRI) is associated with reduced bleeding rates and length of stay (LOS), compared to transfemoral PCI (TFI). However, TRI requires specialized guide catheters, access equipment and costs attributable to a ‘learning curve’ in the US. The cost-effectiveness of transradial vs. transfemoral PCI in contemporary real-world US practice is unknown. Methods: We developed a decision-analytic model (Figure) of costs and bleeding events of transradial vs. transfemoral PCI using inputs from a hospital system, and direct PCI costs from each hospital’s respective cost accounting system. Independent costs of radial PCI, urgent vs. elective PCI indication and bleeding complications were identified by a linear regression model and used as model inputs. The efficacy measure was major bleeding as defined by the NCDR. Results: Cost and clinical data were derived from the 2,972 consecutive PCI procedures (TRI N=559) performed in 6/2009-3/2011. TRI was associated with a shorter LOS (1.4 ± 1.4 days) vs. TFI (1.9 ± 2.3 days), P< 0.001. Although procedural day costs were similar in the 2 groups - $12,949 ± 3932 for TRI vs. 13,104 ± 3325 for TFI, post-procedural day costs were lower in the TRI groups ($1524 ± 4108 vs. TFI group $ 2798 ± 9076), primarily from a reduced LOS. Hence, total costs were lower with TRI ($14,468 ± 5442) vs. TFI ($15,608 ± 6920), P<0.001, by $1,140. There was a trend towards reduced bleeding with TRI (1.1%) vs. TFI (1.9%), P=0.159. In economic analysis, TRI was a dominant strategy. In probabilistic sensitivity analyses (with 1000 simulations to account for variation in clinical practice) the decision-analytic model projected that TRI would remain economically dominant in 96.3% of simulations. Cost data from 4 additional high volume centers will be included prior to the AHA QCOR presentation. Conclusions: This is the first decision-analytic modeling study which shows TRI is an economically dominant strategy with lesser costs and a trend towards greater efficacy (less bleeding), when compared against TFI. Cost savings resulting from TRI are large and exceed $800/patient undergoing PCI. Apart from the known advantages of patient convenience and reduced bleeding complications, increased adoption of TRI may result in significant cost-savings to hospitals and ultimately the U.S. healthcare system.