Chapter 24: Economics

A growing body of literature suggests that the transradial approach (TRA) for diagnostic angiography and percutaneous coronary intervention (PCI) is associated with a significantly lower cost when compared to the transfemoral approach (TFA). Recent studies suggest that total intra- and post-procedural costs of TRA diagnostic angiography and PCI are $275-$830 less when compared to TFA. Factors that contribute to this cost reduction include reduced bleeding and vascular complications, hospital length of stay, and procedural costs. Additionally, greater reductions in cost are observed in patients at higher risk of bleeding.

Bleeding and Vascular Complications

Lower rates of bleeding and vascular complications associated with TRA are responsible for a significant reduction in cost compared to TFA for both diagnostic angiography and PCI. A 2012 meta-analysis of both diagnostic angiography and PCI revealed that rates of TRAassociated bleeding (0.43%) and vascular complications (0.81%) were significantly lower compared to TFA (1.11% and 2.53%, respectively). With an estimated cost of $6,739 per major bleeding event and $6,377 per major vascular complication, the reduction in these complications combined account for a $155.50 cost reduction per TRA patient. Similarly, a 2013 retrospective cohort study of 7,121 patients who underwent PCI found bleeding complication rates of 1.1% for TRA and 2.4% for TFA, and an associated $99 cost savings per TRA patient attributable to this reduced complication rate. While reductions in access site and bleeding complications during diagnostic angiography were more modest for TRA (1.2%) compared to TFA (1.8%), the high cost of these complications offset an increased intraprocedural cost for TRA diagnostic angiography.

Author: 
Max Weiss, MD; Daniel Feldman, MD; Adhir Shroff, MD, MPH