title: Costs Associated With Access Site and Same-Day Discharge Among Medicare Beneficiaries Undergoing Percutaneous Coronary Intervention: An Evaluation of the Current Percutaneous Coronary Intervention Care Pathways in the United States.
abstract: The aim of this study was to examine the independent impact of various care pathways, including those involving transradial intervention (TRI) and same-day discharge (SDD) after elective percutaneous coronary intervention (PCI), on hospital costs.
  
  
  
  PCI is associated with costs of $10 billion annually. Alternative payment models for PCI are being implemented, but few data exist on strategies to reduce costs. Various PCI care pathways, including TRI and SDD, exist, but their association with costs and outcomes is unknown.
  
  
  
  In total, 279,987 PCI patients eligible for SDD in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims files were analyzed. Hospital costs in 2014 U.S. dollars were estimated using cost-to-charge ratios. Propensity scores for TRI and SDD, with propensity adjustment via inverse probability weighting, was performed.
  
  
  
  Of the 279,987 PCI procedures, TRI was used in 9.0% (13.5% of which were SDD), and SDD was used in 5.3% of cases (23.1% of which were TRI). TRI (vs. transfemoral intervention) was associated with lower adjusted costs of $916 (95% confidence interval [CI]: $778 to $1,035), as was SDD ($3,502; 95% CI: $3,486 to $3,902). The adjusted cost associated with TRI and SDD was $13,389 (95% CI: $13,161 to $13,607), while the cost associated with transfemoral intervention and non-same-day discharge was $17,076 (95% CI: $16,999 to $17,147), a difference of $3,689 (95% CI: $3,486 to $3,902; p < 0.0001). Shifting current practice from transfemoral intervention non-same-day discharge to TRI SDD by 30% could potentially save a hospital performing 1,000 PCIs each year $1 million and the country $300 million annually.
  
  
  
  Among Medicare beneficiaries, TRI with SDD was independently associated with fewer complications and lower in-hospital costs. These findings have important implications for changing the current PCI care pathways to improve outcomes and reduce costs.
authors.affiliation: Washington University School of Medicine, Barnes Jewish Hospital, Center for Value and Innovation, Washington University School of Medicine, St. Louis, Missouri. Electronic address: aamin@wustl.edu.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Amin
authors.affiliation: School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Mark
authors.initials: M
authors.lastname: Patterson
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: House
authors.affiliation: ViTA Solutions, Parsippany, New Jersey.
authors.forename: Helmut
authors.initials: H
authors.lastname: Giersiefen
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Dmitri V
authors.initials: DV
authors.lastname: Baklanov
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Adnan K
authors.initials: AK
authors.lastname: Chhatriwalla
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: David M
authors.initials: DM
authors.lastname: Safley
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: The Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000191:economics*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics*; D005260:Female; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007342:Insurance Benefits / Q000191:economics*; D007902:Length of Stay / Q000191:economics*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics*; D018803:Models, Economic; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000191:economics*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics*; D017064:Process Assessment, Health Care / Q000191:economics*; D057216:Propensity Score; D017534:Radial Artery / Q000000981:diagnostic imaging; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: bleeding; costs; health economics; outcomes; percutaneous coronary intervention; radial PCI; same-day discharge; transradial PCI