BACKGROUND: Transradial access (TRA) is associated with a reduced risk of mortality compared with transfemoral access (TFA) in PCI, both in randomised controlled trials and in large national registries, with lower rates of access site-related bleeding complications and shorter length of stay (LoS). National data around healthcare savings from a country that has transitioned to TRA in PCI has not been previously published.
METHODS: Data from 323,656 patients undergoing PCI were obtained from the British Cardiovascular Intervention Society database between 2010-2014. The costs for TRA and TFA PCI by clinical indication were estimated based on procedure cost and differences in the rates of complications (major bleeding, vascular complications, and major adverse cardiac event). In the base case a propensity matched data set was used to directly compare the cost per procedure, while in the real-world analysis the full dataset was used to examine differences in procedure uptake by region and year.
RESULTS: Across all indications and all years, TRA offered an average cost-saving of £296.32 per procedure (25% reduction) versus TFA with the majority of cost saving derived from reduced LOS (£190.43) rather than direct costs of complications (£23.94). In the real-world analysis, adoption of TRA was estimated to have provided cost-savings of £15.33 million across England between 2010-2014; however, if all regions had adopted transradial at the rate of the region with highest uptake, cost-savings of £38.90 million could have been achieved.
CONCLUSIONS: The transition to TRA in England and Wales is associated with significant national healthcare cost savings. This may have significant implications for the US healthcare system during its transition towards TRA in the future