Mamas, MA ORCID: 0000-0001-9241-8890, Tosh, J, Hulme, W, Hoskins, N, Bungey, G, Ludman, P, de Belder, M, Kwok, CS, Verin, N, Kinnaird, T, Bennett, E, Curzen, N, Nolan, J and Kontopantelis, E (2018) Health economic analysis of access site practice in England during changes in practice: Insights from the British Cardiovascular Interventional Society. Circulation: Cardiovascular Quality and Outcomes, 11 (5). ISSN 1941-7713

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Abstract

Background: Transradial access (TRA) for percutaneous coronary intervention (PCI) is associated with a reduced risk of mortality compared with transfemoral access, access site–related bleeding complications, and shorter length of stay. The budget impact from a healthcare system that has largely transitioned to TRA for PCI has not been previously published.

Methods and Results: Data from 323 656 patients undergoing PCI between 2010 and 2014 were obtained from the British Cardiovascular Intervention Society database. Costs for TRA and transfemoral access PCI were estimated based on procedure cost, length of stay, and differences in the rates of complications (major bleeding and vascular complications). In the base case, a propensity-matched data set between transfemoral access and TRA was used to directly compare the cost per PCI, whereas in the real-world analysis, the full data set was used. Across all indications and all years, TRA offered an average cost saving of £250.59 per procedure (22% reduction) versus transfemoral access with the majority of cost saving derived from reduced length of stay (£190.43) rather than direct costs of complications (£3.71). In the real-world analysis, adoption of TRA was estimated to have provided cost savings of £13.31 million across England between 2010 and 2014; however, if operators in all regions had adopted TRA at the rate of the region with the highest utilization, cost savings of £33.40 million could have been achieved.

Conclusions: The transition to TRA in England has been associated with significant cost savings across the national healthcare system, in addition to the well-established clinical benefits.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) will be available online via American Heart Association at http://circoutcomes.ahajournals.org/ - please refer to any applicable terms of use of the publisher.
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
R Medicine > RD Surgery > RD32 Operative surgery. Technique of surgical operations
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 29 Mar 2018 14:58
Last Modified: 19 Jun 2018 11:03
URI: http://eprints.keele.ac.uk/id/eprint/4683

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