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. 2022 Aug 12:28:100555.
doi: 10.1016/j.lanwpc.2022.100555. eCollection 2022 Nov.

Cost reduction associated with transradial access in percutaneous coronary intervention: A report from a Japanese nationwide registry

Satoshi Shoji  1   2 , Shun Kohsaka  2 , Hiraku Kumamaru  3 , Kyohei Yamaji  4 , Shiori Nishimura  3 , Hideki Ishii  5 , Tetsuya Amano  6 , Kiyohide Fushimi  7 , Hiroaki Miyata  3 , Yuji Ikari  8
Affiliations

Cost reduction associated with transradial access in percutaneous coronary intervention: A report from a Japanese nationwide registry

Satoshi Shoji et al. Lancet Reg Health West Pac. .

Abstract

Background: Percutaneous coronary intervention (PCI) is increasingly performed via transradial access (TRA). This study aimed to investigate the clinical and economic benefits of TRA compared with transfemoral access (TFA) under universal healthcare coverage system in Japan.

Methods: A total of 36,153 patients (acute coronary syndrome [ACS], 15,266; stable ischemic heart disease [SIHD], 20,052) across 714 institutions in the Japanese nationwide PCI registry (J-PCI) in 2015 were analyzed (mean age 69.9 ± 11.1 years and 23.6% female). Cost was defined as the total amount of healthcare resources used to care for the patient during hospitalization. Propensity score matching analysis was conducted to balance the baseline characteristics of patients undergoing TRA and TFA.

Findings: The median total cost of PCI was JPY 1,341,176 (interquartile range, 959,052), with higher expenses for ACS (JPY 1,772,116 [1,117,107]) compared with SIHD (JPY 1,119,153 [540,440]) patients. Most patients underwent PCI via TRA (73.8%), and after propensity score matching, TRA was associated with a reduced risk of in-hospital death and bleeding (0.88% vs. 1.91% [P < 0.0001] and 2.18% vs. 4.53% [P < 0.0001] in ACS, and 0.10% vs. 0.28% [P = 0.070] and 0.53% vs. 1.72% [P < 0.0001] in SIHD, respectively), which led to lower costs in both ACS (JPY 1,699,279 [1,164,554] for TRA vs. JPY 1,931,255 [1,070,222] for TFA; P < 0.0001), and SIHD (JPY 1,102,352 [505,904] for TRA vs. JPY 1,311,525 [706,450] for TFA; P < 0.0001) patients.

Interpretation: In this direct cost analysis of a nationwide registry, the use of TRA was associated with cost saving for both ACS and SIHD patients.

Funding: This study was funded by the Japan Society for the Promotion of Science (grant nos. 20H03915, 16H05215, 16KK0186, 20K22883, and 21K08064), Japan Agency for Medical Research and Development [AMED] (grant number 16lk1010004h0002), and the National Clinical Database. The J-PCI registry is led and supported by the Japanese Association of Cardiovascular Intervention and Therapeutics.

Keywords: Cost; Nationwide registry; Percutaneous coronary intervention; Transradial access.

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Conflict of interest statement

SK received investigator-initiated grant funding from Novartis, Daiichi-Sankyo, and Bristol-Myers Squibb and personal fees from Bristol-Myers Squibb and Pfizer. HK, SN and HM are affiliated with the Department of Healthcare Quality Assessment. The department is a social collaboration department supported by National Clinical Database, Johnson & Johnson KK, and Nipro corporation. HK has received consultation fee from Mitsubishi Tanabe Pharma, and speaker fee from Johnson & Johnson KK. H.I. receives lecture fees from Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi Sankyo, Kowa, Mochida, Novartis, Otsuka, Pfizer, and Tanabe-Mitsubishi. All other authors have no relationships relevant to the contents of this paper.

Figures

Figure 1
Figure 1
Study flowchart. ACS, acute coronary syndrome; CPA, cardiac pulmonary arrest; CS, cardiogenic shock; DPC, Diagnosis Procedure Combination; IHD, ischemic heart disease; J-PCI, Japanese percutaneous coronary intervention; SIHD, stable ischemic heart disease.
Figure 2
Figure 2
Cost distribution for transradial access and transfemoral access in the (A) entire population, (B) patients with acute coronary syndrome (ACS), and (C) patients with stable ischemic heart disease (SIHD).
See this image and copyright information in PMC

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