Cost Benefits of Transradial PCI Studied Among Medicare Beneficiaries

February 24, 2017—Findings from an evaluation of the current percutaneous coronary intervention (PCI) care pathways in the United States were published by Amit P. Amin, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2017;10:342–351).

The investigators concluded that among Medicare beneficiaries, transradial intervention (TRI) with same-day discharge (SDD) was independently associated with fewer complications and lower in-hospital costs. They advised that these findings have important implications for changing the current PCI care pathways to improve outcomes and reduce costs.

As summarized in JACC: Cardiovascular Interventions, the aim of this study was to examine the independent impact of various care pathways—including those involving TRI and SDD after elective PCI—on hospital costs.

The investigators analyzed 279,987 PCI patients eligible for SDD in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims files. Hospital costs in 2014 dollars were estimated using cost-to-charge ratios. Propensity scores for TRI and SDD, with propensity adjustment via inverse probability weighting, was performed.

TRI was used in 9% of all PCI procedures performed (13.5% of which were SDD), and SDD was shown to occur in 5.3% of cases (23.1% of which were TRI). TRI versus transfemoral intervention was associated with lower adjusted costs of $916 (95% confidence interval [CI]; $778–$1,035), as was SDD ($3,502; 95% CI, $3,486–$3,902). The adjusted cost associated with TRI and SDD was $13,389 (95% CI, $13,161–$13,607), and the cost associated with transfemoral intervention and non–SDD was $17,076 (95% CI, $16,999–$17,147), a difference of $3,689 (95% CI, $3,486–$3,902; P < .0001).

Shifting current practice from transfemoral intervention non-SDD to TRI SDD by 30% could potentially save a hospital performing 1,000 PCIs each year approximately $1 million and the country $300 million annually, stated the investigators in JACC: Cardiovascular Interventions.