Health economic analysis of access site practice in England during changes in practice: insights from the British Cardiovascular Interventional Society
January 13, 2020
THE HEALTH ECONOMICS QUESTION STUDIED
Transradial access (TRA) for percutaneous coronary intervention (PCI) is associated with a reduced risk of mortality compared with transfemoral access, reduced access site–related bleeding complications, and shorter length of stay. However, while TRA is likely to be associated with cost savings, the economic impact on the healthcare system has not been examined.
Data from 323,656 patients undergoing PCI between 2010 and 2014 were obtained from the British Cardiovascular Intervention Society database. Costs for TRA and transfemoral access PCI were estimated based on procedure cost, length of stay, and differences in the rates of complications (major bleeding and vascular complications). In the base case analysis, a propensity-matched data set between transfemoral access and TRA was used to directly compare the costs per procedure of transradial and transfemoral PCIs in England from 2010 to 2014 for each indication. A real-world analysis used the full data set to examine differences in procedure uptake and key cost drivers for transfemoral and transradial PCIs and the impact of recent trends in procedural access uptake in UK over time.
In Base case analysis (done on 248K patients) done across all indications and all years, TRA offered an average cost saving of £250.59 per procedure (22% reduction) versus transfemoral access with the majority of cost saving (76%) derived from reduced length of stay (£190.43) rather than direct costs of complications (£3.71)The greatest cost saving was in the STEMI indication (£348.26), followed by NSTEMI/unstable (£282.21) and elective/stable (£153.88). In the real-world analysis (done on all patients) adoption of TRA was estimated to have provided cost savings of £13.3 million across England between 2010 and 2014; however, if operators in all regions had adopted TRA at the rate of the region with the highest utilization, cost savings of £33.40 million (£13.31 + £20.09) could have been achieved (Table). The main component of these savings is the reduction in hospital stay, and the highest risk acute cases (ST-segment–elevation myocardial infarction cases) had the greatest benefit associated with TRA.
HEALTH ECONOMICS IMPLICATIONS
This analysis provides evidence that the transition to TRA is associated with significant cost savings, in addition to the well-established clinical benefits. The results of this study should, therefore, encourage a reduction in the variability in uptake, as further uptake of TRA will lead to even greater cost savings.
About the Author
Sr. Strategic Business Manager
As Strategic Business Account Manager, John assists hospitals in understanding the full financial impact of their care pathway redesign and their ROI. John earned a Master’s Degree in Business from Montclair State University, and has spent over 15 years in the health care fields of cardiology, electrophysiology, orthopedics, and diagnostic imaging. He has worked closely with hospital leadership to develop programs focused on the economic costs of healthcare procedures, including initiating radial adoption, creating reprocessing initiatives and establishing value-based contracts.