A new study has shown that shifting 30% of femoral-access PCI procedures to transradial-access with same-day discharge for stable patients could save U.S. hospitals $332 million annually.
Transradial-access PCI was also associated with fewer complications than the femoral-access approach, according to the study.
“I believe this is a remarkable paper that has the [potential] to fundamentally transform how we practice and change the delivery of PCI care in this country,” lead author Dr. Amit Amin told Medscape in an email.
Although the analysis was nonrandomized and based on modeling exercises, independent reviewers agreed that some cost savings should occur if practices switched to transradial PCI.
“Overall, we should be moving more aggressively toward a transradial approach in cath and PCI. The continuing accumulation of clinical and now cost data support this,” Dr. Robert Harrington from Stanford University told the news outlet.
Researchers linked Medicare claims data to 280,000 patients who underwent PCI between July 2009 and Dec. 2012 and used propensity-score matching and inverse probability weighting to estimate hospital costs, taking inflation into account.
The data showed that using transradial access saved $916 per patient after risk adjustment and patients who were discharged in the same day had adjusted costs $3502 lower than the patients who were kept overnight.
The results also highlighted some of the barriers that stand in the way of realizing the potential cost savings with transradial same-day-discharge PCI. Among the nearly 280,000 sampled patients eligible for same-day discharge, only 9% had transradial PCI and 5.3% were sent home the same day.
“We certainly hope that professional societies and guidelines will reassess the accumulating body of literature on the safety of transradial and same-day discharge and provide guidance and direction to physicians, hospitals, and healthcare systems on how to deliver ‘high-value care’ of superior outcomes at lower healthcare costs,” Amin said.
Combining both transradial PCI and same-day discharge resulted in an adjusted cost savings of $3,689 for hospitals compared to a transfemoral approach without same-day discharge, according to the data.
For a hospital performing 1000 elective PCI procedures each year, the researchers calculated that a 30% conversion from the current standards to transradial same-day release could save the hospital $1 million each year.