Comparison of costs between transradial and transfemoral percutaneous coronary intervention: a cohort analysis from the Premier research database

Am Heart J. 2013 Mar;165(3):303-9.e2. doi: 10.1016/j.ahj.2012.10.004. Epub 2012 Nov 15.


Background: Transradial intervention (TRI) for percutaneous coronary intervention (PCI) is associated with shorter length of stay, fewer bleeding complications, and higher patient satisfaction. Less is known about the economic implications of TRI in contemporary practice.

Methods: This is a retrospective inpatient cohort analysis using medical data from the Premier research database (Premier Inc, Charlotte, NC), which contains approximately one-fifth of all acute care hospitalizations in the US annually. The database was queried to identify patients undergoing PCI from 2004 to 2009. Patients with TRI were identified by center-level charge codes for radial-specific devices and matched one-to-many with patients undergoing transfemoral intervention (TFI). Adjusted total hospitalization costs were compared between patients undergoing TRI and TFI. Patients were additionally classified by periprocedural risk of bleeding as low (<1%), moderate (1%-3%), and high (>3%).

Results: There were 609 TRI cases matched with 60,900 TFI cases. Total adjusted costs for TRI were $11,736 ± $6,748 vs $12,288 ± $23,418 for TFI, a difference of $553 favoring TRI (95% CI $45-$1,060, P = .033). Day-of-procedure costs were similar, at $17 higher for TRI compared with TFI (95% CI -$318 to $353, P = .37); however, costs from the following day until discharge were significantly lower for TRI (-$571, 95 % CI -$912 to $229, P = .001). Postprocedure costs were lower for patients with TRI vs patients with TFI at moderate (-$478, 95% CI -$887 to $69, P = .022) and high (-$917, 95% CI -$1,814 to $19, P = .045) risk of bleeding.

Conclusions: In a nationwide administrative hospital database, transradial compared with transfemoral PCI access was associated with lower average direct hospital costs and shorter length of hospital stay. Postprocedure costs associated with TRI were also lower in patients at greater bleeding risk.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cohort Studies
  • Female
  • Femoral Artery / surgery*
  • Health Care Costs / statistics & numerical data*
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Length of Stay / statistics & numerical data*
  • Male
  • Middle Aged
  • Patient Satisfaction*
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / economics*
  • Percutaneous Coronary Intervention / methods
  • Postoperative Hemorrhage / epidemiology*
  • Radial Artery / surgery*
  • Retrospective Studies