Costs associated with transradial access and same-day discharge after percutaneous coronary intervention: a systematic review and meta-analysis

Abstract

Transradial access for PCI (TRI) along with same day discharge (SDD) is associated with varying estimates of cost savings depending on the population studied, the clinical scenario and application to low-risk vs high-risk patients. A summary estimate of the true cost savings of TRI and SDD are unknown. We searched the PubMed, EMBASE®, CINAHL® and Google Scholar® databases for published studies on hospitalization costs of TRI and SDD. Primary outcome of interest in all included studies was the cost saving with TRI (or SDD), inflationcorrected US$ 2018 values using the medical consumer price index. For meta-analytic synthesis, we used Hedges' summary estimate (g) in a random-effects framework of the DerSimonian and Laird model, with inverse variance weights. Heterogeneity was quantified using the I 2 statistic. The cost savings of TRI from four US studies of 349,757 patients reported a consistent and significant cost saving associated with TRI after accounting for currency inflation, of US$ 992

Same-day discharge percutaneous coronary intervention. Where are we?

“…The financial impact of using this protocol in Brazil remains unknown, but international experiences suggest cost reductions. [1][2][3][4] The most recent meta-analysis on costeffectiveness estimates savings of US$ 3,567.58 (95%CI US$ 2,303.39-US$ 4,831.78) per PCI performed in an SDD setting. In the subgroup analysis, it was identified that the cost of hospitalization is the only one that has a statistically significant impact on cost savings.…”

“…The transradial access approach plays a fundamental role in this aspect, as it has been shown to correlate with lower cost and faster discharge, including same-day discharge (SDD). [1][2][3][4] Much of the benefit of the access route is due to the safety of the route and its lower rate of complications, which could extend the patient's hospital stay. 5,6 Different series globally have evaluated SDD after elective PCI.…”