Cost-effectiveness of Radial Access Percutaneous Coronary Intervention in Acute Coronary Syndrome

Clinical trials have shown that radial access percutaneous coronary intervention (PCI) is associated with improved patient outcomes compared to femoral artery access. However, few studies have evaluated the cost-effectiveness of radial access PCI. This analysis sought to evaluate the cost-effectiven...

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Bibliographic Details
Published in:The American journal of cardiology 2021-10, Vol.156, p.44-51
Main Authors: Lee, Peter, Liew, Danny, Brennan, Angela, Stub, Dion, Lefkovits, Jeffrey, Reid, Christopher M, Zomer, Ella
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Age
Angioplasty
Cardiovascular disease
Cardiovascular diseases
Clinical trials
Cost analysis
Cost control
Decision analysis
Femoral artery
Femur
Health care
Heart attacks
Hemorrhage
Markov chains
Mortality
Patients
Sensitivity analysis
Stroke
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Summary:Clinical trials have shown that radial access percutaneous coronary intervention (PCI) is associated with improved patient outcomes compared to femoral artery access. However, few studies have evaluated the cost-effectiveness of radial access PCI. This analysis sought to evaluate the cost-effectiveness of transradial versus transfemoral access PCI for patients with acute coronary syndrome (ACS) using data from the Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox (MATRIX) trial. A decision analytic Markov model was constructed from an Australian health care perspective with a 2 year time horizon. The model simulated recurrent cardiovascular disease and death post PCI among a hypothetical cohort of 1000 individuals with ACS. Population and efficacy data were based on the MATRIX trial. Cost and utility data were drawn from published sources. Over a 2-year time horizon, radial access was predicted to save 12 (discounted) quality adjusted life years (QALYs) compared with femoral access PCI. Cost savings (discounted) amounted to AUD $51,305. Hence from a health economic point of view, radial access PCI was dominant over femoral access PCI. Sensitivity analyses supported the robustness of these findings. Radial access PCI is likely to be associated with both better outcomes and lower costs compared to femoral access PCI over 2 years post procedure. In conclusion, these findings support radial access being the preferred approach in PCI for ACS.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2021.06.034