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

Satoshi Shoji; Shun Kohsaka; Hiraku Kumamaru; Kyohei Yamaji; Shiori Nishimura; Hideki Ishii; Tetsuya Amano; Kiyohide Fushimi; Hiroaki Miyata; Yuji Ikari

doi:10.1016/j.lanwpc.2022.100555

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

Lancet Reg Health West Pac. 2022 Aug 12:28:100555. doi: 10.1016/j.lanwpc.2022.100555. eCollection 2022 Nov.

Authors

Satoshi Shoji^{1

2}, Shun Kohsaka², Hiraku Kumamaru³, Kyohei Yamaji⁴, Shiori Nishimura³, Hideki Ishii⁵, Tetsuya Amano⁶, Kiyohide Fushimi⁷, Hiroaki Miyata³, Yuji Ikari⁸

Affiliations

¹ Department of Cardiology, Hino Municipal Hospital, Tokyo, Japan.
² Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
³ Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
⁴ Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan.
⁵ Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan.
⁶ Department of Cardiology, Aichi Medical University, Aichi, Japan.
⁷ Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
⁸ Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan.

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.