Cost effectiveness of radial access for diagnostic cardiac catheterization and coronary intervention.
OBJECTIVE
To evaluate the cost effectiveness of diagnostic cardiac catheterizations (CATH) and coronary interventions (PCI) performed using radial artery (RA) access compared to femoral artery (FA) access.


BACKGROUND
CATH and PCI performed from the RA reduce access site complications compared to FA, but can increase procedure duration, and equipment and contrast use. Whether resulting increases in utilization costs are offset by reduced costs of complications is uncertain.


METHODS
In all, 6,726 CATH and PCI (RA, 3,368; FA, 3,358) were performed from January 2009 to December 2011. Procedural costs and cost of access site complications were compared for propensity-matched CATH (RA and FA, 1,222) and PCI (RA and FA, 570) throughout a complete transition of the lab from a preferred FA to preferred RA strategy.


RESULTS
Adjusted mean total costs were $10 more (95% confidence interval $613 less to $610 more) for RA-CATH versus FA-CATH and $732 less ($1,345 less to $156 less) for RA-PCI versus FA-PCI. The incremental cost per vascular or bleeding complication avoided with RA-CATH was $1,265, whereas RA was economically dominant with lower costs and fewer complications compared to FA for PCI and all procedures.


CONCLUSIONS
Radial access for CATH and PCI reduced access site complications and overall costs compared to FA procedures with similar baseline clinical and procedural characteristics, making it an economically advantageous strategy.
Section of Cardiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
Robert
R
Applegate
Matthew
M
Sacrinty
Pascha
P
Schafer
Justin
J
Smith
Sanjay
S
Gandhi
Michael
M
Kutcher
Renato
R
Santos
Adam
A
Cecile
William
W
Little
D000046:Academic Medical Centers / Q000191:economics; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D005263:Femoral Artery; D006295:Health Resources / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D017534:Radial Artery; D013997:Time Factors; D016896:Treatment Outcome