Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention.

TitleSystematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention.
Publication TypeJournal Article
Year of Publication2012
AuthorsMitchell MD, Hong JA, Lee BY, Umscheid CA, Bartsch SM, Don CW
JournalCirc Cardiovasc Qual Outcomes
Volume5
Issue4
Pagination454-62
Date Published2012 Jul 1
ISSN1941-7705
KeywordsAngioplasty, Balloon, Coronary, Cardiac Catheterization, Computer Simulation, Coronary Angiography, Cost Savings, Cost-Benefit Analysis, Evidence-Based Medicine, Femoral Artery, Hospital Costs, Humans, Models, Economic, Odds Ratio, Radial Artery, Randomized Controlled Trials as Topic, Stochastic Processes, Time Factors, Treatment Failure
Abstract

BACKGROUND: Radial artery access for coronary angiography and interventions has been promoted for reducing hemostasis time and vascular complications compared with femoral access, yet it can take longer to perform and is not always successful, leading to concerns about its cost. We report a cost-benefit analysis of radial catheterization based on results from a systematic review of published randomized controlled trials.METHODS AND RESULTS: The systematic review added 5 additional randomized controlled trials to a prior review, for a total of 14 studies. Meta-analyses, following Cochrane procedures, suggested that radial catheterization significantly increased catheterization failure (OR, 4.92; 95% CI, 2.69-8.98), but reduced major complications (OR, 0.32; 95% CI, 0.24-0.42), major bleeding (OR, 0.39; 95% CI, 0.27-0.57), and hematoma (OR, 0.36; 95% CI, 0.27-0.48) compared with femoral catheterization. It added approximately 1.4 minutes to procedure time (95% CI, -0.22 to 2.97) and reduced hemostasis time by approximately 13 minutes (95% CI, -2.30 to -23.90). There were no differences in procedure success rates or major adverse cardiovascular events. A stochastic simulation model of per-case costs took into account procedure and hemostasis time, costs of repeating the catheterization at the alternate site if the first catheterization failed, and the inpatient hospital costs associated with complications from the procedure. Using base-case estimates based on our meta-analysis results, we found the radial approach cost $275 (95% CI, -$374 to -$183) less per patient from the hospital perspective. Radial catheterization was favored over femoral catheterization under all conditions tested.CONCLUSIONS: Radial catheterization was favored over femoral catheterization in our cost-benefit analysis.

DOI10.1161/CIRCOUTCOMES.112.965269
Alternate JournalCirc Cardiovasc Qual Outcomes
PubMed ID22740010
PubMed Central IDPMC3430729
Grant List1U54GM088491-0109 / GM / NIGMS NIH HHS / United States
KL2 RR025015 / RR / NCRR NIH HHS / United States
RR025015 / RR / NCRR NIH HHS / United States
U54 GM088491 / GM / NIGMS NIH HHS / United States
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