Transradial interventions, same-day discharges following PCIs save hospitals $300 million per year

An analysis of Medicare beneficiaries found that a transradial intervention during PCI was $916 cheaper and associated with less bleeding, fewer vascular complications and less transfusions than a transfemoral intervention.

The researchers also found that a same-day discharge after PCI cost $3,500 less than a non-same day discharge. They estimated that if hospitals performed transradial interventions and had same-day discharges 30 percent more often than they do now, they could save $300 million per year.

Lead researcher Amit P. Amin, MD, MSc, of the Washington University School of Medicine in St. Louis, and colleagues published their results online in JACC: Cardiovascular Interventions on Feb. 20.

“We now have identified a mechanism for hospitals to improve their efficiency, lower costs and which is associated with improved PCI outcomes simultaneously,” Amin said in a news release. “Our data show there is a tremendous potential to reduce costs of PCI, reduce complications and achieve a ‘win-win’ for both patients and hospitals. Hospitals that redesign their care pathways to perform more same-day, transradial PCIs can potentially save hundreds of thousands of dollars each year.”

Each year, approximately 600,000 patients undergo PCIs, according to the researchers. They added that PCIs cost approximately $10 billion per year, which represents the highest aggregate cost of all cardiovascular procedures and the third highest aggregate cost of all surgical procedures.

For this analysis, the researchers examined Medicare fee-for-service beneficiaries who underwent inpatient and outpatient PCI procedures between July 1, 2009, and Dec. 31, 2012. They linked Medicare claims data to the American College of Cardiology’s National Cardiovascular Data Registry CathPCI registry.

Of the nearly 280,000 PCIs, transradial interventions were used in 9 percent of procedures and same-day discharge occurred in 5.3 percent of cases. Meanwhile, transradial interventions and same-day discharges occurred in 1.2 percent of cases, transfemoral interventions and same-day discharges occurred in 4.1 percent of cases, transradial interventions and non same-day discharges occurred in 7.8 percent of cases and transfemoral interventions and non same-day discharges occurred in 86.9 percent of cases.

The mean age was 71.8 years old, while 63.8 percent of patients were males and 90.4 percent were white. Patients undergoing the transradial interventions and receiving same-day discharges tended to be younger, were more often white men and had a lower prevalence of cardiovascular risk factors and comorbidities.

The researchers found that transradial interventions were associated with $916 lower adjusted costs compared with transfemoral interventions, while same-day discharges were associated with $3,502 lower adjusted costs compared with non same-day discharges.

The adjusted costs were $13,389 for a transradial intervention and same-day discharge and $17,076 for a transfemoral intervention and non same-day discharge, representing a statistically significant $3,689 difference.

Hospitals that perform 1,000 PCIs annually could save $1 million per year if they shift from transfemoral interventions and non-same day discharges to transradial interventions and same-day discharges by 30 percent, according to the researchers.

The study had a few limitations, according to the researchers, including its observational design, which meant the data could be subject to unmeasured confounding and selection bias. The costs were only from a hospital perspective, as well, and were obtained from claims data. They had no data on direct and indirect costs of care. In additions, they linked Medicare claims to registry claims using matching techniques, which they noted were not perfect.

“Further studies are needed to evaluate the impact of changing the current PCI care pathways to improve outcomes and reduce PCI costs for hospitals,” the researchers wrote.