Is it possible to reduce PCI costs without compromising safety?

Courtesy of Dr. Carlos Fava.

Health system costs have increased significantly and there have been attempts to reduce it without compromising the quality of PCI outcomes. The benefits of the transradial approach combined with same day discharge could help reach this goal.

This study included 279,987 MEDICARE PCI procedures where costs were analyzed. Cases were divided in 4 groups according to access site and discharge:

• transradial approach and same day discharge, with 3,424 patients (1.2%)
• transfemoral approach and same day discharge, 11,388 patients (4.1%)
• transradial approach and next day discharge, 21,877 (7.8%),
• transfemoral approach and next day discharge, 243,298 patients (86.9%), which was the overwhelming majority.

Transradial patients discharged the same day were younger, men, with lower cardiovascular risk and less comorbidities.

After variable adjusting, the transradial approach was associated to lower costs, which reached U$S 916 (CI 95%; U$S 778 to 1,035), as was same day discharge (U$S 3,502; CI 3486 to 3902). The total adjusted cost associated to the transradial approach with same day discharge was U$S 13,389 (CI 95%: 13,161 to 13.607), while the transfemoral approach with next day discharge cost U$S 17,076 (CI 95%: 16,999 to 17,147), with an absolute difference of U$S 3,689 (CI 95%: 3486 to 3905; p=<0.0001).

In-hospital evolution, bleeding, transfusion needs, vascular complications and hospitalization days were lower with the transradial approach.

Conclusion

Among patients who benefit from MEDICARE, the combination of the transradial approach with same day discharge was independently associated with less complications and lower in hospital costs. These findings have important implications in the current practice of PCI, since they improve costs and results.

Editorial Comment

This analysis shows it is possible to reduce costs and hospitalization days in selected patients.

As we know, the transradial approach has an important learning curve and we should also implement a hospital system to facilitate patient selection for same day discharge.

As interventionists, when it comes to cost reduction, it is essential to maintain the safety and quality of outcomes, and to remain cautious when deciding patient discharge.

Courtesy of Dr. Carlos Fava. Favaloro Foundation, Buenos Aires, Argentina.

Original Title: Cost 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.

Reference: Amit P Amin et al. JACC Cardiovasc Interv. 2017 Feb 27;10(4):342-351.

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