Mamas Mamas m.mamas@keele.ac.uk
Health economic analysis of access site practice in England during changes in practice: Insights from the British Cardiovascular Interventional Society
Mamas, Mamas; Tosh, Jon; Hulme, Will; Hoskins, Nicki; Bungey, George; Ludman, Peter; de Belder, Mark; Shing Kwok, Chun; Verin, Nathalie; Kinnaird, Tim; Bennett, Ewan; Curzen, Nick; Nolan, James; Kontopantelis, Evangelos
Authors
Jon Tosh
Will Hulme
Nicki Hoskins
George Bungey
Peter Ludman
Mark de Belder
Chun Shing Kwok
Nathalie Verin
Tim Kinnaird
Ewan Bennett
Nick Curzen
James Nolan j.nolan@keele.ac.uk
Evangelos Kontopantelis
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.
Citation
Mamas, M., Tosh, J., Hulme, W., Hoskins, N., Bungey, G., Ludman, P., …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), https://doi.org/10.1161/circoutcomes.117.004482
Journal Article Type | Article |
---|---|
Acceptance Date | Mar 29, 2018 |
Online Publication Date | Jun 18, 2018 |
Publication Date | May 9, 2018 |
Journal | Circulation: Cardiovascular Quality and Outcomes |
Print ISSN | 1941-7713 |
Publisher | American Heart Association |
Peer Reviewed | Peer Reviewed |
Volume | 11 |
Issue | 5 |
DOI | https://doi.org/10.1161/circoutcomes.117.004482 |
Keywords | acute coronary syndrome; budget; cost saving; length of stay; percutaneous coronary intervention |
Publisher URL | https://doi.org/10.1161/circoutcomes.117.004482 |
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Publisher Licence URL
https://creativecommons.org/licenses/by-nc/4.0/
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