title: Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention.
abstract: BACKGROUND
  Radial artery access for coronary angiography and interventions has been promoted for reducing hemostasis time and vascular complications compared with femoral access, yet it can take longer to perform and is not always successful, leading to concerns about its cost. We report a cost-benefit analysis of radial catheterization based on results from a systematic review of published randomized controlled trials.
  
  
  RESULTS
  The systematic review added 5 additional randomized controlled trials to a prior review, for a total of 14 studies. Meta-analyses, following Cochrane procedures, suggested that radial catheterization significantly increased catheterization failure (OR, 4.92; 95% CI, 2.69-8.98), but reduced major complications (OR, 0.32; 95% CI, 0.24-0.42), major bleeding (OR, 0.39; 95% CI, 0.27-0.57), and hematoma (OR, 0.36; 95% CI, 0.27-0.48) compared with femoral catheterization. It added approximately 1.4 minutes to procedure time (95% CI, -0.22 to 2.97) and reduced hemostasis time by approximately 13 minutes (95% CI, -2.30 to -23.90). There were no differences in procedure success rates or major adverse cardiovascular events. A stochastic simulation model of per-case costs took into account procedure and hemostasis time, costs of repeating the catheterization at the alternate site if the first catheterization failed, and the inpatient hospital costs associated with complications from the procedure. Using base-case estimates based on our meta-analysis results, we found the radial approach cost $275 (95% CI, -$374 to -$183) less per patient from the hospital perspective. Radial catheterization was favored over femoral catheterization under all conditions tested.
  
  
  CONCLUSIONS
  Radial catheterization was favored over femoral catheterization in our cost-benefit analysis.
authors: Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, PA, USA. mdmitchell@uphs.upenn.edu
authors: Matthew D
authors: MD
authors: Mitchell
authors: Jaekyoung A
authors: JA
authors: Hong
authors: Bruce Y
authors: BY
authors: Lee
authors: Craig A
authors: CA
authors: Umscheid
authors: Sarah M
authors: SM
authors: Bartsch
authors: Creighton W
authors: CW
authors: Don
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D003198:Computer Simulation; D017023:Coronary Angiography / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005263:Femoral Artery; D017721:Hospital Costs; D006801:Humans; D018803:Models, Economic; D016017:Odds Ratio; D017534:Radial Artery; D016032:Randomized Controlled Trials as Topic; D013269:Stochastic Processes; D013997:Time Factors; D017211:Treatment Failure