Abstract No. 533 Radioembolization cost analysis: transradial versus transfemoral access

Abstract

This study is designed to compare the costs of the arterial access site choice–transfemoral access (TFA) versus transradial access (TRA)–in cases of radioembolization (RE). From 02/01/18-08/31/18, a total of 151 RE procedures were completed via TFA (n=58) in 56 patients and TRA (n=93) in 85 patients. Patient demographics, procedure details, duration of the recovery period, equipment costs, anesthesia costs, and 30-day adverse events were recorded. Costs for technologist and nursing care calculated based on average hourly outlays for those positions. Physician fees, and indirect hospital costs were excluded. Overall costs represent the sum of equipment, technologist, nursing, and anesthesia costs. There were no instances of crossover between TFA and TRA for the 10 patients who underwent serial interventions. Baseline patient and procedure information is provided in Table 1. TRA was associated with significantly more cases of local anesthesia only in this cohort (TFA: 0%, TRA: 14.0%, p=0.011). There were three cases (3.2%) of access site hematoma (SIR-B) in the TRA group and one case (1.7%) in the TFA group (p=0.694). The recovery time was significantly shorter in the TRA group (TFA: 3.3±0.70 hours, TRA: 2.3±0.9 hours, p<0.001). The average overall cost of RE completed via TFA was $18,253.10±$526.57, and the average overall cost via TRA was $18,080.90±$631.93 with no difference between the two groups (p=0.072). Equipment costs were similar between the two groups (TFA: $17,855.76±$514.32, TRA: $17,728±$581.50, p=0.173). Excluding monitored anesthesia care cases, for which Anesthesiology consult was unrelated to access site choice, the costs of anesthesia medications were lower in the TRA group (TFA: $7.36±$0.89, TRA: $6.54±$2.33, p=0.013). Staffing costs were more favorable in the TRA group (TFA: $390.36±$86.81, TRA: $346.38±$108.64, p=0.007). The overall costs of radioembolization performed via TFA or TRA are not significantly different. Transradial access can significantly reduce both the staffing costs and the anesthesia medication costs in RE cases. The staffing cost savings of TRA over TFA in RE are driven by shorter duration of recovery.Table 1Baseline Patient and Procedure CharacteristicsFemoralRadialP ValueAge (years)67.3 ±10.965.5 ±10.30.323Sex0.549 Male46 (82.1%)73 (85.9%) Female10 (17.9%)12 (14.1%)Race0.575 White19 (33.9%)29 (34.1%) Asian15 (26.8%)16 (18.8%) Hispanic12 (21.4%)25 (29.4%) African American8 (14.3%)9 (10.6%) Other or unknown2 (3.6%)6 (7.1%)ASA Status0.698 241 (73.2%)63 (74.1%) 315 (26.8%)21 (24.7%) 40 (0.0%)1 (1.2%)Tumor Pathology0.287 HCC50 (89.3%)80 (94.1%) CRC2 (3.6%)1(1.2%) Other4 (7.1%)5 (5.9%)Barbeau- A-11 (12.9%) B-70 (82.4%) C-4 (4.7%)Fluoro Time (min)12.1 ± 9.413.6 ± 12.20.371Microsphere0.026 Glass57 (98.3%)82 (88.2%) Resin1 (1.7%)11 (11.8%)Catheter- 5Fr Contra 238 (65.5%)- 5Fr Sarah-90 (96.8%) Other20 (34.5%)3 (3.2%)Closure Device- TR Band-92 (98.9%) Angio-Seal35 (60.3%)- Other23 (39.7%)1 (1.1%)Anesthesia0.011 Local only0 (0.0%)13 (14.0%) Moderate sedation55 (94.8%)77 (82.8%) MAC3 (5.2%)3 (3.2%)Vials Delivered0.172 135 (60.3%)60 (64.5%) 216 (27.6%)30 (32.3%) ≥37 (12.0%)3 (3.2%)Values are expressed as number (percentage) and mean ± standard deviation as appropriate.ASA = American Society of Anesthesiologists, CRC: colorectal carcinoma, HCC = hepatocellular carcinoma, MAC = monitored anesthesia care. Open table in a new tab